It was a chilly winter day in January. Hannah Oltman had just finished touring potential colleges with a friend in snow-covered Chicago when she felt a sharp, stabbing pain in her abdomen. Within minutes she crumpled to the floor in overwhelming pain.

After 20 minutes of unrelenting pain, Oltman’s friend called an ambulance and was transported to the nearest hospital where she was admitted to Holy Cross — a Catholic-based hospital in Chicago.

The 17-year-old appeared to have an ovarian cyst — a fluid-filled sac resting on the surface of her ovary.

Oltman endured invasive questions about her sex life and informed her care team that she was on birth control. They ran nearly 20 pregnancy tests — each one came back negative.

A typical course of treatment for an ovarian cyst that is causing pain is surgery. However, Oltman’s care team, which included a Catholic priest, did not want to operate because the cyst lay directly on Oltman’s ovary and they couldn’t rule out pregnancy with 100% certainty — despite 19 negative pregnancy tests and three ultrasounds.

Hannah Oltman.

Oltman said she was told, “We’re not allowed to give this care. It’s against our laws.”

After 18 hours of staff members contemplating and praying over the right course of action, Oltman was sent home.

A week later, in her home state of North Carolina, the pain returned. Oltman’s parents rushed her to the emergency room and she was taken into emergency surgery. The cyst had ruptured, causing damage to the ovary and after four hours of surgery, the ovary had to be removed.

Catholic-affiliated health care in the U.S. has been steadily rising over the past two decades, posing a threat to patients such as Oltman, who unknowingly seek care at a Catholic hospital and are met with religious restrictions affecting treatment options.

The Catholic Church controls nearly 16% of all short-term acute care hospitals in the United States — each one adhering to Ethical and Religious Directives authored by the United States Conference of Catholic Bishops. These directives deem certain medical procedures and vital reproductive health care as “immoral” — including access to contraception, abortion, sterilization, tubal-related procedures and gender-reassignment surgeries.

How did we get here?

Father Scott Jakubowski, associate pastor at St. Vincent de Paul Parish in Los Angeles, said Catholic health care began as a way to give back to the community by serving the poor.

Charity Hospital, the first Catholic hospital built in the U.S., was founded in 1727 by French sailor Jean Louis who left a large sum of money in his will to create a hospital in New Orleans, Louisiana, to serve the poor and indigenous.

Throughout the next two hundred years, at least one Catholic hospital was established in every major city in the United States.

In 1914, Catholic health ministry leaders united to respond to the technological advancements in health care created in response to World War I. A year later, the Catholic Health Association of the United States (CHA) was founded to ensure their Catholic mission and identity would remain in the evolving healthcare world.

Today, CHA is the largest group of nonprofit healthcare providers in the U.S. — controlling more than 600 hospitals and 1,600 healthcare facilities in all 50 states.

For some, the growth of Catholic-affiliated hospitals is a win. For others, such as Oltman, it directly affects their ability to receive care in their community.

The scope of the problem

Alaska, Iowa, South Dakota, Wisconsin and Washington are dominated by Catholic health care, with 40% or more hospital beds controlled by the Catholic church. In five states, it’s 30% or more. And, in 21 other states, one-fifth of hospital beds reside in Catholic hospitals — leaving vulnerable populations at a higher risk of not accessing vital health care.

Much of the rise in Catholic health care can be attributed to hospital mergers and acquisitions — the combining of two or more hospitals or healthcare companies to operate under one system.

The expansion of Catholic health care in the form of mergers and acquisitions is made possible by the nearly $48 billion Catholic hospitals and systems receive each year — a 76% increase since 2011.

“Catholic healthcare systems are very well funded,” Shannon Russell, Director of Policy at Catholics for Choice, said. “They have the power to grow and multiply.”

Russell explained this power is dangerous because the expansion of Catholic health care means they have the ability to take over an entire community.

In Oltman’s case, the ambulance followed protocol — take the patient to the nearest hospital.

Oltman, who is Jewish, said she “didn’t even know” the hospital was Catholic. She thought the name was strange but there were no signs or evidence that the hospital could not offer reproductive care. And, after realizing the problem involved Oltman’s reproductive organs, she said her providers were “tiptoeing around” that they couldn’t provide her the care she needed.

“It was really, really painful,” she said.

Russell said Catholic health care is “particularly insidious” because its hospitals do not make it known what care they will and will not provide. She explained they attempt to reach vulnerable populations with their mission of serving the poor without stating which services are not included.

“These injustices are being done in the name of faith,” Russell said. “And that’s unacceptable.”

A group that the Catholic church historically discriminates against is the LGBQT+ community.

Ann Sanders, the liaison to healthcare ministry for the Archdiocese of Los Angeles — which oversees 11 Catholic hospitals in L.A., said, “anyone that needs medical care will be given medical care, regardless of how they identify themselves.”

When asked if gender-affirming care is included, Sanders said that is “not something that the Catholic church could participate in.”

One of the three pillars of Catholics for Choice is education. Russell and her dedicated team of faith-driven advocates believe there needs to be more transparency from Catholic hospitals, so patients are aware of the ethical and religious restrictions in place before they end up in a situation similar to Oltman’s 18-hour debacle.

“This is a problem that impacts everyone,” Russell said. “And people should know about it.”

How the Catholic faith is interpreted and practiced varies from person to person. Some Catholic healthcare providers are motivated by their faith to not provide abortion, gender-affirming care and end-of-life care because it goes against their moral code. Others feel called by their devotion to provide the most vulnerable populations with access to those services.

Russell said she is driven by her faith to help the LGBQT+ community and people seeking reproductive care. “The Catholic hospitals were founded on the idea that we should help the poor and the marginalized among us,” she said. “But that’s not happening if you’re only giving selective types of care.”

Father Jakubowski visits Catholic hospitals in the L.A. area at least once a week to offer patients nearing the end of their life communion, prayers or spiritual guidance. He wished there was more of an emphasis on God’s love within the hospital system rather than politics.

Sanders, who has 40 years of experience as a faith-based practitioner, believes she is “extending the healing of Jesus” and that includes ensuring life is respected from conception to natural death.

Four years ago, Oltman was denied reproductive care at a Catholic hospital and lost an ovary a week later during an emergency procedure. Today, Oltman is working on finishing her undergraduate degree at the University of California in Los Angeles. She is looking forward to graduating and beginning her career. At 22, starting a family is not something that she was previously concerned about — but now it is.

In a recent visit with her healthcare provider, Oltman’s doctor explained that she can function with only one ovary and even become pregnant, but it’s not an ideal circumstance and her chances are lower. Oltman is contemplating freezing her eggs to increase her odds of becoming a mother one day — something she would like to be but on her own timeline.

“Overall,” she said. “Medical professionals should be setting healthcare standards – not religion.”