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For the first time, Coloradans have a clear picture of where they can go for sometimes-controversial health services such as abortion, gender-affirming care or medical aid-in-dying.
In much of the state, though, the answer is “nowhere close.”
Hospitals are required to disclose data about 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 also must provide copies of their disclosure forms to patients ahead of their appointments.
Only three Colorado counties — Denver, Douglas and Weld — have unrestricted access in at least one hospital to three services from the list that The Denver Post sampled.
Access to gender-affirming surgery was especially limited; only 13 of Colorado’s 64 counties have a hospital without non-medical restrictions on a double mastectomy, also known as “top surgery,” for gender affirmation. (Eighteen counties have no hospital within their borders, and the rest either don’t offer mastectomies to anyone or restricted who could receive one.)
Nor was access to the other sampled services much broader.
Thirteen Colorado counties have a hospital that would assist with a request for medical aid-in-dying without religious or other non-medical limitations, and 15 have one that would provide comprehensive treatment for a miscarriage, which can include drugs and procedures used in induced abortions.
Facilities that restrict the services they offer aren’t likely to make changes because of the law — particularly 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 health care.
Of course, transparency only does so much for people who live in a county where the only hospitals are Catholic-owned, Gabow said. Catholic hospitals, which include those owned by CommonSpirit Health and some belonging to Intermountain Health, generally don’t offer contraception, sterilization, gender-affirming care, medical aid-in-dying or abortion.
“People who live in Durango, I don’t know what they’re supposed to do,” she said.
Mercy Hospital in that city follows Catholic ethical and religious directives for health care, and the closest hospital that offers 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 near death, she said.
“We respect and honor the physician-patient relationship, and medical decisions are made by a patient and their doctor. Patients who seek care at a CommonSpirit Health hospital or clinic are fully informed of all treatment options, including those we do not perform,” she said in a statement.
Geographic and political differences
Generally, access to potentially controversial services was greater in more areas with larger populations, though with significant exceptions.
Both of Jefferson County’s hospitals, St. Anthony Hospital in Lakewood and Lutheran Hospital in Wheat Ridge, won’t allow measures to end a pregnancy if a fetus still has a heartbeat.
The state’s form conflates “threatened” and “completed” miscarriages, said Sara Quale, spokeswoman for Intermountain Health, which owns Lutheran Hospital. The hospital doesn’t restrict care once a fetus has died, but if it still has a heartbeat, doctors attempt to treat whatever is causing the miscarriage, she said. The most common cause of miscarriages is a problem with a fetus’s chromosomes, which doesn’t allow it to survive and has no treatment.
In contrast, people in rural Prowers County on the Eastern Plains can get comprehensive miscarriage treatment without driving elsewhere. So can residents of Rio Grande County.
Local politics also don’t necessarily match up with 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.
While their residents might differ on many issues, Weld and Douglas counties shared one common characteristic with Denver: They’re home to at least one hospital owned by a secular system, such as UCHealth, Denver Health or HCA HealthOne.
At least 22 hospitals in Colorado have religious restrictions on care options: 17 owned or formerly owned by Catholic organizations, and five affiliated with the Adventist faith. In some cases, when a hospital changes hands, provisions of the deal require the new owner to honor the seller’s religious and ethical rules, even if the buyer is secular.
Some secular organizations also listed certain services as restricted.
UCHealth generally doesn’t serve patients under 15, while Denver Health doesn’t provide abortions under certain circumstances because of concerns about losing federal funding, spokesman Dane Roper said.
The seven HealthOne hospitals also had non-religious restrictions, but didn’t specify their nature. Banner Health didn’t respond to inquiries about service limitations at its five Colorado hospitals.
Informed decision-making
So far, Colorado is the only state that requires hospitals to directly tell patients when they don’t offer services for religious or other non-medical reasons, said Alison Gill, vice president of legal and policy with American Atheists, which supported the law as it went through the legislature.
That provision will be important not only for Coloradans seeking care, but for people traveling to the state because of its welcoming policies around reproductive and gender-affirming care, she said.
“We are encouraging other states to enact similar provisions because it is essential to provide patients with information about service availability so that 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 system doesn’t have to give patients the disclosure form, and insurers don’t have to include hospitals offering care without limitations in their networks, she said.
Colorado’s law won’t inherently increase access to health care, but it may prevent surprises for patients who don’t know to look up the closest hospital’s religious affiliation or don’t realize it could affect them, said Dr. Sam Doernberg, a physician researcher at Brigham & Women’s Hospital in Boston.
Doernberg wrote a study that found 132 counties nationwide had “religious monopolies” in their hospital markets as of 2020. The vast majority involved Catholic hospitals, and 11 involved Adventist hospitals. The study didn’t include counties that don’t have a hospital and are adjacent to a monopoly county, so the actual number where people don’t have the full range of choices may be higher, he said.
While no states have tried them yet, researchers do have a few ideas to more directly increase access to care while still 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 system limits options, or they could require that insurance companies don’t charge patients an out-of-network rate if none of the in-network hospitals offer gender-affirming care, for example, he said.
“There are other possible solutions that are not currently being pursued,” he said.
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Originally Published:
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Meg Wingerter
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