by For the first time, Coloradans have a clear idea of where they can go for sometimes controversial health care services like abortion, gender-affirming care or medical aid in dying.
In much of the state, however, the answer is “nowhere around.”
Hospitals are required to disclose data on restrictions on 66 services related to reproductive, gender-affirming and end-of-life care to the Colorado Department of Public Health and Environment under a law passed in 2023. Starting this month, they must also provide copies of their disclosure forms to patients prior to their appointment.
Only three Colorado counties — Denver, Douglas and Weld — have unrestricted access in at least one hospital to three services from the list The Denver Post compiled.
Access to gender-affirming surgeries was extremely limited; only 13 of Colorado’s 64 counties have a hospital with no non-medical restrictions on double mastectomy, also known as “top surgery,” for gender affirmation. (Eighteen counties have no hospital within their borders, and the rest don’t offer mastectomies to anyone or limit who can get one.)
Access to the other services included in the sample was also not much wider.
Thirteen Colorado counties have a hospital that can assist with a request for medical assistance in dying without religious or other non-medical restrictions, and 15 have one that provides comprehensive treatment for miscarriage, including medications and procedures used in induced miscarriages. abortions.
Facilities that limit the services they offer are unlikely to make changes because of the law — especially since many of the restrictions stem from religious beliefs — but at least patients will know what to expect when they go for care, said Dr. Patricia Gabow. , a former CEO of Denver Health who has written about the intersection of religion and healthcare.
Of course, transparency only does so much for people who live in a province where the only hospitals are Catholic-owned, Gabow said. Catholic hospitals, including those owned by CommonSpirit Health and some by Intermountain Health, generally do not provide contraception, sterilization, gender-affirming care, medical assistance in dying or abortion.
“People who live in Durango, I don’t know what to do,” she said.
Mercy Hospital in that city follows Catholic ethical and religious guidelines for health care, and the nearest hospital that provides comprehensive reproductive services or assistance with medical aid in dying is in Del Norte, about two and a half hours away.
Catholic doctrine requires health care providers to “respect all stages of life” and not participate in procedures such as medical aid in dying or sterilization without a medical reason, said Lindsay Radford, spokeswoman for CommonSpirit Health, which owns Mercy.
The system’s hospitals work with patients and their families to provide appropriate pain and symptom relief as they approach death, she said.
“We respect and honor the doctor-patient relationship, and medical decisions are made by a patient and their doctor. Patients seeking care at a CommonSpirit Health hospital or clinic are fully informed of all treatment options, including those we do not administer,” she said in a statement.
Geographic and political differences
Overall, access to potentially controversial services was greater in more areas with larger populations, albeit with significant exceptions.
Both of Jefferson County’s hospitals, St. Anthony Hospital in Lakewood and Lutheran Hospital in Wheat Ridge, do not allow measures to terminate a pregnancy if a fetus still has a heartbeat.
The state form combines “threatened” and “completed” miscarriages, said Sara Quale, spokeswoman for Intermountain Health, which owns Lutheran Hospital. The hospital does not limit care once a fetus has died, but if the fetus still has a heartbeat, doctors try to treat the cause of the miscarriage, she said. The most common cause of miscarriages is a problem with the fetus’s chromosomes, which prevents the fetus from surviving and has no treatment.
In contrast, people in rural Prowers County on the Eastern Plains can receive comprehensive miscarriage treatment without having to drive elsewhere. That includes residents of Rio Grande County.
Local politics also don’t necessarily equate to access.
The three counties that had at least one hospital offering unrestricted access to the three sampled services were deep blue Denver and thoroughly red Weld and Douglas.
Although their residents may differ on many issues, Weld and Douglas counties had one commonality with Denver: They are home to at least one hospital owned by a secular system, such as UCHealth, Denver Health or HCA HealthOne.
At least 22 Colorado hospitals have religious restrictions on care options: 17 are owned or formerly owned by Catholic organizations, and five are affiliated with the Adventist faith. In some cases, when a hospital changes ownership, the terms of the deal require the new owner to adhere to the seller’s religious and ethical rules, even if the buyer is secular.
Some secular organizations also listed certain services as limited.
UCHealth generally does not serve patients under the age of 15, while Denver Health does not offer abortions under certain circumstances due to concerns about losing federal funding, spokesman Dane Roper said.
The seven HealthOne hospitals also had non-religious restrictions, but did not specify their nature. Banner Health did not respond to questions about service restrictions at its five Colorado hospitals.
Informed decision making
So far, Colorado is the only state to require hospitals to directly notify patients if they are not offering services for religious or other non-medical reasons, said Alison Gill, vice president of legal and policy at American Atheists, who supported the law as it passed through the legislature.
That provision will be important not only for Coloradans seeking care, but also for people traveling to the state for its welcoming policies around reproductive and gender-affirming care, she said.
“We encourage other states to adopt similar provisions because it is essential to provide patients with information about the availability of services so they can make informed decisions about their health care,” she said.
The law has some limitations, said Gabow, formerly of Denver Health. For example, an outpatient gynecology office owned by a religious health care system doesn’t have to give patients a disclosure form, and insurers don’t have to include hospitals that offer care without restrictions in their networks, she said.
Colorado’s law won’t inherently improve access to health care, but it could prevent surprises for patients who don’t know how to look up the religious affiliation of the nearest hospital or don’t realize it could affect them, said Dr. Sam Doernberg, a physician. researcher at Brigham & Women’s Hospital in Boston.
Doernberg authored a study that found that 132 counties across the country had “religious monopolies” in their hospital markets as of 2020. The vast majority were Catholic hospitals, and 11 were Adventist hospitals. The study did not include counties that don’t have a hospital and border a monopoly region, so the actual number where people don’t have the full range of choices may be higher, he said.
Although no state has tried them yet, researchers have some ideas to increase access to care more directly while respecting the religious rights of organizations that own hospitals, Doernberg said.
For example, they could directly fund public health departments so they can provide more reproductive services in areas where the dominant health care system limits options, or they could require that insurance companies not charge patients out-of-network rates if none of the hospitals in the network provide gender-affirming care, for example. , he said.
“There are other possible solutions that are not currently being pursued,” he said.
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