In Washington state, the percentage of beds in religiously affiliated hospitals has risen from 26 percent in April 2010 to nearly half today, according to the ACLU. Press Association via AP Images

Washington state is leading the nation in mergers, spurred by the Affordable Care Act, between Catholic and non–religiously affiliated hospitals, according to civil liberties advocates.

Catholic hospitals told Al Jazeera they’re saving their secular counterparts from financial ruin, but reproductive rights activists say the partnerships threaten women’s lives.

In Washington state, the percentage of hospital beds that are in religiously affiliated hospitals has risen from 26 percent in April 2010 to nearly half today, according to calculations by the local American Civil Liberties Union. In at least eight states, more than 30 percent of all hospital care is Catholic — and often subject to the directives of regional bishops, according to statistics from CatholicWatch.org.

For reproductive rights advocate Mary Kay Barbieri, the change is more than a business decision made to adapt to government regulation. She wants you to imagine that your “sister, wife, daughter” is pregnant. Doctors have examined her and determined she’s miscarrying.

At a secular hospital, Barbieri says, doctors would advise that her pregnancy is not viable and that chances are she will get a life-threatening infection. But at some Catholic hospitals in Washington state — bound by directives barring abortion of a potentially viable pregnancy in any circumstance — the protocol is different, Barbieri said.

“We have documented cases where the woman has returned to the ER (at Catholic hospitals) several times and been advised to go home and wait,” she said. “They are not advised that their pregnancy is not viable, and are not advised they could become seriously ill if they continue with the pregnancy.

“In the cases we’re aware of, the infection is not treatable until the uterus is evacuated … The hospital refers the case to an ethics committee. They either do or don’t believe the woman is sick enough to authorize a termination. In other cases, the woman goes (to a non–religiously affiliated institution) and is told, ‘Oh, my gosh, you are seriously ill and need a termination.’”

Reproductive rights advocates like Barbieri are collecting testimony from women subjected to what they call inhumane medical practices at Catholic hospitals in Washington state.

“One of the consequences of the Affordable Care Act is that there are more mergers and consolidations in the health care industry,” said Monica Harrington, co-chair of Washington Women for Choice and editor of a blog on the issue, CatholicWatch.org. “The Catholic churches and ministries are in a special position, in large part because of special exemptions and no-tax status they get from laws governing religious institutions. They are flush with cash at a time when many health care practices can’t survive unless they merge with others.”

Issues surrounding Catholic health care haven’t just affected women in Washington state. The Michigan chapter of the ACLU filed a lawsuit in December for a woman who miscarried and was denied the emergency care she needed by a hospital that the ACLU reports was abiding by religious directives. The national ACLU office told Al Jazeera there have not yet been any developments in the case.

But some Catholic hospitals see themselves as rescuing non-Catholic American health care from financial crisis.

“It’s more difficult than ever for communities, especially in rural areas, to meet local health care needs on their own,” said Tim Strickland, spokesman for international Catholic health-care facility PeaceHealth. “They need partners, and PeaceHealth has been willing to step up and help when others have not.”

In a number of counties in rural Washington, Catholic hospitals are already all that’s available, Barbieri said.

“If our public hospitals continue on the course they are pursuing, then all of the health care from Canada to Seattle and from the mountains to Puget Sound will be Catholic,” she said.

In northern Washington’s Skagit County, where Barbieri lives, there are four public hospitals. Beginning last year, “all four of them decided to consider partnering with the Catholic hospital system.” Barbieri said one recently halted efforts to merge after community pushback, and another is negotiating with PeaceHealth.

Referring to controversies raised in recent years over reproductive health care facilities at Catholic hospitals and the lack thereof, Strickland said, “We hope the day comes when all the energy now going into this controversy could be channeled into meeting the health care needs of the people. That’s the real crisis we face in this state, and one that affects virtually every Washingtonian.”

Strickland noted that in December the Health Care Research Group of the Washington State Office of Financial Management said it has not found evidence that access to reproductive health care has been restricted in communities served by Catholic hospitals.

But some reproductive rights advocates say reproductive health care practices at Catholic hospitals demand more scrutiny.

As Barbieri notes, in cases where time is of the essence, some women are made to wait for the Catholic hospitals’ committees to rule on ethical issues.

The National Catholic Bioethics Center, which is open Monday through Friday, 9 a.m. to 5 p.m., is made up of “ethicists” who rule on such cases.

In the event of a “true emergency,” the NCBC’s after-hours voice mail advises callers to dial 4, and they are then advised to leave a message for an ethicist. There is no emergency number given. The NCBC was not available for comment at time of publication.

Waiting for ethicists in an emergency is not the only problem with Catholic health care, reproductive rights advocates say.

When a pregnant woman’s fetus lodges in her fallopian tube in what doctors call an ectopic pregnancy, she usually has two options: Doctors can extract the fetus or in some cases the entire fallopian tube surgically, or she can take a drug called methotrexate to dissolve the pregnancy, and her body — and fertility — will remain intact.

But at some Catholic hospitals, reproductive rights advocates say, a patient is given only the option of losing the fallopian tube, in what is considered to be an “indirect abortion” to save the woman’s life.

“There are all these women out here who’ve had fallopian tubes removed unnecessarily,” said Harrington. “They didn’t know it wasn’t necessary … In a majority of those cases they should have been given a drug that would have flushed the nonviable embryo from their body.”

Judy Kimelman, an obstetrician-gynecologist at Seattle Obstetrics and Gynecology Group, affiliated with Swedish Medical Center, which was at the center of a controversial partnership with Catholic-run Providence Health & Services in 2011, said she’s never heard of doctors removing fallopian tubes at Catholic hospitals, except in the event of the tube getting infected.

But Barbieri, who says she’s collected accounts of the practice, feels it is barbaric.

“I know that Catholic hospitals would look at (female genital mutilation) and say that’s abhorrent, but then they don’t think their own practices that risk women’s lives and fertility are abhorrent. That’s strange,” she said.

Asked if PeaceHealth uses methotrexate in the event of ectopic pregnancies and what the protocol is in these cases, Strickland said, “PeaceHealth employs the best-practice standard of care to remove the pathological tissue that threatens the life of the mother.”

Pressed on whether PeaceHealth doctors advise women that they can be issued the drug at other facilities, Strickland reiterated that “PeaceHealth employs the best standard of care to remove the pathological tissue that threatens the life of the mother.”

Policies vary at different institutions, as steadfast as Catholic directives may be.

Providence “does use methotrexate to treat ectopic pregnancies when determined it is needed by a clinical care team, and Providence clinicians exercise their best judgment to ensure safe, quality care,” spokeswoman Colleen Wadden said.

Harrington noted that in the many instances when she’s encountered women unnecessarily losing an organ, the cases are “rife for trial attorneys to get engaged.”

But women aren’t making reports, Barbieri said, either because they don’t want to come up against the only health care — and its powerful legal teams — in their rural areas or because attorneys simply don’t want to take the cases.

“It’s hard to get a malpractice lawyer to take on the huge task of taking on a Catholic health care entity,” she said.