[The conversations represented here took place over the last week and are compressed for your reading pleasure. My husband and I are real people and said the things represented here. The rest of the dialogue is provided by intentionally fictionalized characters that are not meant to represent any one person. All sentiments and facts expressed here are genuine to the best of my recollection, but the characters saying them were selected by drawing names from a hat. I, alone, am responsible for this content.]

The Quickening

“They canceled Andrianna’s tubals yesterday,” I inform Steve in the hall outside the conference room. “They didn’t even give her a whole day’s notice so she could talk to her patients before they did it.”

“I got virtually no notice either when they canceled mine on Monday,” he replies.

“Really?” I am shocked by this. I have never heard of a hospital canceling cases so abruptly without involving the surgeon. “Who ordered the cancellations like that?”

“Don’t know. We’re only told the surgery scheduler, but someone gave her the order.”

We enter the conference room to find Norm waiting for us. The other gynecologists filter into the room. Both the hospitals the Sisters of Orange own are represented: the hospital in my town, St. Joseph’s, and the one south of us, Redwood Memorial.

“We had hoped this would blow over but the sisters feel backed into a corner.” Norm starts. “They have no choice but to get tough on this issue.”

“What brought all this on?” Steve asks.

“The edict came down from the new Bishop in Santa Rosa,” Norm says, “but we got targeted when they pulled the diagnosis codes for the hospital. It was obvious we were doing more sterilizations than they were in Southern California.”

“In Southern California you can go down the street from any Catholic institution and run into a secular hospital.” I try to defend us. “The Catholic Church bought almost all the hospitals in this area. For the last six years they’ve been trying to drive the last secular hospital under.”

“Never the less, we were doing a lot of tubals for ‛psychological’ reasons.”

“We were hardly doing a lot of sterilizations,” I say. “Other hospitals preform far more tubals a year. The stigma the Church gives the procedure already curtails many woman from asking for sterilization.”

“So what’s the plan?” Steve says, rescuing the meeting from disintegrating into complaints about the Church.

“Nothing.” Norm states. “This is a game we can’t win. The more public pressure the Catholics face, the more they will dig in. We have to keep quiet and wait. That will take the pressure off the nuns. When you’re approached by the media, and you will be approached, my advise is to refer them to the CMO. That’s what he gets paid for. Don’t talk to the media, or write letters to the editor. Don’t talk to your patients about it. We need to keep the lid on this to stop it from blowing up.”

“Too late. The patients already know.” I inform him. We all know there was an article in the local alternative paper, The Journal. The “real” paper in town, the Times Standard, has been silent on the issue. “I spent half an hour at a Pap smear today with an irate woman who vented the whole time about how this was unreasonable and unfair.”

“I wouldn’t encourage her. And don’t talk to your staff about this either,” Norm says.

“How am I going to do that? I’m taking my patients to Mad River. They all know why I stopped operating at St. Jo’s.”

“What do you say to the patients?” Steve wants to know.

“The truth. I don’t think it’s fair to deny all the women in an entire county a procedure on religious grounds. And the patients agree with me. I have an eighty year old woman who lives as far south in the county as you can go. I told her why I was taking my patients north, but seeing where she lived and considering her age I told her I would make an exception for her and operate on her at St. Jo’s. She told me, ‛Don’t you dare. I don’t want to support that any more than you do.’ This octogenarian wants to drive past the two hospitals the Sisters own to have her surgery at Mad River Hospital.”

“This hospital is facing hard times right now.We’re barely holding on ourselves. We can’t afford to lose any patients. We don’t want to lose patients or doctors.” Norm seems genuinely alarmed.

“Great. Go back to the way it was, and I’ll bring my surgeries back to St. Jo’s.” I feel for Norm, but I will not be moved.

“Look, if they made us take all the hysterectomies to ethics committee, the way they threatened to, then I would do the same thing.” Wendy said. “But it’s just the tubals.”

“The only reason they didn’t is because they found out the insurance companies already reviewed all our hysterectomies and would not pay without an adequate medical diagnosis.” I tell her. “They weren’t being magnanimous. They just didn’t want to duplicate the work.”

“You can’t take your surgeries to Mad River.” Quinn, always the practical one, tells me. “I’ve looked at the labor numbers. St. Jo’s is hemorrhaging money in Obstetrics. The hospital will take the Laborist program away. The only reason you came here was for that program. You don’t want to see it die, do you?”

