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Medical trainees and graduate students at the University of Washington say they worry that a deal with a Catholic health-care system could create gaps in medical training and limit research and patient care because of faith-based restrictions.

The University of Washington has said its medical practices would not be affected by an agreement linking taxpayer-supported UW Medicine with PeaceHealth, a Clark County-based Catholic health-care system operating nine hospitals and physician groups throughout the Northwest.

In May 2013, the two systems described their intent to develop a “formal affiliation,” but the 12-page final document, signed in September, describes the arrangement as a “health system collaboration agreement.”

Now, a group of UW doctors in training, nine graduate-student organizations and the Graduate and Professional Student Senate, in two letters and a resolution, are asking UW leaders and administrators for more details about the agreement.

In addition, they want a comprehensive statement of the UW’s policies on reproductive health, end-of-life care and nondiscrimination in care and employment.

The UW will become the primary referral center for PeaceHealth patients needing complex care, and UW medical residents will rotate through PeaceHealth clinics, particularly in more rural areas, as they have in the past.

In their June 24 letter to UW leaders, the doctors in training acknowledged that expanding training sites was a critical need for the UW medical school, which they called a “state of the art hospital system and training institution.”

“However, we are concerned that PeaceHealth’s involvement in WWAMI (the UW’s five-state training area) programs and activities will limit teaching and provision of comprehensive reproductive health care, including contraception services, abortion care, pregnancy options counseling and end-of-life care, including Death with Dignity discussions and options,” they wrote.

Dr. Ying Zhang, a fellow in the UW Family Medicine program, is a leader of the medical trainees’ group that includes residents from Family Medicine, OB/GYN, Internal Medicine and Pediatrics, as well as fellows from Adolescent Medicine.

Zhang said the UW’s arrangement with PeaceHealth and the potential for expansion of training at PeaceHealth sites has spurred concern among her colleagues that their training there, as well as at other Catholic-affiliated clinics and hospitals, could be constrained by Catholic directives.

In the last few years, the region has undergone a flurry of affiliations between Catholic health-care systems and secular hospitals and clinics.

Tina Mankowski, UW spokeswoman, said the UW plans to provide more information to the trainees about religious affiliations of rotation sites.

The training programs are the UW’s, not PeaceHealth’s, she said, and if residents or other trainees don’t get training they need at one rotation site, UW program leaders will work to ensure they get the training or experience elsewhere in the program.

“We’re one of the finest medical schools in the country,” Mankowski said. “Our goal is to make sure we have the best-prepared physicians.”

She said the UW is considering formulating a statement of UW policies in the areas of concern.

In a separate letter, nine graduate-student organizations, which represent about 1,300 students of medicine, nursing, pharmacy, law, social work, public health and other related disciplines, said they have “deep concern” about the UW-PeaceHealth arrangement.

“PeaceHealth says that it follows the Religious and Ethical Directives for Catholic Health Care (ERDs), which is a 43-page set of rules that all PeaceHealth employees, including physicians and nurses, must follow,” the graduate students said in their letter.

“Because of this, we believe it’s important that the UW be very clear about how the Directives might influence or affect any research, medical training/rotations, and/or joint clinical or joint marketing programs with PeaceHealth.”

The ethical directives prohibit direct sterilizations, promotion of contraceptive practices, prenatal diagnosis when the intention is to abort an unborn child with a serious defect, condoning or participating in physician-assistance in death for the terminally ill, and other procedures and treatments that conflict with Catholic moral principles. The directives also bar research using embryonic stem cells.

“These issues are important not just to UW students but to patients and physicians,” said Robert Franceschini, president of the local chapter of Law Students for Reproductive Justice, one of the organizations signing the letter.

The medical trainees’ group has asked for written confirmation that trainees and providers won’t have to follow the Catholic directives at UW-affiliated hospitals and clinics. They also seek clarity about any restrictions during rotations at religiously affiliated sites.

“It’s not clear to all trainees what happens when we go off-site,” Zhang said.

Zhang said the residents and fellows want to make sure they are able to provide “the best care we can to all the patients we see, not discriminating on sexual orientation or their choices in health care, and making sure we practice evidence-based medicine,” which she said is not always reflected in the religious directives.

In the agreement with the UW, PeaceHealth said the alliance will not change its ethics policies and standards.

Although PeaceHealth providers do not perform elective abortions or “facilitate physician-assisted suicide,” those procedures are seldom done in hospitals and that stand does not affect training, said Tim Strickland, spokesman for PeaceHealth.

“PeaceHealth prides itself on evidence-based medicine, and clinical rounds at PeaceHealth produce well-prepared physicians,” Strickland said. “Medical students on rotation at PeaceHealth hospitals will receive exposure to a full range of medical services appropriate to the rotation.”

Regarding their training in contraceptive methods or discussions with patients, he would say only: “When it comes to contraception, we support the patient-physician relationship and are confident that our physicians are making the best decisions in conjunction with their patients.”

The groups’ letters and resolution were sent to Johnese Spisso, UW Medicine’s chief health-system officer; Stephen Zieniewicz, UW Medical Center’s executive director; Dr. Paul Ramsey, CEO of UW Medicine and dean of the University of Washington School of Medicine; and other top administrators, including UW President Michael Young.

UW Medicine includes the University of Washington and Harborview medical centers, Northwest Hospital & Medical Center, Valley Medical Center and multiple clinics.

The resolution approved by the graduate student senate, which represents some 60,000 graduate and professional students, noted that affiliations between public-university teaching hospitals and faith-based medical providers are “nearly unprecedented” and future impacts are therefore “unpredictable.”

The student senate complained that UW’s information about the arrangement with PeaceHealth isn’t easily accessed because it is contained in “multiple and disjointed online and offline sources,” and is difficult to understand as a “complete and coherent statement of values.”

The resolution urges the UW to consolidate all information about the affiliation in one location “so that the public may clearly understand the nature of the affiliation between the two organizations.”

It also directs the student senate president to monitor UW Medicine policy and advocate for medical and other clinical students as needed.

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