Seething Battle Continues Over Catholic Takeover of Hospitals in Denver


Backroom deals, multiple lawsuits and $600 million dollars
mark the Sisters of Charity attempt to force religious medical directives on
non-sectarian medical centers in Colorado.

A controversial move to transfer operational control of three
secular Denver-area hospitals to a Catholic healthcare system expected to take
place on December 31 appears to be on hold pending federal approval.

The unexpected delay by the Federal Trade Commission to
bless the transaction may provide local critics with a last gasp effort to
continue fighting the deal. Community members and medical professionals contend
the transfer would unfairly subject comprehensive reproductive health and
end-of-life care to church doctrine over patients’ needs. The Catholic church
considers abortion, contraception, elective sterilization and termination of
invasive life support as "intrinsically evil" and refuses to provide
these medical services or respect patients’ advance directives.

The disputed takeover in Denver exemplifies the very serious
implications for the 127 non-denominational hospitals that succumbed to merger
fever with cash-flush Catholic health care systems in the 1990s. According to a
study by Catholics
for Choice
, half of merged secular-Catholic hospitals suspended most
or all of their reproductive health care services. Eighty-two percent denied
emergency contraception to rape victims — and more than a third refused to
provide a referral.

But for some tax-exempt, nonprofit hospitals co-owned by
secular and church interests, there was little more than a wink and a nod to
church mandates on care. Comprehensive reproductive healthcare services quietly
remained available.

These practices received higher scrutiny in 2001
when the U.S. Conference of Catholic Bishops revised its Ethical and Religious
Directives for medical care to address "misinterpretation and
misapplication of the principle of cooperation with other-than-Catholic
organizations." In other words, the church would no longer turn a blind
eye to reproductive health and end-of-life care at its secular partner
facilities that did not meet strict Catholic orthodoxy.

MergerWatch.org notes several examples
of broken promises by Catholic healthcare systems to preserve reproductive
health services at non-religious hospitals it acquired through mergers. Typical
reasons included newly installed diocesan bishops with more dogmatic views on
medical directives or the Vatican overturning decisions made by previously
autonomous bishops.

More importantly, the local hospital policymaking was a
little noticed precursor to the bare knuckles strategy on recent display with
the church’s relentless lobbying for the 2009 Stupak
and Nelson amendments
to further restrict access to abortion care via
publicly-subsidized health insurance plans. At the same time, the Catholic
Archdiocese of Washington, D.C., threatened
to end social service programs
for tens of thousands of poor residents if
the city council approved a same-sex marriage ordinance.

Now, the Denver hospital takeover is offering a glimpse of
the intense pressure being brought to bear by the church on its healthcare
partners. The Vatican’s renewed insistence on complete doctrinal influence on
patient care is bolstered by very real threats to hold desperately needed
institutional capital funds hostage until its theological demands are met.

And that once delicate balance between serving patient needs
and adhering to strict Catholic medical directives is unraveling in plain
sight.

Another Example of Follow
the Money

Exempla Lutheran in Wheat Ridge, Colo., and Exempla Good
Samaritan Medical Centers in nearby Lafayette have been sponsored by the
Community First Foundation, the former fundraising arm of Lutheran Medical
Center, and the Kansas-based Sisters of Charity of Leavenworth in a complex
joint partnership since 1997. The two organizations formed the non-sectarian
Exempla Healthcare System to manage the hospital operations of the medical centers
founded from the ashes of two former Lutheran facilities and St. Joseph
Hospital, a 130-year-old institution in the city of Denver, which is wholly
owned by the Sisters of Charity.

With the three Denver hospitals in need of major
infrastructure investments to keep pace in a highly competitive health care
market, the Sisters of Charity began flexing their muscle by demanding complete
say in day-to-day operations. The Catholic health system complained to the Kansas
Business Journal
that without administrative control it could not borrow money
needed for capital improvements.

Namely, that would mean the ouster of Exempla and its
non-sectarian medical policies.

