The National Catholic Review

I had occasion earlier this month to spend a day with over a hundred representatives of Catholic health systems. I had been invited to give a talk to the Illinois Catholic Health Association on the topic of religious liberty. What I came away with from that meeting, however, was a heightened sense of how intricately complicated Catholic hospitals and systems have become.

Stand-alone hospitals have little chance of surviving. Thus, a huge wave of consolidation of hospitals is occuring. Reimbursement challenges, spiraling health costs and a slow economic recovery are driving this new wave of hospital consolidations. Hospital mergers and acquisitions can increase market share, cut reduplications and gain new possibilities for negotiating leverage with commercial payers. They also significantly lower medical costs. There has also been an expansion of health insurance companies into direct healthcare services. At present, some 60 percent of hospitals are non-profit, 25 percent are government owned and operated. Fifteen percent are for-profit systems (and they are growing). Today, Catholic hospitals (there are 629 Catholic hospitals and some 56 different Catholic hospital systems) represent around 12 percent of all hospitals. One in six Americans receives treatment each year in a Catholic hospital.

Some Catholic hospital systems are fairly large. The largest, Ascension Health, operates 61 acute care hospitals, 4 long term acute care facilities and 4 rehabilitation hospitals. Catholic Health East operates 35 hospitals; Catholic Health Initiatives runs 77 facilities; Providence Health operates 34 hospitals; Trinity Health has 44 and Wheaton-Franciscan Health operates 16. Catholic hospitals are generally well-placed to acquire, engage in a merger or a joint operating agreement with other, secular, not for profit systems. The Catholic church is far and away the single largest provider of not-for-profit health care in the country.

There are a number of questions about maintaining and monitoring the Catholic identity of a given hospital or system. The bishops have promulgated ethical and religious directives for Catholic Health care ( ERDS). These preclude elective abortion, in vitro fertilization, stem cell research using embryonic stem cell material and direct sterilizations. When a Catholic health system absorbs what had, previously, been a secular non-profit hospital or hospital system, it, generally, asks the newly merged hospital also to abide by rules which preclude abortion, in vitro fertilization and sterilizations. This has caused lawsuits and complaints about a Catholic acquisition of a secular, non-profit hospital, over the issue of a reduction of reproductive services for a region or rural area. There have been some horror stories of women in rural communities, undergoing a miscarriage, being denied abortions to save the life of the mother or save her womb from serious infection. In one documented case in Arizona, a woman was sent by a taxi to the nearest medical institution 90 minutes away, at risk of hemorrhaging and infection and significant emotional distress.

Many women who have had several caesarian section births opt for a tubal ligation to fend off further operations that endanger their womb and their health. These are not generally possible in a Catholic hospital or in many of the secular, non-profit, hospitals taken over by a Catholic hospital system. (An online organization closely monitor such mergers, mainly involving Catholic hospitals). The Governor of Kentucky blocked a proposed merger of a Louisville Public hospital with a Catholic system because it would limit reproductive services for the region.

Some forms of mergers or joint operations have found some solutions to the availability of various forms of reproductive care. When a secular hospital in Kingston, New York merged with a Catholic institution, in effect reducing the community's hospitals from three to two, administrators of the secular hospital set up a separate maternity unit in the parking lot. It provides a full range of reproductive services, including abortions. In Troy, New York, leaders of a newly merged Catholic-secular hospital came up with a different solution. The maternity unit operates on the second floor as an alternative "hospital within the hospital"—complete with its own financial operations. Besides direct acquisition and mergers of hospitals, some systems opt for a non-merger active parent affiliation, such as one finds between Saint Joseph's Hospital in Baltimore and the University of Maryland Medical System or between Providence Health and Swedish hospital in Seattle.

Not all the mergers have been of secular, non-profit smaller hospitals with larger Catholic systems. Thus, Caritas Christi Catholic hospital system was taken over and sold to a for-profit health system in Massachusetts, Steward Health Care. St. Joseph's hospital in Atlanta is now under the majority ownership of Emory University Health. In each case the Catholic hospitals are still bound to the ERDS. Attempts are made to have a board structure which respects the Catholic nature of the subordinate Catholic facility. Some mergers are also fought because they will represent a reduction of competition in health care in an area. Earlier this year, Catholic Health Care West severed its formal ties to the Catholic Church and renamed itself Dignity Health. It has twenty-five Catholic hospitals, still bound to the ERDS and fifteen secular, non-profit hospitals. Part of its reason for severing its ties to the church was to facilitate further mergers and acquisitions of smaller, secular, non-profit hospitals.

By and large, state law demands of non-profit hospitals that they engage in 4 to 8 percent of a case load which is charity-based or free or reduced cost care for the indigent. For-profit systems do not need to carry this burden. Non-proftis also are assumed to take into greater account the very communities they are located in and serve. But some Catholic hospitals have been taken over by for-profit systems. St. Vincent Hospital in Worcester, Massachusetts has been a for-profit hospital for fifteen years. Ascension Health has a for-profit affiliate organization, Ascension Health Care Network. Whether a for-profit structure can continue the ideals of Catholic hospitals to care for the weakest and neediest is, for me, a pressing question mark.

