I’ve been living in the Cheltenham area for several years now, and my family has used Abington Memorial Hospital’s services as needed. I’ve known the ob/gyn chair, Dr. Joel Polin, for many years professionally, and also know that he is as supportive of abortion access as I am. Not many abortions take place annually at Abington; somewhere between 50-100/year overall. But if many are like the procedures I once performed at an inner-city hospital in Philadelphia, these are not cases that could be done at a freestanding clinic such as Planned Parenthood or Philadelphia Women’s Center. Access to abortion within teaching hospitals is important, both for the patients and for the next generation of abortion providers (ie, the residents). Hospitals are much less of a target for anti-choice protesters, and it is also easier to manage the occasional complication (abortion is a very safe procedure, but complications minor and major can happen). A few years ago, I counter-protested against some anti-choice folks at Abington, and I know that the hospital had stood up for reproductive rights and maintained their abortion services in the face of some opposition.
That may change. In a very surprising move, the Board of Directors of Abington Memorial Hospital has moved forward with a Letter of Intent to merge with the local Holy Redeemer Hospital, a Catholic hospital located not far away in the Meadowbrook section. As a result, even though Abington is the stronger party financially, abortions, selective reductions and physician-assisted suicide cannot be performed at Abington under the merger.
Now, physician-assisted suicide is not permitted in the Commonwealth of PA, so that is a nonissue. But abortion and selective reduction will be forbidden at Abington, as they would be at any Catholic sectarian entity. Under agreement, contraceptive and sterilization access will be maintained at Abington.
Some might say that this is really not too bad. Unlike what happens at Catholic institutions, women will still be able to get their contraceptives, and men and women can also undergo sterilization. There will still be IVF services and other assisted reproduction at Abington (just as Holy Redeemer has reproductive endocrinology services that involve assisted reproduction). Not many women locally undergo abortion, selective reduction is probably very uncommon even with all the IVF and ovulation induction going on, and this isn’t Mississippi. There are abortion providers in the Philadelphia area, including a hospital-based service at nearby Albert Einstein Medical Center (disclaimer: I have an adjunct faculty appointment at Einstein, but have no financial or other interest in that institution).
But this is not a minor issue; this is a problem of nuclear proportions. And it’s not just about abortion, but affects women who have very desired pregnancies. Here are some questions and issues that help demonstrate why this is a big deal:
• Selective reduction (which is not always thought of in the same context as abortion, as the intent is to sacrifice one or more multiple fetuses to save the remaining); for those women with triplets, quadruplets and higher-order multiple pregnancies, they will either have to undergo reduction in Philadelphia or else take their chances with the outcome
• Preterm premature rupture of membranes (PPROM); will Abington physicians be permitted to induce labor in that situation or would they have to wait for intrauterine infection to evolve into sepsis? This is not a theoretical situation; this exact scenario played out with our former Senator’s wife (Karen Santorum). In that case, she made her own personal choice to delay labor induction. While it is not what I would recommend, I respect her choice as a patient. But that was her own choice, not one imposed upon her by a Catholic hospital.
• If there is nonreassuring fetal monitoring at < 26 weeks’ gestation, will women be given a choice of labor induction vs. stat classical Cesarean section (mandating future C/S)?
• Management of second-trimester inevitable miscarriage (eg, 18-22 weeks); will physicians be required to take unusual and medically futile measures?
• Provision of emergency contraception (EC); regardless of what the current plan and/or potential contract agreement is between the two hospitals, EC is (wrongly) considered to be an abortifacient by the Church and proscribed as much as surgical or medical abortion. So, if a victim of a sexual assault presents at Abington’s Emergency Ward (EW), will she be offered EC? At a significant number of sectarian and nonsectarian hospitals throughout Pennsylvania, EC is not offered to victims of sexual assault, so this is not a theoretical construct.
• Management of anencephalic and other lethal malformations detected with sonography or with other prenatal testing prior to, or past, the 24-week viability standard; based on Catholic teachings, abortion would not be available even in the presence of lethal anomalies
• Perinatal testing for pregnancies that are likely nonviable or severely compromised, with the potential for futile C/S if nonreassuring testing results from these actions
• Management of pregnant women with treatable cancers that are generally managed with pregnancy termination followed by definitive treatment of the malignancy (eg, stage IB cervical carcinoma diagnosed at 14 weeks’ gestation; one potential management option would be radiotherapy or D&E to terminate the pregnancy followed by gravid radical hysterectomy)
• What about the CREOG/RRC requirements to maintain AMH ‘s residency accreditation in light of the lack of training in abortion technique and aftercare?
• How will women who need postabortion care (for abortions done elsewhere) be managed?
• Will the merger affect standard management of ectopic pregnancies? I suspect not, but while treating a patient with a tubal pregnancy via laparoscopy at Graduate Hospital in the 90′s, a scrub nurse told me that if it were her, she would wait for her tube to rupture before taking action, since I was essentially terminating a life. This was a very good scrub nurse, and she knew very well the implications of untreated ectopic pregnancy, such as hemorrhage and death.
• How iron-clad is the commitment/agreement to continue to provide standard contraception and sterilization services?
• How will they weigh the life of a mother vs her unborn baby in circumstances where they may only save one life and the mother is not capable of expressing her desire? And would that differ from cases where the mother can express her desire?
• Management of severe non-immune hydrops fetalis during labor and deliver (ie, given the lethal nature of the condition for the fetus, will drainage of excess fetal fluid from various cavities be considered to effect vaginal delivery, or would that be proscribed as being similar to intact D&E?)
