Harrison Medical Center in Bremerton and the Franciscan Health System, a Roman Catholic organization, formally joined Wednesday after the state declined to review the proposed arrangement.

The affiliation, proposed in October 2012, is the latest in a string of partnership proposals between secular and religious health-care systems. Like the others, it has prompted protests.

By declining to review the proposed partnership, the state is “abdicating its role as a watchdog for health-care transactions,” charged the ACLU (American Civil Liberties Union) of Washington.

“The proposed affiliation will have significant impacts on patient access to lawful health care and is precisely the type of transaction which should undergo government review,” the ACLU said in a statement.

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In late June, Gov. Jay Inslee directed the Department of Health to update rules for its Certificate of Need process, which governs major changes to hospitals, saying it should focus on the effects of such affiliations on patients’ access to health services, regardless of the form of the arrangement.

Tacoma-based Franciscan, like other Catholic health-care systems, typically restricts reproductive and end-of-life options in its hospitals and in those of its partners.

Harrison’s president and CEO, Scott Bosch, said Harrison negotiated an unusual arrangement with Franciscan to create a third company, “Franciscan Health Ventures,” essentially a holding company or sister corporation.

Although the hospital has agreed not to perform elective abortions or Death with Dignity (assisted dying) services — neither of which it has done in the past, Bosch said — the new arrangement will allow the hospital to continue doing tubal ligations, a sterilization procedure prohibited by Catholic ethical directives.

“We do things that Franciscan does not,” Bosch said. “We do tubal ligations, which Franciscan does not. We negotiated to continue to do the things we have always done.”

Earlier this year, Harrison officials said the medical center would remain “secular” but would be governed by the ethical standards of Catholic Health Initiatives, Franciscan’s national parent company.

Although Franciscan becomes Harrison’s corporate parent, doctors who practice at Harrison will not be restricted in their discussions with patients, Bosch said.

“They are free to discuss abortions and Death with Dignity with all of their patients,” he said, something both board members and medical staff felt strongly about. “I know people are skeptical, because in other parts of the country things are happening differently.”

Bosch said Seattle Archbishop J. Peter Sartain, whose approval is needed before Catholic hospital systems in his archdiocese affiliate with secular hospitals, has approved the arrangement.

Franciscan Health System CEO Joe Wilczek, in a statement, said the organizations share values, including long traditions of providing health care to everyone, regardless of ability to pay. Both he and Bosch said the arrangement would allow broader access to services for patients, employers and communities.

“The Franciscans were very flexible,” Bosch said. “They saw more benefits in coming together than in forcing us to give up the things we thought we need to provide to the community.”

But working out the arrangement was not simple, he added. “That’s why it’s taken us 10 months to negotiate. Harrison is — and is remaining — a private, nonprofit charitable and secular institution.”

Harrison, a regional center serving Kitsap, north Mason, Clallam and Jefferson counties, is the seventh hospital in the Franciscan system.

Carol M. Ostrom: costrom@seattletimes.com or 206-464-2249. On Twitter @costrom