There is no doubt that there is also an increasingly hostile public health establishment, inimical to Catholic values concerning abortion, embryonic stem-cell research, in vitro fertilization and sterilization. According to the Kaiser Family Foundation, 46 percent of all employer sponsored health insurance firms offer abortion coverage; 87 percent cover sterilization services and 86 percent offer full contraceptive coverage. In most instances, the employee-based plans pay for services by organizing a network of preferred hospitals and physicians to whom they send their employees and families for care. To stay in business, Catholic hospitals and physicians need to be able to see patients covered by such plans, which puts an added pressure on them.

As one author, Jonathan Coh, put it in a New Republic article earlier this year, "Unholy Alliance": "For better or worse, the government depends on Catholic hospitals to provide vital services—and the hospitals depend on the government for money to provide them. Convoluted solutions may be the only way for this convoluted mix of public purpose and private institutions to survive." Whether a secular elite hostile to Catholic positions on reproduction or our bishops can find their way to creative, if "convoluted," solutions is not yet clear to me. But without expansion and further mergers, the presently healthy Catholic hospital system might find itself in jeopardy. What a loss that would be!

John A. Coleman, S.J.

Comments

John Hayes | 12/4/2012 - 10:05pm
Here is the official version (from the HHS website) for the requirements I was doing from memory. See the link for more details:


What are the rules on funding religious activity with Federal money?

The United States Supreme Court has said that faith-based organizations may not use direct government support to support "inherently religious" activities. Basically, it means you can not use any part of a direct Federal grant to fund religious worship, instruction, or proselytization. Instead, organizations may use government money only to support the non-religious social services that they provide. Therefore, faith-based organizations that receive direct governmental funds should take steps to separate, in time or location, their inherently religious activities from the government-funded services that they offer.
Such organizations should also carefully account for their use of all government money. This does not mean your organization can't have religious activities. It simply means you can't use taxpayer dollars to fund them. Some faith-based organizations set up separate charitable organizations (so-called "501(c)(3) corporations") to keep programs that receive government money separate from those that engage in inherently religious activities.

http://answers.hhs.gov/questions/3271 

Concerning religious activities, what are federally funded faith-based organizations allowed to do?

Faith-based organizations who received funding are allowed to:

    Use facilities without removing religious art, icons, scriptures or other religious symbols
    Retain religious terms in organization's name
    Select board members on a religious basis
    Include religious references in their mission statements and other governing documents
    Retain their federal exemption under Title VII of the Civil Rights Act, which allows them to hire on a religious basis, except in cases where the federal program statute forbids it
    Retain their authority over internal governance


http://answers.hhs.gov/questions/3523
Tim O'Leary | 12/4/2012 - 10:00pm
Jeanne #21
In your first paragraph you are basically warning pregnant women and the elderly to stay away from Catholic hospitals for the good of their health. In your second paragraph you call for the pope and all the bishops to resign (in capitals). And in your third paragraph, to mock their clothes and their beliefs. And you think this is objective fact-based judgment. It is laughable. It is worse than the anti-Catholic bile of any backwoods fundamentalist. Perhaps, you should just come out and say the Catholic Church should go extinct - the Final Solution of all anti-Catholicism.

You claim to have facts to indict most of the American bishops. Why not give it to the police. Or, do you think they are in on the conspiracy? If it is not sufficient to get the police interested, how is it credible?
Jeanne Linconnue | 12/4/2012 - 2:11pm
I just re-read your post, Tim. You have charged me with ''calumny''  - with lying with the intent to defame. 

I can document every single statement about the bishops and the pope that I have made. I chose to not outline my theory as to why Benedict may have acted differently in the Maciel case than in other cases precisely because I cannot document this theory. Since I cannot support it with objective data from a reliable and objective source, I chose not to say anymore. 

 I am quite willing to discuss issues with those with whom I disagree if the other party is doing so in a spirit of good will. That seems now not to be the case with you  since you choose to attack me personally without offering any documentable evidence that the information I have repeated in my posts is not true. But you can't do that, because, sadly, it is true. So you attack me instead.

Tim O'Leary | 12/4/2012 - 12:05am
Jeanne. I thought you wanted to stick to the topic of hospitals! But, you can't seem to get away from the the bishop bashing. Oh well, here goes...

Despite all the statistical data, and all the recent reports of misgovernance in the non-celibate public schools (Sandusky, Norwalk, CT, NY, LA, etc.), boy scouts, public television (BBC - Saville case, PBS - Elmo guy), you only focus on the Church. You are puzzled about Maciel? Of course! Because your calumny is wrong, and willfully so (so, check your own conscience). And, of course, like all conspiracies, you have a secret theory, just over the horizon, that will explain it all, in a new expose, a documentary, or better, a docudrama.

