But the ERDs are guidelines, not hard-and-fast rules. Depending on the local bishop, Catholic providers have a certain amount of leeway in how they interpret them. In Washington state, religious hospitals have been more willing than in some other places to negotiate and accommodate their partners’ concerns, an attitude Reynertson and others call “Catholic lite.”
PeaceHealth, for example, “strongly respects the patient-physician relationship and decisions that are made jointly by physicians and patients in the best interests of those patients,” Strickland said. This means that it will allow its affiliates to dispense birth control and do emergency abortions to save the life of the mother, he said. Franciscan is seen as being stricter, but even so, its secular partner in the small city of Bremerton is continuing to perform tubal ligations on women immediately after they give birth — the medical standard in most hospitals for women seeking such procedures, but verboten in most Catholic ones.
But usually, it’s the non-religious partner that has to give. The most high-profile example involves Swedish Health Services, a secular hospital system that partnered last year with Providence Health & Services. Like most of the recent Washington deals, this one was a kind of workaround, crafted to protect Swedish’s autonomy, reassure its patients, and mollify its critics. “To ensure Providence remained Catholic and Swedish remained secular, the partnership was intentionally structured as an affiliation, not a merger or acquisition,” Swedish said in a statement to ProPublica, adding: “As a secular organization, Swedish is not subject” to the ERDs. Among other things, this allows it to continue providing the full range of birth control services, including tubal ligations and vasectomies.
But a few days after the partnership was announced, Swedish said it would stop doing elective abortions, which it had been offering as part of its reproductive health services for years. Instead, it gave $2 million to Planned Parenthood to open a clinic adjacent to Swedish’s main Seattle hospital.
By structuring deals as “affiliations,” “partnerships” or “collaborations,” hospitals gain another advantage: sidestepping regulators. Washington’s process for scrutinizing hospital mergers only kicks in if there’s a sale, purchase or lease of an existing hospital, but most of the recent agreements have stopped short of that line. Thus, the Swedish-Providence deal did not go through a full review, even though the combined health care system is by far the largest in the state. Nor did Franciscan’s affiliation with Harrison Medical Center, the only full-service hospital serving much of the hard-to-reach Kitsap Peninsula and nearby islands, which ACLU-Washington criticized as “a thinly veiled … transfer of assets” tantamount to a sale. Terms like “affiliation” and “alliance” leave “a lot of room to maneuver,” said the ACLU’s state legislative director, Shankar Narayan. “Without government oversight, once the camel’s nose is in the pen, you don’t have much control of where the affiliation is going to go.”
“The legitimate concern is: What happens to this relationship later?” Reynertson said. “Is this affiliation, this engagement, going to last? When are they going to get married? Once things like IT infrastructure … are intertwined, a full merger may become inevitable. It’s a connection that can never be undone. And of course, at that point the mergers will be approved, because look how well they’re working already.”
Robb Miller, executive director of Compassion & Choices of Washington, which helped pass the state’s assisted-suicide law, doesn’t actually think things are working all that well right now. The Death With Dignity Act isn’t mandatory for providers, and even before the wave of mergers, many secular hospitals had opted not to dispense or administer lethal medications to terminally ill patients. The Catholic partnerships have drastically shrunk the pool of providers willing or able to help dying patients end their lives. Since PeaceHealth took over the public hospital serving Clark County (in the southwestern part of the state) in 2010, Miller says, doctors, nurses and social workers have stopped referring patients for counseling to groups like his. “They went from a secular organization with reasonably good policies on death with dignity to an organization with anti-choice policies based on the ERDs.” The practical result is that many terminally ill patients “simply lose their medical options” for a peaceful death, Miller said.
Strickland acknowledges that PeaceHealth forbids both physician-assisted suicide and elective abortions at its affiliates. But he insists that this not as big a change as it sounds, since many community hospitals don’t offer those health care options anyway. “We only go into communities where we’re invited,” he said, “and we have a very strong track record of adding services, not taking them away.”
But what about the future, asks PFLAG’s Reim. She notes that PeaceHealth and other Catholic-affiliated providers are unlikely to add health care services restricted by the ERDs.
“We’re expecting another 40,000 people to move to this part of the state,” she pointed out. Some of these newcomers are likely to be gay couples and transgender people who could find themselves unable to get fertility treatments or hormonal therapy in their communities. “This isn’t just about protecting the rights of the people who already here, but the rights of the people who are coming,” she said.
For Mary Kay Barbieri, co-chair of a Skagit Valley group called People for Healthcare Freedom, the other big fear is that the Catholic Church and the men who run it could suddenly decide to take a harder line in how they interpret the ERDs. Or a Catholic lite provider could be gobbled up by one with stricter views, as almost happened this year when PeaceHealth and Franciscan’s parent company, Colorado-based Catholic Health Initiatives, were in talks to merge (later scuttled). “That was very worrisome,” Barbieri said.
Meanwhile, the state’s largely hands-off attitude may be ending. This summer, Gov. Jay Inslee, a Democrat, directed the Department of Health to update its hospital merger oversight process, while Democratic Attorney General Bob Ferguson issued an opinion requiring all public hospital districts that offer maternity services to also provide birth control and abortions. But how those orders will play out remains a very big question. “We will be watching closely,” Barbieri said.
This post was originally published in Pro Publica
Photo Credit: Mercy Health
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