Dignity Health and the University of California: A Longstanding Partnership Now in Jeopardy

Very much so -- our partnership is playing a pivotal role in battling the Covid-19 pandemic, particularly for those most vulnerable to it:

• Dignity Health’s Saint Francis Memorial Hospital and UCSF Health together opened San Francisco’s first dedicated unit to care for COVID-19 patients, staffed by physicians from both health systems and caring for up to 48 patients at a time.
• In January, Dignity Health partnered with UCSF on the city’s first large-scale community vaccination event at City College of San Francisco.
• In the Central Valley, Mercy Medical Center Merced and UC Merced are partnering on community vaccine clinics to vaccinate over 2,500 people; and additional clinics are planned.
• The Sacramento County Department of Public Health, in partnership with Dignity Health and UC Davis Health, hosted community-based COVID-19 vaccination clinics beginning in February.

In many cases, Dignity Health offers certain services that UC Health currently does not provide, including acute rehabilitation, acute adolescent psychiatry, and burn care. Additionally, many UC Health facilities are nearing capacity. UC regularly transfers patients to Dignity Health hospitals – and Dignity Health transfers patients to UC – with the confidence they will receive high-quality, evidence-based care.

For decades, Dignity Health and UC Health have worked together to provide specialty medical care, physician training and vital health programs to communities across the state. Many thousands of patients across California access these collaborations – which often provide the only locally available care of its kind. In addition to our recent collaborations around the Covid-19 pandemic (please see above) other examples include:

• UCLA specialists provide pediatric trauma services at Northridge Hospital—the only program of its kind in the San Fernando Valley.
• UCSF residents receive specialized training in burn care through Northern California’s largest burn unit, located at Saint Francis Memorial Hospital.
• Pediatric telemedicine consultations with UCLA specialists are available to patients in the San Fernando Valley through Northridge Hospital.
• The San Fernando Valley’s only radiation-oncology treatment center is a partnership between UCLA and Northridge Hospital. It served 8,500 patients in FY19.
• UC Davis and Mercy Medical Center Merced jointly run a cancer center providing treatment for more than 12,000 patients annually -- the only cancer center of its kind in the region.
• St. Joseph’s Medical Center in Stockton partners with UCSF to give patients access to cancer clinical trials that would otherwise be out of reach.
• San Francisco’s only inpatient headache unit is a UCSF program at St. Mary’s Medical Center.
• At California Hospital in Los Angeles, up to 1,000 ER patients a year receive critical cardiac care thanks to a partnership with UCLA.
• Behavioral health services are available at Mercy San Juan Medical Center in Sacramento through a partnership with UC Davis.
• A partnership with UCSF helped launch a post-acute behavioral health rehabilitation unit at St. Mary’s Medical Center in San Francisco that keeps 56 patients off the streets.
• Resource and referral services in Sacramento emergency rooms help patients access health care and insurance coverage thanks to a partnership with UC Davis.
• At St. Mary’s Medical Center, UCSF patients can access San Francisco’s only inpatient adolescent psychiatry unit.
• A UCLA partnership allows for biochemical, molecular, and cell biology tests that guide diagnostic and treatment decisions in the San Fernando Valley and Long Beach.
• Education programs for thousands of UC medical students and residents at Dignity Health hospitals throughout California.

“Health inequities” are differences in the health status – and in access to health services - among different population groups, arising from race, ethnicity, income and other socio-economic factors. The Covid-19 pandemic has made very clear how much more vulnerable to infection, illness and death, those impacted by such inequities are, compared to the population overall. The Dignity Health-UC partnership is grounded in shared social values which make addressing health inequities a top priority. That is why the partnership is so active in communities that would lose local access to critically needed services without it. And, as the #1 and #2 providers of Medi-Cal services in the State, respectively, Dignity Health and UC simply must collaborate – to leverage each other’s strengths, fill in coverage gaps, and address chronic capacity issues – in order to address the health inequities prevalent within this low-income patient population.

This vital element of the partnership addresses both California’s acute physician shortage; and the need for the medical workforce to be as diverse as the patients it serves. Our partnership brings together the best of academic medicine and community-based care. As the largest hospital system in the State, Dignity Health hospitals can provide training for thousands of UC medical students and residents, while instilling a will to care with compassion for the vulnerable and underserved.

No. Dignity Health expects all clinicians practicing at its facilities to provide services in accordance with their professional judgment and the needs and wishes of their patients at all times. Dignity Health also expects every clinician to inform patients of all their health care options; and to transfer a patient to another provider if a certain service is not offered. In the decades we have been working together to provide services, we are not aware of any instance in which a patient did not receive the care they needed, or where a clinician was constrained in providing care. Nonetheless, over the past year, Dignity Health and UC have worked to amend all physician contracts to expressly address these issues and formally allay any such concerns.