There is a whole industry built around anti-Catholicism. It has very little to do with actual pedophiles, because its purpose is to attack the Church as an institution, not to protect the children. It pays no attention to the efforts the Bishops have made to bring in procedures and safeguards to protect the children. There is no campaign to bring these safeguards into the secular institutions, or the movie industry. It is all about some imagined massive coverup by stone-hearted celibates.

I do not think an email exchange could shed any light, since you are so convinced of other's sins. To paraphrase your line above, why would I get closer to the truth from a stone-hearted bishop basher.
Jeanne Linconnue | 12/3/2012 - 11:11pm
The pope has a mixed record in terms of personal responsibility. He got rid of Maciel, but I'm not sure why, because that was a break from his normal pattern of how he treated abusers.  Normally he did nothing about them except ensure that all efforts were taken to contain the story and protect the church (not the kids).  I have a theory about why his handling of Maciel was the exception, but since it's pure theory, I won't discuss it in this forum.

The case when Ratzinger was bishop probably was under his rada,r as child abuse by priests was seen as primarily a problem of potential ''scandal'' and lower level staff could handle it (and cover it up). The concern was always ''scandal'' and protecting the institution (and the priest/pervets even) and never the kids. At the CDF he was actively involved in setting policy and making decisions - which consistently were to cover it up. The most egregiously immoral decision he made personally was probably his refusal to defrock the priest who abused more than 200 deaf students in a boarding school, even after repeated appeals from the man's bishop.  http://www.nytimes.com/2010/03/25/world/europe/25vatican.html?pagewanted=all 

I
 understand that this case is the subject of a new documentary. http://www.huffingtonpost.com/2012/11/16/mea-maxima-culpa-catholic-child-abuse_n_2143748.html 

He authored the letters to bishops that ordered them, for all practical purposes, to maintain silence in these cases and not contact civil authorities when learning of priests who were sexually abusing children. None of these bishops broke ranks - to this day. They ''obeyed'' a man and his ''laws'' instead of God's laws. After Ratzinger became pope he allowed Cardinal Law to continue to enjoy his luxurious lifestyle in Rome (away from US civil authorities) and did not strip him of any of his prestige or power (such as his role in choosing new bishops).  It would have sent a powerful and positive message had he sent Law to a monastary to pray, or to work in the soup kitchens of Rome, or to a mission in a poor third world country. Instead Law's lavish lifestyle was funded by Rome, which means funded by you and me.  He appointed Cardinal Levada, another big offender in terms of protecting priests instead of kids, to take his own job as head of CDF. I could go on, because there is a great deal more to indicate that Benedict was hardly ''on the side of the angels'' in this - and definitely not on the side of the kids - but perhaps you might want to educate yourself?

A full accounting of the bishops' behavior can be found at bishopaccountability.org. They have links to many court documents as well.

Cardinal George was elected to head the USCCB only about a year after he admitted failing to report another abuser (nor warn families in parishes) just a few years after the Dallas Accords when the bishops solemnly promised ''Never again.'' Well, it didn't take long for them to forget this particular solemn vow. Again, rubbing salt in the wounds and clearly signalling that their concern was for themselves, their priests, and the institution, not the kids.  None of the relatively ''innocent'' bishops has yet spoken up about any of their brother bishops - and when the only bishop to speak out in a big way, Geoffrey Robinson of Sydney, Australia, came to the US to speak about his book, the bishops of every single diocese where he was scheduled to speak banned him from all parishes and other church-related venues. Yet, Bishop Finn was accorded equal status in Baltimore last month. And even though Bishop Finn could not volunteer or work with kids in his own diocese under his own ''rules'', he remains in office as bishop. The records from Philadelphia would turn your stomach if you really care about kids and if you would have the courage to actually read them yourself. They are online, as are the documents from the trial in Boston, some of which will also turn your stomach.

I would be happy to discuss the role celibacy plays on this but not on this site. I could write pages on the subject - literally. Again, I invite you to send me an email if you wish to discuss this further. I think true celibacy is a gift to the church (the people) - but one that is found very rarely. I think it is primarily a gift found in those who seek monastic orders. Please send me an email if you wish to discuss.

Perhaps you are simply naive. If so, you can easily educate yourself.  Perhaps you have chosen not to know the real truth. There is nothing ''anti-Catholic'' or ''anti-church'' in knowing the truth. Only when you know the truth and accept it (even those truths that are absolute horrors) can you begin to honestly work to eliminate the sources of this evil.  Deciding to learn the truth is the first step and takes courage. That's another matter for your own conscience.
Jeanne Linconnue | 12/3/2012 - 12:45pm
Tim - you put words in my mouth - specifically these words: ''What a pity that you cannot even see the good the Church does in hospitals.''  Where did I say that I don't see the ''good'' the SISTERS of the church do in Catholic hospitals? The SISTERS do wonderful work, caring for all. Unfortunately the male celibate bishops who are the final word on what the sisters are allowed to do sometimes tie their hands when they are trying to save a life.

