Posted on: Saturday, May 10, 2003
Pill legislation faces possible court test
By Lynda Arakawa
Advertiser Capitol Bureau
A bill requiring hospitals to provide rape victims emergency contraceptives has drawn a line between victim advocates and the state's only Catholic hospital system, St. Francis Healthcare System.
The Legislature passed and sent the governor a bill mandating hospitals that provide emergency care to sex-assault victims to inform them about emergency contraception, also called the "morning-after pill," and provide it if requested. The intent is to protect victims from the additional trauma of a pregnancy from rape.
But St. Francis officials argue that it would force them to operate counter to their religious beliefs and said they may challenge such a law in court. St. Francis does not provide birth control or abortion services.
Gov. Linda Lingle said that while she has not made a decision about the bill, she was surprised lawmakers did not provide an exemption for church-run hospitals.
"That's one that there are a lot of strong feelings about," she said. Lingle has 45 days following the May 1 adjournment of the Legislature to act on bills.
Emergency contraceptives are essentially high-dose birth control pills taken within 72 hours of unprotected sex. The contraceptives prevent the fertilization of an egg and also prevent a fertilized egg from implanting into the uterus, a point of contention for the Roman Catholic Church in Hawai'i and others opposed to abortion, who argue that life begins at conception.
The medical definition of pregnancy is when implantation occurs. The drug will not terminate an existing pregnancy.
Eugene Tiwanak, chief foundation officer of St. Francis Healthcare System, said St. Francis has no problem informing victims about emergency contraceptives. But he said requiring it to provide the medicine not only conflicts with its religious beliefs but goes too far in the medical arena.
"It's telling us now how to practice medicine, and I think it's a dangerous precedent," he said. "There is no question we will continue to show compassion and treat those sex-assault patients that come into the emergency room as we do now. But we believe the current system really works."
Tiwanak said St. Francis, with medical centers in Liliha and 'Ewa, takes every effort to care for a victim's injuries as well as provide any psychological or spiritual care. He said victims are referred to and assisted in going to the Sex Abuse Treatment Center at Kapiolani Medical Center for Women and Children for further treatment.
"We really work with them to get them over there," he said.
But Adriana Ramelli, director of the Sex Abuse Treatment Center, said that practice places the burden back on the victim.
Ramelli said: "What if that person walks into St. Francis and says, 'I don't want to go all the way to Kapiolani, I don't want to have to even begin to repeat my story, but I am concerned about this. Can I just please get the emergency contraceptive pill?' They should have that choice. This is not about religion, it's about sex assault."
Ramelli said the Ethical and Religious Directives for Catholic Health Care Services make an exception for contraception when it relates to rape victims. But Tiwanak said those directives from the National Council of Bishops include caveats, including that emergency contraceptives should only be considered if tests determine they will not affect a fertilized egg.
He also said St. Francis follows the rules of Honolulu Diocese, which is opposed to contraceptives.
Castle Medical Center, which is affiliated with the Seventh-day Adventist Church, does not have a problem with the bill, hospital spokesman David Earles said.
But Earles added: "We feel for St. Francis, and we struggle with the concept of the Legislature ever dictating morals and ethics to an organization."
Under the bill, hospitals not in compliance would pay an administrative fine of $5,000 per sexual-assault victim who is denied information about emergency contraception or was not offered or provided it. After two violations the state would suspend or revoke the hospital's operating license.
A 2002 statewide survey conducted by Healthy Mothers, Healthy Babies Coalition of Hawai'i concluded there are significant barriers to obtaining emergency contraceptives within the recommended 72-hour time frame.
The study included a survey of 20 emergency rooms statewide, and found that 18 of them were not able to provide emergency contraceptives within 72 hours.
Sixteen of the 20 Republican lawmakers and two Democrats voted against the bill after heated, largely partisan debates on the House and Senate floor.
During the floor debate Sen. Paul Whalen, R-3rd (Kohala, Kona, Ka'u), called the bill a "great intolerance" of people who have different beliefs about emergency contraception.
"I don't know why we continue to force things like this down people's throats," he said.
But Senate Health Committee Chairwoman Roz Baker, D-5th (W. Maui, S. Maui), said it would be "unconscionable" to have healthcare providers allow victims to go through additional trauma of a pregnancy from rape. She said emergency contraceptives would provide a measure of relief to a woman who has been sexually assaulted.
Reach Lynda Arakawa at larakawa@honoluluadvertiser.com or at 525-8070.