“I don’t.” Everything he says is true. Medicaid doesn’t even cover the cost of deliveries for most hospitals. The one wing devoted exclusively to women is a loss leader for most hospitals in the nation. Obstetricians get treated like the red-headed-step-children of the family of physicians because we don’t make the hospital any money. Having a Laborist program is a rare luxury. It meant I could sleep through the night for the first time in years, watch a whole movie in a theater, have a conversation with my husband–uninterrupted by the other woman…one with vaginal discharge. I do desperately want to keep that indulgence. “It’s not just about what I want. If they take the Laborist program, there’s little reason for me to be at St. Jo’s at all. I’ll not just take surgery to Mad River, I’ll take my labor patients as well.”

“If we don’t support the hospital it won’t be there to care for us.” Wendy says. “I for one want a hospital here when I retire.”

“Not taking care of the needs of half of the population is not caring for us.” I can feel my control slipping. “If they are unwilling to serve half the population’s health care needs, what are they doing in the business in the first place? They should sell the hospital—preferably back to the community to be run cooperatively.”

“This happens every seven years or so.” Elroy, the oldest member of our tribe, says. “The last time it was a new nun sent to take over the hospital. She had all the tubals canceled too.”

“How did that get resolved?” I ask.

“She died and it got forgotten.”

“So we’re waiting for the Bishop to die? Or just waiting for him to change his mind?” I say with more than a little heat. “The Bishop isn’t the only one with strong feelings on this.”

“The hospital can make it hard for you.” Adrianna has arrived late to the party due to her patients. “Remember Tony? He got in that spat with the hospital and started talking to people—even people in the Foundation. It got back to the Board of Trustees and they dragged him into Medical Executive Committee. Now he has that mark on his record forever.”

I know she is trying to warn me. I’m no stranger to this tactic. Though I have not seen it used at St Jo’s, I’ve seen it used elsewhere to strike fear into doctors. A hospital will use its power to remove incompetent doctors on a doctor who is medically competent but has a disagreement with the hospital. They sacrifice one physician, ending his or her career, to scare the other physicians into compliant silence. There are even courses for hospital administrators instructing them how to do this effectively. I’ve avoided such abuses of power so far, but I’ve seen it used time and again on colleagues.

“Look, it’s not just our patients. I was already scheduled to talk about this subject on a national level. I can’t act like it’s not happening to me on a personal level as well. You see, I’m an editor of this blog…”

The Egg

I rarely write about health care and almost never discuss the war on women, because our “uniquely American” health care system has given me battle fatigue. Everyday it is some new insult. Last week, I was handed a list of over 90 medications the pharmaceutical industry is withholding in order to drive the price of drugs higher. On the list are popular pain medications, almost all the nausea medications, life saving emergency drugs and cancer therapy drugs.

Cathleen Kaveny explaining how the Catholic Church works.

This week, at the direction of our new Bishop, Northern California will deny birth control to as many women as possible. Tubal ligation, even if future pregnancies endanger the life of the mother, will not be allowed in any of the Catholic hospitals.

Somehow, my small isolated burg has been caught up in a national health care battle over just who should have control of a woman’s body.

The Affordable Care Act guidelines already include a religious exemption. An institution which provides its employees with health benefits can qualify for it, if its major purpose is to employ and serve co-religionists — like a church. That’s not enough for the Catholic Church, which says (though possibly not in these words) that it doesn’t want to subsidize the shameful non-procreative sexing of its employees at affiliated hospitals, charities and universities, whether they agree with the Church about birth control or not. The United States Conference of Catholic Bishops are pushing for a far more expansive religious exemption.–Salon

Our small county of 135,000 people spread over 3,600 square miles supports three hospitals. Two are run by the Catholic Sisters of St. Joseph of Orange in Orange County.

The last secular hospital in the area is barely hanging on. Our hospital has waged an all out competitive war against the hospital so they can capture its market share. The last secular hospital in the area, Mad River Hospital, is located on the northern edge of the county and ill equipped to increase its volume substantially.

