Dear Chancellor Hawgood and President Napolitano,

We write on behalf of the Board of the UCSF Faculty Association to oppose the proposed affiliation agreement between UCSF and Dignity Health.  We do so while acknowledging that the need for UCSF Health to achieve economic viability now and in the future may require UCSF Health to foster agreements with a range of health care institutions. Our opposition is to affiliation with this particular institution.

We have surveyed our membership about the proposed affiliation and the results are overwhelmingly in opposition (a quarter were neutral, but among those choosing a position, three-quarters were in opposition).   The specific comments of some of our respondents are instructive.  Other than editing for typos, we include them in the pages to follow.  One of the supporters perhaps states how distasteful the proposed affiliation is even to one supporting it.  The supporter wrote:

“I am reluctantly voting to support.  I am holding my nose.”

The practices of Dignity Health violate the duty of a state institution to serve the needs of its patients based on their medical needs and the best evidence-based treatments of the patients’ choosing.  With respect to Dignity Health, the issue is usually framed in terms of reproductive rights of adult women.  We think that that is a crucial issue and ought to be determinative in of itself, but this framing ignores the needs of patients of all ages.  For adolescents, the issue of access to information about reproductive issues and to the full range of medically-indicated contraception is important.  For adults of all ages, the issue of access to effective palliative care is germane.  One of the majority in opposition to the affiliation wrote:

“Any association with religious-led health care systems should be opposed by an institution that is promoting diversity and inclusion and is science driven”.

There is also an opportunity cost in the education of medical students, residents, and clinical fellows.  Time spent in clinical environments in which there is no exposure to all medically-indicated treatments short-changes the trainees, meaning that the trainees have to seek the exposure during the times normally devoted to other training opportunities or forego training in the proscribed areas.

We sincerely hope that the University will not persevere to effectuate the agreement with Dignity Health.

Sincerely,
The Board of the UCSF Faculty Association
Member, Council of UC Faculty Associations

 

Comments of Respondents to the Faculty Association Survey

The Faculty Association should probably remain neutral, because there are strong enough arguments to support either side. But it was annoying to read the editorial by David Teitel in the Chronicle supporting the affiliation, without to my knowledge, a vote of the full UCSF Academic Senate in favor of his position. Why was the vote supporting in position undertaken by only the “Executive Council”? The performance of the UCSF Academic Senate leaves a bad smell.

The FA should support the affiliation *if* Dignity health is willing to affirm in the strongest legal terms that UCSF providers are not only allowed to discuss reproductive and end of life options not offered at that facility with patients, but also (1) post signs saying so, (2) offer up to date printed lists of services and locations where patients can receive the services, and (3) allow providers the time and resources to make “warm hand offs.”

I agree with the concerns about differences in family planning goals. The importance of this from a genetics and neurodevelopmental perspective will continue to grow and we should not be tacitly endorsing the Catholic view as acceptable. I worry the perception will be very damaging long term. How will we respond if the President of the US tweets that we agree abortion for any reason should be prevented. San Francisco is a target for this type of polemicism.

Dignity health is against giving women reproductive choice. It goes against UCSF mission.

In the current atmosphere of LGBTQ marginalization, attacks on women’s right to choose and the most recent invocation of the ‘conscience’ rules by the Trump administration, I do not believe it is in the best interest of UCSF to align itself with Dignity Health.

Any association with religious-led health care systems should be opposed by an institution that is promoting diversity and inclusion (UCSF) and is science driven. The stated pros/cons are only part of the larger picture. Many of the students, staff, faculty and patients might have an issue of working/learning/serving in Catholic led institution. UCSF as a major leader in health has a choice who to partner with, and that should be an institution that has the same values as our University.

I think there are good arguments on both sides. Devil is in details and I would want to see them before making an opinion. I strongly oppose making their positions on implementation of the end of life option act an issue parallel to gender and reproductive health. Lethal prescriptions are not medical care, nor should we be pressuring anyone or any organization to participate. That, in fact is illegal.

Students can be informed of the religious based limitations and the alternative options can be offered to patients.

As indicated they provide excellent services that are needed and there is no oath to accept or abide by catholic doctrine.

I can honestly and sincerely see both sides of this issue. I would say, that if we do proceed, the learning opportunities to show how systems differ based on religion vs. science and the resulting impact on patients should be a core part of curriculum for anyone rotating through. For patients, the access vs women’s health access issue is a hard choice. Philosophically I am completely against the affiliation, but pragmatically I can see the benefits.

As written, UC is providing its imprimatur to an organization that does not provide a full-range of reproductive health services to women, limits the scope of contraceptive services and counseling available to patients of all genders, and restricts the extent of end of life care.

Look at what just happened in Georgia – the right to choose is under fire. Do not support limits to a women’s rights.

I prefer no association This is a Catholic organization and not a representative of all religions groups.

I do not believe that we can ethically support this affiliation.

“Dignity Health”. Ha. There is nothing dignified about denying health care based on superstition and religious prejudice.

I do not believe that UCSF, as a state institution, should affiliate with a health care organization that has religious affiliations that result in a restriction of care. UCSF should find more compatible institutions to affiliate with that share our mission and goals.

Thanks for your leadership in our abiding by our values.

Putting UCSF’s logo on these hospitals would be give the impression that we accept the limits that they place on access to reproductive care. It would be better if the affiliation was not listed as a full affiliation but rather as a “partial” affiliation.

I am reluctantly voting to support. I am holding my nose. I very much disagree with the position the Catholic church takes on the treatment of women and LGBTQ persons carrying over to the health care that Dignity health provides.

This issue requires more discussion and debate. Thus I refrained from voting yes or no. I am also distressed that the sensitivity of this issue was not identified earlier — before the agreements were started.

If our trainees are to rotate through these hospitals, I would favor an affiliation only if there was no gag order regarding counseling patients on the full range of options regarding birth control and choices regarding abortions.

Whereas I understand the benefits of an alliance with a “feeder” health care organization, and have personally had excellent care at Dignity, I cannot support UCSF’s imprimatur on their denial of full services to women.

UCSF currently seems to care about nothing but money.

The compromise with our beliefs is too large.

I support the affiliation but opinions are strong and emotional on both sides. The FA should abstain as there are good arguments on both sides and the FA’s position is not going to be a major determinant of what will actually happen.

Both positions arguing and arguing against this issue have merit. At this time the Faculty Association should take a neutral stance concerning this affiliation.

The upside of providing optimal care to patients make the merger worthwhile while the students are sufficiently savvy to appreciate the problems working in a restrictive environment but they will have to deal with these problems when leaving into practice.

We should not give up training time while serving in a setting which doesn’t provide the full range of reproductive and end of life care.

I think there are good arguments on both sides.

On balance this will improve health care for many individuals. It is not an approval of the Dignity/Catholic philosophy as multiple alternatives are available.

Dignity has one of the better records on indigent care. I would support a statement after the affiliation deploring their stance on women’s health services.

Opposes unless Dignity will allow UCSF’s docs to provide evidence based reproductive health care.

No matter what efforts are made on our part, patients and the public (and many medical providers) will be confused and will think we are endorsing some of their principles (i.e. it’s fine to impose your own personal religious beliefs on the health care of other people).

Although Dignity Health provides some important services, I am concerned about the precedent of affiliating with an organization that does not honor the PRIDE values that are considered integral to our mission as UCSF.

Women’s health, while important, is a single issue. Dignity is the state’s largest provider of care for the underserved, which trumps the women’s health issue. If we don’t proceed with affiliation, it will limit our ability to meet our mission to serve the people of the Bay Area and beyond.