Dignity Health hospitals are committed to providing equitable, knowledgeable and welcoming care for LGBTQ patients and their families. They have too often faced discrimination in health care, and Dignity Health does not tolerate discrimination of any kind.

• We serve all patients regardless of their background, sexual orientation, or gender identity.
• We offer primary and specialty care for transgender patients, including hormone therapy and surgical services.
• Dignity Health operates one of the only specialty transgender care centers in San Francisco -- the Gender Institute at Saint Francis Memorial Hospital -- and provides primary and specialty care for LGBTQ patients every day at its hospitals and clinics across the state.
• We provide PrEP and PEP HIV prevention in our health facilities and physician offices.
• Our hospitals were among the first to offer services in response to the AIDS crises in the 1980s when few others did – often in partnership with public health agencies in San Francisco, Los Angeles, Sacramento and other counties.
• Our St. Mary’s Medical Center in San Francisco has been providing compassionate, groundbreaking outpatient care to HIV patients since the AIDS epidemic devastated the city in the early 1980s. A UCSF specialist leads the clinic.

Our Catholic-sponsored hospitals agree to uphold Catholic values. This includes not providing a small number of services at those facilities, including elective (non-emergent) abortion, elective (non-emergent) procedures for the primary purpose of sterilization such as tubal ligations, hysterectomies (when no pathology is present), vasectomies and in-vitro fertilization (the latter two services are not typically performed in hospitals regardless of religious affiliation). That said: our hospitals do not limit the availability of medically necessary pregnancy care or rape victims’ access to emergency contraception. Relative to pregnancy complications, emergency care is always provided, even if it results in the foreseen, but unintended, death of a fetus. Any doctor practicing at a Dignity Health location is always expected to prescribe all appropriate medications, including contraceptive medications.

Like many other health systems across the country, Dignity Health’s history is rooted in the Catholic faith. In 1854, eight Sisters arrived in San Francisco and immediately began caring for residents of a city struck by cholera, then typhoid and influenza. They founded St. Mary's Medical Center, the longest continuously operating hospital in the city. That commitment to caring for all people, especially those who are poor and vulnerable, continues today.

Because it is our mission to care for the most vulnerable in our communities, Catholic hospitals are more likely to offer less profitable services that other health systems might avoid, such as maternal care, mental health, and trauma care. Catholic hospitals also typically provide more care for at-risk and low-income patients. In fact, Dignity Health cares for more Medi-Cal patients than any other hospital system in California.

Catholic hospitals agree to uphold Catholic values and in doing so adhere to the Ethical and Religious Directives for Catholic Health Care Services. This includes not providing a small number of services at their facilities, including elective (non-emergent) abortion, elective (non-emergent) procedures for the primary purpose of sterilization such as tubal ligations, hysterectomies (when no pathology is present), vasectomies and in-vitro fertilization (the latter two services are not typically performed in hospitals regardless of religious affiliation). As with many hospitals, our Catholic hospitals do not offer the more complex bottom surgeries for gender reassignment, which result in sterilization. Emergency care is always provided.

Critics of the Dignity Health- UC partnership have argued that it conflicts with secular providers’ values by not offering certain procedures and services that are contrary to the Catholic faith, arguing that this may restrict a physician’s ability to practice evidence-based medicine, or that this discriminates against certain populations such as the LGBTQ community. At the present time:

• Legislation has been introduced in Sacramento that would effectively force an end to the Dignity Health-UC Health partnership unless certain conditions are met, some of which would directly disregard core tenets of Catholic health care;
• UC’s governing Board of Regents is anticipated to debate and then vote on a motion that, if passed, could have the same outcome.

As you have read here: we strongly believe that these assertions are un-founded – and that dissolving the partnership could destroy access to life-saving care for many thousands of Californians across the state.

Ending the partnership could result in a devastating loss of access for:

• Patients in rural and underserved areas -- who today can access care from UC specialists through Dignity Health care centers, for specialty services like pediatric trauma, cancer care, and mental health care, that would not otherwise be available locally.
• Low- income patients -- who today can turn to Dignity Health and UC as the #1 and #2 Medi-Cal (Medicaid) providers. Not being able to partner and efficiently coordinate would have a tremendous negative impact on coordinating care for those patients.
• Many thousands of Californians -- who today can receive outstanding care from UC specialists at nearby Dignity Health care centers.

Yes you can - your voice is critical to preserving the future of this life-saving partnership.

To voice your support for continued collaboration, you can voice your support to continue these vital health programs by submitting comments directly to the UC Regents.