I recently cared for a pregnant woman with two children, a 2-year-old daughter and 4-year-old son. She had delivered her two previous children via cesarean section and wanted to do the same for her third. She felt her family was complete with three children and wanted a sterilization procedure at the time of her C-section. I delivered her daughter and did the procedure, and she recovered well and went home happy and healthy.
But at some hospitals in California, I wouldn’t have been able to support my patient when she needed me. Not having the sterilization she desired would mean that she would have to have a yet another surgery. Making it to another appointment and recovering from a second surgery are hard to do when you’re busy caring for three children. If she had another pregnancy she decided to continue, she would need a fourth cesarean section. Each C-section brings higher risk of complication and difficulty with recovery. These are all unnecessary risks. These hospitals aren’t restricting care based on the medical evidence. They’re institutional policies that deny patients the best care possible.
The University of California, the public institution where I have spent the last three decades of my life working to provide compassionate, patient-centered care, has contracted with some of these very hospitals. These contracts tie the hands of providers like me and the learners I work with. The legislature must pass the Equitable and Inclusive UC Health Care Act (SB 379) to ensure that our system gives every patient the medical care they deserve.
I have stayed at University of California, San Francisco, since I was a medical student because of the values that ground our work. As a public institution in a state that prides itself as a leader in reproductive and LGBTQ+ rights, we have built a powerful record of providing excellent care. We care for our patients without judgment and with a commitment to science. The discriminatory policies of restrictive hospitals fly in the face of those values. Dignity Health, one of the hospital systems UC has entered into secretive contracts with, is tied up in litigation for refusing care to transgender patients and prohibiting doctors from performing requested tubal ligations. Under contracts with restrictive hospitals, UC providers would have no choice but to defer to policies that cause patients this kind of emotional turmoil and subject them to unnecessary medical procedures.
Partnering with restrictive institutions creates two standards of care — one for patients near cities who can visit UC-run facilities and one for rural Californians whose only access to UC care is through restrictive hospitals. Low-income people and people of color bear the biggest burden of this disparity. At one hospital I could provide a safe procedure to help someone manage an incomplete miscarriage. At the other I would have to wait until she was sick with infection before I would be allowed. At one hospital I could treat someone with a dangerous ectopic pregnancy. At the other, I would have to send them to another facility, who knows how far away. At one hospital I could dispense emergency contraception to a patient who had just suffered a sexual assault. At the other I would have to send her to an outside pharmacy to pick up a prescription, adding more barriers for someone dealing with a traumatic experience. These restrictions aren’t just inconvenient. They’re dangerous. Are we willing to tell some Californians that this inferior care is the best we can do for them?
Everyone deserves access to the highest quality of care. A public institution that touts its commitment to nondiscrimination and excellent medical care has no business placing its providers and learners in an environment where they are prohibited from living up to those values. UC has left us all in the dark as they negotiate these contracts behind closed doors. The legislature must ensure they remain true to our commitments to equity and evidence-based care by passing SB 379.
Dr. Jody Steinauer is the director of the Bixby Center for Global Reproductive Health at the University of California, San Francisco.