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As the battle for which private hospital can call upcounty its home picks up speed, some critics say Holy Cross Hospital, governed by Catholic religious doctrine, provides less health care coverage than any other hospital in the area and should not be allowed to expand.

But Holy Cross counters that many of the services it is morally prohibited from providing are not usually performed in a hospital anyway and that its charity work more than makes up for the few services it cannot offer.

All Catholic medical institutions are governed by a set of ethical and religious rules decided by the Vatican in Rome. The directives follow the moral guidelines of the Catholic faith, which require an utmost respect for human life in any form, according to the official Web site for the United States Conference of Catholic Bishops.

For example, Catholic hospitals do not provide abortions, even in cases of incest or rape; they do not provide any form of contraceptives, except in cases of rape where the victim does not test pregnant; they do not provide sterilization; and they do not provide most infertility treatments. They also cannot provide some end-of-life choices, such as euthanasia. The patient's decision-maker should be "faithful to Catholic moral principles," according to the directives.

But to others, the directives read as a limited, often discriminatory, denial of essential reproductive and overall health care rights.

"How can you provide a range of services for men if you don't provide a range of services for women?" said Montgomery County National Organization of Women member Lynette Long at a meeting last week with  Holy Cross doctors and officials in Wheaton to discuss what services the Germantown hospital would provide. Many at the meeting were critical of the hospital's religious practices.

"The Holy Cross proposal would significantly undermine the public-health priorities of Montgomery County and the state of Maryland," stated a Sept. 14 letter to the Maryland Health Care Commission from a variety of women and health care groups. "Indigent citizens, whose care is reimbursed by state funds, would also be subject to these restrictions on their access to health care services and information."

The letter argued Holy Cross Hospital's limited practices handicap the state's goals of preventing unintended pregnancies and the spread of AIDS.

The discussion about what Holy Cross can and can not do for its patients has heated up this month as the state's commission reviews a proposal for Holy Cross, which announced in August 2008 a plan to build a 93-bed hospital on Montgomery College's campus in Germantown, and another proposal for Adventist HealthCare, which announced in April a plan to build a 100-bed hospital on part of a health care campus in Clarksburg. It is unlikely the commission will approve both hospitals, and it has not yet set a date for when it will make a decision.

"If they're taking up space and representing a hospital, they should [offer full health care services]," said MCNOW member Carole Rayburn, who was concerned that Holy Cross does not provide vasectomies or tubal ligations for family planning. "Otherwise, they should get out of the way."

But Holy Cross provides excellent women's and overall health care to all of its patients, said Dr. Ann Burke, who is Holy Cross's medical director of obstetrics and gynecology, at the meeting.

"Holy Cross supports families of all definitions," she said of accusations the hospital doesn't respect gay or lesbian partners.

Burke, who is not Catholic, said she had concerns before joining Holy Cross that the hospital would limit her ability to treat patients. But she has everything she needs to do her job at Holy Cross, she said, and the hospital doesn't insert itself in confidential talks with patients.

Besides, many of the procedures prohibited by the Catholic health care doctrine are not usually performed in hospitals, she said. Most are done within the context of specialized clinics or primary-care physicians.

And there are many other places in the community for residents to get those few services that Holy Cross doesn't offer, said Yolanda Gaskins, spokeswoman for Holy Cross Hospital.

"Their arguments center around the few services we don't provide as opposed to all the services we do provide to keep a community healthy," Gaskins said.

But that doesn't change the fact that a woman in desperate need of emergency contraception or an abortion might lose precious time visiting Holy Cross first, said a member of MCNOW and Upcounty Action, a civic advocacy group in the county that opposes the Holy Cross expansion, who declined to give her name for the story.

"People often don't know when services are banned until they need them," she said.

Burke responded that Holy Cross has actually increased access to health care in the county with the opening of a new primary-care clinic for the uninsured in Gaithersburg last year, and a new one is set to open next year in Wheaton. Holy Cross, which provides charity work for the uninsured as part of its mission statement, already runs one in Silver Spring that treats about 9,000 patients a year.

Adventist HealthCare also runs a primary-care clinic for the uninsured in Shady Grove Adventist Hospital's Germantown emergency center. The clinic now has a pre- and post-natal department for uninsured patients that provides family planning, according to Washington Adventist Hospital's spokeswoman Lydia Parris.

Adventist HealthCare is owned by the Seventh Day Adventist Church, which has no religious policies governing health care. Adventist hospitals perform abortions and provide a full range of reproductive care, Parris said.

"We understand that these are decisions made between a woman and her physician, and we do not interfere with that individual decision," she said.

Parris said Adventist HealthCare is staying out of the church-and-state fight of Holy Cross's religious doctrine but that her organization opposes Holy Cross's plans for Germantown because it's poor planning and too close to Shady Grove's emergency department.

But there is a need for a full-service hospital in the upcounty area, and Holy Cross can provide just that, Gaskins said. More than 700 women now travel from upcounty to the Holy Cross Hospital in Silver Spring for maternity care, Gaskins said.

Correction: Sharon Dooley was incorrectly quoted in place of an anonymous source in the story. While Dooley is a member of MCNOW and Upcounty Action, she was not present at the meeting with Holy Cross officials.