California Atty. Gen. Xavier Becerra disclosed Tuesday that his office is investigating whether the Catholic healthcare chain Providence Health has violated its legal commitments by applying religious restrictions on care at one of Orange County’s premier hospitals.
Becerra’s office is requesting a heap of documentation from Providence about its dealings with Hoag Memorial Hospital, a Newport Beach medical center with which it has partnered since 2016 and is now in an acrimonious dispute.
It comes as Becerra awaits Senate confirmation of his nomination as President Biden’s secretary of Health and Human Services.
Becerra’s action follows a confidential complaint that several doctors at Hoag filed with his office in October.
The doctors, all women’s health specialists, detailed numerous instances in which they said Providence applied the Ethical and Religious Directives for Catholic Health Care to Hoag.
Providence has established a history of broken trust in its relationship with us, with absolutely no end in sight.
Hoag doctors’ complaint to the state attorney general
Applying the Ethical and Religious Directives to most treatments at Hoag would be in direct breach of conditions that Becerra’s predecessor as attorney general, Kamala Harris, imposed when she approved an affiliation between Hoag and the Catholic healthcare system St. Joseph Health in 2014. Hoag was founded as a Presbyterian institution in 1952.
Harris had jurisdiction over the affiliation because both parties were California nonprofit institutions. When St. Joseph merged with Providence Health & Services in 2016, creating the nation’s fourth-largest Catholic hospital chain, Harris required that the merged enterprise accept all the 2014 conditions.
At that time, Providence stated that all the conditions would be “scrupulously followed.”
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According to the doctors’ complaint, Providence’s physician management arm, Heritage Healthcare, has been routinely refusing to pay for contraceptive services for HMO patients at Hoag. Providence has also delayed authorizations to treat miscarriages or other women’s health services, they said.
In at least one case, they said, Heritage specifically cited the Ethical and Religious Directives in refusing to pay for a patient’s intrauterine device insertion.
“Providence has established a history of broken trust in its relationship with us, with absolutely no end in sight,” stated the complaint, which is not a public document but which I reviewed.
Harris mandated, among other things, that St. Joseph and Providence would maintain the pre-merger levels of women’s services at Hoag until at least 2033. Her approval also specified that Hoag would not be subject to the Ethical and Religious Directives then or “in the future.”
There was only one exception: Harris permitted Hoag to be subject to a ban on “direct abortions” — a Catholic term with no medical definition. Harris was elected U.S. vice president in November.
Becerra disclosed his investigation in a letter sent Tuesday to administrators at Hoag, St. Joseph, Providence and Covenant Health (the formal designation of the affiliation between Hoag and Providence).
The letter states that Becerra’s office is “monitoring” whether the Ethical and Religious Directives “are or have been applied to any aspect of a service, procedure, or other activity … performed by Hoag obstetrician/gynecologists.” The letter includes an extensive document request related to the issues, with a March 23 deadline.
The letter also says the attorney general is “monitoring whether administrative hurdles are or have been placed on Hoag OB/GYNs’ efforts to obtain reimbursement for ERD-restricted women’s reproductive services, procedures, or other activities.”
That appears to be a direct reference to the physicians’ complaint, which stated that “Providence has increasingly disallowed women’s health services when they involve any form of contraceptive care,” even when IUDs are prescribed for reasons other than birth control, such as heavy menstrual bleeding.
“We have seen IUD reimbursements, for example, pending for as long as two years, requiring multiple appeals and grievances on behalf of patients,” the complaint stated. “In many cases, payment is never received.”
Providence told me by email that it “welcomes the Attorney General’s request for further information, and is confident that the review will demonstrate that Providence has always complied with all requirements under the merger conditions.”
Hoag’s increasing discontent with its affiliation with Providence Health broke into the open in May, when its management sued Providence to dissolve the arrangement.
The lawsuit cites Providence’s increasingly stringent religious-based limits on medical treatment at Hoag. It also says that Providence, which is based in Renton, Wash., has failed to make good on the affiliation’s original goal of enhancing local decision- and policy-making at its Orange County hospitals.
Providence is fighting the dissolution in court, arguing that Hoag doesn’t have the right to dissolve the arrangement unilaterally. But it also has been quietly negotiating for Hoag’s exit, perhaps upon a financial payment by Hoag.
Bad blood between the affiliation partners has intensified since the lawsuit. As I reported last month, Providence has dropped Hoag doctors and urgent care facilities from its provider network, forcing thousands of patients to find new specialists and seek urgent treatment elsewhere.
Providence also erased mention of Hoag from its website listing of its Southern California locations.
Hoag providers contend these moves are retaliation for the dissolution case, which Providence denies, blaming its actions on Hoag doctors’ choices not to participate in its network.
