Doctors' beliefs can hinder patient care

Complaint filed, but case closed
The stakes were high for Realtor Cheryl Bray when she visited a physician in Encinitas, California, two and a half years ago. Though she was there for a routine physical, the reason for the exam was anything but routine: Then a single 41-year-old, Bray had decided to adopt a baby in Mexico and needed to prove to authorities there that she was healthy. "I was under a tight deadline," Bray remembers; she had been matched with a birth mother who was less than two months from delivering. Bray had already passed a daunting number of tests — having her taxes certified, multiple background checks, home inspections by a social worker, psychological evaluations. When she showed up at the office of Fred Salley, M.D., a new doctor a friend had recommended, she was looking forward to crossing another task off her list. Instead, 10 minutes into the appointment, Dr. Salley asked, "So, your husband is in agreement with your decision to adopt?"

"I'm not married," Bray told him.

"You're not?" He calmly put down his pen. "Then I'm not comfortable continuing this exam."

Bray says she tried to reason with Dr. Salley but received only an offer for a referral at some future date. Dr. Salley disputes this, telling SELF that he offered to send Bray to another doctor in his group that day. "My decision to refer Ms. Bray was not because she was unmarried; rather, it was based on my moral belief that a child should have two parental units," he adds. "Such religious beliefs are a fundamental right guaranteed by the Constitution of the United States."

Bray sobbed in her parked car for another 45 minutes before she could collect herself for the drive home. "I had a lot of pent-up emotions," she remembers. "When you are going through an adoption, you have to prove that you are a fit parent at every stage. I really felt put through the ringer, and the doctor compounded that feeling."

Bray managed to get an appointment with another physician about a month later and was approved for the adoption two weeks before her daughter, Paolina, was born. But she remained furious enough that she filed a complaint against Dr. Salley with the Medical Board of California — and then was shocked when, in April 2006, the board closed the case without taking any action. When she complained to Dr. Salley's employer, a clinic official wrote back that "based on personally held conscience and moral principles" her doctor had been within his rights to refuse her as a patient. "Apparently," she says, "it's OK to discriminate against somebody, as long as it's for religious reasons."

Providers often prevail
It's true that several lawsuits have favored health providers who refuse services based on their principles. In a 2002 wrongful-termination case in Riverside County, California, for example, a born-again Christian nurse was fired for refusing to give out emergency contraception — but she was vindicated when the jury agreed that her rights had been violated, awarding her $19,000 in back pay and $28,000 for emotional distress. And in a recent case in San Diego, an appeals court ruled against 35-year-old Guadalupe Benitez. Hoping to start a family with her lesbian partner, Benitez received fertility treatments for nearly a year at North Coast Women's Care Medical Group in Encinitas. But when drugs and home inseminations failed, two doctors and a nurse all bowed out of doing an intrauterine insemination, saying their religion would not allow it.

Their reasoning is in dispute: Benitez has claimed both doctors told her they objected to her sexual orientation. Carlo Coppo, a lawyer for the doctors, says they refused because she was unmarried. Benitez, who went on to have three children with the help of another clinic, has appealed to the California Supreme Court and is awaiting its decision.

Her attorney, Jennifer C. Pizer of Lambda Legal in Los Angeles, says she's heard from numerous lesbians denied access to fertility treatments. "Reproductive medicine has given human beings choices that didn't exist in previous generations, but the rules about how we exercise those choices should be the same for all groups of people," she argues. Allowing doctors to refer a patient to someone else, she adds, is the equivalent of a restaurant telling a black person, "Go next door. We don't serve your kind here."

In the end, the women in all of the incidents above were able to get the treatment they wanted, even if they had to go elsewhere. So one could see doctor refusals as a mere inconvenience. "In 99.9 percent of these cases, the patients walk away with what they came for, and everyone's satisfied," Manion asserts. "I know there's the horror story of the lonely person in the middle of nowhere who meets one of my clients. But those cases are so rare." Access to reproductive health care, however, is already a challenge in some areas. "Out here, it's a very real issue," says Stacey Anderson of Planned Parenthood of Montana in Helena. "We have some really gigantic counties where if you're refused a service by a primary care physician or a gynecologist, you might have to drive two, three hours to find another."

Moreover, you don't need to be in a rural area to have limited access, points out attorney Brooks; all you need to be is poor. "Lower-income people who are refused health care are trapped," Brooks says. "They can't pay out of pocket for these services. And they may not have transportation to go elsewhere. So they really don't have options."

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