[The conversations represented here took place over the last week and are compressed for your reading pleasure. My husband and I are real people and said the things represented here. The rest of the dialogue is provided by intentionally fictionalized characters that are not meant to represent any one person. All sentiments and facts expressed here are genuine to the best of my recollection, but the characters saying them were selected by drawing names from a hat. I, alone, am responsible for this content.]
“They canceled Andrianna’s tubals yesterday,” I inform Steve in the hall outside the conference room. “They didn’t even give her a whole day’s notice so she could talk to her patients before they did it.”
"I got virtually no notice either when they canceled mine on Monday,” he replies.
“Really?” I am shocked by this. I have never heard of a hospital canceling cases so abruptly without involving the surgeon. “Who ordered the cancellations like that?”
“Don’t know. We’re only told the surgery scheduler, but someone gave her the order.”
We enter the conference room to find Norm waiting for us. The other gynecologists filter into the room. Both the hospitals the Sisters of Orange own are represented: the hospital in my town, St. Joseph’s, and the one south of us, Redwood Memorial.
“We had hoped this would blow over but the sisters feel backed into a corner.” Norm starts. “They have no choice but to get tough on this issue.”
“What brought all this on?” Steve asks.
“The edict came down from the new Bishop in Santa Rosa," Norm says, "but we got targeted when they pulled the diagnosis codes for the hospital. It was obvious we were doing more sterilizations than they were in Southern California.”
“In Southern California you can go down the street from any Catholic institution and run into a secular hospital.” I try to defend us. “The Catholic Church bought almost all the hospitals in this area. For the last six years they’ve been trying to drive the last secular hospital under.”
“Never the less, we were doing a lot of tubals for ‛psychological’ reasons.”
“We were hardly doing a lot of sterilizations,” I say. “Other hospitals preform far more tubals a year. The stigma the Church gives the procedure already curtails many woman from asking for sterilization.”
“So what’s the plan?” Steve says, rescuing the meeting from disintegrating into complaints about the Church.
“Nothing.” Norm states. “This is a game we can’t win. The more public pressure the Catholics face, the more they will dig in. We have to keep quiet and wait. That will take the pressure off the nuns. When you’re approached by the media, and you will be approached, my advise is to refer them to the CMO. That’s what he gets paid for. Don’t talk to the media, or write letters to the editor. Don’t talk to your patients about it. We need to keep the lid on this to stop it from blowing up.”
“Too late. The patients already know.” I inform him. We all know there was an article in the local alternative paper, The Journal. The “real” paper in town, the Times Standard, has been silent on the issue. “I spent half an hour at a Pap smear today with an irate woman who vented the whole time about how this was unreasonable and unfair."
“I wouldn’t encourage her. And don’t talk to your staff about this either,” Norm says.
“How am I going to do that? I’m taking my patients to Mad River. They all know why I stopped operating at St. Jo’s.”
“What do you say to the patients?” Steve wants to know.
“The truth. I don’t think it’s fair to deny all the women in an entire county a procedure on religious grounds. And the patients agree with me. I have an eighty year old woman who lives as far south in the county as you can go. I told her why I was taking my patients north, but seeing where she lived and considering her age I told her I would make an exception for her and operate on her at St. Jo's. She told me, ‛Don’t you dare. I don’t want to support that any more than you do.’ This octogenarian wants to drive past the two hospitals the Sisters own to have her surgery at Mad River Hospital.”
“This hospital is facing hard times right now.We're barely holding on ourselves. We can’t afford to lose any patients. We don’t want to lose patients or doctors.” Norm seems genuinely alarmed.
“Great. Go back to the way it was, and I’ll bring my surgeries back to St. Jo’s.” I feel for Norm, but I will not be moved.
“Look, if they made us take all the hysterectomies to ethics committee, the way they threatened to, then I would do the same thing.” Wendy said. “But it’s just the tubals.”
“The only reason they didn’t is because they found out the insurance companies already reviewed all our hysterectomies and would not pay without an adequate medical diagnosis.” I tell her. “They weren’t being magnanimous. They just didn’t want to duplicate the work.”
“You can’t take your surgeries to Mad River.” Quinn, always the practical one, tells me. “I’ve looked at the labor numbers. St. Jo’s is hemorrhaging money in Obstetrics. The hospital will take the Laborist program away. The only reason you came here was for that program. You don’t want to see it die, do you?”
“I don’t.” Everything he says is true. Medicaid doesn’t even cover the cost of deliveries for most hospitals. The one wing devoted exclusively to women is a loss leader for most hospitals in the nation. Obstetricians get treated like the red-headed-step-children of the family of physicians because we don’t make the hospital any money. Having a Laborist program is a rare luxury. It meant I could sleep through the night for the first time in years, watch a whole movie in a theater, have a conversation with my husband--uninterrupted by the other woman...one with vaginal discharge. I do desperately want to keep that indulgence. “It’s not just about what I want. If they take the Laborist program, there's little reason for me to be at St. Jo’s at all. I’ll not just take surgery to Mad River, I’ll take my labor patients as well.”
“If we don’t support the hospital it won’t be there to care for us.” Wendy says. “I for one want a hospital here when I retire.”
“Not taking care of the needs of half of the population is not caring for us.” I can feel my control slipping. “If they are unwilling to serve half the population’s health care needs, what are they doing in the business in the first place? They should sell the hospital—preferably back to the community to be run cooperatively.”
“This happens every seven years or so.” Elroy, the oldest member of our tribe, says. “The last time it was a new nun sent to take over the hospital. She had all the tubals canceled too.”
“How did that get resolved?” I ask.
“She died and it got forgotten.”
“So we’re waiting for the Bishop to die? Or just waiting for him to change his mind?” I say with more than a little heat. “The Bishop isn’t the only one with strong feelings on this.”
“The hospital can make it hard for you.” Adrianna has arrived late to the party due to her patients. “Remember Tony? He got in that spat with the hospital and started talking to people—even people in the Foundation. It got back to the Board of Trustees and they dragged him into Medical Executive Committee. Now he has that mark on his record forever.”
I know she is trying to warn me. I’m no stranger to this tactic. Though I have not seen it used at St Jo’s, I’ve seen it used elsewhere to strike fear into doctors. A hospital will use its power to remove incompetent doctors on a doctor who is medically competent but has a disagreement with the hospital. They sacrifice one physician, ending his or her career, to scare the other physicians into compliant silence. There are even courses for hospital administrators instructing them how to do this effectively. I’ve avoided such abuses of power so far, but I’ve seen it used time and again on colleagues.
“Look, it’s not just our patients. I was already scheduled to talk about this subject on a national level. I can’t act like it’s not happening to me on a personal level as well. You see, I’m an editor of this blog...”