These are just some of the things I came up with off the top of my head in a few minutes the other week. I’m sure there are others I did not think of.
Abington Memorial is one of the largest hospitals in the county. While it is not a major academic medical center like Mass General or the Hospital of the University of Pennsylvania, it is a very large hospital that does more deliveries per year than many hospitals in the area. Over the past several years, we have lost many obstetrical services in the Philadelphia area; the hospital where my daughter was born is now a hospice or some other outpatient facility (ironically, owned by Abington Health). Two local hospitals within a short distance of Abington Memorial, Jeanes and Elkins Park Hospitals, no longer have OB care. It is not feasible for most women in the Abington/Jenkintown/Cheltenham area where I live to travel into Philly for their OB care and delivery, nor will most people choose to go to Einstein; it’s a good hospital, but it’s in an underserved area and most folks in my area just don’t go there. Einstein is building a new facility in the Blue Bell area, but unless you’re really determined to avoid Abington at all cost, it’s quite a hike from this area. So for all practical purposes, most women do not have other good options for their OB and other care.
I have nothing against Holy Redeemer Hospital per sé. It is a good hospital. My children see pediatricians in their medical office building. I have to remind myself that it is a Catholic institution; unlike places like Mercy-Suburban and other hospitals that are affiliated with the Sisters of Mercy, Holy Redeemer doesn’t wear its Catholicism on its sleeve. I’ve yet to see a cross there, not that there is anything wrong with it (the Pieta of Michelangelo is one of my favorite sculptures, ever). But my point is that it has a pretty low-key approach to being a Catholic hospital, to its credit. But at the same time, it remains a Catholic hospital. And while the folks who run it might be willing to look the other way when Abington, under the merger, provides sterilization and contraceptive care, they clearly will not, and cannot, support any affiliated entity having anything to do with abortion. Low-key, yes, but there are limits.
So that’s the quandary. In order to have this merger go through (and the business rationale for the merger, other than the value of the land Holy Redeemer sits on for additional office and OR space, escapes me), Abington will have to adhere to the directives of the Catholic Church as regards abortion and selective reduction. I respect all religions, regardless of my own atheism, and while I might not agree with Holy Redeemer banning abortion within its own hospital grounds, it is well within its right to do so. The problem is when sectarian hospitals merge with nonsectarian ones and impose their own sectarian beliefs on medical care delivered at the formerly nonsectarian institution.
We live in a diverse country, which is a good thing. And the Cheltenham/Abington/Jenkintown PA area is known for its diversity and generally progressive population of all religions, ethnicities and backgrounds. So the idea that a proposed takeover of a Catholic hospital would lead to the loss of abortion services at our most prominent local hospital, the one that is the stronger institution at this time, is mind-boggling and offensive to many in this area. As a result, more and more people are taking a stand against the merger, and that’s a good thing.
I’ve sent e-mails and received canned responses, so I imagine most people who write will receive similar responses from the Abington management. But the more people write, the more the board and other management at the health system know there is solid opposition to this.
We also need more physicians on staff at Abington to speak up and, if it comes to it, even resign their positions. When I was an attending physician at one Philadelphia hospital, I ended up leaving to go to Pennsylvania Hospital in large part because my former dept. chair was anti-choice and decided to go over my head and cancel one of two second-trimester abortions I had scheduled in the OR there (he couldn’t cancel the second patient, much as he wanted to, as I had already placed laminaria into the cervix to prepare it). At some point, we physicians need to uphold our own principles and ethical standards. If we cannot make a decision based on medical evidence but have to comply with religious dogma in certain situations, all of us have a choice to make in terms of whether or not that is acceptable based on our interest in providing the best medical care for our patients.
Abortion is not a happy procedure, unlike much of obstetrics (although OB is often anything but happy, but that’s another discussion). I’ve never had a patient who took it particularly lightly, or who loved undergoing the procedure. But it is often a necessary procedure, both medically and from a public health standpoint. Some of my colleagues have died for providing this legal procedure. LeRoy Carhart, whom I’ve spoken with and admire greatly, has had his life disrupted and threatened on multiple occasions for his dedication to providing this service to his patients. Warren Hearn, whom I also think very highly of as a physician, is often under armed guard due to threats against his life. Those of us who have provided abortion services do not have an easy time of it. Besides the protestors and the inappropriate social stigma, many of our own colleagues (even in ob/gyn) disrespect us and treat us like undesirables. So when I hear of yet another hospital that will no longer provide abortion services, it touches a raw nerve. Many people have worked for years to do whatever they could to make sure that women at least have some places where they can exercise control over their own reproductive destinies. That’s because a lot of us feel that women who cannot control their reproduction are not truly free. So this is important to those of us in women’s healthcare, and from the responses to the Abington Board’s decision, I’m glad that this is very important to a lot of people in the local area as well.
Feel free to e-mail the management of Abington Memorial Hospital. Just to make it easier, here are their e-mail addresses (keep it civil and polite, however. This isn’t personal):
Mr. Laurence M. Merlis (Chief Executive Officer and President): Lmerlis@amh.org
Meg McGoldrick (COO): Mmcgoldrick@amh.org
Ivy Silver (Chair, Foundation Board of Trustees): Isilver@amh.org
Robert Infarinato (Chairman of the Hospital Foundation, Chairman of the Board of Trustees): RInfarinato@amh.org