As blue states try to shore up access to abortion and reproductive care, some are facing a threat they didn’t see coming: Catholic health care mergers.
In the first segment, Reveal’s Nina Martin takes us to New Mexico, a blue state that’s been working hard since the U.S. Supreme Court struck down Roe v. Wade to strengthen its already sweeping protections for many forms of reproductive care. But those guarantees have been threatened by a local merger between Gerald Champion Regional Medical Center, the only hospital in rural Otero County, and a Catholic health care system out of Texas, CHRISTUS Health. Like all Catholic hospitals, the newly merged hospital will be subject to the Ethical and Religious Directives for Catholic Health Care Services, written by the U.S. Conference of Catholic Bishops. Known as ERDs, they limit or ban a number of reproductive services, including birth control, sterilization, abortion and gender-affirming care. Where will people go if they can’t get the care they need? The next closest hospital is an hour away.
In the next segment, Martin travels to Alamogordo, where Gerald Champion is located, to try to find out how things are changing. Then she widens her lens, talking to a leading researcher on Catholic health care to see how ERDs play out in other hospitals around the country. She closes by talking to two Catholic experts about what ERDs require and how to improve transparency for patients.
In the final segment, Reveal’s Laura C. Morel follows the story of Kelly Flynn, an abortion provider who has clinics in Florida and North Carolina, two states that had been abortion havens for women around the South before Roe fell. But now, lawmakers in North Carolina have imposed a 12-week ban on abortions, and the Florida Supreme Court is weighing a six-week ban. So Flynn has spent the last few months preparing for access to keep shrinking by quietly opening a new clinic in a state that still has relatively strong abortion protections – Virginia.
Dig Deeper
Read: Bigger and Bigger: The Growth of Catholic Health Systems (Community Catalyst)
Read: “Bishops and Bodies: Reproductive Care in American Catholic Hospitals” by Lori Freedman
Read: “The Catholic Church and Its Hospitals: A Marriage Made in Heaven?” by Dr. Patricia A. Gabow
Read: “Reproductive Justice and the Catholic Church” by Emily Reimer-Barry (available summer 2024)
Credits
Reporters: Nina Martin and Laura C. Morel | Producer: Ashley Cleek, with support from Steven Rascón and Michael Montgomery | Editor: Cynthia Rodriguez | Fact checkers: Nikki Frick and Kim Freda | Production managers: Steven Rascón and Zulema Cobb | Digital producer: Nikki Frick | Original score and sound design: Jim Briggs and Fernando Arruda | Interim executive producers: Taki Telonidis and Brett Myers | Host: Al Letson | Special thanks to Justin Garcia, Alison Swaim and Katharine Mieszkowski
Support for Reveal is provided by the Reva and David Logan Foundation, the John D. and Catherine T. MacArthur Foundation, the Jonathan Logan Family Foundation, the Ford Foundation, the Hellman Foundation, the Robert Wood Johnson Foundation, and the Park Foundation.
Transcript
Reveal transcripts are produced by a third-party transcription service and may contain errors. Please be aware that the official record for Reveal’s radio stories is the audio.
| Al Letson: | From the Center for Investigative Reporting and PRX, this is Reveal. I’m Al Letson. We’re beginning this hour in New Mexico, a state that allows abortion with really no limits. Linda Serrato is a state representative there. |
| Linda Serrato: | I remember it really clearly because I was getting my daughter ready for day care. |
| Al Letson: | She’s remembering back to the day Roe v. Wade was overturned, |
| Linda Serrato: | Fighting with her about pants or whatever. You have to do this before you go to day care. This is what we’re got to do. We got to hurry. You’re going to be late. |
| Al Letson: | Linda’s dressing her daughter when all of a sudden she gets a news alert on her phone. |
| Linda Serrato: | And literally, it just stopped me in my tracks that I’m looking at my daughter and it just broke my heart that if she leaves New Mexico, I can’t protect her in the same way that we can protect her here in New Mexico. |
| Al Letson: | New Mexico’s governor is a woman. The House of Representatives is majority women. The state has a lot of protections for reproductive health, but Linda knows that once Roe is gone, the states next door, Texas, Oklahoma, Arizona, are going to either ban, or severely restrict abortion, and women are going to start pouring into New Mexico. |
| So Linda and her colleagues start passing even more laws to protect them. | |
| Linda Serrato: | We will not disclose patients or information or doctor’s information who may be performing reproductive or gender-forming health care. And the stories we’re hearing of people traveling tens of hours without their cell phone because they’re scared of being traced, that’s a protection for them. |
| Al Letson: | And the lawmakers are right. Women do come to New Mexico in droves. Abortions in the state have more than tripled since Roe fell. But as Linda and her colleagues are passing these new laws, something else is happening that they didn’t see coming. A hospital merger in Alamogordo, a small city in the south-central part of the state, the catch the merger will make the hospital Catholic. |
| Reveal’s Nina Martin has been investigating how this unremarkable business transaction in rural New Mexico threatens to undermine access to all kinds of reproductive services, not just abortion. She starts in Alamogordo. | |
| Nina Martin: | The town of Alamogordo comes out of the desert, kind of all of a sudden on one side of town is a railroad check. On the other side is this spectacular mountain range covered in sage and brittle brush and these massive rock formations. |
| And while Alamogordo is small, Otero County is vast five times the size of Rhode Island. There’s an Air Force base there, the Mescalero Apache Reservation, but there’s only one hospital: Gerald Champion Regional Medical Center. | |
| And when it announced that it was merging with Christus Health, a Catholic chain from Texas, there was no press conference, no public ceremony. What there was was a press release on Facebook and the only reason most people even paid attention to the hospital’s Facebook page was because the county’s health care services director started posting comments. Her name is Amber Mayhall. | |
