Bigger did not seem better to many Santa Feans when confronted in 2008 by a merger and expansion impacting the city’s only hospital.

In April, St. Vincent Regional Medical Center signed a partnership agreement with CHRISTUS Health, a Catholic-hospital chain based in Texas.

In some ways the merger reflected a larger pattern of corporatization of health care. It also allowed the hospital to wipe out millions of dollars of debt and expand its regional coverage.

Perhaps most significantly, the merger raised red flags for doctors, patients and civil rights advocates. Groups like NARAL Pro-Choice New Mexico and the American Civil Liberties Union expressed concern that the region’s only major hospital could leave some women without access to vital reproductive services because doctors working for CHRISTUS are bound by the Catholic company’s Ethical and Religious Directives (rules that prevent Catholic hospitals from providing services of which the church doesn’t approve).

Then, as now, CHRISTUS maintained that all services would remain available.

In fact, state law requires that New Mexico doctors offer family-planning counseling and birth control, emergency contraception be offered in hospital emergency rooms and hospitals comply with patients’ advance directives and do-not-resuscitate orders.

“The misconception is that family planning occurs in hospitals and it doesn’t,” Arturo Delgado, manager of communications and public relations for what is now called CHRISTUS St. Vincent Regional Medical Center, says. “That generally happens with your doctor in a different kind of setting,” he explains, adding that family doctors at clinics on the hospital campus have continued to provide family-planning services.

Services that are not required by state law and are forbidden by the Ethical and Religious Directives, such as vasectomies and tubal ligations, are still provided, he says, under a separate nonprofit entity called SupportCo.

“If someone wants a voluntary sterilization, then it still happens, just not in the hospital. It can be done at Physicians Plaza, which is still on our campus,” Delgado says. (The hospital also continues to provide tubal ligations to women immediately after they give birth, he says.) “All the services we provided truly are continuing as they always have been,” he insists. “We’re branded with the CHRISTUS name, but there still is a certain amount of independence we have that’s different from the rest of the hospitals [in the network].”

But not everyone is satisfied. “There are still enormous questions about what SupportCo is covering, who pays for it and whether that process is seamless for patients,” Jane Wishner, executive director of Southwest Women’s Law Center, says. “Do they have protocols in place to ensure there are no gaps in coverage?”

St. Vincent was founded in 1865 by the Sisters of Charity and is the state’s oldest hospital.

Throughout the year, there also were tensions between the hospital and Santa Fe County officials.

The Board of County Commissioners requested hospital board meetings be opened to the public because the hospital receives public funds.

Santa Fe County Commission candidate Liz Stefanics made the merger a campaign issue. Stefanics, a former Democratic state senator who is now director of the New Mexico Health Policy Commission, won the seat and continues to follow the merger closely.

Some concerns about the availability of services could be put to rest if the state Legislature passes the Freedom of Choice Act, which is expected to be introduced again when the session convenes in January. With more progressive Democrats at the Roundhouse and a strong supporter in Gov.-in-waiting Diane Denish, that just might happen.

In the meantime, "I'm hoping that CHRISTUS will make good on all its promises," Heather Brewer, executive director of NARAL Pro-Choice New Mexico, says. "But we do have to be very vigilant because it really is the sole provider of a lot of services and a lot of care for northern New Mexico.