Spokane

Law makes hospitals offer birth control for rape victims
But some say Catholic facilities don't comply with statute, own rules

Carla K. Johnson
Staff writer

Gov. Gary Locke signed a law last week requiring hospitals to offer emergency contraception to rape victims.

Spokane's two Catholic hospitals say that has been their policy, but advocates who accompany rape victims in the city's emergency rooms say a few patients have not received that offer.

"We provide contraceptive drugs for the purpose of preventing fertilization in cases of sexual assault," said Sacred Heart Medical Center spokeswoman Marilyn Thordarson. That's been the policy at Sacred Heart, Holy Family Hospital and other Sisters of Providence hospitals for years.

A Planned Parenthood leader said she's spoken with two rape victims who said they weren't offered emergency contraception at Sacred Heart.

"What I would hope is the anecdotal evidence I hear is wrong and that the new law will reinforce what is already happening," said C.J. Gribble, chief executive officer of Planned Parenthood of the Inland Northwest.

"I hope that women in emergency rooms will get good information to make individual choices about what will happen to them now at this most difficult point in their lives."

Victim advocates hope the new law will raise awareness about so-called "morning-after pills," which are also available in Washington from authorized pharmacists without a doctor's visit.

Emergency contraception pills contain hormones that reduce the risk of pregnancy. They are taken in two doses, 12 hours apart, within 72 hours after unprotected intercourse.

Two products specifically marketed as emergency contraception are Plan B, which contains progestin only, and Preven, which contains estrogen and progestin.

Both are "safe and effective," according to the U.S. Food and Drug Administration. Side effects include nausea and abdominal pain.

Emergency contraception is not the same as the abortion pill RU-486 (mifepristone), which the FDA approved in 2000.

Birth control pills also can be used as emergency contraception. Instructions are available from Planned Parenthood and on a Web site operated by Princeton University (www.not-2-late.com).

A question for Catholics

According to the FDA, it's unclear how emergency contraception pills work. Do they stop fertilization before it happens? Or do they prevent a fertilized egg from implanting in the woman's womb?

The distinction is important to Catholics seeking to follow the church teaching that a fertilized egg is a human life.

The Catholic Health Association, a national organization of Catholic health-care providers, issued a statement March 21 on the issue.

"If, after appropriate testing, it is considered medically appropriate, approved FDA drugs can be administered in a Catholic hospital for contraceptive purposes for the prevention of fertilization," the statement reads in part.

"In a narrow set of circumstances, a Catholic hospital cannot provide these drugs if their effect would be abortifacient: that is, the fertilized ovum would be destroyed."

Today it's impossible in the first 72 hours to determine with certainty whether a rapist has impregnated a woman. Therefore, the ethical question becomes one of the woman's and the caregiver's intent, said Dr. Jim Shaw, chair of Providence Services' ethics committee.

(Providence Services is the parent organization for Sacred Heart, Holy Family and several rural hospitals. It represents the Sisters of Providence.)

"If the woman's intent and the medical personnel's intent is to prevent conception, our policy would agree (with the new law)," Shaw said.

In Spokane's busiest emergency room, Holy Family, nurse Michele Carney said her personal beliefs as a Catholic are not as important as her patients' needs.

"It's not what your beliefs are as a caregiver, it's the patient's," she said. "They're the ones you're caring for and I think that's what we're here for."

What happens in the ER?

Advocates who accompany rape victims in Spokane emergency rooms say practices vary depending on the workers involved.

"Within hospitals, staff reaction is very different," said Dayna Blaser, a victim advocate for two years with the Sexual Assault and Family Trauma Response Center.

"I have been in the position of very strongly having to advocate for a woman who kept asking, `Isn't there anything you can do so I won't get pregnant?' And the nurse kept saying, `I really don't know about that.' Totally blowing her off."

That victim, who received care in Sacred Heart's ER, did get a prescription for emergency contraception from a doctor, Blaser said.

Blaser is a member of a year-old violence prevention group called Stop the Clock. She said her group may contact the hospitals for clarification on their policies. The next time she accompanies a victim in the emergency room, she would like to have a copy of the law and a copy of hospital policy, she said.

Marcia Black-Gallucci, legal advocate for Sexual Assault and Family Trauma Response Center, also has seen variations in how emergency contraception is offered -- sometimes pills are given, sometimes a doctor writes a prescription for the pills.

She would rather see the pills given because a prescription is less convenient for the victim.

An ER visit after sexual assault can last several hours. The victim talks with a nurse and a social worker, then is examined by a doctor who takes swab samples for evidence. If the victim wants to file a police report, an officer arrives to do an interview.

The victim normally would hear about emergency contraception from the doctor, who also might discuss antibiotics to prevent sexually transmitted disease. The victim also might get information on how and when to get an HIV test.

Victims' emotional and spiritual needs may be neglected in the process, said Shaw, who is also medical director of the Providence Center for Faith and Healing.

"What we do know about the care of sexual assault victims -- any gender and particularly women -- is we still fall short of being able to provide for them what they need," Shaw said.

In Spokane's non-Catholic hospitals, Deaconess Medical Center offers emergency contraception, while Valley Hospital and Medical Center has not yet trained staff to do emergency assault response.

Planned Parenthood's Gribble told of two incidents at Sacred Heart in which women said they did not receive emergency contraceptive information.

The agency provided an abortion to one of those women, Gribble said.

In another, Gribble took a phone call from a victim from a rural area who said she had not been told at Sacred Heart about emergency contraception.

"She said, `I just heard about it now. What do I have to do to get it?' She was worried she would have to come back to the emergency room."

In that case, Gribble advised the woman to go to a pharmacy near her.

Washington is one of only a few states where authorized pharmacists can dispense emergency contraception without a doctor visit. Advocates say that policy makes the state a leader in accessible emergency contraception.

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