| Amber knew there were certain rules that Catholic hospitals are supposed to follow, and she worried about losing access to health care that conflicted with Catholic doctrine. | |
| For instance, the Catholic Church doesn’t believe in birth control. So, would contraception continue to be available? What about abortion if the woman’s life is in danger or after a sexual assault, her comments tore through the town. | |
| Amber Mayhall: | I was like, what in the actual hell is going on? |
| Nina Martin: | Women start asking their own questions. |
| Amber Mayhall: | Okay, so what happens with contraceptives? |
| Nina Martin: | Rumors starts circulating that if this merger doesn’t happen, the hospital could eventually go bankrupt. |
| Speaker 5: | Maybe it was one of my friends from the school board said, “This feels like they gave us a parachute. It just has a couple of tears in it.” |
| Nina Martin: | People are confused. If patients can’t get what they want or need, where will they go? Some fear the worst. Others say, “Let’s wait and see.” |
| Speaker 6: | My feeling was let’s be patient. Let’s not throw a bunch of negativity at it. |
| Nina Martin: | Of course there is a way to resolve these questions. The state government could demand answers, but like a lot of states, New Mexico doesn’t have a mandatory review process for hospital mergers. The only government officials who might be able to force some oversight are the three conservative Republicans elected to run the county. |
| So, here we are. We’re going to go see Amy Barela, who is a commissioner on the Otero County Commission. I reached out to all the commissioners, but Amy was the only one who agreed to an interview. We meet at a coffee shop in Alamogordo during a break from her other job. | |
| Amy Barela: | I am Amy Barela. I am county commissioner for Otero County District two. |
| Nina Martin: | You also drive a tow truck? |
| Amy Barela: | Yes, we own. My husband and I own two tow companies and an auto salvage yard- |
| Nina Martin: | In Alamogordo? |
| Amy Barela: | Right here, born and raised. |
| Nina Martin: | Amy knows this part of New Mexico really well. It’s deeply conservative. A red patch in a blue state. Her predecessor on the county commission was the co-founder of Cowboys for Trump. He was at the insurrection on January 6th, convicted of illegally entering the Capitol grounds, and disqualified from holding public office. |
| Amy used to describe herself as far right. She supports Trump, she’s anti-abortion but once she became a commissioner, she realized that local politics was less about culture wars and more about concrete issue. | |
| Amy Barela: | Roads and blight houses. That is the biggest concern of everybody. |
| Nina Martin: | The population here is aging and when somebody dies, there’s often no one to take over the family home. So Amy stepped in and made this a priority. |
| Amy Barela: | It’s a big project, it’s not as easy as you can say, just, “Oh, we want this property cleaned up and gone.” It takes months. |
| Nina Martin: | This is the kind of person Amy is. She likes projects. So when she heard about the merger, she started Googling. |
| Amy Barela: | Well, obviously I wanted to know what Christus was all about. |
| Nina Martin: | So she looked up the ratings of a hospital in Santa Fe that Christus had taken over 15 years ago. |
| Amy Barela: | The national rating before the merger and then after the merger, and within one year, customers, patients and employees all went up with satisfaction. |
| Nina Martin: | Christus was promising to make Gerald Champion a lot better too. Invest $100 million in the hospital over the next 10 years. Set up a $240 million foundation to support community health. Bring in more doctors, or specialists. Amy also called Gerald Champion’s CEO. His name is Jim Heckert. |
| Amy Barela: | And he spent some time with me because I did have concerns. |
| Nina Martin: | What were your concerns? |
| Amy Barela: | What is this new hospital going to do for our community? Are we going to still have the same services? You hear these big mergers, is it going to fire all of our current employees and bring in from out of state? Is it going to interfere with any cancer treatments or anything going on? |
| Nina Martin: | Some of the other things people were worried about, like abortion? To Amy that seemed like a non-issue. |
| Amy Barela: | Elective abortions were never provided before, and they’re not provided now. |
| Nina Martin: | After talking with Jim, Amy felt satisfied. |
| Amy Barela: | And he answered all of my questions. I feel perfectly… I believe that we’re going to be able to bring more specialty services to our community because of it. |
| Nina Martin: | As we’re talking. Amy’s husband John Paul is next to her eating lunch. He keeps interjecting himself into the conversation, making little comments and faces, mostly off-mic. |
| John Paul wears his politics on his sleeve. Literally. He’s in a President Trump T-shirt that later when we take pictures, Amy will try to cover with her hands, and as we’re waiting for a blender in the background to quiet down John Paul suggests, joking, but not really. The Catholic beliefs about abortion and trans care kind of match his politics. | |
| You said that they align with your politics actually. Is that fair? | |
| John Paul is nodding his head. | |
| Amy’s being quieter. | |
| Amy Barela: | I try not to make it political. I try to do for the community. So when we talk about the politics of it, as a commissioner, I don’t want to make it political. |
| Nina Martin: | But when it comes to abortion, it is political. In 2022 after Roe was overturned, the commission passed a resolution to make Otero County a “Sanctuary for the unborn.” Amy wasn’t on the commission then, but she tells me she agrees with the resolution. What she doesn’t agree with is regulation. |
| Amy Barela: | This is a private hospital, so though it is our job as elected officials to make sure that we provide all the services needed for our community, we only have so much say over private industry. |
