Dr. Debra Stulberg
Dr. Debra Stulberg, a Family Medicine physician in Chicago, Illinois, experienced the obstacles that arise when a Catholic hospital merger threatens to impede reproductive healthcare services—and learned how physicians’ efforts to preserve those services can make a difference.
In the fall of 2003, West Suburban Health Care announced that it had signed a letter of intent to become part of Resurrection Health Care, Chicago’s largest Catholic healthcare system. While West Suburban never provided abortions, it did provide contraception, tubal ligations, family planning counseling, referrals for abortion, emergency contraception and other related services. West Suburban is also a teaching hospital with residents in Family Medicine and Internal Medicine and fellows specializing in Maternal-Child Health. When merger talks began, it was unclear how the merger would affect the different aspects of the residency programs, the service delivery and the patient care.
“I was on call when the proposed merger came to my attention,” Dr. Stulberg said. “Sitting in the cafeteria across from my attending, I was thinking about our active labor patients and rushing to finish dinner, not the least bit prepared for the statement he was about to make: ‘So, it looks like we’re going to be working for the Pope.’
“I chuckled politely for a moment,” she continued, “trying to identify what he was referring to, before recalling a vague rumor about our hospital being in talks about a possible affiliation with Resurrection Health Care, a large Catholic hospital system. I had barely taken note the first time I heard this allegation, probably because the administration often sent out memos concerning the hospital’s critical financial status, and this was not the first time a merger partner had been mentioned. But the way the attending said it this night sounded different. It was as if the decision had been made, that the merger was inevitable.
“I am a first-year Family Medicine resident at West Suburban Hospital, an independent community hospital situated between Oak Park, a relatively affluent suburb, and the west side of Chicago, one of the poorest and most medically underserved urban communities in the country,” Dr. Stulberg explained. “Our Family Medicine residency has a great reputation, both as a strong general training program and for its strength in women’s health. This specialization, as well as the diverse patient population, initially provided the attraction for my training. The hospital does not provide abortions, which disappointed me, as I knew going into residency that I wanted to be trained as a provider. When I asked the residency director about this possibility, she was effusively supportive, stating there would be no problem using my allotted electives to receive this training. She said that with my commitment to reproductive rights and women’s health, I would fit right in.
“As of yet, I have not been disappointed. Our Maternal-Child Health service provides a large volume and great breadth of obstetrics; the majority of clinic patients are women of reproductive age, ensuring that family planning services are a key component of the program; and the program’s culture is generally aligned with the principles of reproductive choice.
“Thinking through the possibility of working for Resurrection, my concern was whether or not I would be able to obtain abortion training. I envisioned having to avoid the administration’s notice and I contemplated whether my program would continue to be supportive. Driving home post-call the following morning, I realized that this merger was not a foregone conclusion, that this type of situation has been previously encountered and, occasionally, thwarted. I was galvanized for action. The ensuing process has been truly amazing. It is thrilling to see the community of activists, both internal and external to the hospital, that has sprung up to defend the services upon which our patients rely.
“With the future uncertain, life as a resident is more difficult. I continue to plan for my abortion electives and tell interested medical students that West Suburban is a great place to train. I continuously remind myself why I came here and why I chose to become a physician. Reproductive health services are threatened by mergers, provider shortages and numerous barriers throughout the country. With this threat now affecting my own training and the care my patients receive, defending these services has become as much a part of my job as learning and providing them.”
West Suburban Health Care’s merger with Resurrection Health Care was finalized in 2004. Due to much effort by Dr. Stulberg, diverse community members and reproductive health advocates, agreements were made to accommodate family planning requests from patients by creating an outpatient clinic as a separate entity of Resurrection. Dr. Stulberg and her physician colleagues continue to provide the best medical care possible for their patients.
Debra Stulberg, MD, is on the Board of Directors of Medical Students for Choice.
Dr. Wayne Goldner, an obstetrician/gynecologist with a practice in Manchester, New Hampshire, witnessed the challenges that often arise when abortion is banned as a result of a religious hospital merger.
Dr. Goldner’s patient Kathleen was 14 weeks pregnant when her membranes ruptured. After examining her and performing an ultrasound, Dr. Goldner told her that her chances of successfully carrying the pregnancy to term were minuscule. Even if she attempted to carry the pregnancy to term, there was, at most, a 2% chance the baby would survive. Continuing the pregnancy would place Kathleen at increased risk of developing an infection, which could jeopardize her ability to become pregnant in the future.
After considering her options, Kathleen decided to terminate the pregnancy. However, Dr. Goldner’s admitting privileges were at the nonsectarian Elliot Hospital, where abortion had been banned following its merger with a Catholic hospital. Hospital administrators told him that because the fetus still had a heartbeat and Kathleen showed no signs of infection, the case did not meet the hospital’s criteria of when an abortion could be performed. They refused to allow Dr. Goldner to perform the abortion.
Because the nearest alternative hospital was 80 miles away and Kathleen had no transportation, Dr. Goldner attempted to schedule the surgery at Elliot Hospital despite the administration’s denial. In response, the hospital told Dr. Goldner that he would lose his admitting privileges if he performed the abortion, and the staff was told that they would lose their jobs if they assisted him. Rather than delaying the procedure and risking his patient’s future fertility in an attempt to prove the procedure was medically necessary, Dr. Goldner put his patient in a taxi for the 80-mile trip to a hospital that would treat her.
Dr. David Mesches
Some physicians have paid a high price for speaking out against religious restrictions or expressing thoughts contrary to religious or moral positions.
Dr. David Mesches, former chair of the Roman Catholic-affiliated New York Medical College’s Family Medicine program, lost his job for expressing a view that did not conform to the Catholic Church’s position on abortion. In a newspaper article about his decision to lease space in a medical building he owned to a clinic that would provide abortions, Dr. Mesches commented, “It’s the law of the land, and the right thing to do.” According to Dr. Mesches, the dean of the Medical College’s School of Medicine told him, “It would not be possible for [you] to hold this public position on abortion and continue to chair the department.”