SCHENECTADY — Reproductive health care and abortion services are too important to be limited or lost in a proposed Ellis Medicine merger, advocates say.
The procedures and care currently provided by the secular hospital’s health care providers would be subject to the religious guidelines of the Catholic health care system Ellis would join if it goes through with a planned merger with St. Peter’s Health Partners.
Even a hybrid agreement for shared management services — instead of or as a prelude to an actual merger — could limit fertility treatments, sterilization and abortion in Schenectady, advocates worry.
Ellis and SPHP have submitted a proposed Management Services Agreement to the state Department of Health for approval but they and DOH refuse to make its details public until DOH approves it. So it’s impossible to know what impact the agreement would have until it is in place.
A separate agreement would place Ellis doctors, physician assistants and nurse practitioners under St. Peter’s Health Partners management.
Ellis last week said there has been no recent movement — the proposed agreement is still under state review and the merger is on hold until Ellis can regain the financial stability it lost in the pandemic.
St. Peter’s Health is part of Michigan-based Trinity Health, which like other Catholic health care organizations conforms to the U.S. Conference of Bishops’ Ethical and Religious Directives for Catholic Health Care Services. The sixth edition contains 77 specific directives, 11 of which methodically lay out the requirements for non-Catholic institutions to follow church doctrine upon absorption by a Catholic institution.
Other directives forbid surrogate pregnancy, use of donated eggs or sperm, abortion, prenatal diagnosis for purposes of terminating a defective fetus, male or female sterilization, anything resembling abortion of an ectopic pregnancy and promotion of artificial contraception.
Ellis Medicine says roughly 50 abortions are performed each year at Bellevue Woman’s Center, the small OB/GYN hospital it operates in Niskayuna, and has confirmed that the procedures would be halted if Ellis merges with SPHP.
In the Capital Region and eastern Mohawk Valley, women’s options for reproductive care can be roughly divided into three settings: hospitals, Planned Parenthood clinics and obstetrics/gynecological practices.
There are secular hospitals in Albany, Cobleskill, Glens Falls, Gloversville, Hudson, Saratoga Springs and, for now, Schenectady and Niskayuna. Hospitals in Albany, Amsterdam and Troy are Catholic-affiliated and follow the bishops’ directives.
OB/GYN practices dot the landscape and have admitting privileges at one or more area hospitals when a patient’s needs can’t be met in the office.
Planned Parenthood health centers in Schenectady and Queensbury offer abortion via office procedure up to the 19th week of pregnancy; its centers in Albany and Hudson offer the procedure up to the 15th week of pregnancy; these four centers and the clinics in Amsterdam, Bennington, Cobleskill, Johnstown, Troy and Saratoga Springs offer abortion via medication up to the 10th or 11th week of pregnancy.
(The differences in pregnancy terms are due to the equipment and staff expertise available on site.)
With such a wide array of providers in such a wide area, the logical conclusion is that if one or two drops out, the others can pick up the caseload and patients will need only to drive another 15 minutes to the next-closest location.
“When we talk about access to other places like Albany, there are folks in Schenectady who for a whole host of reasons don’t leave Schenectady for medical care. It just doesn’t happen,” said Michelle Ostrelich, a founding member of the Schenectady Coalition for Healthcare Access that formed in response to the merger plan announced nearly a year ago.
The coalition is not flatly opposed to the merger itself; it is trying to avert the potential results of such a merger.
“One woman denied is unacceptable,” Ostrelich said.
The coalition also is seeking insight into the process of the merger. It is concerned that the two medical organizations are taking steps short of a merger, then announcing details after the fact, and that some of the most contentious aspects of a merger may be locked in place before a merger is ever formally proposed.
“There are ways to preserve secular care,” Ostrelich said, citing previous agreements between secular and Catholic hospitals. “We’re not asking for something that’s never happened.”
Dr. Nisha Verma, Darney-Landy Fellow at the 58,000-strong American College of Obstetricians and Gynecologists, told The Daily Gazette via email that the continuum of care requires an array of providers.
Abortions carried out with pills provided by some Planned Parenthood clinics are as safe and effective as office procedures in the first 70 days or so of pregnancy, but the patient should have a choice rather than be locked into one option because the other isn’t available.
The “abortion pill” — actually one dose each of mifepristone and misoprostol — allows the patient to remain in the comfort of her home but typically causes heavy cramping and bleeding on the scale of the worst menstrual periods.