| Nina Martin: | One person in town has been trying to convince Amy and her fellow commissioners that it is their responsibility to look into this merger. Amber Mayhall, the county health official who first commented on the hospital’s Facebook page. |
| Amy Barela: | She is a asset. She’s a… Have you spoke with her yet? She is a whippersnapper. She is so smart. |
| Nina Martin: | Everyone I talk to tells me I’ve got to talk to Amber, and I try, but Amber tells me as a county employee, she isn’t allowed to speak to the press. |
| Amber Mayhall: | Good morning commissioners. Amber Mayhall health care services director. |
| Nina Martin: | This is Amber testifying at the only public meeting held on the merger. |
| Amber Mayhall: | So I realize that this is not a very easy issue to consider, but it is an issue that does need to be considered. |
| Nina Martin: | Amber’s been in public health for eight years. A big part of her job is ensuring that poor people, uninsured people, all people can access health care. She basically forced this issue onto the commission agenda. |
| Amber Mayhall: | There was no community consideration, no community input about what the services are going to look like here for Otero County, and Otero County residents deserve to know and they deserve to have input, and we do not deserve to have such a large consequential economic decision to be made in the dark. |
| Nina Martin: | Again, there’s no automatic review process for hospital mergers in New Mexico. The one thing Amber could think of was to ask this Republican County Commission to ask the State Attorney General, who’s a Democrat, to review the merger and make sure the community wouldn’t lose services. She even drafted the letter for them to sign. When Amber finishes. Amy Barela is the only commissioner with questions. |
| Amy Barela: | So specifically what services are we losing? |
| Amber Mayhall: | At the hospital, you’ll be losing the full range of reproductive care. That is birth control. You’ll be losing the IUD and the only time that an individual will be allowed to have any kind of birth control is if you have a medical diagnosis. |
| Amy Barela: | [inaudible 00:11:38] at the hospital into that one. |
| Nina Martin: | But before she does, she tells Amber she thinks the hospitals have very similar values. |
| Amy Barela: | So did you look at the mission statement of what Gerald Champion currently has in Christus Health Care? |
| Amber Mayhall: | Their mission statements could be exactly verbatim, but at the end of the day, Gerald Champion is secular and has to follow the medical standards of care, and Christus is a Catholic faith-based organization and they follow the ethical and religious directives. |
| Nina Martin: | The Ethical and Religious Directives for Catholic Health Care Services or as they’re often called the ERDs. |
| The ERDs are a set of 77 rules written by the U.S. Conference of Catholic Bishops. Catholic hospitals and clinics are required to follow these rules to ensure that the care they provide aligns with Catholic moral and religious beliefs. The ERDs are not mentioned in the press release that Christus and Gerald Champion put out about the merger, but they’re the reason Amber’s worried. | |
| The ERDs dictate all kinds of health care. They say, for example, that Catholic hospitals can’t offer the pill or IUDs or tubal ligations for the sole purpose of birth control. There’s no fertility treatments like IVF, no gender-affirming care. | |
| Jim Heckert: | We went and visited three Christus hospitals and the ERDs was a big concern of ours because it’s just hard to understand. |
| Nina Martin: | At the meeting Jim Heckert, the head of Gerald champion addresses the ERDs. |
| Jim Heckert: | We had our physicians with us, we had our chief of OB with us and they just didn’t see you where that became a critical decision point in that process, they just didn’t see it. |
| Nina Martin: | Jim brings up some of the issues that he knows people are worried about. |
| Jim Heckert: | Tubal ligations after childbirth will continue to be done if there is a medical reason to do them. |
| Nina Martin: | Here’s what Jim means. If you have something like a bad heart that could get worse if you get pregnant, then the hospital will tie your tubes. |
| But if you want your tubes tied just because you’re done having kids, that’s not going to happen. Jim says that whatever services the new hospital isn’t allowed to provide, those services will be outsourced to another clinic. What he doesn’t mention is that many of the other clinics in the area are owned by Gerald Champion. | |
| Another concern Jim’s heard about involves sexual assault. | |
| Jim Heckert: | Rape victims that present to the emergency room will receive emergency contraception, because that’s a law by New Mexico. And let’s be clear, religious does not overrule laws, and so we have to abide by that. |
| Nina Martin: | New Mexico has enshrined emergency contraception, birth control, abortion, gender-affirming care, even the right to die into its laws. |
| But what happens when there’s a conflict between state law and religious doctrine? | |
| Lawyers I talk to say it’s really unclear how New Mexico’s laws would hold up to a hospital’s claims of religious freedom. | |
| Jim’s convinced the merger will be good for the community. He’s worried that without it, the hospital will struggle to stay open. | |
| Jim Heckert: | We’re only doing this for one reason: to ensure that it’s there for you in the future. I would ask for your patience and your support. Folks, I need your support. |
| Nina Martin: | Jim cautions, against sending Amber’s letter to the Attorney General. He’s worried it could blow up the whole deal. |
| Jim Heckert: | That is the wrong message to send to this hospital, and to Christus, and you don’t know where that’s going to go. |
| Nina Martin: | The commission agrees with Jim. They don’t send the letter. |
| On June 30th, 2023, less than two months after it was announced, the deal becomes final. The hospital is now Catholic. | |
| Al Letson: | And this is just the beginning. When we come back, the hospital starts to transform. |
| Speaker 10: | The ERDs are very clear. We do not provide or promote or refer for abortion, contraception, sterilization, that kind of thing. |
| Al Letson: | That’s next on Reveal. |