Your leap to change the subject from the bishops' and Rome's complicity in enabling sexual child abuse to ''feminist abortion providers'' is a rather transparent and sad attempt to deny the evil done by the bishops' and Ratzinger's failure to act against priests who sexually abused children. Have you ever examined your conscience on this?

I hate abortion as much as anyone. However, that is a totally separate issue from the tragic reality that those who literally claim to speak for God (how dare they!) enabled child abuse, continue to enable child abuse and are not held accountable either by themselves or by the pope. 

It would be good if you would learn not only to refrain from twisting people's words to suit your own argument but to also keep deflect discussion from the actual issues raised. 

If you wish further discussion, please send me an email.
Tim O'Leary | 12/2/2012 - 7:33pm
Jeanne #15
I don't see any post from a Bruce above, but the words I used were in your own post #4. Here again is the quote: ''some stone-hearted male celibate who has never loved either a woman as a husband or a child as the father.'' I interpreted you to be associating ''male celibate'' with ''stone-hearted'' and ''who has never loved...'' and it is hard to see otherwise. But, maybe you don't associate Jesus and St. Joseph with male celibacy.

I am not surprised that you went back to the argumentum ad pedophilium, as it seems you have indicted all bishops or at least the modern ''male celibates'' for this crime, while clearing everyone else, and most pointedly, the feminist abortion enablers, of any child abuse. Wouldn't you have seen that the Sandusky case and the Boy Scouts and the LA public schools (and this week the Elmo guy) show that celibacy has nothing to do with this?

As regards your preference for non-Catholic hospitals, well, that is your choice and 80% of hospitals will be able to accommodate you. I am sure there are many anti-Catholics who will want the same choice. But, I want there to be hospitals that are truly Catholic, and that should be my choice.
John Hayes | 12/2/2012 - 12:11pm
The Archdiocese has the right to terminate Steward's use of the Catholic identity if it determine's that Steward is not following the Directives. In that case Steward would also have to pay the $25 million, change the hospital names, etc

However, if Steward is legally required to do something that violates the Directives, it does not have to pay any money (but must change names, etc if the Archdiocese terminates).

It's a complicated issue


 
John Hayes | 12/4/2012 - 8:32pm
John Allen has this in the current NCR

"Among other things, the Vatican appeared to want Caritas, and Catholic charities generally, to have a more specifically "missionary" orientation, meaning promoting the faith alongside meeting basic humanitarian needs.
One veteran of the Catholic charities scene summed things up this way at the time in a background comment to NCR: "When it comes to charity work, there's a continuum from secular humanism on one end to aggressive proselytism breeding 'rice Christians' on the other. Nobody's saying Caritas ought to be at either extreme, but it's clear the Vatican is pushing us further in the direction of promoting the church while we provide humanitarian and emergency assistance."
In Saturday's document, Benedict XVI insisted that "The service of charity is a constitutive element of the church's mission and an indispensable expression of her very being."
 http://ncronline.org/blogs/ncr-today/new-rules-aim-beef-catholic-identity-church-charities

My sense has alway been that Catholic charities provide help to people out of the love of God and without strings attached - in other words without the old "Rescue Mission" requirement that if you are hungry you have to listen to a sermon and sing some hymns before we will give you food. 

Marvin Olasky, who advised George Bush, criticized proposals that federal "faith-based" programs exclude proselytizing as "bread-only" charity and asked why, if we value religion for ourselves we would not want to share it with poor people, for whom it would be more valuable than food. 

The compromise that has evolved over the years is that federal funds cannot be used for programs that include proselytizing or other religious activities. Groups that receive federal funds can proselytize and provide religious activities but not at the same time nor in the same space where the federally funded services are provided, and attending hose activities cannot be a condition of receiving the federally-funded services. 

It's hard to see how "promoting the faith alongside meeting basic humanitarian ways" could be reconciled with using federal funds. If this is what is intended, the "freedom of religion" argument between the USCCB and the government may go on much longer than anticipated. 
Jeanne Linconnue | 12/4/2012 - 10:47am
Tim, the issue was whether or not Catholic hospitals treat patients with more ''human dignity'' than do other hospitals. This is not something I have personally experienced. I think Catholic hospitals do a good job, as do most hospitals. For most patients, the competency of the doctors and staff take precedence over religious management.  There are exceptional circumstances where going to a Catholic hospital could mean a different ''standard'' of care (not better), which could, unfortunately, put the lives of young pregnant women at risk. Young pregnant women facing an emergency and a choice of hospitals would be well advised to go to a hospital where the staff's medical decisions cannot be overruled by a bishop if there is time to make a choice.  Similarly, those in the end stages of life who wish to leave this life in a natural way and with human dignity might be well advised to choose a non-Catholic hospital since in Catholic hospitals the staff may be forced by a bishop to ignore the dying person's stated wishes about how he or she wishes to die. Several real cases in recent years have highlighted that bishops' guidelines for Catholic hospitals sometimes show very little concern for the ''human dignity'' of the pregnant woman or of the dying person.

