Today, State Attorney General Bob Ferguson's office issued a statement confirming that public hospital districts that contract with religious hospitals cannot refuse to provide reproductive services like abortion and contraception if they offer any form of maternity care.

"A public hospital district that provides, directly or by contract, maternity care benefits, services, or information to women, through any program administered or funded in whole or in part by the district, must also provide the substantially equivalent benefits, services, or information required by RCW 9.02.100 and .160," Ferguson's statement reads. (Note the broad language! There is very little room left for wiggling!)

The statement was issued in response to a letter sent by state Senator Kevin Ranker (D, Orcas Island) earlier this year, asking for clarification on the responsibilities of religious hospitals—which are merging with public hospitals in unprecedented numbers—to provide a full range of reproductive healthcare to patients.

Ferguson acknowledges that refusing women access to their full reproductive and family planning options violates the 1991 voter-approved Initiative 120, otherwise known as the Reproductive Privacy Act, which declares that residents have a “fundamental right to choose or refuse” birth control or abortion. The law prohibits the state from discriminating against women's healthcare rights through “regulation or provision of benefits, facilities, services or information.” It also requires the state (including public hospital districts) to provide equal parity for maternity care and contraception/abortion services.

"People should be excited that the attorney general affirmed what Washington voters have affirmed seven or eight times now—that women and men have the right to make their own reproductive choices," says Lisa Stone, Executive Director of the women's legal rights group, Legal Voice. "Maternity services in this state are defined very broadly, and the attorney general has made it clear that if any public funds are used for maternity services, cleverly structured transactions [i.e. hospital mergers] should not succeed in stripping women's right to contraception and abortion."

"It would be a rare hospital that does anything around women's reproduction that could say it wasn't providing any maternity care services," Stone adds.

That's the good news.

The bad news is that Ferguson's statement only applies to public hospital mergers—like those being considered in public hospitals in Mount Vernon, Anacortes, and Arlington—but not to private hospital mergers. For example, it wouldn't have applied to Swedish hospital's merger with the Catholic-based Providence Health Services two years ago.

More bad news: The AG's statement is limited in scope to the question of women's reproductive health. It doesn't address equally pressing questions advocates have raised about Catholic hospitals' (mis)handling of end-of-life care, their care for LGBT patients, or the rights of their employees, who can be legally discriminated against by their employers.

I'm interested to hear the ACLU's take on Ferguson's statement; I'll update this post when I hear back from them.

UPDATE: Here's what the ACLU of Washington has to add (bolds mine).

The Opinion sends a strong message that as hospitals in our state—such as the “Interlocals” (Skagit Valley Hospital, Island Hospital, and Cascade Valley Hospital)—move forward with potential mergers, they must ensure their obligations under Initiative 120 are met by providing reproductive and contraceptive services as well as maternity care services. These are essential, basic health care services to which all Washington women should have access.

While today’s action is an important step forward, it is limited in its scope given the narrow question to which it responds. It addresses only obligations to provide reproductive services covered by I-120, and does not address the obligations of private entities outside of the public hospital district context.

Our overarching goal remains much broader—that all patients should have access in their local communities to a full range of lawful, best care medical services, and that no patient should be refused access to such services because of the religious doctrines of the organization controlling a hospital, clinic, or other medical facility. Washington’s Certificate of Need statute and Gov. Inslee’s directive 13-12 both emphasize the need to “promote, maintain, and ensure the health of all citizens in the state by providing accessible health services, health facilities, and other resources....”

Washington’s policymakers must act far more comprehensively to meet the threat to access to health care services posed by hospital mergers in Washington. And they must do so quickly—the pace of Washington’s hospital mergers is unprecedented nationally. A full-scale response requires:

• a complete review of Washington’s health care laws and policies in light of this game-changing trend;
• a clear, transparent process for meaningful government oversight of mergers;
• legislative and regulatory safeguards that protect access to a full range of services, including end-of- life care, care for LGBT families, and reproductive services, when mergers do move forward; and
• more enforcement mechanisms to ensure that entities that fail to provide a full range of services are held accountable.

These changes require concerted, decisive action from the Governor’s office, lawmakers, executive agencies, and other public entities. We look forward to working with all of those to protect Washingtonians’ access to health.