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Concerns for LGBTQ Care, Reproductive Services, Lead UCSF to Nix Closer Ties With Dignity Health

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Aerial view of UCSF's Parnassus Heights campus. (UCSF)

UCSF Medical Center officials said Tuesday they no longer would pursue a formal affiliation with Dignity Health, a large Catholic health care system that restricts care on the basis of religious doctrine.

The decision follows months of heated protest from hundreds of UCSF faculty and staffers who argued that such an arrangement would compromise patient care and threaten the famously progressive health system’s reputation as a provider of unbiased and evidence‐based care.

In a letter to staff announcing the decision to end negotiations, UCSF Chancellor Sam Hawgood and UCSF Health President and CEO Mark Laret cited “strong concerns about a significantly expanded UCSF relationship with a health care system that has certain limits on women’s reproductive services, LGBTQ care, and end‐of‐life options.”

Among other prohibitions, Dignity hospitals ban in vitro fertilization, physician‐assisted death and abortions (unless the mother’s life is at risk).

Twenty‐four of Dignity’s 39 hospitals prohibit contraception services and gender‐affirming care for transgender people, such as hormone therapy and surgical procedures.

The proposal sharply split faculty and the medical staff at UCSF, who aired their differences in heated public forums. Supporters of a closer alliance with Dignity said it would add capacity to a public health care system that is strapped for bed space and turns away more than 800 patients a year. They also noted that Dignity is California’s largest private provider for patients with Medi‐Cal, the state‐federal insurance program for the poor.

Dignity hospitals are bound by ethical and religious directives from the United States Conference of Catholic Bishops.

Under the proposed affiliation, UCSF would have remained independent and continued to provide such services, but UCSF physicians would have had to abide by Dignity’s care restrictions while practicing at Dignity hospitals. Dignity, meanwhile, would have benefited from operating under capacity.

The two systems already have a relationship among several departments, including neurology, adolescent psychology and pediatric burn care. The new proposal would have deepened the affiliation at Dignity’s four Bay Area hospitals.

UCSF said the decision to end negotiations was made over the past several days, following internal meetings with Dignity officials and members of the UC Board of Regents, whose approval was required. In a written statement, a Dignity Health spokesperson said system officials understand the concerns raised by UCSF faculty and others, and "agree that we cannot move forward."

In April, Laret told a meeting of the UC Regents that UCSF had no "good Plan B" for adding capacity and that disengaging from the partnership would be "catastrophic for the health care delivery system in San Francisco.” On Tuesday, UCSF released an FAQ saying the medical center would continue to look for new ways to work with Dignity, including in the areas of adolescent and adult psychiatry, surgical services, primary care and cancer care.

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The proposal for formal affiliation had drawn vocal opposition from California's lieutenant governor, some major UCSF donors and dozens of organizations advocating for reproductive rights and the gay and transgender communities.

“I’m really happy they made this decision,” said Dr. Daniel Grossman, a professor of obstetrics and gynecology who helped write a letter of opposition that was signed by more than 1,500 faculty members, residents, students and alumni. “Particularly in this moment when the rights of women and LGBT folks are under attack, this [affiliation] was just not the right decision, and I’m glad they recognized that. It’s important that California remain a haven state for these services.”

But Grossman said he remains concerned about UCSF’s ongoing collaboration with Dignity, and the possibility it still could expand.

“We need to be vigilant and really hold them accountable moving forward,” he said.


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