Other secular hospitals existed in the area in the past, but they were bought by the Catholic Church during last decades spending spree. The one to the south was bought in 1998. After the purchase, the Catholics closed the attached clinic for the sin of prescribing birth control. The threat to eliminate birth control options spurred enough controversy back then to beget a bill in the local assembly requiring the hospital to contract with another institution to provided the needed services. Unfortunately, the bill was voted down.

When new seismic safety standards forced St. Joseph Hospital to renovate in 2000, the Church bought the other secular hospital in the area. They needed a place to treat patients while their hospital was under construction. Now, the old hospital is relegated to offices and outpatient services like lab.

In the late 1990’s the Catholic Church bought and merged with quite a few hospitals, resulting in 611 Catholic Hospitals in 60 health care systems in America, caring for half a million patients—12% of the nation’s health care. Catholic Directives to these hospitals come down from local Bishops.

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A  hospital acquired by the Catholic Church can no longer provide contraception, abortion, sterilization, and in vitro fertilization. Only 28% of Catholic hospitals said they would provide women who had been raped or trafficked emergency contraception through their ER.

Old Men in Skirts and Womens HealthIn a poll, 68% of women were opposed to a Catholic Hospital merger if it meant reproductive services would be curtailed. That same poll indicated 75% of women were opposed to Catholic health care imposing these restrictions on women if they took tax payer money.

All hospitals are funded by tax payer money—largely Medicare and Medicaid. Yet, the Church specifically denies women reproductive rights regardless of who pays for the services or the religious beliefs of the woman in question. St. Joseph does not even allow its non-Catholic employees to purchase health insurance that covers birth control.

Only 20% of Humboldt county are practicing Catholicism. Most women facing these restrictions do not recognize the authority of the Bishop to make such a decision for them. In fact, 98% of Catholics in America use birth control. For many rural women, a Catholic hospital is the only one in the local area. For the poor, without adequate transportation, getting care from a distant secular hospital is impossible. The Bishop is preventing me, a non-Catholic, from preforming tubal ligation on other women who are not Catholic, because he is allowed to own the only operating room in town.

When St. Joseph ran short of funds to complete their seismic renovations, they asked the community to donate money. The community of Humboldt obliged, giving $12.5 million. Over half of the population in the county is women, but when the time comes to move into the new 100,000 square foot, 3 floor facility, the only major branch of the hospital that won’t be going will be Labor and Delivery.

When one of our nurses asked how the hospital could take community support from women, but then refuse to provide services for half of the members of the community, she was told by the CEO of the hospital, that Obstetrics was lucky to get room in the old building. The Board had considered closing Obstetrics all together, and using the space for rehabilitation.

Think about that for a second. Pharmaceutical companies can withhold life saving medications to drive up cost. The Catholic Church has the power to deny an entire county of women contraception AND the ability to deliver children in a safe environment. And they both have the will and the ability to use their power against my community. We are quite literally being held hostage by actors in the health care arena who are motivated by any thing but keeping people healthy. For insurance companies and Big Pharma it is profits. For Catholics it is control of women’s bodies.

The Sperm

Contraception by Jenny van SommersBeing female is a preexisting condition. Right now women are charged 15-30% more for health insurance then men. In addition, these policies actually excluded the benefits women specifically needed: contraception and obstetrics. During one survey of insurance, it was discovered that 90% of insurers covered Viagra and only 20% covered contraception. Even now, many insurance providers are telling women in my area they cover Intra Uterine Devices when the truth is they pay me less than it costs to purchase one, let alone insert it. They let me take the blame for not being able to afford to subsidize birth control for hundreds of women.

Women make up the majority on Medicare and Medicaid. They are more likely to be under insured or uninsured due to poor insurance in most jobs women do. These health care systems have a long history of being unfair to women. Medicare pays Gynecology about a third of what it pays Urology to do similar procedures on women than men.

Birth control itself has become a weapon in California. The state “insures” a enormous number of indigent women, telling them they have health insurance. In truth, the California program ONLY covers Pap smears and birth control. Women come to me for a number of complaints and I can only draw labs or work them up if they pay out of pocket. I have to explain that even if I think that huge mass on her face is cancer, her state “insurance” won’t pay for a biopsy. In essence, it is a state-run Eugenics program leveled against poor women.

There has been no controversy about Viagra—it is covered almost universally, including by Catholic institutions. For a while, Medicare even covered Viagra while denying prescriptions for vaginal estrogen cream.