My last post was in response to your claims that the majority of bishops are ''innocent'' of wrongdoing in protecting pedophiles, which is factually not true. The tragedy is real - and it is not an anti-Catholic conspiracy to acknowledge its reality. It was also in response to your claim that the current pope is innocent - ''on the side of the angels'' - also factually not true. If you prefer to cling to a fantasty of a ''perfect'' Catholic hierarchy to the real world and real problems, so be it. Problems cannot be solved until they are faced.  Until the pope and members of the hierarchy ACT - demonstrate that they understand the harm they did and RESIGN, then all the words and all the paper and all the guidelines mean absolutely nothing when it come to them. The policies all impact lower level staff and volunteers - there is NOTHING in place to this very day that holds hierarchy accountable or responsible for facilitating sexual crimes against young people.  This would have been stopped at the first cases if the bishops - if not directed otherwise by Rome - had simply called the police. Instead tens of thousands became victims who might not have been victims. What good are the ''protective'' guidelines when it seems that they impact only CYO coaches and lay staff? The Finn case shows this all too clearly, as did the George case in Chicago and he was rewarded for his actions by his fellow bishops by being elected to head the USCCB.  Too many Catholics are so infatuated with their own institutional church that when those who lead these institutions do great harm to the innocent, they cling to denial rather than face the truth.  Too often people are more caught up in being Roman Catholic than in being christian.

If some prefer to ignore these things because these men wear mitres and fancy clothes and have titles and claim to speak for Christ without demonstrating that they understand the first thing about Jesus's message nor understand even basic morality, then what does it say about their ''real'' religion?  Have they set up false gods?  Are their real gods an institution and the human beings who are its executive staff?  Or do they have the courage to face the truth, and follow Jesus's example when he overturned the tables in the temples because those who were charged with keeping the temple holy had defiled it?
Tim O'Leary | 12/3/2012 - 2:19pm
Jeanne#17
As regards my conscience, let me say categorically that child abuse, of any kind (lethal or sexual) is terrible and evil and I hope I never indicated otherwise. And, anyone who enables either should be held accountable, and will be held so on Judgment Day. But, I strongly disagree with your charaterization of the involvement of Pope Benedict XVI or most of the Catholic bishops, and your denigration of their vow of celibacy every time you insult them. That is bearing false witness, in my opinion. From everything I read (barring those with an anti-catholic axe to grind), this Pope is on the side of the angels in this area.

But, you are right. These abuse topics have less to do with the actual issue raised on this post - Catholic hopsitals.
Jeanne Linconnue | 12/2/2012 - 3:53pm
Tim, like Bruce, you often put words in people's mouths.

I did not say that I don't see ''any good'' in Catholic hospitals.  However, I do not believe that the care in Catholic hospitals is innately superior (even in terms of ''preserving human dignity'') than secular hospitals. I think the SISTERS who run most Catholic hospitals do an excellent job, especially in those neighborhoods of poor people around the world whom others often do not wish to care for.

 Your charge that I am ''denigrating'' Christ is offensive.  I don't think Christ, unlike most bishops including the pope himself, would have stood by silently, moving his male disciples from town to town after he had learned that they were molesting, raping and sodomizing children. Unlike too many bishops, Christ's love for children was real. The bishops don't ''love'' children judging by their actions - to this very day (words are often meaningless and sadly, this has been the case from the bishops as a group, and from the pope). Not a single bishop who hid criminal behavior, and enabled perverted priests to prey on more victims - parish by parish - has yet held himself responsible, including Bishop Finn who is a sitting bishop even though he would not be permitted to coach a CYO team in his own diocese with his record. Nor has the pope held a single bishop acountable for enabling child abuse.  In addition, the pope has promoted a number of bishops who were among the worst offenders - some to head their own dioceses and some to important jobs in Rome. This does not demonstrate any love at all for children.  Nor do bishops who callously decree that saving the life of a mother even when her death would not save her unborn child's life is the moral decision. The disregard for a woman's life that might be saved does not show ''love'' for women, it shows a total contempt for her life. Most mothers would willingly die IF her death would mean her child would live.  But when a mother's death will NOT save the unborn child's life, only a stone-hearted male celibate would order the staff of a hospital to not take the life-saving measures (including an indirect abortion) needed to save the only life they can save.  Loving women and children has nothing to do with sex - not loving them has at least something to do with patriarchy and misogny, which is too much in evidence among some celibate clergy at all levels. NO - not all priests are patriarchal misognysts. But some are. Some bishops are. And some popes are also. Jesus was not guilty of either of these sins, so do not insult him by comparing him to those bishops who have not demonstrated any love at all for either dying women or for children who became victims of sexual predators that these men could have stopped but chose not to in order to protect their ''brother priests'' and to prevent 'scandal''. [That didn't work very well, did it? And the scandal continues.} Clericalism at its worst. Because of too many bishops' callous attitudes about saving women's lives when they can be saved and their unborn child's cannot even if the woman dies, I would say that some secular hospitals have more concern for the  innate human dignity and human worth in these tragic situations than do some bishops.
Jack Barry | 12/2/2012 - 10:00am
The sale of the six Boston archdiocesan hospitals to which John Hayes refers (#2, #7) is interesting for associating a dollar value with the continued maintenance of the hospitals' Catholic identities.  
 