| From the Center for Investigative reporting in PRX, this is Reveal. I’m Al Letson. We’ve been looking at what happens when a Catholic hospital takes over a non-Catholic hospital and religious teachings collide with reproductive rights. That’s what happened in Otero County, New Mexico. | |
| Gerald Champion, the only hospital serving a vast rural region is now Catholic, Reveal’s Nina Martin went to the hospital to see what’s up. | |
| Nina Martin: | Oh wait, emergency it says. Here we go. So here we are. This is so interesting. It doesn’t look like a hospital to me. |
| Al Letson: | The hospital is in the foothills of the Sacramento Mountains. It’s a series of orange and beige buildings spread out like a school campus. |
| Nina Martin: | Everywhere are signs that say “Proud to be part of Christus Health.” |
| Al Letson: | These big purple plastic banners are strung up across the front of buildings. |
| Nina Martin: | These signs kind of slapped on everywhere telling you that something has happened, and something is going to be different, but not telling you what that is. |
| Al Letson: | Of course, you can’t see what’s really happening with a merger by driving around in a car. So Nina starts asking around town, what if anything has changed? I’ll let Nina take it from here. |
| Nina Martin: | It’s only five months into the merger, so it’s hard to find people who’ve already been affected, but it’s not hard to find women who, even before the merger, were struggling to get basic reproductive services. Women like Vanessa Eiland. |
| I meet her at a local coffee shop. Vanessa grew up in Alamogordo as a military brat. | |
| Vanessa Eiland: | So we got stationed here and they were like, “Okay, two years and you can move.” And we kind of got stuck here. |
| Nina Martin: | Vanessa’s 25, with a big comfortable smile. She works at Walmart, walking the aisles packing stuff that people order online. |
| Vanessa Eiland: | The one thing about Walmart is since it’s one of the only grocery stores, you basically see everyone. And for the most part, no one knew the hospital was changing |
| Nina Martin: | At first, Vanessa wasn’t really following the merger closely either. She’s busy, she has a full-time job and two kids. |
| Vanessa Eiland: | I had my first kiddo… I was 15 days into 19, so it’s still technically a teen pregnancy. When I was growing up, I mean we had probably 10 girls in my class that had kids throughout middle school, high school. It wasn’t too uncommon. |
| Nina Martin: | About two years ago, way before the merger, Vanessa had her second child at 23, and at that point she decided, “You know what? We are done. No more babies.” So she asked her doctor for a tubal ligation, but she says the doctor wouldn’t do it. |
| Vanessa Eiland: | And that’s when he was like, “Yeah, well you’re too young. You might want kids in five years.” It’s unfortunate. |
| Nina Martin: | Vanessa had planned on finding another doctor who would honor her decision and tie her tubes, but that takes time. And so she and her husband decide, you know what? He can get a vasectomy. So he starts the process. This is in the spring of 2023, still pre-merger. |
| Vanessa Eiland: | The first time that he was scheduled to have it done, he couldn’t actually make that appointment, so they had to get him rescheduled. |
| Nina Martin: | His new appointment is later that summer, but then the hospital announces it’s merging with Christus and out of the blue Vanessa says he gets a letter saying his appointment is canceled. |
| Vanessa says her husband threw out the letter and he didn’t want to talk to us. And when I called the hospital, they said they’re still doing vasectomies, though they might have to move them to another office. | |
| I’d heard secondhand accounts that other vasectomies had been canceled, and I knew changes around reproductive health were happening because I saw a memo to employees. It was alerting them that their health insurance will cover birth control pills and tubal ligations under certain circumstances. | |
| I wanted to get some clarity, so I asked to interview Gerald, Champion’s CEO, Jim Heckert, but the hospital sent me to Christus, which sent me a two-sentence statement. | |
| They say they’ve addressed the community’s concerns honestly and openly last summer. Now they’re focused on the future on providing high-quality care. | |
| Meanwhile, around town, what I hear is resignation, but also hope. Maybe Gerald Champion will become a much better hospital. | |
| Dr. Debra Stulb…: | We were told the same thing. We were told, don’t worry what is actually the problem and there were huge problems. |
| Nina Martin: | This is Dr. Debra Stulberg. Today, she’s a professor and head of family medicine at the University of Chicago, but 20 years ago, she was a resident at a hospital in Chicago that was taken over by a Catholic system. Not Christus, but similar. |
| Dr. Debra Stulb…: | We very quickly lost the ability to provide tubal ligations even access to contraception, like getting an IUD in your doctor’s office, emergency contraception in the emergency room. |
| Nina Martin: | What she witnessed brought up so many questions about the ERDs, the ethical and religious directives that guide Catholic hospitals, and how they conflict with what she learned at medical school. And that kicked off two decades of research into Catholic health care with colleagues around the country. They interviewed doctors and nurses. |
| Dr. Debra Stulb…: | We’ve also talked to midwives, doulas, family physicians. |
| Nina Martin: | One of the reasons they felt driven to do this research is because Catholic health care is expanding. |
| The number of Catholic hospitals has increased nearly 30% in the last two decades. Today, Catholic hospitals, clinics and nursing homes make up the biggest group of nonprofit health care providers in the country. | |
| And what Debra and her colleagues found was that when Catholic chains merge with non-Catholic hospitals, there are often conflicts with ERDs. | |
| A particularly thorny one that kept coming up is abortion, but not in the way that people usually think of it. | |
| Dr. Debra Stulb…: | Because it’s not usually people who are coming in seeking to end their pregnancy. It’s people who are planning to continue their pregnancy and have an unexpected complication. |