Not surprisingly, the ultimatum raised the hackles of
community members, patients and healthcare professionals at the Exempla-run
hospitals. The initial offer sought to buyout Community First’s co-membership
in Exempla for $311 million with the Sisters of Charity committing an
additional $300 million in capital improvements to the hospitals – a deal the
charitable foundation readily agreed to as a way to plump up its sagging
recession-battered assets and its growing distaste for the healthcare business.

The Community and Politicians
Fight to Protect Women’s Healthcare

The Exempla board and a citizen group filed lawsuits in 2008
to block the sale citing, in part, concerns that non-sectarian medical policies
would end under a Roman Catholic healthcare system. Community members formed
Save Lutheran Medical Center and produced a petition signed by more than 9,000
local residents to reject the deal.

But it was all for naught.

Two years of lawsuits resulted in a June 5 binding
arbitration agreement that nullified the cash payment to Community First as a
violation of state law since the community, not the foundation, owns the assets
of the tax-exempt, nonprofit hospitals.

But in a blow to reproductive health advocates, Arbitrator
William Meyer determined that the takeover could still occur as long as nothing
of value exchanged hands between the foundation and the Sisters of Charity. He
also disregarded the religious medical directive argument claiming that the
founding documents of the two Lutheran hospitals didn’t require them to remain
secular.

While the cases played out in court and behind closed doors
in the private arbitration hearing, Colorado state lawmakers worked to minimize
the damage of losing hospital-based reproductive healthcare services.

Issues of religious doctrinal interference in
physician-patient decision making came to a head in 2007 when Gov.
Bill Ritter signed a law
requiring hospitals and pharmacies to provide
sexual assault victims information about emergency contraception. However, a
conscience clause was added to the bill in order to get conservative Democrats
on board after heavy lobbying by the Colorado Conference of Bishops.

Likewise, during the 2009 legislative session, the state
passed a landmark Birth
Control Protection Act
to legally define contraceptive treatments,
procedures and devices to stem future challenges to health insurance benefits
or from "personhood" laws devised to give fertilized eggs civil right
protections.

Though, again, the Catholic church forced a compromise to
exclude mifespristone, or RU-486, and other federally approved pharmaceuticals
that induce abortion.

Yet, despite the efforts of pro-choice lawmakers there are
no safeguards in place to mandate other hospital-based reproductive health
services, like sterilization or abortion, or in end-of-life care procedures
that require the removal of feeding tubes or ventilators at tax-exempt,
nonprofit facilities.

An 11th-Hour Reprieve
Wrapped Up in Red Tape

Since the summer arbitration ruling, Community First and the
Sisters of Charity have forged a new deal that keeps the foundation on as a
co-partner but exempts it from any fiscal responsibility for the mounting $2.1
billion in capital needs at the three hospitals. The duo will then transfer
control of Exempla to the Sisters of Charity, putting it in complete charge of
the hospitals’ administration.

Critics of the latest deal pinned their hopes on a 2008
state law that requires the state attorney general to review nonprofit hospital
transactions that could substantially change hospital services the public has
come to expect. Despite that law, Colorado Attorney General John Suthers, an
anti-choice Republican, said in November there was no need to hold a hearing on
the Sisters of Charity deal because it was now merely a change in bylaws and
not a merger.

Meanwhile, the two partners continue to finalize the phasing
out of Exempla’s independence. A new board of directors, comprised of an equal
number of appointees by Community First and the Sisters of Charity, was
announced December 13.

The last remaining obstacle to the church’s imposition of
religious directives on care is the Federal Trade Commission which must approve
the deal.

A decision was expected by year-end but has not yet
been made public. An FTC spokesperson could not be reached for comment about
the delay.

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To schedule an interview with contact director of communications Rachel Perrone at rachel@rhrealitycheck.org.

  • waterjoe

    You completely ignored the religious liberty question and the fact that no hospital can provide every service. Why should someone other than the owners/operators decide what should be offered?

