For the last several weeks, all eyes have been focused on the high-profile clash between Catholic bishops (if not their parishioners) and the Obama administration over mandated insurance coverage for contraception at their non-church institutions. But in cities and towns across the country, a second battlefront is jeopardizing access to essential reproductive care for millions of American women. As The New York Times and the New Republic each recently documented, the expansion of Catholic hospitals nationwide is putting women's reproductive care?and in some cases, their lives?at risk.
For over a hundred years, Catholic hospitals have been one of the cornerstones of the U.S. health system, providing care to tens of millions of Americans of all faiths, races, ethnicities and income levels. TNR's Jonathan Cohn explained just how big a role they play and the public support they enjoy in return:
Today, Catholic hospitals supply 15 percent of the nation's hospital beds, and Catholic hospital systems own 12 percent of the nation's community hospitals, which means, according to one popularly cited estimate, that about one in six Americans get treatment at a Catholic hospital at some point each year. We now depend upon Catholic hospitals to provide vital services--not just direct care of patients, but also the training of new doctors and assistance to the needy. In exchange, these institutions receive considerable public funding. In addition to the tax breaks to which all nonprofit institutions are entitled, Catholic hospitals also receive taxpayer dollars via public insurance programs like Medicare and Medicaid, as well as myriad federal programs that provide extra subsidies for such things as indigent care and medical research. (Older institutions also benefited from the 1946 Hill-Burton Act, which financed hospital construction for several decades.)
But increasingly, Cohn cautioned, "the dual mandates of these institutions?to heal the body and to nurture the spirit, to perform public functions but maintain private identities?are difficult to reconcile." For many communities, a Catholic facility is already the only choice. And with the accelerating trend of hospital mergers and partnerships, policies forbidding contraception, abortion and sterilization are becoming the norm at formerly public hospitals. In cities around America, the result is growing confusion for physicians and greater risk for their patients.
As The New York Times detailed, over just the last three years about 20 new partnerships combining stand-alone hospitals or smaller systems with larger, financially stronger Catholic institutions is adversely impacting the availability of common reproductive health care services. For example:
In Seattle, Swedish Health Services has offered elective abortions for decades. But the hospital agreed to stop when it joined forces this month with Providence Health & Services, one of the nation's largest Catholic systems.
And when Seton Healthcare Family in Texas, a unit of Ascension Health, began operating Austin's public Breckenridge hospital in 1995, it curbed reproductive health care services available to its patients:
In that case, Mr. [Charles] Barnett [of Ascension Health] says the system never agreed to provide services like elective abortions and sterilizations, and public officials and hospital administrators initially struggled to find a compromise. Although another system eventually offered sterilizations on a separate floor of the hospital, complete with a separate elevator, another hospital now provides those services.
Increasingly, the clashing requirements of the Catholic hospitals' public mission and religious tenets are putting patients, doctors and staff at risk. In 2007, physician Ramesh Raghavan wrote in the Journal of the American Medical Association of his wife's experience. As Cohn explained the horrifying episode:
[Raghavan's wife], a woman, also pregnant with twins, whose pregnancy was failing, threatening infection that could jeopardize her ability to have future children and perhaps her life. Distraught, she and her husband decided to terminate the pregnancy--only to learn the Catholic hospital would not perform the procedure.
A few years later, New Hampshire waitress Kathleen Prieskorn went to her doctor's office after a miscarriage?her second?began while she was three months pregnant. She quickly learned that her emergency was not one for which treatment would be available from her hospital's new operators:
Physicians at the hospital, which had recently merged with a Catholic health care system, told her they could not end the miscarriage with a uterine evacuation--the standard procedure--because the fetus still had a heartbeat. She had no insurance and no way to get to another hospital, so a doctor gave her $400 and put her in a cab to the closest available hospital, about 80 miles away. "During that trip, which seemed endless, I was not only devastated but terrified," Prieskorn recalled. "I knew that, if there were complications, I could lose my uterus--and maybe even my life."
Perhaps the most notorious case, as both The Times and the New Republic reported, involved Catholic Health West and one of its hospitals in Phoenix. A 27-year-old woman, 11 weeks pregnant and suffering from "right heart failure" came to St. Joseph's Hospital and Medical Center. What happened next may be a frightening omen of things to come:
Physicians concluded that, if she continued with the pregnancy, her chances of mortality were "close to 100 percent." An administrator, Sister Margaret McBride, approved an abortion, citing a church directive allowing termination when the mother's life is at risk. Afterward, however, the local bishop, Thomas Olmsted, said the abortion had not been absolutely necessary. He excommunicated the nun and severed ties with the hospital, although the nun subsequently won reinstatement when she agreed to confess her sin to a priest.
The growing crisis for women's care resulting from the partnership and merger movement is leading to a backlash and some sadly creative solutions. Catholic Health Care splits its network into 25 Catholic and 15 non-Catholic facilities under the new name, Dignity Health. In Kentucky, Governor Steve Brashear blocked "a bid by Catholic Health Initiatives, another large system, to merge with a public hospital in Louisville, in part because of concern that some women would have less access to contraceptive services." Meanwhile in Rockford, Illinois, there is growing resistance to let the Sisters of the Third Order of St. Francis buy a local hospital because of "new restrictions that would require women to go elsewhere if they wanted a tubal ligation after a Caesarean section."
Still, the worrying trend is creating problems for all parties. Sister Carol Keehan, president of the Catholic Health Association of the United States, which represents the nation's roughly 600 Catholic hospitals, said of Americans' increasing dependence on her organization's facilities, "That is a constant challenge. It's a challenge we take very seriously." But for American women, the challenge of getting reproductive care isn't just serious; it could be very dangerous. AS Jill C. Morrison, of the National Women's Law Center worried, the new restrictions mean "women simply don't know what they're getting."
If, that is, they can get it at all. As Lois Uttley, director of MergerWatch explained, "There are a lot of rural places that now have only a Catholic hospital." Arizona obstetrician Bruce Silva, who lamented that he can no longer provide routine services like a tubal ligation, worried about his lower-income patients:
"If you're wealthy, you go up to Tucson and you get a hotel. But a lot of people can't even pay for the gas to get up there."
Which makes for the final, tragic irony of the expansion of Catholic hospital networks across the United States. In refusing to provide basic reproductive services and even life-saving care, more and more they will be neglecting the "least of these."
(This piece also appears at Perrspectives.)