| Nina Martin: | Doctors kept mentioning one type of complication in particular, when a woman’s water breaks too early for the fetus to survive, it’s often unexpected and terrifying, and if there’s an infection, it can be really dangerous. |
| In a non-Catholic hospital, a patient is given three options. | |
| One. | |
| Dr. Debra Stulb…: | They can stay pregnant with close monitoring. |
| Nina Martin: | Two. |
| Dr. Debra Stulb…: | Have the labor induced by taking medicine. |
| Nina Martin: | Or three. |
| Dr. Debra Stulb…: | She can have a procedure to expedite the end of the pregnancy. |
| Nina Martin: | These last two options, they’re abortions. |
| Dr. Debra Stulb…: | At a Catholic hospital, if the woman is completely healthy, there is no sign of infection. She will generally be told that there’s nothing that can be done. |
| Nina Martin: | As long as there’s a fetal heartbeat, the patient can either stay at the hospital and be monitored, or she can go home and wait. |
| Dr. Debra Stulb…: | And it’s indefinite. It could be hours to days, and sometimes longer. |
| Nina Martin: | Only when there’s no heartbeat or the woman shows signs of an infection are doctors at a Catholic hospital allowed to terminate. |
| Dr. Debra Stulb…: | Even when that includes someone losing their pregnancy, being in pain for hours and hours and asking, “Can’t we just get this over with?” |
| They’re told “No, you have to let nature take its course.” I mean just the ways in which this presents as mistreatment and cruelty really caught me by surprise. | |
| Nina Martin: | The first time this happened, Debra says she was shocked, but now… |
| Dr. Debra Stulb…: | I’m not surprised because I’ve seen that over and over and over in other hospitals, that we accept throwing reproductive health care under the bus. We accept that people will have to go through extra hoops. |
| Nina Martin: | Some of these hoops involve workarounds. Ways of ensuring that reproductive health care won’t be lost, and some are really complicated. |
| For example, at the hospital where Debra did her residency. | |
| Dr. Debra Stulb…: | The purported workaround for postpartum tubal ligations was to do a same-day transfer to another hospital a few miles away. |
| Nina Martin: | Oh my God. |
| Dr. Debra Stulb…: | And you can imagine that that was not really realistic for most new moms. |
| Nina Martin: | Medically speaking, the ideal time for most new moms to have a tubal ligation is right after childbirth. But at Debra’s hospital, the ideal was that the woman would be transferred to another hospital and then operated on. |
| Mixing religion and medicine, it makes the Doctor-patient relationship way more complicated | |
| Dr. Debra Stulb…: | And nowhere in the ethical framework that we’re working with in modern American health care, is it, “And what does the local bishop think about this patient’s situation?” |
| Nina Martin: | I wanted to clarify how the ERDs will be applied in Alamogordo, and that depends a lot on the local bishop. So I call the bishop who oversees Alamogordo. |
| Sharon: | Office of the bishop. This is Sharon. May I help you? |
| Nina Martin: | Sharon tells me to send an email, so I do, but I never hear back. |
| I also reach out to the U.S. Conference of Catholic Bishops. They write the ERDs. | |
| Speaker 14: | US CCB Office of Public Affairs. |
| Nina Martin: | Okay, my name is Nina Martin. I’m a reporter with the Revealed Radio… |
| I try a few times, nobody gets back to me. | |
| Finally, I find someone who is willing to talk to me at the Lepanto Institute, a Catholic watchdog, very conservative whose mission is to make sure Catholic organizations are following Catholic teachings. | |
| Michael Hichbor…: | The ERDs are very clear and the statements are very, very clear. |
| Nina Martin: | This is Michael Hichborn. He’s Lepanto’s founder and president. I ask Michael about the potential for a Catholic hospital to provide workarounds to get patients care that’s not technically allowed under the ERDs. |
| Michael calls them carve-outs and his answer is clear. | |
| Michael Hichbor…: | So when we’re talking about allowing a carve-out for a hospital to do tubal ligations or something along those lines, what you’re doing is saying, “Well, we’re not going to do that, but we’ll allow somebody else to commit this mortal sin to damn themselves and to damn their patients by performing this mortally sinful act.” |
| And by doing that, they participate in that sin. So having a carve-out is completely unethical. And again, it’s completely contrary to Catholic moral teaching. We do not provide abortion. We do not provide or promote, or refer for abortion, contraception, sterilization, that kind of thing. | |
| So there really isn’t a matter of interpretation to be discussed here. It’s really a matter of application. | |
| Emily Reimer-Ba…: | So I think I would disagree with what he said then and say that it’s not a fair characterization. |
| Nina Martin: | This is Emily Reimer-Barry. She teaches Catholic Theology and Moral Reasoning at the University of San Diego, a Catholic school. |
| She also has a book coming out titled Reproductive Justice and the Catholic Church. | |
| Emily Reimer-Ba…: | So coming to a morally correct decision in a particular case is just not that straightforward. |
| Nina Martin: | Emily says the ERDs aren’t these black and white rules. They’re more like guidelines drawn from hundreds of years of moral thought, a framework to help make really complicated decisions that involve a lot of people, hospital officials, lawyers, doctors, and bishops. |
| The problem, she says, is that the patient’s needs and voice often get lost, and some of that is because the bishops who write the ERDs aren’t doctors and they’re all men. | |
| Emily Reimer-Ba…: | It has implications for a lack of attention to women’s experiences and even sometimes lack of sensitivity or a lack of empathy with women’s suffering. |
| Nina Martin: | Emily says one of a patient’s greatest needs is for information and she thinks Catholic hospitals aren’t transparent enough about the ERDs, and how they could impact the care patients receive. She tells me she looked at Christus’s website and she could find very little on the ERDs. |
