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Washington hospital districts that receive tax funding and provide maternity services or information to women must also provide equivalent services or information about contraceptives and abortion, state Attorney General Bob Ferguson said in a legal opinion released Wednesday.

The opinion was requested in April by state Sen. Kevin Ranker, D-Orcas Island. An affiliation between a San Juan Island hospital district and a Catholic health-care system, PeaceHealth, stirred opposition in his district.

Wary of religious restrictions on patient options, critics cited a wave of mergers and proposed partnerships between smaller hospitals, including some in taxpayer-supported public hospital districts, with Roman Catholic hospital systems.

“I think it is a powerful and broad-reaching opinion,” Ranker said. “It’s what I was hoping for when I posed the question to the attorney general, and I think it clarifies that women’s reproductive rights need to be and are protected under the law in a public hospital district.”

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It’s unclear how Ferguson’s opinion, which does not have the force of law, might affect services at Roman Catholic system-affiliated hospitals. And, to make matters more complicated, not all of Washington’s hospital districts provide maternity services.

Greg Reed, CEO of United General in Sedro-Woolley, said the hospital supported by taxpayers there, which merged with PeaceHealth in January, has never provided maternity services. “So it’s not an issue with us,” he said.

But Reed said he expected questions will continue to surface as market forces and regulations drive consolidations. “What happens when you have dominant players that are faith-based? This is happening all over the country.”

On San Juan Island, the new Peace Island Medical Center is run by PeaceHealth with hospital-district funds. PeaceHealth says the hospital does not provide maternity services, but island residents said the hospital contracts with an Anacortes doctor for some types of women’s services.

Even if a hospital outsources maternity services or information, Ferguson said in the opinion, the district must provide “substantially equivalent” benefits for other reproductive choices.

In some instances, religious-based systems prohibit physicians in affiliated hospitals not only from providing services, but also from supplying patients with referrals or information.

PeaceHealth officials, who were in a lengthy administrative meeting Wednesday, said they had not had time yet to read the opinion.

In the formal opinion, Ferguson analyzed and quoted the laws created as part of Initiative 120, adopted in 1991, which state that every individual has the “fundamental right” to choose or refuse birth control or abortion.

Mary Kay Barbieri, who heads People for Healthcare Freedom in Skagit County, said: “This is a great victory for those of us who are working to maintain reproductive rights in the face of public-hospital affiliations with religious health-care entities.”

Others said that while they welcomed the opinion, there was more to be done.

“This is just the beginning of a longer-term battle to ensure patient rights and taxpayer rights are protected in the face of religious extremism,” said Monica Harrington, a San Juan Island resident and critic of the arrangement there.

The opinion is “an important step forward,” said Shankar Narayan of the American Civil Liberties Union of Washington State. But, he added, state officials must take a broad look at such mergers and their effects on patients’ access to legal services.

“This is an issue that is urgent, it’s huge, and it requires a statewide solution that looks at Washingtonians’ health care more generally,” Shankar said. “We’re not just talking about reproductive services, but end-of-life care and LGBT services. We’re long overdue for a comprehensive look at that.”

Carol M. Ostrom: 206-464-2249 or

On Twitter: @costrom

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