When Tenet Healthcare Corp. sought to acquire Queen of Angels-Hollywood Presbyterian Medical Center three years ago little was said about Tenet's pledge to continue operating the facility under the moral teachings of the Catholic Church, which prohibit abortion, sterilization and other reproductive services.

But as the Santa Barbara-based company seeks to buy the Daniel Freeman hospitals in Marina del Rey and Inglewood, a women's group opposing the reproductive policy has caught the ear of the state Attorney General, which has regulatory authority over hospital sales. An official there called the issue one of the "red flags" raised by the prospective sale.

The California Women's Law Center wants Tenet to either provide reproductive services at the Inglewood and Marina del Rey hospitals as a condition of the $55 million purchase, or provide for them in some other way.

"While we don't believe that Catholic hospitals should be able to limit health access, they feel they have a right to do so. Tenet has no right to do so. It's a business decision," said Susan Fogel, legal director of the Women's Law Center.

The loss of reproductive services at hospitals once they merge into Catholic health systems is a major issue among women's health advocates. Less has been said about the maintenance of bans on abortions or other services once hospitals emerge from Catholic systems.

Tenet's Catholic system

Buying Catholic hospitals has become a standard strategy for Tenet, which already operates seven hospitals nationwide under the Ethical and Religious Directives for Catholic Health Care Services. It also has another purchase pending in St. Louis.

The chain, the nation's second largest with 114 acute-care hospitals, denies it is reducing reproductive services by not offering them at hospitals that had not been doing so anyway.

Tenet owns Centinela Hospital Medical Center, which is about a mile away from Daniel Freeman Memorial Hospital in Inglewood. Centinela offers a broad range of reproductive services, notes Harry Anderson, Tenet's chief spokesman. "This transaction, if it is approved, will not take away any services to women," he said.

Moreover, Tenet had to agree to abide by the reproductive directive in order to even bid for the hospitals, which are owned by Carondelet Health System, a Catholic hospital chain based in St. Louis, he said.

Carondelet issued a statement affirming that such a pledge was a precondition for any bidder.

"These directives have been part of the operating guidelines since the (Inglewood) facility was founded more than 50 years ago," read the statement. Carondelet purchased the Marina hospital in 1980.

Deputy Attorney General Chet Horn said Tenet's agreement to abide by the ethical directives is a top concern of the office, which must review the effects of any sale on the availability of health care in the community. But he conceded that it might be hard to prove the sale would limit care.

"It is difficult to argue when you are talking about a Catholic hospital that has never provided reproductive services, and when this transaction simply continues the status quo," he said.

Emergency services an issue

Horn said he was equally concerned that Tenet, as part of the agreement, was guaranteeing continued emergency services for only two years. He said the Inglewood facility's emergency room in particular is heavily used.

(In response, Anderson said Tenet plans to continue operating the hospitals as acute care facilities and views emergency services as an "essential element" of such hospitals.)

Despite Tenet's assertions that reproductive services would not be reduced, Fogel said the law center plans to push to have Tenet make some additional services available. That could include offering funding for other providers of such services, or setting up off-site clinics.

The law center also plans to make its concerns heard at a public hearing the state has scheduled on the sale for Oct. 18 at Inglewood City Hall.

Anderson said any new conditions placed on the sale that would raise its costs would not be acceptable to Tenet, which already has agreed to spend $50 million over 10 years to improve the hospitals and expand their services.

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