The Republican run Congress has been incredibly misogynist on this issue. Their hearing on the matter was almost comedy. Exclusively run by men, and all but two of the witnesses testifying were male.

So what did Maloney have to say about the lack of uteri in the contraception hearings, just moments before she walked out of the proceedings with fellow awesome person Delegate Eleanor Holmes Norton?

“What I want to know is, where are the women? I look at this panel, and I don’t see one single individual representing the tens of millions of women across the country who want and need insurance coverage for basic preventative health care services, including family planning.”–The Jane Dough

Really?

Not to be outdone by the laugh a minute Congress, women have mounted their own comedy campaign. A flurry of bills making it difficult to get Viagra and vasectomies have been purposed in various state legislatures. Even a bill to prevent a man from spilling sperm anywhere but inside a woman!

EVERY SPERM HAS A RIGHT (OKLAHOMA): To poke fun a “personhood” bill that give full rights to a zygote, state Sen. Constance Johnson (D) introduced an amendment that would also declare every sperm to be sacred. “However, any action in which a man ejaculates or otherwise deposits semen anywhere but in a woman’s vagina shall be interpreted and construed as an action against an unborn child,” her amendment stated.

CHILDREN DENIED BIRTH BECAUSE OF VASECTOMIES (GEORGIA): State Rep. Yasmin Neal (D) introduced legislation that would limit vasectomies. “Thousands of children are deprived of birth in this state every year because of the lack of state regulation over vasectomies,” Neal explained. Her measure is in response to a bill that would ban abortions after 20 weeks on the grounds that a fetus can feel pain — a claim disputed by doctors.

MORE HOOPS TO CLEAR FOR VIAGRA (OHIO): In response toGOP Running Mate: The Pill! Ohio’s so-called Heartbeat Bill, which would prevent abortions once a fetal heartbeat is detected, state Sen. Nina Turner (D) will introduce a bill that would make men jump through hoops, like a psychological screening, before they could obtain Viagra and similar drugs for erectile dysfunction. “All across the country, including in Ohio, I thought since men are certainly paying great attention to women’s health that we should definitely return the favor,” Turner said.

RECTAL EXAMS FOR A VIAGRA PRESCRIPTIONS (VIRGINIA): To protest Virginia’s bill requiring women to receive an ultrasound before an abortion, state Sen. Janet Howell (D) attached an amendment to the bill that would have required men to receive a rectal exam and pass a cardiac stress test before doctors wrote them a prescription for erectile dysfunction medication. “We need some gender equity here,” Howell said. The Virginia Senate rejected her amendment, but both chambers passed the ultrasound requirement after clarifying that women would not be forced to undergo a transvaginal ultrasound.

KNOW THE SIDE EFFECTS OF VIAGRA (ILLINOIS): State Rep. Kelly Cassidy (D) decided to push back against GOP attacks on women’s health by offering an amendment that would require men to watch a “horrific video” about the side effects of Viagra before the received a prescription for the drug. His bill is in response to a measure requiring women to undergo an ultrasound before an abortion. “If we are going to do this, we need to do it in a way that is applied equally,” Cassidy said.

PROTECT ALL SPERM (DELAWARE): Mocking the “personhood” measures, the town council in Wilmington, Delaware approved a satirical resolution “that asks state legislatures and U.S. Congress to enact laws that forbid men from destroying their semen.” The resolution notes that if lawmakers think a female egg has full rights, then they should say the same thing about sperm.

Think Progress

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Republicans war on women - the female anatomy target zoneOnly in America could this happen. For decades, other countries have seen the error of allowing money and and markets to run their health care and they have moved away from that system. But not here in the US. We ignore all fact and reason, forcing our health care system into a state of permanent collapse. Now the government is on the verge of forcing women to purchase health insurance while allowing others to prevent women from obtaining health care services. How can we even dream of complying with that idea?

Many people have likened the Affordable Care Act to the Swiss Health Care system. That couldn’t be further from the truth. The Swiss do not allow their employers to pick health insurance for the employee, so the workers at St. Jo’s could get health insurance with birth control if they wanted. Though the Swiss system allows private insurance, the Swiss government laid down the law about what minimum benefits constitute “insurance” and defined what constitutes qualified health care. The Swiss also prevent insurers from making a profit on the basic health care plan (which is very extensive). The insurers can only make a profit on perks like guaranteeing a private room or providing coverage for alternative medicine. The American system shirks its responsibility to get tough with the powerful in the health care game, and only focuses on forcing the average citizen to purchase a product—a product that might or might not provide the real benefit of health care.