So some patients prefer the medical procedure in an office setting, Verma said, while others have underlying conditions or physical abnormalities that rule out the use of the pills. Still other patients can’t be counted on to follow the dosage and care instructions accurately.
“This is an individual decision that each person and family should be able to make with their health care providers,” she added.
(The Guttmacher Insitute, which advocates for reproductive and abortion rights, reports that the number of U.S. abortions via medication has been rising annually even as the total number of abortions has been falling annually. In 2017, 39% of all abortions in the United States were carried out with pills, it said.)
For abortions completed with medical procedures, a Planned Parenthood clinic or other nonhospital setting is generally fine but sometimes it isn’t, and for that reason it’s important that hospitals continue to be available, Verma said.
“Some patients may need to receive abortion care in a setting that is able to provide appropriate levels of intervention,” she said. For example, a woman with suspected placenta accreta — in which the placenta has grown too deeply into the uterine wall — should undergo an abortion where personnel and equipment are on hand to perform resuscitation if needed.
ACOG’s position, she said, is that hospitals should be encouraged to support abortion care as essential medical care and eliminate barriers rather than create barriers.
“Outpatient medical facilities are able to provide exceptional care,” Verma said. “However, eliminating hospital settings for abortion will absolutely restrict the ability of some patients to get the care they need — including those whose lives will be put at risk.”
Discussions over the availability of many types of reproductive care at Ellis and Bellevue continue against the backdrop of a growing number of restrictions on abortion in other states.
As firmly as abortion-rights supporters believe access to the procedure should be unimpeded, a large number of Americans believe abortion is profoundly wrong, even a crime or sin.
Some act on a smaller scale, such as the annual 40 Days For Life prayer vigil outside the Planned Parenthood Schenectady Health Center on State Street. The 2021 vigil will start Wednesday and continue through Oct. 31.
Others, such as the Texas Legislature, are taking bigger steps and enacting a near-ban on abortion procedures. Texas law SB 8 bans abortion if a fetal heartbeat can be detected, which starts to happen before some women even know they’re pregnant. The Texas Heartbeat Act, as SB 8 is known, was signed into law this past spring and took effect Sept. 1.
It went into effect when the U.S. Supreme Court declined to delay it amid ongoing legal challenges, and some are calling it a preview of the holy grail of abortion foes: reversal of the landmark Roe v. Wade ruling that eliminated many state restrictions on abortion.
Even before SB 8, Capital Region Planned Parenthood clinics had been seeing an increased number of out-of-state residents seeking abortions, said Emma Corbett, spokeswoman for Planned Parenthood Empire State Acts, the statewide legislative advocacy group for Planned Parenthood affiliates.
New York is the polar opposite of Texas on abortion: It took steps to codify the legality of the procedure and women’s rights to it.
But Corbett, who is part of the Schenectady Coalition for Healthcare Access, said the piecemeal loss of community services has an impact on women that, while less extensive than a statewide restriction, is still significant.
“When you limit options, the compound effect is you find people in situations where there were preventable conditions that were missed because people could not travel,” she said.
Not everyone can hop in a car and drive wherever an appointment is available, Corbett said, adding that when she worked at the Schenectady Health Center she met women who’d never left the county or even the city in their lives.
“For folks at Ellis and St. Peter’s to say they can just go to Albany, it’s really an unrealistic burden to place on patients who are already marginalized.”
Corbett wouldn’t say how many women undergo abortions per year at Planned Parenthood’s Schenectady clinic, but said that in 2019 there were 30 who needed to be referred to Ellis for issues including edema, hemorrhaging and ectopic pregnancy, in which the embryo is embedded outside the uterus, threatening the mother’s health.
“To imagine that some patients wouldn’t have all options — it’s a heartbreaking thing to imagine,” Corbett said.
Nor, she said, should Planned Parenthood’s Schenectady Health Center be viewed as an alternative to Ellis.
“Planned Parenthood is not a hospital,” she said. “We’re not open at 2 a.m. in the morning in an emergent condition.”
It also doesn’t do procedures to enhance fertility or vasectomies and tubal ligations to end fertility.
“Having a strong community hospital is critical for Schenectady,” Corbett said.
Reach John Cropley at [email protected], 518-395-3104 or @cropjohn on Twitter.