  • crowepps

    It’s true that no hospital can provide every service but a hospital which can provide a service (like tubal ligation or turning off a no-longer desired respirator) and yet refuses to do so on the grounds that the administration has a superior ‘religious liberty’ and the right to impose its religious tenets of those who do not share them ignores the fact that religious liberty is reciprocal.  One cannot argue religious freedom for oneself and simultaneously deny it to others.  The policies do not just refuse to offer services, they also refuse to STOP services even when the patient has clearly indicated in advance a point at which he/she no longer wishes them to be provided.

     

    I’m sure this ability to highjack the patient’s body (and wallet) and continue to bill for services that are not wanted is great for the bottom line, as is the insistence that women cannot be allowed to prevent pregnancy and so must continue to pay for the delivery of infants they don’t want, but arguing that doing so is based in ‘religious liberty’ of the most conservative members of the governing board of the institution seems pretty thin, particularly when their peculiar views are inflicted on non-Catholics.

  • elm

    It is a shame that one child has to die so we can live as we want.

    “Backroom deals, multiple lawsuits and $600 million dollars”

    That sounds a lot like Congress right now.

    Your rights stop where mine begin. I have a right to practice my faith, you have the right to not visit my services. (at the moment)

  • prochoiceferret

    It is a shame that one child has to die so we can live as we want.

    Yeah, the Iraqi War is a bitch, isn’t it?

    Your rights stop where mine begin. I have a right to practice my faith, you have the right to not visit my services. (at the moment)

    Just like women have the right not to continue being pregnant, and to have access to the full range of reproductive services—and you have the right not to avail yourself of same.

  • wendy-norris

    Your rights stop where mine begin. I have a right to practice my faith,
    you have the right to not visit my services. (at the moment)

     

    Hospital care is dictated by one’s health insurance plan and physician’s admitting privileges. Patients have very little say in what facility they will be treated in or admitted to unless they’re willing to assume the total cost of care — a burden few people can shoulder.

  • wendy-norris

    If the Sisters of Charity want to limit certain services performed at their hospitals that violate the church’s theological stance, it’s fairly easily solved by rescinding their tax-exempt, not-for-profit status and assuming the rights and responsibilities of the private health care industry.

     

    Otherwise, they are in violation of the law and spirit of charitable care and the financial advantages the hospital system derives at the community’s behest to provide services without regard to patients’ personal circumstances.

     

    Too many nonprofit organizations, especially those with religious origins, disregard their charitable, serve-all-comer obligations by discriminating against certain classes of patients or failing to provide the care they need. Invoking a conscience clause should be a one-way ticket to losing one’s tax exempt status.

  • wildthing

    Public money shouldn’t be used for any medical facility that limited legal medical procedures. No financial support of any kind.

  • faultroy

    But I’m really confused by a number of things not clearly indicated by this article/blog. 1) How many non secular hospitals are there in the greater Denver area? 2)Does the fact that the Sisters of Charity are non profit have anything to do with being able to run these hospitals in a more efficient and therefore more profitable manner? (3) According to the above article, (according to Catholics for Choice), in half of the secular mergers, they suspended some of all of their reproductive services…that means that half didn’t!! Why didn’t they all and what specifically does "half or all" mean? What did they cut and what did they leave? Don’t you think that is important???? (4)It sounds pretty obvious from reading this article that the former owners did not do a very good job or running a hospital since they had run up hundreds of millions of dollars of "infrastructure costs upgrades" why? what happened? (5) When a company buys another out, this is what usually happens. I don’t get what the problem is? Why should this be any different? It’s a company just like any other. Just because of the fact that it is a non profit does not have any effect on the fact that once they fork over the money, they have a right to run it in any way they choose–isn’t that correct?   I’m not trying to debate this, I’m really not sure if I am seeing it correctly or if there is something I am missing