If the signed contractual agreement (John Hayes #7) which requires the new owner Steward to preserve Catholic identity becomes ''materially burdensome'' to Steward or any of the hospitals, as determined solely by Steward, the obligation may be dropped with the payment of $25 million by Steward to a public charity chosen by the Archdiocese (Sect. 6.2c).   A detailed discussion of that case as seen in May 2011 could find no assurance that the hospitals would remain Catholic institutions.  The Boston Globe had reported the ''secular option'' a year earlier.   This may be an example of the ''convoluted'' solutions to which Fr. Coleman refers which may be unavoidable in view of the vigor and complexities of the hospital merger and acquisition wave in progress.  
http://www.catholicworldreport.com/Item/762/the_terms_of_the_agreement.aspx  
http://www.boston.com/business/healthcare/articles/2010/05/07/caritas_deal_has_a_secular_option/   
 
Jeanne Linconnue | 12/2/2012 - 7:58am
David - over the many years, we have had family members treated in a range of hospitals - Catholic, Seventh Day Adventist, non-sectarian, American hospitals, and overseas hospitals (France, England, China). In various encounters with hospitals, the best care family members have received (dignity as a person and medically) occurred in a French military hospital who treated a family member [who was not one of their own nationals] in an acute emergency and who was there for more than a week until permission was given to fly back to the US (immediately admitted to a new hospital), and in a non-sectarian Children's Hospital. I have never seen any difference at all in treatment in Catholic v. not-Catholic hospitals in terms of ''human dignity''.  What is 'routine'' care?  Most people are in hospitals either due to emergency or for a scheduled non-emergency (but often serious) operation or treatment.  In the case of the scheduled operation or cancer treatment or whatever, most patients choose the specialist, and go to the hospital the doctor is affiliated with. Their concern is competency not religion. My first pediatrician, a Catholic who was recommended by many Catholic friends, was a cold man, the father of seven. Personally I think he had too many kids, and treated too many kids, and really didn't like kids or their worried parents very much by the time we became patients of his practice. Cold and indifferent. My second pediatrician (I changed when my first child was 1 year old) was Jewish and he was wonderful. Our pediatrician had to ''fire'' our kids when they hit 21 (they loved him), and many of his patients returned to him with their own kids. ALL of his patients were ''people'' to him, treated with the utmost dignity, unlike the assembly-line Catholic pediatrician.  Our Jewish pediatrician once personally opened his office on Christmas Day (he had given his non-Jewish staff the day off) to see our 3 week old who was sick and having breathing problems.  When I asked him if I should call the office the next day about paying the bill, he told me ''No charge - Merry Christmas.''  We called him once on a Friday evening, when he was celebrating Shabbat with his family. He took our call personally, and was so concerned about what we said about our child's symptoms that he left and met us at the emergency room to personally oversee the situation.  Talk about treating patients with dignity, as God's children! 

The main exception to this is pregnancy/childbirth. If a family member was pregnant and experiencing a problem, it would be better for her to go to a non-Catholic hospital where the staff's hands aren't tied by the Catholic church. In a Catholic hospital these days her risk of being allowed to die when she might be saved would be all too real (cases in Arizona, Ireland just in the last couple of years underline this tragic possibility).

Perhaps you had bad luck in a non-Catholic hospital somewhere, but I personally would never choose a hospital based on its religious affiliation.
David Smith | 12/1/2012 - 7:12pm
Jeanne (#4), I'm thinking about routine care, not liver transplants and triple bypasses. The Catholic ethic comes into play decisively where the dignity of the patient as a person is concerned.  Am I a person, a child of God, or am I a body in a bed?
Names are owned.  ''St. Joseph's Hospital'' can be sold, just like ''Verizon''.
Tim O'Leary | 12/1/2012 - 3:00pm
I thank Fr. Coleman for the excellent article and the statistics that underlie the Catholic mission to the sick. The so-called reproductive “services” are a minor part of any health care system, which is focused on efficiently getting sick people back to health, caring for birthing mothers and nursing the very old or infirm on their way to the next life with full human dignity right to the very end.

