Candice Rich knew that she wanted a tubal ligation after she gave birth. From July 2008 through February 2009, Candice had gone to St. Luke Hospitals in northern Kentucky for all her prenatal care. From the beginning, she had told her doctors that she wanted a postpartum tubal ligation. There are medical benefits to having the procedure immediately after childbirth, and it's generally less expensive to do so. Everything seemed to be on track. Her doctor repeatedly assured her that she could have the procedure at St. Luke immediately after delivery.
The hospital had some plans of its own. The nonreligious St. Luke was in the process of completing a business merger with a religiously affiliated institution that severely restricts reproductive health care. The birth control counseling and services, IUD insertion, infertility procedures, and tubal ligations that, for years, St. Luke provided to women in northern Kentucky would, without warning, no longer be available at the hospital after the merger. Women in the region seeking these services – especially low-income women and those who rely on Medicaid for their health care – would have little or no access to these important services.
No one bothered to tell Candice this until two days after her due date when she saw her doctor and had an ultrasound. At this visit, Candice's doctor recommended that she undergo a cesarean section. Again, Candice discussed her desire to have a tubal ligation at the same time as the cesarean. It was then that her doctor told her, "because of the Vatican," St. Luke no longer offered tubal ligations.
Candice's doctor gave her the name of a physician in Ohio who practices at a hospital that provides tubals and told Candice to talk to St. Luke Hospitals Women's Health Nurse Advocate. The hospital also told Candice for the first time that Medicaid requires informed consent for a tubal ligation 30 days prior to the procedure. Clearly, a requirement Candice could no longer meet.
When Candice, now three days after her due date, called the nurse advocate, she received no assistance in making arrangements to give birth and receive a postpartum tubal elsewhere. Frantic, Candice called a number of doctors on her own until the recommended Ohio physician agreed to help her. At the last minute, Candice had to switch to a new hospital and doctor to give birth, and she had to pay in full out-of-pocket for the tubal ligation on the day of the surgery. She didn't have the $1,700 she needed; her mother agreed to put it on her credit card.
Last week, the American Civil Liberties Union and the ACLU of Kentucky asked Kentucky's Cabinet for Health and Family Services to conduct a hearing into the reduction of reproductive health services at St. Luke Hospitals and to restore access to reproductive health care in northern Kentucky. In the course of the merger, St. Luke had promised to build a separate Women's Health Ambulatory Surgical Center that would provide many of the lost services. In seeking authorization from the cabinet to build such a facility, the hospital noted that "reproductive health is a basic women's health service to which any female resident of northern Kentucky should have access." St. Luke has yet to establish the center and make good on its promise.
Unfortunately, last week's filing will not help Candice, but it can help other women and families in the area. It also puts other hospitals considering mergers on notice. According to MergerWatch, a nonprofit that fights mergers between secular and religiously affiliated hospitals throughout the country, since 1990, there have been more than 100 such mergers, resulting in lost reproductive and other crucial services in an alarming number of communities. If we've learned anything in recent months, we need to pay attention to business decisions and, as in Kentucky, act to protect access to crucial care when necessary.