  • faultroy

    Hi Wendy: I think I understand the way you feel about this, but are you saying that you think it illegal or are you saying this is how they should pursue it.  I’m not sure what non profit has to do with it. I mean RHReality Check.org also obtains government funding  and no one would say they are "impartial,", and so do many churches–kind of like the Rev. Jeremiah Wright Church that President Obama worked at as a community organizer.  And of course there are thousands of other programs that benefit the poor including Catholic Charities that get government contracts etc.  Would you feel the same if in doing this to the Sisters of Charity– in order to be fair– we stop all subsidies to non profits that seek to help the poor and just let federal, state and local government pick up the tab?

       We could do this, but it would probably cost the government at least double.  Note that we have many secular organizations that derive almost all their income from government contracts like Planned Parenthood, and other Abortion providers.  I really think that the Sisters of Charity would welcome a decision like you are suggesting.  It would eliminate all public support of abortions.  Isn’t that what Prolife organizations want?  Not to be argumentative but it sounds like you’ve given this some thought and I would like to hear your ideas.

  • faultroy

     Well, that is true–kind of–it all depends on the plan…well actually no, that is not true.   For example, most plans have contracts with large hospital networks or HMOs.  If however there were a reason that one of the networks did not offer services that you needed, that insurance company would have to provide that service in some way.  For example I’ve known a number of people that have gone out of state with their maladies–most specifically to the Mayo Clinic in MN for consults and work done.  Furthermore if you were insured and covered for an Abortion, and your Hospital Network was with a hospital that did not do this service, they must send you to a hospital that does–so I don’t get your point–can you elaborate?  And Wendy, you know that every insurance company that supplies emergency insurance coverage (and I don’t know of any that don’t) will pay for all services needed at any hospital in state, out of state or out of country.   And as far as a physician’s admitting privileges, if you don’t like the hospital your doctor wants to send you to, get another doctor!  Or ask him to give you to an associate that has privileges at a hospital that you like.  I’ve never heard of a plan that could not accomodate someone in some way.  So what are you talking about?  Keep in mind that when you obtain medical insurance, you do so with the company–it’s not your job to figure out how they are going to regotiate with a hospital for better pricing etc.  And many savvy insured are now doing their own research to find hospitals within their networks that specialize in certain procedures–such as heart operations etc.  So educate us and show us examples of situations in which your above comments would apply?

     

  • crowepps

    I live in a small town – here there is ONE hospital.  Using an alternate hospital would mean traveling 150 miles to the closest larger city where there is a choice of TWO hospitals, one of them Catholic.  Part of the problem may be the distribution of hospitals.

    In 2002, there were 4,835 short-term general hospitals in the United States. Nearly half of all U.S. counties (49%) had only 1 short-term general hospital, approximately 20% had 2 or 3, and close to 10% had 4 or more. The frequency distribution indicates that a very small percentage of counties had more than 8 short-term general hospitals. About 22% of all counties in the United States did not have a short-term general hospital.

    http://www.cdc.gov/dhdsp/library/stroke_atlas/section_five.htm

    To recap these stats:

    49% of the counties in the United have only one hospital (and an additional 22% have no hospital at all) – that means residents of almost half of the counties in the United States would have no access to sterlilization or other basic reproductive health care if their hospital policies were set by Catholic bishops.

