In January 2012, the U.S. Supreme Court ruled unanimously that religious institutions have a “ministerial exception” that allows them to hire and fire without being subject to anti-discrimination laws.

The decision was sweeping and applies to any worker who, in the eyes of a religious institution, is considered to be advancing its religious mission. In a case now before the Washington state Supreme Court, Franciscan Health, a subsidiary of PeaceHealth’s once-intended partner, Catholic Health Initiatives, is arguing that a security guard is a “minister” under the law.

According to Chief Justice John Roberts’ writeup of last year’s decision, an animating principle behind the First Amendment’s religious liberty clauses was “to prohibit government interference in the internal affairs of religious groups.”

The government shouldn’t interfere in how religions conduct their affairs. But the government shouldn’t fund religion either. And that’s why Washington state policy makers must stay true to the language in our Constitution that, “no public money shall….support any religious establishment.”

Because too many people were previously lax in enforcing our Constitution, Washington state now has the highest percentage of Catholic healthcare system ownership and/or control of any state in the nation. Make no mistake: These institutions answer to the Catholic bishops.

In a public meeting last year, PeaceHealth’s Sister Kathleen Pruitt said very clearly, “We will not disobey the bishop.” She was talking about Archbishop J. Peter Sartain, the cleric tasked by the Vatican with bringing Catholic nuns into line on issues like fighting contraception, same-sex marriage, and abortion under all circumstances.

Part of Sartain’s mission is to ensure that the religious institutions founded and traditionally run by nuns adhere to all of the bishops’ Ethical and Religious Directives for Catholic Health Care, which forbid, among other things, contraception, abortion under all circumstances – even when a mother’s life is at stake, any participation with Death with Dignity, and any procedure or intervention that conflicts with Catholic doctrine.

It was in this spirit that Sartain “requested” that PeaceHealth quit running lab tests for Planned Parenthood patients in Bellingham last year, a request that would have put patient lives at risk, especially in the event of an ectopic pregnancy.

As Washington’s Catholic hospital systems pass from the nuns’ control to the control of highly compensated lay professionals, they are only going to become more rigid and doctrinal. A “feisty” nun could sometimes ignore the bishop; an executive whose million-dollar paycheck depends on the local bishop’s approval will not.

In 2011, the Providence CEO who was in charge at the time the deal was struck to take over Swedish (a deal that almost certainly had to be approved by the bishop) made $6.3 million. Expanding the bishops’ sphere of control is big business.

All of this is why issues of religious interference in health care are front and center now in Washington state. We’re currently awaiting the Attorney General’s opinion on the question Kevin Ranker posed in early April.

Last week a group of advocates, led by Planned Parenthood Votes, raised concerns about UW Medicines’ “groundbreaking strategic affiliation” with PeaceHealth. And on May 31, a group of patient rights’ advocates, led by the ACLU, asked Governor Inslee to postpone all hospital mergers for six months until the broader ramifications of these issues can be fully assessed. Many people also expect at least one of these merger cases to be tested soon on Constitutional grounds.

Here on San Juan Island, it seems likely that the people who put together the hospital deal either had no idea how aggressive and assertive the Catholic bishops intended to be when it comes to enforcing their “right” to interfere, or they didn’t care.

In any event, now that we all know, it is time to insist that our state’s leaders enforce the Constitution so that patient rights and taxpayer rights are respected, and so that our scarce public resources can be applied to healthcare that operates free of religious interference.

— Editor’s note: Co-chairwoman of Washington Women for Choice, Monica Harrington is a part-time resident of San Juan Island.