| Emily Reimer-Ba…: | So I cannot explain the decisions that have been made regarding their lack of transparency, but I can say that I think that patients are right to be concerned about that lack of information sharing. |
| Nina Martin: | Emily says transparency is especially important for patients in the post-Roe era. As reproductive care becomes more restricted in many states. |
| Emily Reimer-Ba…: | They should have as much information available to them as possible, so that they can really discern, thoughtfully, about where they should seek care. And especially when women are experiencing distressing complications, time is of the essence. |
| Nina Martin: | Calls for transparency and oversight of hospital mergers, Catholic and non-Catholic are getting louder around the country. At least 14 states have passed laws to require more oversight of hospital mergers that now includes New Mexico, where this February, lawmakers passed a bill that does some of what Amber Mayhall, the health official in Alamogordo, was pushing for. It requires the state to review any hospital merger before it can become vital, but it doesn’t require community input. And it expires next year. For Alamogordo, the bill comes too late. |
| Al Letson: | Thanks to Reveal’s Nina Martin for bringing us this story. |
| Coming up, we head across the country to a state that’s become a safe haven for abortion in the South. | |
| Victoria Cobb: | People don’t want to see a commercial that says, “Come to Virginia, visit historic Williamsburg and get your abortion while you’re here.” |
| Al Letson: | That’s next on Reveal. |
| From the Center for Investigative Reporting and PRX, this is Reveal. I’m Al Letson. | |
| Speaker 17: | [inaudible 00:32:01] |
| Al Letson: | It’s a cloudy Friday morning and our reporter Laura Morel is in Tallahassee, Florida. She’s in town to hear oral arguments in a case before the Florida Supreme Court. |
| The case revolves around whether Florida’s constitution protects the right to an abortion. | |
| Laura Morel: | Okay, I am recording. What’s your name and what org are you with? |
| Sadi Summerlin: | I am Sadi Summerlin. My organization is Pro-Choice with Heart Gulf Coast, and- |
| Al Letson: | Sadi drove more than seven hours to watch a hearing in a state where she doesn’t live, because this case has national implications. |
| Laura Morel: | And why did you decide to come from Louisiana to be here today for oral argument? |
| Sadi Summerlin: | It was really kind of a non-option for Louisianans. We have been living without body autonomy and reproductive rights now since Roe fell. And our only option for access is Florida. So Florida’s fight is our fight. |
| Al Letson: | Louisiana, Mississippi, Alabama, Tennessee and Arkansas have all banned abortion since the U.S. Supreme Court struck down Roe v. wade in 2022. |
| Georgia and South Carolina only allow abortions up to six weeks, before most women know they’re pregnant. Up until recently, Florida was a stronghold of abortion access in the South. | |
| Over the last seven years, more than 30,000 abortions were performed on patients from out of state. But in 2022, a Republican super majority passed a law banning abortions after 15 weeks. | |
| And then last year they passed a six-week ban. And Sadie says, if the Florida Supreme Court upholds this ban, women’s health across the South will be at risk. | |
| Sadi Summerlin: | It is scary to be somebody capable of becoming pregnant right now. It is terrifying. And when I say- |
| Al Letson: | Sadi’s standing with about five other activists, she’s holding a bullhorn and a sign that says “Pro-women. Pro-choice.” |
| Sadi Summerlin: | We need Florida. We need Florida. |
| Speaker 17: | If Florida falls, where would people go? |
| Sadi Summerlin: | Florida falls, Virginia, basically, they’re going to have to go up to Virginia. |
| Al Letson: | Virginia. It’s the one state in the South where abortion is still legal. Up to 26 weeks. Over the last six months, Laura’s been talking to one Florida abortion provider who’s been preparing for this very moment. Laura takes it from here. |
| Laura Morel: | It’s July 2023, two months before the hearing at Florida Supreme Court, and Kelly Flynn is preparing for abortion access to keep shrinking across the South. |
| Kelly Flynn: | All right, you got the measuring tape? |
| Laura Morel: | She’s standing in a medical plaza in Danville, Virginia checking out an office. She put an offer on site unseen and she’s trying to be inconspicuous. |
| Kelly Flynn: | Yeah, so I’m been trying to be really discreet about this because I don’t want to get any backlash before we open. |
| Laura Morel: | Kelly walks across the parking lot with a purple notepad and a Diet Coke. This is her latest venture, her next abortion clinic, and she’s got to do it quietly, because she’s worried about protests and pushback. |
| Kelly Flynn: | But yeah, we’ll take a walk around and see. |
| Laura Morel: | This used to be an OBGYN’s office, but it’s been empty for a while and it looks pretty rough. Kelly’s walking around the rooms, making notes, measuring door frames. |
| Kelly Flynn: | Oh whoa, this room, it’s orange. And brown. Or something. |
| Laura Morel: | It’s truly an awful color like pumpkin pie filling, but years expired. |
| Kelly knows she’s got a lot of work ahead of her. There’s water damage. A bunch of the cabinet doors are broken and there’s a room with stacks of documents from 2001. She keeps clicking her pen. It’s this giveaway that she’s anxious. | |
| Kelly Flynn: | I’m really excited, nervous and scared at the same time, because I never know how unpredictable these laws are going to be, but it looks like Virginia is pretty safe right now. |
| Laura Morel: | In Virginia. Democrats have been protective of abortion rights. They’re in control of the state legislature, and won’t face reelection in the Senate until 2027. |
| Kelly Flynn: | So my contractor is going to be here in just a little bit to go ahead and start the remodeling process. We plan to close on this building pretty quickly, as our patients in North Carolina need somewhere to go. |
| Laura Morel: | She owns three clinics in North Carolina and one in Florida. And ever since Roe fell, Kelly’s been shifting and pivoting like a point guard scanning the court for the next open play. |
