Utah's Mark Shurtleff is one of 13 attorneys general urging the Department of Health and Human Services to withdraw a rule issued Thursday that reinforces protections for health care workers who cite religious or moral objections in refusing to participate in abortions and other procedures.
The attorneys general warn the federal regulation would have "significant, adverse consequences" on care provided to patients and rape victims, and on states' efforts to ensure equal access to medically necessary services.
Critics say the regulation's protections for health care workers are so broad they limit a patient's right to get care and accurate information. For example, they fear it could make it possible for a pharmacy clerk to refuse to sell birth control pills or AIDS medication and face no ramifications from an employer.
But the rule's potential impact on Utah patients and providers is unclear. A spokesman for University of Utah Hospital anticipates no changes, since he said it already respects providers' individual beliefs and has a large enough staff to accommodate patients' needs.
MountainStar Chief Medical Office Scott D. Williams said, "It applies to situations that very seldom arise in our hospitals, and for which we already have patient rights and staff rights policies." But during the next 30 days -- before the regulation takes effect -- Williams said he would review existing policies to make sure they are consistent.
Daron Cowley, a spokesman for Intermountain Healthcare, and Reid Barker, executive director of the Utah Pharmacists Association, agreed it's unlikely the regulation would have a major impact in the state.
"A pharmacist doesn't have to fill any prescription that comes in the door although it's very rare for refusals to take place," he said. He acknowledged he does know of Utah pharmacists who do not offer emergency contraception.
Under long-standing federal law, institutions may not discriminate against individuals who refuse to perform abortions or provide a referral for one. The new rule is intended to ensure that providers who violate those laws don't receive federal funds, officials said.
"Doctors and other health care providers should not be forced to choose between good professional standing and violating their conscience," said HHS Secretary Mike Leavitt.
The rule requires recipients of federal funding to certify their compliance with laws protecting conscience rights. The administration argued the rule was needed "to raise awareness of federal conscience protections and provide for their enforcement."
But the attorneys general said in their Sept. 24 letter that it "completely obliterates the rights of patients to legal and medically necessary health care services" and "unconscionably favors one set of interests, upsetting the carefully crafted balance that many states have sought to achieve."
And many groups describe the rule as a last-minute push to make it harder for women to obtain services such as contraception, or for pregnant women to learn all options.
"This is a very politically driven thing that the department has done when there is no need for the regulation," said Melissa Bird, executive director of Utah's Planned Parenthood Action Council.
Nan Streeter, director of the state's Maternal and Child Health Bureau, is concerned patients won't get all the information they need.
"Health care providers should at least discuss all options that an individual may have for whatever they've come in for," she said. "It doesn't mean they have to do it or they have to support it."
Jay Jacobson, chief of the Division of Medical Ethics and Humanities at LDS Hospital and the University of Utah's School of Medicine, said the rule could restrict access to a host of reproductive services, including vasectomies and infertility treatments. Providers could even object to nonreproductive procedures, such as surgeries and transplants.
He is concerned about rural residents who have limited access to care and patients who need help in emergencies.
Several medical associations were among the more than 200,000 who wrote to the department to protest the rule after it was proposed. The Utah Medical Association had not analyzed the rule and couldn't predict its impact.
Executive director Val Bateman said the group supports the rights of providers to follow their conscience. "There are plenty of providers throughout the state that seem to be able to meet the need of any patients," he said.
Abortion opponents hailed the rule, saying a lack of regulation had resulted in confusion and little awareness. Paul Ray, a Utah representative who would like to forbid abortions except in the cases of rape, incest, grave fetal defect or serious risk to the mother's life, liked what he heard of the federal rule.
"Why should you be forced to do something you have a moral objection to?" said the Clearfield Republican. "It goes back to your right, you have the right to choose."
Several lawmakers have promised to take up legislation that would overturn the rule once Congress reconvenes in January. Another option is for the Obama administration to issue new regulations that would trump it.
The administration estimated the cost of complying with the rule at $43.6 million annually, which is spread throughout the hundreds of thousands of health providers subject to the rule -- from hospitals and physician offices to medical schools and pharmacies.
Making birth control more -- not less -- accessible is the best way to prevent unintended pregnancies and reduce abortion," said Nita Lowey, D-N.Y.
"In just a matter of months, the Bush administration has undone three decades of federal protections for both medical professionals and their patients, replaced them with a policy that seriously risks the health of millions of women, then tried to pass it off as benevolent," added Nancy Northup, president of the Center for Reproductive Rights.
The Associated Press contributed to this story.