Saturday, April 9, 2011

Putting Women at Risk: The Rise of Catholic-Secular Hospital Mergers

When two hospitals in Sierra Vista, Arizona attempted a trial merger a group of community activists, including doctors and retirees, became alarmed at what the merger would mean for the quality of reproductive health care at the newly merged hospital.  The Cochise Citizens for Patients' Rights (CCPR) decided to fight the merger.  The two hospitals, the Sierra Vista Regional Health Center and the Catholic Carondolet Health Network, would become a singular institution that would be controlled by the the Ethical and Religious Directives for Catholic Health Care Services

CCPR activists organized rallies alerting the public and the media to the situation.  Eventually, the Arizona Attorney General began investigating “…after the National Women's Law Center filed a complaint alleging that the Board violated its duty to the community when it entered into a deal that eliminated access to certain services”.

Religion & Ethics Newsweekly and PBS correspondent Lucky Severson stated, “[w]hat the merger means is that Sierra Vista, a rural, secular hospital, must now abide by the Catholic ethical and religious directives which prohibit certain procedures.  So physicians can no longer do abortions, even when the mother’s life is in danger, and they can no longer perform sterilizations or provide contraception.” 

Dotti Wellman a spokesperson for CCPR explained that the county “…has one of the highest teen pregnancy rates in the country, not just the county.  Immediately when this arrangement went in there would be no talk of birth control.  If we had two hospitals, we would not be here, because there would be a choice.” 

Dr. Bruce Silva, an ob-gyn at Sierra Vista, expressed concern regarding who would have the ultimate authority to make medical decisions for his patients.  Dr. Silva said that “[t]he person who makes that decision is not me and the woman.  We can make that decision, but then it has to be okay’d by someone else who puts their belief systems and their ethics on me and on my patients, which I just don’t think is right.”

A few days after PBS aired its Religion & Ethics Newsweekly report on the public outcry, the merger was cancelled.  After concerns were raised by many about the impact of the merger on reproductive health care, Sierra Vista Regional Health Center decided to end the trial merger with the Catholic hospital system.  The National Partnership for Women & Families reported that the president and CEO of Sierra Vista Regional Health Center said:

…the directives were one reason the hospital called off the merger.  ‘We couldn't make that work’…adding that the hospital was unable to obtain approval from the local bishop to allow it to continue to provide sterilization and reproductive health services.

The National Women’s Law Center declared, “[w]e hope that other nonsectarian hospitals will take notice of this coordinated grassroots organizing, media, and legal effort, and think twice before entering into partnerships that harm women’s health.” 

On January 20th the National Women’s Law Center issued two reports revealing “…that certain religiously affiliated hospitals put women’s health and lives at risk by restricting doctors’ ability to provide the best medical care to pregnant women experiencing miscarriages and ectopic pregnancies.” 

The National Women’s Law Center filed a complaint with the U.S. Department of Health and Human Services urging them to remind all health care providers that they must abide by all Medicare Conditions of Participation (CoPs), and “…require hospitals to institute policies and procedures to protect patients’ legally enforceable rights; to investigate the failure of hospitals to provide standard of care and informed consent, and to take corrective action to prevent further violations.”

Catholic hospitals make up approximately 15 percent of U.S. hospital beds.  Earlier this year St. Joseph’s Hospital and Medical Center in Phoenix lost its certification from the Roman Catholic diocese because the hospital performed a life saving abortion on a mother of four. 

The situation at St. Joseph’s involved a 27 year old woman that was 11 weeks pregnant.  She needed an emergency abortion and she agreed to the procedure.  However, St. Joseph’s was then “…a Roman Catholic institution governed by the Ethical and Religious Directives for Catholic Health Care Services, a series of doctrine-based rules imposed by the U.S. Conference of Catholic Bishops.”  The directives specifically prohibit abortions in all cases – regardless of whether the mother’s life is in danger.    Sister Margaret McBride, the hospital’s administrator, was excommunicated for approving the abortion decision that “…was made after consultation with the patient, her family, her physicians, and in consultation with the Ethics Committee.”  Sister McBride was also demoted.  Bishop Thomas J. Olmsted of Phoenix told her that she had created a “scandal” later informing the hospital that it was no longer a “Catholic institution.”  However, St. Joseph’s is standing by its decision. 

Another aspect to consider is the fact that Catholic hospital systems “…receive generous public subsidies and in some parts of the country may be the only medical option for residents, yet they impose a strict interpretation of Catholic dogma on all patients – Catholic and non-Catholic.”

Reproductive health services for women are not the only health care services put at risk in these hospital mergers.  End-of-life care, vasectomies, and services for infertile couples are also jeopardized.  Significantly, if these hospitals are the only option available to a low-income woman who has been raped, she may not even be provided with the “morning after” pill to prevent a pregnancy.  And make no mistake, within the Catholic hospital system it is the church bishops that have the final say on medical care – not the doctors and not the hospital staff. 

