MEDICAL EMERGENCY: How A Decision By One Bishop In Iowa Upended Health Care For Thousands Of People.

Author:Littlefield, Amy

Ebonie Bailey was seven months pregnant when she and her family moved to Waterloo, Iowa, for her husband's job at John Deere. Her provider back home had recommended the midwives at Covenant Medical Center, one of two hospitals in town. Ahead of her delivery there, Bailey toured the sprawling brick building. She was surprised when the tour guide pointed out that the hospital had two sides: one Catholic, the other not.

"I was like, 'I don't understand. Do you mean like, there's a church over there?'" Bailey recalled. "And they were like, 'Well, there's certain procedures that cannot be done on that side of the hospital.'"

"I was like, what? What year are we in?" Bailey said. "I was so confused."

Unbeknownst to many patients who rely on them, Catholic hospitals like Covenant are supposed to follow religious directives that ban abortion, sterilization, and all contraception except for natural family planning. But some of these hospitals have found creative ways to get around the rules.

Bailey's hospital, which rebranded in February as MercyOne Waterloo Medical Center, had an area that one provider wryly called the "sin room." Devised in the 1980s following the merger of a Catholic and non-Catholic hospital, the workaround allowed providers to perform tubal ligations and other procedures banned by the Catholic directives in an operating room suite on the labor and delivery floor.

Even outside this area, midwives like Bailey's freely provided contraceptive prescriptions and Depo Provera injections, as did the OB-GYNs at the hospital, whose independent practice, Partners in OB/GYN, rented office space above the labor and delivery floor. The doctors inserted IUDs in their office; the midwives used the "sin room."

"We all knew we were violating Catholic hospital guidelines, but we believed we were giving good health care, and so we did what we needed to do to take care of our patients," Dr. Suzy Lipinski, who worked at Partners and served from 2011 to 2015 as chair of the OB-GYN department at Covenant, said. "We just thought we had a workaround that was acceptable."

Last year, that all changed. In June, the U.S. Conference of Catholic Bishops approved new directives for Catholic hospitals, declaring that in any affiliation, a Catholic facility must ensure that its administrators and employees will not "manage, carry out, assist in carrying out, make its facilities available for, make referrals for, or benefit from the revenue generated by immoral procedures."

Dubuque Archbishop Michael Jackels cracked down. Representatives from the archdiocese--which includes some 200 parishes encompassing the northeastern corner of Iowa and from Covenant's parent company, MercyOne, informed the providers that they would have to stop offering tubal ligations. (Procedures have continued for patients who were already scheduled.) While the hospital never announced it publicly, a new policy implemented on April 1 went even further, banning contraceptive implants like IUDs altogether and allowing other forms of hormonal contraception only for medical reasons like heavy bleeding.

MercyOne declined to answer a detailed list of questions from Rewire. News about the changes and the lack of transparency surrounding them.

"As a Catholic health care organization, MercyOne is called to observe the Ethical and Religious Directives for Catholic Health Care Services (ERDs)," a spokesperson said in a statement. "We work with our providers and colleagues to ensure the medical services we provide are in accordance with these guidelines. We remain committed to caring for the patients and communities we serve in the spirit of our Catholic values and faith-based mission."

The changes have prompted widespread confusion and outrage, along with a patient exodus. They reflect the longstanding tension between Catholic health system providers and administrators--who may recognize that refusing to offer birth control is not a viable business decision--and the bishops charged with ensuring that hospitals under their jurisdiction comply with Catholic doctrine.

As Catholic systems have expanded their reach, often by merging or partnering with secular systems, the bishops have increasingly tightened the religious...

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