  • faultroy

      This is an excellent point crowepps and thanks for bringing it up.  But let me ask you:  You mention that you may have to drive 150 miles to a larger city to obtain alternatives.  That is perfectly valid, but we are talking about apples and oranges aren’t we?  I mean you bring up the fact that there is only one hospital in the area because of population density.  But what are we talking about?  I mean if there are so few people, do you think they are going to have full facilities for services that may not regularly be used?  There are a lot of hospitals (small)that don’t have the patient volume to justify full scale state of the art facilities.  Let’s say you want to have heart surgery?  Are you telling me that you would want a hospital surgeon to operate on you that has done maybe one 20 years ago?  Or would you prefer to drive 150 miles to go to a heart center where they have a turnkey system and are totally focused on being able to deliver quality surgeons who may do 40 a week and have a survival ratio of maybe 92% as opposed to your local community hospital that may if lucky not botch it up.  It certainly is legitimate to bring up the idea of paucity of service.  Most of these small community hospitals in low density areas do either chronic care or emergency care anyway and send major medical conditions to the larger more fully equiped and larger staffed hospitals anyway.  So having said that, now give us the kind of services that you would expect a small low density hospital should provide as opposed to driving three hours to go to a properly equiped one.  That brings up another issue and that is population density.  There are very few places in the USA where one can drive 150 miles without hitting some large city.  And utilizing counties’ demographics is not really a good way of doing so, since there are many counties in places like Idaho, North and South Dakota, Oregon, Washington, Montana, Wyoming, in which the populations  are so small as to make it unrealistic to have a full servce hospital.  These kind of areas are usually in the Great Desert Basin of the West.  I really can’t think of many places East of the Mississippi that you can not conveniently find a large city hospital within reasonable driving distance.

    Let me give you a personal example.  A few years ago, my Sister had a freak accident in which she broke the inside of her foot.  She lives 45 minutes southeast of Nashville TN.  Her Orthopedist said that in his opinion this operation was so sensitive that there were only two places she should have the sugery–New York City or Atlanta. She had to drive to Atlanta and I had to take a plane from Milwaukee to Atlanta, meet her at the hospital and drive her back home. I think that was about 400 miles.  The insurance company never blinked. 

  • euphrosyne

    Many regional hospitals aren’t equipped with the latest shock-trauma care medical technology. Many lack certain laser surgical equipment needed for the most advanced life-saving procedures. Many don’t have the most advanced technology in caring for critically injured burn victims. Often these and other patients have to travel from their home or their local hospital to a more distant hospital to receive the care they need – and during that that travel, these patients are often bleeding, on dialysis, on oxygen, and have IV tubes running into their veins. But travel they do.

    Is it surprising more Americans have been concerned about hospitals providing these services regionally to critically ill and injured patients, rather than about persons having to travel to seek an elective procedure – which most abortions are – at a hospital?

  • crowepps

    But let me ask you:  You mention that you may have to drive 150 miles to a larger city to obtain alternatives.  That is perfectly valid, but we are talking about apples and oranges aren’t we?  I mean you bring up the fact that there is only one hospital in the area because of population density. … I mean if there are so few people, do you think they are going to have full facilities for services that may not regularly be used? 

    Since the services we originally were discussing were sterilizations (tubal ligations/vasectomies) and the provision of Plan B to rape victims, it seems to me even a small clinic should be able to provide those.

     

    Our hospital provides obstetric services and abortions to complete miscarriages.  At the present time, doctors do tubal ligations after deliveries (the time at which they are physically safest for the woman).  It has a CAT scan and an MRI and a very good oncology clinic and an excellent emergency department which does provide Plan B to rape victims, as well as SART/SANE exams.  They are also compliant with end-of-life declarations and the patients’ rights to be the ultimate decisionmaker about their care.  We lack an neo-natal intensive care nursery which requires a LifeFlight to Anchorage, and specialized treatment for severe burns which requires being sent to Seattle, and at the present time don’t have a specialist who can do tricky pediatric surgeries, but it’s a fine little hospital.

    http://www.cpgh.org/

     

    The point of the discussion is that in the unlikely event the hospital were to change administrations and become affiliated with the Catholic Church there would be changes – no more tubal ligations, no more Plan B, no respect for end-of-life directives.  Even though the hospital has provided them in the past, now one religion would use its economic muscle to set policies forcing patients, staff, even non-Catholic doctors, to conform to its religious rules.  People would continue to be able to access high-quality, high-tech care locally for illness or trauma with only one exception – their reproduction care would return to 1860.