While the vast majority of abortions are confined to PP-type abortuaries, the real problem facing hospitals in this time of life-extending technologies, aging populations and massive government indebtedness is the great pressure a secularist bean-counting government agency will have on speeding up the “dying process” of the elderly (as in the UK or the Netherlands, with their national health systems).

It is fine to go to the best technical hospital, secular or religious, when one is looking for a specific diagnosis or procedure. Many of us will die in a hospital and we and our families will face hard choices about technologies that might extend life, but still not be the wise and prudent thing to do. If and when I am in this situation, I want my last decisions to be made with priests, nuns and doctors dedicated to loving God and the patient and understanding the fullness of Catholic ethics, so I am not worried that I will fail my last challenge in this world.
Jeanne #4 – What an awful picture you have of the clergy “some stone-hearted male celibate who has never loved either a woman as a husband or a child.” It’s as if you think not having sex with someone prevents one from loving, or equating the absence of sex as an absence of love. You are not only denigrating priests, but also Christ (and St. Joseph) and the many celibate nuns and unmarried young medical people? What a pity that you cannot even see the good the Church does in hospitals.
John Hayes | 12/1/2012 - 2:30pm
David Smith wrote:

"When a merger occurs that effectively prevents a formerly Catholic hospital from continuing to act as a Catholic hospital, the name should probably be changed to something clearly non-religious."

Here is the agreement between Steward and Caritas Christi going into all the details of renaming the hospital and not using "Catholic" or any saint or pope's name in renaming the hospitals if it bought itself out of complying with the ERDS.

http://www.mass.gov/ago/docs/nonprofit/caritas/executed-stewardship-agreement.pdf
 
jfx gillis | 12/1/2012 - 1:51pm
John Hayes:

It's clear from Article 7 what the Pope's strategy is here:

Art. 7.§ 1. The agencies referred to in Article 1 § 1 are required to select their personnel from among persons who share, or at least respect, the Catholic identity of these works.

§ 2. To ensure an evangelical witness in the service of charity, the diocesan Bishop is to take care that those who work in the Church’s charitable apostolate, along with due professional competence, give an example of Christian life and witness to a formation of heart which testifies to a faith working through charity. To this end, he is also to provide for their theological and pastoral formation, through specific curricula agreed upon by the officers of various agencies and through suitable aids to the spiritual life.

He wants to make Catholic Charities a true extension of the Church, thereby rendering it exempt from the mandates of the ACA. One of the distinctions between "religious" and "secular" institutions is whether the employees have to be congregants (that also applies to discrimination in employment which would otherwise be illegal).
David Smith | 12/1/2012 - 7:35pm
John (#7), thanks for that document.  Impressive and reassuring.
John Hayes | 12/1/2012 - 2:47pm
Jfxgillis. could be but It probably wouldn't meet all of the US legal requirements to be exempt

It may be a continuation of last year's campaign to strengthen the "Catholic identity" of charities. You may recall that there was some uproar when the Vatican refused to give its nihil obstat for the re-election of Lesley-Anne Knight to a second term as head of Caritas Internationlis. 

"Rome’s reasons for failing to allow the re-appointment of Dr Knight as secretary general of the Rome-based Caritas Internationalis (CI) are given in a letter sent by the Vatican Secretary of State, Cardinal Tarcisio Bertone SDB, to all the world’s episcopal conferences and seen this week by The Tablet.

“During the next four years particular attention will have to be given to harmonising the theological dimension of Caritas Internationalis … with its role as an organisation operating on the international stage,” says the three-page letter, dated 15 February. It adds that the next CI secretary general will also need to improve communication with other ecclesial bodies and with the dicasteries of the Roman Curia that have an “interest” in CI activities. 

The letter, which was also sent to bishops responsible for the 165 member charities that make up the Caritas confederation, further indicates that the advocacy work that Caritas carries out must be better coordinated “in strict cooperation with the Holy See, which is specifically competent in this regard”

 http://www.thetablet.co.uk/article/15956
John Hayes | 12/1/2012 - 11:44am
Rocco reports that a Motu Proprio was issued today regarding charitable organizations: "Intima Ecclesiae Natura"

http://whispersintheloggia.blogspot.com/2012/12/de-caritate-ministranda.html

This seems to give bishops more direct control over charities operating in their dioceses. It's not clear to me, at first reading, how this relates to the current situation in the USA in which many hospitals, universities, services to the poor and homeless, etc, traditionally considered "Catholic"  are directed by lay trustees and are not controlled by the bishop.
David Smith | 12/1/2012 - 6:44am
Thanks for that outline of the situation.  Worth re-reading.

When a merger occurs that effectively prevents a formerly Catholic hospital from continuing to act as a Catholic hospital, the name should probably be changed to something clearly non-religious. The public is ill served by being led to believe that the Catholic care ethic persists where it does not.  

