When the Obama administration decided that birth control coverage would be mandatory for all insurance policies, even those provided to employees by large religious institutions, the outcry from Catholic leaders and social conservatives surprised a lot of people. But conflicts between health care and religion, particularly Catholicism, are not news in many parts of the country. Just ask physicians in Sierra Vista, Arizona.
Sierra Vista is a rural community about 80 miles southeast of Tucson and about 20 miles north of the Mexican border. It has one hospital: the Sierra Vista Regional Health Center. In 2010, administrators announced that their secular institution would be joining the Carondelet Health Network, a system of Catholic hospitals. The intention was to make the hospital more financially viable, the administrators explained, but it would also entail some changes: The obstetrics service would have to abide by care directives from the Catholic Church. Although the merger would not be official for another year, staff would begin observing Catholic medical guidelines right away.
The hospital did not perform elective abortions, which is typical for small conservative communities. But the obstetricians were accustomed to terminating pregnancies in the event of medical emergencies. And just such a case presented itself one November morning, when a woman, 15 weeks pregnant, arrived at the emergency room in the middle of a miscarriage. According to a deposition later obtained by The Washington Post, the woman had been carrying twins and passed the first fetus at home in the bathtub. When she arrived via ambulance, she was stable and not bleeding. But the umbilical cord from the first fetus was coming out of her vagina, while the second fetus was still in her uterus.
Robert Holder, the physician on duty who gave the deposition, said the odds of saving the second fetus were miniscule. Doctors would need to tie off the umbilical cord and put the woman at severe risk of infection. After discussing the options, the family, with some difficulty, opted for a medical termination. But, under the new rules, Holder had to get approval from a nurse manager and eventually a more senior administrator. When Holder briefed the administrator, she asked whether the fetus had a heartbeat. It did, he said. “She replied that I had to send the patient out for treatment,” Holder later recalled. He arranged for the woman to get the procedure at the nearest major medical institution—in Tucson. According to his account, the 90-minute trip put her at risk of hemorrhaging and infection, which did not happen, and “significant emotional distress,” which did.