Tuesday, May 31, 2016

Why You Won’t Hear About Abortion From Arizona’s Largest OB-GYN Network

 Nicole Knight Shine

MomDoc imposes a virtual gag order on employees when it comes to abortion care, as a half-dozen former OB-GYNs, nurse practitioners, and support staff told Rewire in a series of interviews.
The voice on the other end of the phone is friendly, but unhelpful, when a Rewire reporter says she’s six weeks pregnant and would like an abortion.
“We don’t provide that,” Marie says.
Marie makes appointments for MomDoc, Arizona’s largest women’s health network. MomDoc is owned and run by Mormons who ascribe to a belief that opposes abortion in nearly all cases.
“Can you tell me where I can get an abortion?” the reporter asks.
Marie says she can’t. “I’m sorry,” she adds.
MomDoc imposes a virtual gag order on employees when it comes to abortion care, as a half-dozen former OB-GYNs, nurse practitioners, and support staff told Rewire in a series of recent interviews by phone and email. What they described affords a window into the workings of a private medical practice, one that opposes abortion care and attempts to suppress abortion access on religious grounds.
What MomDoc represents is a real-life test case pitting the power of religious beliefs against the provision of basic health information about a procedure that, according to the Guttmacher Institute, 30 percent of all U.S. women will have before age 45.

MomDoc CEO Nick Goodman didn’t respond to repeated requests for interviews and comment.
It’s good business to oppose abortion in the sprawling Phoenix basin, home to the largest concentration of Mormons outside of Utah, according to the most recent U.S. Religion Census.
Started in 1976 by two Mormon OB-GYNs, MomDoc has 21 offices that operate under various names, such as Goodman & Partridge, MomDoc Midwives, MomDoc Women for Women, and Mi Doctora. MomDoc health-care centers offer reproductive services like birth control, and accept Medicaid patients, which means MomDoc is paid with federal dollars.
That Arizona’s largest OB-GYN practice opposes abortion care disturbs pro-choice advocates in a state where reproductive health access is constricted by forced waiting periods, parental consent requirements, and state-directed counseling intended to discourage patients.
Ethical guidelines from the American Congress of Obstetricians and Gynecologists (ACOG), a professional organization of 57,000 members, advise physicians who object to abortion on religious grounds to notify patients beforehand and to refer them to abortion providers.
“You need to give your patients all the options so they can make their own choice,” Julie Kwatra, legislative chair of the Arizona chapter of ACOG, told Rewire in a phone interview. “Not telling a patient information is in opposition to every rule of medicine.”
In 2012, Arizona’s right-leaning legislature instituted a religious privilege law that shields health-care professionals who hold religious beliefs from losing licensure.
These protections, critics argue, further stigmatize a legal medical procedure that’s already under attack in GOP-held legislatures nationwide.
MomDoc’s website and advertisements make no mention of its faith-based opposition to abortion rights, pro-choice advocates note.
“Drive down the freeway and every other billboard will be a MomDoc billboard on how they provide midwife care and how they really care about the family,” Kat Sabine, executive director of NARAL Arizona, said in a phone interview with Rewire. “To me it’s almost like locking down and cordoning off abortion care even more than it is in the community.”
By asking its employees to refrain from discussing abortion care, MomDoc runs counter to prevailing professional health-care norms to inform and refer patients, explained Lori Freedman, author of Willing and Unable, a book about doctors’ constraints on abortion.
“I think there’s an ethical problem there—this is information patients would want,” Freedman said a phone interview with Rewire.
It’s impossible to know how many religiously run practices across the country try to silence employees when it comes to abortion care. The executive director of the American Association of Pro-Life Obstetricians and Gynecologists said the group has not polled its 2,500 members on whether they refer patients to abortion providers, but said the organization’s overall position is “abortion hurts women.”
A recent attempt to muzzle a Washington, D.C., OB-GYN grabbed national headlines after her employer told her not to “put a Kmart blue-light special on the fact that we provide abortions.” Although the facility where the provider works doesn’t restrict access to abortion care, the case and MomDoc’s policy are both rooted in a federal measure called the Church Amendment.
Adopted in 1973 shortly after the landmark Supreme Court ruling Roe v. Wade, the Church Amendment offers protections for health-care workers at federally funded institutions who object to participating in abortions for moral or religious reasons. Attorneys for a Washington OB-GYN are arguing in a complaint filed with the Office for Civil Rightsthat those protections also extend to doctors who wish to speak up in favor of abortion.
MomDoc’s abortion taboo pervades its hiring and employment practices, former employees told Rewire. They askedRewire not to reveal their names, fearing employment reprisals. Local OB-GYNs familiar with MomDoc, or whose colleagues had interviewed with the practice or work there, helped to corroborate these accounts.
“They brought it up at the [job] interview,” said an OB-GYN who worked for nearly five years in MomDoc clinics in the Arizona towns of Gilbert and Queen Creek. “They said they don’t do abortions, don’t talk about it, don’t refer [patients].”
The OB-GYN and others felt the prohibition was a condition of employment, saying that those who opposed MomDoc’s staunch anti-choice stance “got screened out.”
Once hired, the former OB-GYN said of abortion, “I talked about it, I know other doctors talked about it.”
Indeed, the former MomDoc OB-GYN said of discussing abortion care with patients: “I would always start off telling the patient, ‘I’m not supposed to talk about this, but I will.’” 
The former OB-GYN told Rewire that she’d caution patients to stay mum, and not tell her employer.
“Kind of saying, if you tell them I did [discuss abortion], I’m going to deny it,” the former OB-GYN explained, adding that discussing abortion wasn’t something she felt would lead to her termination.
The day-to-day reality of MomDoc’s abortion taboo seemed to depend on the employee’s position. Support staff described to Rewire how supervisors and team leads imposed an ongoing gag order on abortion.
“I was told in my training that abortion was not something we did, it was not something we promoted, it was not something we referred [patients to],” said an employee who worked in surgery and referrals from 2011 to 2012.
“They told us every conversation was recorded,” said a 72-year-old former appointment setter who worked for six years in MomDoc’s corporate office in Chandler, where she was told not to provide abortion information to callers. She said she’d occasionally “sneak in” a referral to an abortion provider.
“I worked in the medical field for 35 years, and I have never been told I can’t discuss a procedure,” the former scheduler said.
Asked how the policy was enforced, a former OB-GYN said, “I don’t remember anything being in my contract about abortions; it was more of a verbal thing.”
At times, the application of the anti-choice policy seemed uneven. A former nurse practitioner, who worked in Goodman & Partridge and MomDoc facilities from 2013 to 2014, said she was warned in a job interview not to talk about Plan B, emergency contraception that helps prevent pregnancy, rather than abortion.
“I was never told that directly that I couldn’t refer patients to abortion providers,” she recalled in a phone interview. “I had patients that did choose abortion, and I referred them.”
In the end, what the former employees described perhaps exposes the practical limits of imposing a religious gag order on a legal health-care procedure on staff who may not share their employer’s beliefs. Those in a position to do so may merely pay lip service to the prohibition.
“Obviously, when you have a crying teenager in front of you,” a former MomDoc OB-GYN said, “you’re going to help them, you’re going to refer them.”