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Religiously Affiliated Hospital Mergers
Religiously Affiliated Hospital Mergers
By Lisa Brown
With the latest trend of religiously affiliated hospital mergers, particularly Catholic hospitals, a female tax-payers right to the full range of health care is becoming incidental. In many cases, when two hospitals merge, womens reproductive rights become a bargaining tool. Often, a Catholic hospital will pull out of a merger if its stated religious needs are not met. If a secular hospital is in economic jeopardy and needs the merger in order to survive, its policy makers might sacrifice womens health care and succumb to the demands of the Catholic hospitals.
While the problem of religiously influenced health care is not solely a result of Catholic institutions, the Catholic health-care system has grown larger over the past eight or so years and Catholic control over health care has reached an all time high. According to Catholics for a Free Choice, in 1990 there was one Catholic/non-Catholic merger. In 1991 there were none. There were two in 1992 and zero in 1993. However, in 1994 there were 19 mergers and affiliations, and in 1995 and 1996 there were a total of 48 mergers and affiliations. And, the number of mergers each year keeps rising. Of the mergers in 1996 and 1997, all or some of the reproductive health services were discontinued in 48 percent of the hospitals.
As a rule, Catholic hospitals must adhere to guidelines which are dictated by the National Council of Catholic Bishops, called The Religious and Ethical Directives for Catholic Heath Care Services. If a Catholic hospital diverges from these guidelines, the Catholic Church can deny support. The Directives prohibit abortions, tubal ligations, vasectomies, in vitro fertilization, and contraceptive devices and drugs. While emergency contraception is technically permitted for sexual assault victims with a negative pregnancy test, in practice, this is often denied to women. Any time a woman enters a Catholic Hospital her reproductive rights are restricted in varying degrees by these regulations. Sometimes the effects of a merger are not even made clear to the community. In addition, many HMOs are affiliated with one specific hospital. If that hospital is Catholic then the patients (whether Catholic or not) will not receive comprehensive health care. If a woman needs reproductive health care (even such standard services as family planning) she must go elsewhere and pay out-of-pocket. This cost would be difficult for anyone and particularly devastating for any low-income woman.
The Catholic Hospital Directives not only have a disabling effect on womens health care but they also can have a tremendous impact on doctors who are committed to providing their patients with a full range of health care services. In Manchester, New Hampshire, Dr. Wayne Goldner is an OB-GYN at Optima Healthcare, the parent company that was created as a result of the 1994 merger between Elliot Hospital and Catholic Medical Center (CMC). Goldner was assured by his administrators that when Elliot Hospital merged with the Catholic institution its policy on abortion and other reproductive services would remain unchanged, in a sort of dont ask, dont tell policy. However, in November 1996 the integrity of Elliot Hospital and all of its pro-choice medical care givers was compromised when a receptionist at the hospital leaked information to the media and an anti-choice group that an abortion was scheduled to take place. Representatives of the CMC claim they did not know abortions were being performed at Elliot and would not have merged with Elliot had they known. Doctors at Elliot say they openly performed abortions and upheld a womans right to choose. In an effort to appease both sides of the community, Optima came up with the following policy: All patients...shall have no restrictions placed on them based upon religious belief...All employees and all professionals...shall have no restrictions placed on them based upon religious belief. However, it is agreed that: The directly intended termination of pregnancy before viability or the directly intended termination of a viable fetus is never permitted.
This policy has obvious conflicts within it. If biased, religious medical care will not be tolerated, then why are abortion and abortion related services denied for women? Goldner suggests the message this sends to employees is that if doctors and pro-choice care givers do not fight the no abortion policy, then Optima will not impose its religious beliefs in any other case. But this policy does not address the increasingly complicated issues of the morning-after pill, the abortion rights of rape victims, birth control failure, or tubal ligation. Kathleen (not her real name), a patient of Dr. Goldners, could not get an emergency abortion because of the Directives. When her water broke at 14 weeks and Goldner decided that she needed an abortion to save her life, Optima Healthcare would not allow him to perform it and threatened him with suspension if he did. As a result, Kathleen, who does not have a car, was forced to ride 80 miles in a taxi to Dartmouth-Hitchcock Medical Center in Hanover for the procedure. Goldner said of the incident, I feel that it is deplorable that due to Catholic Church doctrine, a poor woman of very limited means is being forced to travel to an unfamiliar environment to have a procedure that is readily available from her trusted personal physician.
Doctors, community members, and local activists have been at the head of the fight against the Optima merger. In a letter to the president of the Medical Staff at Optima, Seymour Romney, an MD on the Board of Directors at Physicians for Reproductive Choice and Health insists, Medical decisions must be made by the physicians and their patients together. Each decision must be made for the best interest of the individual patient given his/her individual circumstances. Romney points out that the implication that administrators should decide a patients care, rather than the patient and her personal doctor is not only irresponsible, but immoral and dangerous. This could begin a trend towards health care that is increasingly governed by administrators rather than doctors.
Goldner has suffered for his stubborn refusal to have his practice be governed by religion. His house has been picketed, his teaching position lost, and, most recently, his daughters school received a bomb threat. Standing up for his right to practice and for the reproductive rights of the women in his community, has been a nightmare. To be an activist is to be alone, he says of his experiences in fighting the merger. He has been disappointed with how little support he has received from fellow doctors, although recently 200 doctors at the hospital voted that the church should not dictate their right to practice medicine. Hate mail and phone calls barrage his home every time he makes a public stand. But Goldner says that he knows what he is doing is right. His wife and kids have been extremely supportive. When asked why he sees no compromise in Optimas future, Goldner responds, There is no such thing as a merger with a Catholic institution. Their guidelines say they must dictate.
Manchester, New Hampshire is just one example of a community fighting a Catholic hospital merger but history is being made at other locations in the country. The two most recently terminated negotiations happened this July within two weeks of each other. In Miami, a potential merger was terminated after nearly two years of negotiations because activists and medical providers would not allow their medical rights to be compromised. In upstate New York, a three-way merger was also ended by community activists. Hopefully, the women and men of Manchester can look on these triumphs as hope for their own cause. Z
Lisa Brown is an intern for the Abortion Access Project of Massachusetts.