When people enter hospitals, they're under emotional stress. I'd think most patients might be at least a little comforted by the thought that they're going to have heart surgery at St. Joseph's Hospital, rather than at City Health Services. It seems likely that the principal reason for retaining the Catholic name after a merger would be to give prospective patients a false sense of security.
Michael Barberi | 11/30/2012 - 5:29pm
Thank you Fr. Coleman for describing a potential problem for non-profit Catholic hospitals.

You make a great point about the prevalence of coverage for abortion, in vitro fertilization, sterilization and contraceptive services among employer-sponsored health plans. Usually, a hospital becomes part of a "preferred network of providers" when they accept the reimbursement scheme as well as other requirements of the administering health insurance organization. Nevertheless, such requirements do not usually include the provision to cover the services offered under the health plans that participate in the preferred network. Sometimes sponsoring employers highlight the fact in employee benefit communications that certain services are not offered by participating Catholic hospitals. This often discourages potential patient-employees from selecting the Catholic hospital because of the fear that a service may not be provided in an emergency...for example, an event where the termination of the pregnancy was necessasry to save the life of the mother. 

Sterilizations, in vitro fertilizations and contraceptive services are mostly elected procedures. Hence, those individuals that want these services have time to research and select a non-Catholic participating hospital who perform these services. 

Based on 30+ years of healthcare experience as an SVP of a major healthcare organization and as a senior partner in a world-wide healthcare consulting firm, the non-provision of certain healthcare services by participating Catholic hospitals has never been a major problem for employers or participating hospitals.

IMO, the public awareness of the decision by the Bishop of Phoenix in the St. Joseph Hospital case was more damaging to Catholic hospitals (at least in the West). Despite the moral analysis of Therese Lysaught of Marquette University to Catholic Healthcare West (and sent to the bishop) that concluded the procedure was "indirect abortion", sighted the supporting opinons from prominent theologians Germain Grisez and Martin Rhonheimer. Nevertheless, the bishop condemned the termination of the pregnancy as direct abortion. In this case, the fetus could not survive in or outside the womb of the mother under any circumstances, was under the immmediate threat of death (as was the mother), yet the Church by its decision would have preferred that two people die, rather than one. 

As Fr. Coleman pointed out, there are many horror stories associated with other cases where the procedure being requested was refused by the Caholic hospital and the patient was sent to another hospital despite an unstable and dangerous condition. However, as serious and alarming as these cases are, they have been around for a long time. Fr. Coleman rightly points out that more competition, lower reimbursement rates, mergers with secular for-profit hospitals, and other pressures have now become very serious for Catholic hospitals.

A greater challenge to Catholic hospitals is the contraceptive mandate in the Affordable Care Act. This problem will only be resolved by the Supreme Court. If Catholic hospitals loss this fight, then they will face a much more dramatic financial and moral crisis. 
Jeanne Linconnue | 12/1/2012 - 11:11am
David Smith, Catholics don't own names like St. Joseph's.  A ''Catholic ethic'' of care is seldom in question when someone is being treated for disease or emergency trauma. If the best care for heart surgery is at City Health Services, most people will go there (if they have the choice under their health insurance), whether or not they find the religion of the hospital management ''comforting.''  We live near a Catholic hospital and would go there in certain cases because it is close to home. But every year we fly to another city for regular visits for a complicated health situation faced by a family member because that's where the ''best''  is for this family member's medical problem - it's not a Catholic hospital but we feel a far greater sense of ''security'' going there rather than to the nearby Catholic hospital that lacks staff with the same level of expertise.  

Some might feel very insecure and rightfully concerned about who is running a hospital and what a bishop has 'obligated'' them to if a there is an emergency during a pregnancy - will the mother's life be saved if a termination is required to do so? Or will some stone-hearted male celibate who has never loved either a woman as a husband or a child as the father decree that she must die, even though it won't save the unborn life.  At the end of life, there may be other concerns  - will a patient's wishes to be spared mechanical interventions that simply delay the natural course of death be honored? Or will some bishop decree that the body must be kept going artificially for years and years? I would not have a sense of security at all if I went to a Catholic hospital under certain circumstances.  I would feel far safer in the hands of the equally competent medical staff at the non-denominational hospital across town.
John Hayes | 11/30/2012 - 9:20pm
Caritas Christi Catholic hospital system was taken over and sold to a for-profit health system in Massachusetts, Steward Health Care. St. Joseph's hospital in Atlanta is now under the majority ownership of Emory University Health. In each case the Catholic hospitals are still bound to the ERDS

My recollection is that the Caritas Christi agreement provides that Steward can drop the ERDS compliance by making an additional payment to the Archdiocese of Boston. A figure of $20 million or $25 million sticks in my my mind. 

Steward was set up by a venture capital firm to buy Caritas Christi as the starting point for building a larger health care system which it will guide to profitabilty and then probably sell off. The ability to escape the ERDS may be important in getting the highest price for it. 

Steward has already added several other hospitals to the group