Republicans war on women – the female anatomy target zoneOur system is quite literally owned by people who have motives other than the health of the population and we are held hostage by those forces. Where else but in health care is it considered reasonable to provide necessary services for just half of the population based on sex? If the Catholic Health Care system is unable or unwilling to care for half of the population in the communities it serves, should it be allowed to continue these restrictions? Should we continue to be held hostage by insurance companies, pharmaceutical companies and Religious dogma we do not even subscribe to?

I might point out here that Single Payer insurance alone would not cure this ill. The government must take the same hard line with the powerful that it has taken with the meek.

Or the meek could balk at the government edicts. I might also point out that true Socialized Medicine, the type they have in England, would fix this problem. Socialized Medicine is also how the Indian Health Service, the Veterans Administration and the Active Duty Military are run. Those systems are owned by the American people. They are paid for by our tax dollars. They are ours to control.

The next round of bills to force a real health care solution into our nation might do well to include an attempt to open those hospitals for a buy-in by the American public. Those system would get a welcome influx of cash and the American people could have access to a national system already in place with a decent health care package.

The Campaign

teaball contraceptionIt’s no wonder women approached Obama about shoring up the gross inequities in the system. Now, it appears, Obama might cave to the pressure of the Catholic Church and leave women out in the cold again.

I agree with the majority of women in America. If a health care service is taking government funds, it should provide service for everyone. If an institution is incapable or unwilling to do so, it should be forced to sell its health care assets to the local communities. These hospitals should be cooperatively run and federal funds should be set aside to aid in the transition. At the very least, these institutions should be forced to contract out the needed services.

Many of you laughed at our April Fool’s image of angry women throwing contraceptives at the feet of the President. Now, I want us to do just that. I propose the Pelt the President with the Pill Campaign. Save your, or a friend’s, spent birth control containers and send them to your Congressional leadership and the White House with this letter:

Date

Name

Address (with Zip Code)

Contraception is health care. We demand access to affordable birth control for everyone. Providers that can not provide for 50% of their patients, should not get federal funds.

Signature

If you don’t have any spent pill containers, don’t fret—send a condom. They are still available at the grocery store—at least at the time of this posting. The point is to send some contraceptive device. Why send a contraceptive? Because emails are ineffective at getting attention. Mere letters are also ignored. But sending some symbol of your discontent gets attention.

If you find yourself in Humboldt county, come by my office. We are forbidden from throwing outdated birth control in the trash because it contaminates ground water. Until now, I didn’t know what to do with all those pills.Think contraception

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The Choice:

My husband greets me at the door with a chilled glass of white zin and a mushroom cheeseburger.

I smile and sip the wine. “Yeah, it was just that bad.”

“What did you find out?”

“We don’t know where the orders are coming from.”

“What’s the Gynecology Department doing about it?”

“Apparently, the winning game plan is to hope the bishop kicks the bucket soon.”

He snorts and takes a bite of his burger. “What are you going to do about it?”

“The bishop isn’t the only one with strong feelings on this issue.”

“So you’re going to move your surgeries?”

“I already told them my cases are going to Mad River.”

“What did they say to that?”

“They were angry..afraid. They want me to keep my mouth shut about the tubal decision.”

“Powerful people seem to want you to keep your mouth shut all the time. You gonna do it this time?”

I push corn around on my plate.

“I see,” he says. “Your stunt with the TSA cost over three thousand. What’s this going to cost us?”

I look up from my plate. “If I have to leave St. Jo, at least Mad River is closer to the home.”

“Mad River isn’t very big, hardly more than a super clinic. Some of your patients won’t go.”

My bravado has fooled no one. “I know.”

He locks eyes with me. My shoulders tense and I prepare for the Principle over Practicality argument…again. A storm gathers in the silence between us, ready to hails down angry words we will both regret.

His hand extends across the table, palm open.

Stunned, I place my hand in his. His warmth soaks my fingers, draining away my tension.

“That’s my girl,” he whispers.

 

Every Sperm is Sacred