In the 1990s and 2000s after a rash of hospital mergers occurred nationwide, a New York City based organization called the MergerWatch Project developed an advocacy program to help local grassroots activists and coalitions challenge these mergers.  The MergerWatch Project was founded in 1996 after a merger between a religious and secular hospital in Troy, NY led to the loss of all contraceptive services that the secular hospital once provided at an outpatient clinic.  MergerWatch helped the CCPR activists organize in Sierra Vista, Arizona as well. 

Some of the threats to health care and patient rights they have identified include:

·         Pharmacists may refuse to fill prescriptions for contraceptives and other medicines they view as morally unacceptable.
·         Hospitals may ban treatment that conflicts with religious doctrine.
·         Employers and managed care plans may refuse to provide health insurance coverage for contraception, sterilization, or abortion.
·         Physicians may refuse to provide fertility services to families they find morally unacceptable.
·         Politicians responding to religious conservatives may enact laws that make it difficult for patients to refuse end-of-life treatment.

MergerWatch’s 2002 report titled, Public Funding of Religiously-Sponsored Hospitals in the United States, explained that because of the increase in mergers across the country “…many managed care plans are restricting patients’ choices of which local hospitals they may use, leaving them fewer options of where to receive care.  As a result, more and more patients are finding that the only available hospital is one owned by or affiliated with a religious denomination that restricts access to health services.” 

Is it “…appropriate for a hospital that is licensed to serve the general public and receives public funding to be allowed to use religious teaching to restrict the health care it provides to a diverse community?  What are the rights of patients and caregivers in such a situation, and how might they be protected?” 

Religious hospitals receive Medicare, Medicaid, and other government funds for about 50% of their operating revenues as well as many other benefits from their tax-exempt status. 

MergerWatch summed up the problem as the following:

Sectarian hospitals are able to receive public funding while using religious doctrine to guide health care because of a combination of: 1) a lack of explicit standards for protecting patients’ rights and 2) the proliferation of special government exemptions, known as “refusal clauses,” which permit hospitals to refuse to provide services that violate religious teachings.  In essence, the public dollars going to religiously-sponsored hospitals arrive with few or no policy “strings” attached.

And as mergers have increased and religiously affiliated hospitals are now serving more and more communities some hospitals founded by Presbyterians, Episcopalians, Lutherans, and Jews have become non-sectarian with respect to health care delivery services.  However, the Catholic hospital system, Seventh Day Adventist, and some Baptists organizations are still being guided by their strict religious doctrine when determining the parameters of health care delivery services. 

As the National Women’s Law Center report illustrates, the exemptions that federal and state governments have provided to religious hospitals has put women’s health and their very lives at risk. 

The Religious Coalition for Reproductive Choice has also issued a report identifying the health risks that women face as more and more secular and religious hospitals merge as a cost-saving measure.  The Religious Coalition for Reproductive Choice’s report states, “[i]n more than 34 states, mergers of religious and community hospitals have curtailed or eliminated comprehensive reproductive health care services, including abortion services.  ‘Merger mania’ has created a hidden crisis in reproductive health care.”  And “[o]f 589 Catholic hospital emergency rooms surveyed by Catholics for a Free Choice, 82 percent deny emergency contraception to rape victims—and of those, almost one third refuse to provide a referral.”  

When reproductive health care is threatened by mergers vulnerable, low-income women, generally in rural areas, bear the greatest and most disproportionate burden.  The Religious Coalition for Reproductive Choice has noted the following facts:

  • As a result of mergers since 1990, the sole hospital in 91 counties is operating under Roman Catholic health care directives.  In 95 percent of those counties, only a minority of the population is Roman Catholic.
  • From 1997 to 1998, the number of Catholicoperated hospitals grew by 11% while the number of secular facilities declined by 2.1%.  
  • Of the 127 mergers between Catholic and nonCatholic hospitals from 1990 to 1998, Catholics for a Free Choice estimates that half resulted in the elimination of all or some reproductive health services. 
And then there’s the House GOP’s recent attack on women’s health care with the introduction of H.R.358, the so-called “Protect Life Act.”  H.R.358 would allow, among other things, health care facilities the freedom to refuse a woman an emergency abortion or referral services for an emergency abortion even if doing so would end that woman’s life.  H.R.358 would eliminate the federal Emergency Medical Treatment and Active Labor Act (EMTALA) requirement specifically and solely for abortion services. 

EMTALA was enacted in 1986 and requires health care facilities that receive Medicare or Medicaid to “…treat, stabilize, or, if needed, transfer patients for appropriate care."  A hospital receiving Medicare or Medicaid could quite literally let a woman die if she needed an emergency abortion and still not lose its federal funding.

MergerWatch stated that hospitals are “…licensed to serve the public, and should be expected to do so in a way that meets accepted medical standards of care.”

Learn more about the National Women’s Law Center’s efforts to draw attention to this issue.  Share your story if you have been denied care or treatment for pregnancy complications and take the pledge to educate yourself and others about this risk and help put an end to dangerous practices affecting women’s health care. 

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