| So, when Florida passed a 15-week ban, Kelly sent her patients to North Carolina where abortion was still legal up to 20 weeks. But then last year, North Carolina passed a 12-week ban, so Kelly sent her patients back to Florida, but now that Florida is facing a possible six-week ban, her new plan is that women can come here to this clinic in Danville, Virginia. | |
| Kelly Flynn: | I have big visions for this place. It’s going to look really pretty when we’re done, and the goal is to be open, ideally… I mean in a perfect world, I’d like end of August, but I’m thinking mid-September. |
| Laura Morel: | Kelly’s on a mission to make sure people can access abortion and it’s something she can relate to. She had two abortions during college and the second time she ended up comforting another patient because Kelly knew what to expect. She held the patient’s hand while they ate crackers in the recovery room, the clinic staff noticed and offered her a job. That was her path to becoming a provider. |
| I’ve known Kelly since 2021, when I interviewed her for a story about harassment and violence targeting abortion clinics. After that story aired, Kelly and I kept in touch mostly over the phone. I wanted to understand what the fall of Roe would mean for providers. | |
| And Kelly agreed to let me follow her. | |
| Kelly Flynn: | Just text me if you need anything. And I’m sorry about the delay in the schedule. |
| Laura Morel: | Oh, it’s fine. No worries. We’ll touch base next week. |
| One I learned about Kelly early on is that she’s really careful. | |
| Kelly Flynn: | Because I’ve got my little boy. I never know how crazy somebody can get, and how obsessive they become. So I mean, I take it very personally, and I’m careful in terms of who I choose to bring into my circle. |
| Laura Morel: | And this venture into Danville. Only a very select group of people know about it. Kelly’s worried about attracting backlash before she’s even had a chance to open, and there’s good reason to be so cautious. |
| After Tennessee banned abortion, a clinic in Bristol crossed state lines to open in Virginia, and almost immediately, it faced legal challenges and protests. | |
| Victoria Cobb: | Virginians, no matter where they stand on the value of human life, don’t want abortion to be part of the tourism offerings. |
| Laura Morel: | This is Victoria Cobb, president of the Family Foundation of Virginia, an anti-abortion group based in Richmond. Victoria doesn’t live in Bristol, but her group has organized residents there and in other cities along Virginia’s border to advocate for laws that would stop abortion providers from coming to the state. |
| Victoria Cobb: | People don’t want to see a commercial that says, “Come to Virginia, visit historic Williamsburg and get your abortion while you’re here.” |
| That’s not any community’s desire. And so that’s what these communities are trying to do, is wall off being exploited by the abortion industry. | |
| Laura Morel: | What is abortion tourism? How would you define that? |
| Victoria Cobb: | I would say it is marketing our location, our commonwealth as a place to pursue your abortion. |
| Laura Morel: | Victoria’s organization had a strategy for Bristol. They drafted a zoning ordinance that would ban future abortion clinics from operating within city limits. |
| Victoria Cobb: | Yeah, I mean it’s essentially in the same way that an ordinance would prevent a strip club from setting up next to a church or a school, for example. |
| Laura Morel: | Bristol’s ordinance hasn’t gone into effect yet. It still has to be approved by other city officials. |
| It is a particularly hard time to open an abortion clinic in the US. There’s a complicated web of local ordinances and state laws to maneuver around. And with so many states enacting all-out bans, more than 60 clinics have closed or stopped offering abortion care across the country. | |
| But that also means they’re clearing out offices, getting rid of equipment. | |
| Kelly Flynn: | I’ve got equipment in my garage that I bought from another office earlier this year, like exam tables and chairs. |
| Laura Morel: | It’s all now heading to Virginia. |
| Honestly, it’s like the floor is lava. You know that game where you jump from couch to chair across your living room? Each state that passes a ban is one less safe place for abortion providers like Kelly to stand. | |
| I don’t know. I am assuming that’s got to be a very surprising shift for you in the last few months, just realizing that, “Well, if I want to keep doing this, then I’m going to have to go to another state.” | |
| Kelly Flynn: | Right. I feel like I’m too young to retire and too stubborn to quit, and this is my life’s work. I am still in a little bit of disbelief that we are going backwards. |
| Laura Morel: | In October, I visit the Danville clinic. The sale finally happened. Kelly owns it now, and it’s looking better. The office has been gutted and cleaned. The contractor’s painting the walls a calming gray. |
| Kelly Flynn: | Is this the front? Okay. Patients will come in. So I like it because it- |
| Laura Morel: | Oh, yes. |
| Kelly Flynn: | Offers some security. |
| Laura Morel: | At this point, Kelly’s still pushing to open before Florida Supreme Court rules on the six-week ban. The ruling is supposed to come on a Thursday. |
| Kelly Flynn: | So every Thursday we wake up on pins and needles waiting on that opinion. |
| Laura Morel: | Kelly seems equal parts excited and anxious. She’s concerned that word is getting out. |
| Kelly Flynn: | So one young lady came over yesterday, next door, introduced herself, and she’s very pleasant. She was like, “Welcome, welcome. What are you guys going to be doing here?” |
| Laura Morel: | It seems like an innocuous question, but when you’re an abortion provider, you’re always on alert. Kelly says she told the woman they were opening a gynecology center. |
| Kelly Flynn: | So I didn’t want to tell her too much. |
| Laura Morel: | Months tick by. As the work continues, Halloween passes, and so does Thanksgiving and Christmas. |
| By February, 2024, Florida Supreme Court still hasn’t ruled, and Kelly’s finally ready to open. | |
| We just passed a sign that said, “Welcome to Virginia. So now we’re in Virginia.” | |
| I’m on my way to Kelly’s Clinic. A woman’s choice of Danville. | |
| Like this is probably the last state in the South where abortion access is still widely available. So a lot of Kelly’s patients will probably be taking this highway into Danville. | |
