Jefferson County had the second-highest abortion rate of any county in the state per 1,000 women in 2013 – but the 55 women who had abortions that year did not go to Jefferson Healthcare.

The public hospital system here does not offer abortions, and that’s an issue for the American Civil Liberties Union (ACLU).

Jefferson Healthcare officials are in the process of responding to an ACLU letter dated Feb. 18 that challenges the local public health care system’s failure to offer abortions. In that letter, ACLU policy council official Leah Rutman asks Jefferson Healthcare to “change its policies and practices to fulfill its obligations” with the 1991 Reproductive Privacy Act (RPA).

“We believe that Jefferson Healthcare’s failure to provide abortion services violates state law,” Rutman wrote. “Our goal is to ensure that women seeking reproductive health care services at Jefferson Healthcare have access to the full range of services as required by law.”

The law, according to the letter from Rutman, establishes that “[e]very woman has the fundamental right to choose or refuse to have an abortion” and that public hospital districts “shall not deny or interfere” with this fundamental right.

Rutman also says that if a hospital district provides maternity care benefits, services or information, it must also provide abortion services.

Jefferson Healthcare officials say they do not have a policy against abortion services; they provide referrals regarding voluntary termination of pregnancy.

Jill Buhler, the Jefferson Healthcare commission’s chief governing officer, said on March 2 that she expects the board to take up the issue when the board meets on Feb. 4. (That meeting begins at 3:30 p.m. in the Vic Dirksen Auditorium in the hospital, 834 Sheridan St., Port Townsend.) She expects the discussion to occur in a closed executive session because she believes the ACLU has threatened the hospital with legal action.

“We’re in a dichotomy,” Buhler said. “Where do we go if the doctors don’t feel qualified to do it because there are so few [abortions]?

“My fear is if rural hospitals are forced to provide these services on site, we’ll have to close down our birthing facilities,” Buhler said. “I just hope they realize the ramifications of this. The last thing we'd want to do is curtail our birthing services.”

In 2013, there were 103 births at Jefferson Healthcare. The public healthcare system boasts of being one of the first five hospitals in Washington to be designated as “Baby Friendly” by the World Health Organization and the only one in the country with the designations of being both Baby Friendly and Mother Friendly.

Jefferson Healthcare CEO Mike Glenn said the ACLU letter raises some interesting “legal and capacity-of-care questions, and we intend to provide a thoughtful response.”

Though the ACLU did not ask for a response in writing, spokesperson Kate Burke said Glenn expects to do so.

QUALITY AND COST

Joe Mattern, chief medical officer at Jefferson Healthcare, said he thinks the intention of the ACLU is to make sure that women have “accessibility to high-quality reproductive care, including elective pregnancy terminations in or close to their communities.”

“I don’t agree with their interpretation of the reproductive privacy law that because we provide maternity services, termination services need to be offered as well,” Mattern wrote. “Smaller communities may or may not have the resources to provide termination services with the same level of quality and cost efficiency that a free-standing clinic like Planned Parenthood can provide. In fact, medical and surgical terminations are best provided in an office-based environment.”

Mattern also said that hospitals, in general, “should not be the primary place to have a surgical or medical termination.”

“The main reason is that this can be performed very safely and much less expensively in an outpatient clinic. Everything done within the hospital will tend to be more expensive, because the overhead of running a 24-hour acute care facility is part of the cost,” Mattern said.

That said, Mattern noted that there has been discussion about providing termination services, but that local health care officials were “not certain it was in the best interest of the community because there are services that are available in Clallam and Kitsap counties, and they do a really great job. If that was not the case, I think that would change the discussion.”

REFERRALS, NO PAGES MATCHING

Mattern said Jefferson Healthcare’s website does provide descriptions and referrals for services.

Under “Women's Health Services” on its website, the public health care system states that it offers a variety of services from adolescence through menopause, including contraceptive care and referrals for specialized treatment.

A March 2 search for “abortion” services produced the message “There are 0 pages matching ‘abortion’ ”and ”There are 0 articles matching ‘abortion.’”

Mattern said primary care practices and the county health department are trained to assist women in connecting with facilities.

Mattern also said Dr. Molly Parker had advised him that physicians keep a list of options for pregnancy terminations, and that list includes facilities in Bremerton, Port Angeles, Seattle and Renton. Mattern said Parker indicated that most referrals are done over the phone.

ABORTION RATE

In her letter to Jefferson Healthcare, Rutman estimated that there were 3,554 women of reproductive age in Jefferson County and 205 births in 2013. (Not all the births took place in Jefferson County.)

What Rutman’s letter does not point out is that while Jefferson Healthcare did not provide abortions, 55 women from Jefferson County sought abortions that year for an abortion rate of 15.5 per 1,000 women. It was the second-highest abortion rate in the state. Pierce County had the highest rate of 16.8 abortions per 1,000 women of childbearing age in 2013, according to statistics kept by the state Department of Health.

That year, almost half of the 55 women from Jefferson County who opted to end their pregnancies – 24 – did so in King County. Three women went to Pierce County; one went to Snohomish County; and the 27 other abortions were performed in other counties, according to Lauren Jenks, health statistics manager with the state Department of Health.

The state does not identify some counties that may have one provider offering the service, she said of those “other places” where those 27 Jefferson County women accessed services.

Mattern said he knows of no providers at Jefferson Healthcare or in private practice in Jefferson County who are providing elective terminations.

In 2010, Jefferson County also had the second-highest abortion rate in the state with 18.6 abortions performed per 1,000 women. Pierce County has had the highest rate of abortions of all counties since 2009, according to state health records.

NOT THE ONLY HOSPITAL

Jefferson Healthcare is not the only hospital to receive a letter similar to the one Rutman sent.

The ACLU also sent letters to public hospitals in Mason County and on Whidbey Island.

And the ACLU has filed a lawsuit against Skagit Regional Health on behalf of a Mount Vernon woman over its compliance with the 1991 RPA. The lawsuit and the letters that the ACLU wrote to the public hospital districts are available at aclu-wa.org.

PREVIOUS COMMENTS

Rutman and several other women’s health care advocates were at a forum in Port Townsend in May 2014 where Glenn and Harrison Medical Center CEO Steve Bosch were questioned about their end-of-life and reproductive policies in light of affiliations of hospitals in Washington with Catholic health care systems.

Glenn said last year that abortion services are not offered at Jefferson Healthcare, although there is no policy prohibiting abortions.

“It’s a provider and patient discussion that occurs, and if that is the procedure the patient desires, then they go to Kitsap County Planned Parenthood,” Glenn said last May.

Glenn also said that if the community wanted the health care system to offer that service, it is something that would be discussed by the commissioners and based on community need.

“We don’t get in the way of patients’ and providers’ decisions. If that needs to occur, that will occur. There’s nothing that steps in the way,” Glenn said.

(A link to the Leader's article on that 2014 event is posted with this story on ptleader.com.)