| And it’s a short drive for them. About an hour away from Kelly’s closest clinic in Greensboro, North Carolina. I get there before patients arrive. There’s no sign for the clinic, but the glass on the front door is emblazoned with a purple circle above a cross, the universal symbol for females. | |
| Kelly Flynn: | And then? |
| Laura Morel: | Inside the clinic, sunlight is pouring into the waiting room. Blue and purple clipboards are prepped with intake forms and stacked up at the front desk. |
| Dozens of swag bags are lined up, packed with maxi pads and condoms and fuzzy socks: a gift to patients from a Virginia nonprofit Kelly’s in black scrubs and a gray T-shirt that says Pro-1973 Roe on the front. | |
| Kelly Flynn: | I really like wearing this out in public, especially when people stop me and they’re like, “I love it.” |
| They whisper. “I like your T-shirt.” | |
| I’m like, “It’s okay to say it out loud.” | |
| Laura Morel: | While we talk. She’s smoothing out blankets on the recovery chairs and turning on the heating pads. |
| She starts filling up syringes with an anesthetic and labeling them. She’s very into labeling. | |
| Kelly Flynn: | You have to label everything. I mean, even I’m surprised my Diet Coke isn’t labeled. |
| Laura Morel: | The first appointment is at 9:00 AM. and the waiting room begins filling up with patients from all over the South. Georgia, South Carolina. They’re expecting someone from Nashville, which is more than a seven-hour drive from here. That patient has called the clinic multiple times, trying to figure out how to get to Danville. |
| Another woman they’re expecting first tried to go to one of Kelly’s clinics in North Carolina. | |
| Kelly Flynn: | So she went to our Charlotte office, couldn’t be seen there. She measured past 12-six. |
| Laura Morel: | 12 weeks and six days. That’s the cutoff for abortions in North Carolina. |
| Kelly’s relieved that she now has an option for patients like this one. This woman’s now in her second trimester, and this is becoming more common. Before Roe fell. Most abortions happens in the first trimester, but as access shrinks, it’s causing delays. | |
| And more women are further along in their pregnancies before they can get an appointment at a clinic. | |
| Patients keep arriving and clinic staff are busy getting them checked in. There are a few no-shows, including three minors. | |
| Kelly Flynn: | Her mom was iffy, so we think she might not be coming, but the other two, we’re a little surprised, because we confirmed. |
| Laura Morel: | And when one woman gets nervous and wants to know what to expect, the clinic manager takes her to a room to talk. |
| It feels tense, quiet, no one’s speaking to each other. And as of right now, there’s no protesters | |
| Kelly Flynn: | So far. Knock on wood, we’ve not had any opposition. |
| Laura Morel: | But that could be short-lived. Kelly heard that an anti-abortion group from another part of the state is trying to organize a protest. She’s not too worried. |
| There’s no public sidewalk in front of the clinic and the building’s on private property. | |
| Kelly Flynn: | Now listen, they can go out and stand across the street over Bojangles if they want. |
| Laura Morel: | She thinks this is the same group that got the zoning law passed in Bristol, Virginia. The group that’s accusing clinics like Kelly’s of creating abortion tourism. |
| Kelly’s hoping that the people of Danville won’t agree, and will instead see her clinic as something valuable. But it’s day one, so it’s too soon to tell. | |
| It is the end of the day. And staff tell me they’ve seen 13 patients. The woman from Nashville never showed up. They say she rescheduled for next week. | |
| Kelly seems relieved that the clinic is now open, but she knows from experience not to get too comfortable. | |
| Kelly Flynn: | This work is so unpredictable and from day to day, you don’t know what could happen in terms of regulations change, laws change, then you have to shut your clinic down in the middle of the day, because they passed a bill at a 2:00 hearing. And if I worried and worried I would be a hot mess. Not that I’m already not a hot mess, but it would just tear me up inside. And I can’t live with that kind of negative energy. |
| And this is one of the biggest lessons that I’ve learned in this work, is that you got to let the things unfold how they’re supposed to unfold. | |
| I mean, not just turn your head the other direction, but we can control what we can control. And that’s it. | |
| Laura Morel: | In her nearly 30 years in this business, Kelly’s seen it all. |
| Roe is gone now, and across the country. Access to abortion is, too, but Kelly’s pushing against that tide, she’s opened a clinic, a place for patients to be able to get health care that no longer exists in most of the South. | |
| Kelly just hopes they can get here. | |
| Al Letson: | This story was reported by Reveal’s Laura Morel. |
| The Florida Supreme Court still hasn’t ruled on the state’s six-week ban, but an amendment that would restore abortions in Florida is expected to be on the ballot in November. | |
| A lead producer for this week’s show is Ashley Cleek. Cynthia Rodriguez edited the show. Thanks to producer Alison Swaim for help on the abortion clinic story. And to reporter Justin Garcia and producers Michael Montgomery and Katharine Mieszkowski for their help with the story out of New Mexico. Nikki Frick is our fact-checker. | |
| Victoria Baranetsky is our general counsel. Our production managers are Steven Rascon and Zulema Cobb, scored and sound designed by the dynamic duo, Jay Breezy, Mr. Jim Briggs and Fernando “My Man, Yo” Arruda. | |
| Our CEO is Robert Rosenthal. Our COO is Maria Feldman. | |
| Our interim executive producers are Brett Myers and Taki Telonidis. Our theme music is by Comorado Lightning, support for Reveals, provided by the Reva and David Logan Foundation, the Ford Foundation, the John D. and Catherine T. MacArthur Foundation, the Jonathan Logan Family Foundation, the Robert Wood Johnson Foundation, the Park Foundation, and the Hellman Foundation. | |
| Reveal is a co-production of the Center for Investigative Reporting and PRX. I’m Al Letson. | |
| And remember, there is always more to the story. |