In virtually every major industry, including broadcasting, the common belief to get bigger or get out of business. Multibillion dollar mergers affect every aspect of our lives, including our health. In order to compete for the big managed-care contracts, hospitals - both public and private - must merge or affiliate, must become part of a conglomerate. Does that mean better health care? Maybe yes and maybe no.
Four out of 10 of the largest health-care systems in America are controlled by the Roman Catholic Church. In general, the services they offer to their 85 million patients - most of whom are non-Catholic - are as good as any, but when Catholic hospitals merge with non-Catholic hospitals, religious doctrine may supercede medical advice, as Morley Safer reported for 60 Minutes on Dec. 10, 2000. Here is a transcript:
Frances Kissling: It's not like the old days. Doctors are no longer gods. Now we have bishops who are gods.
Morley Safer: Frances Kissling is a Catholic, but she's on a crusade to keep Catholic doctrine out of medicine. She's the President of Catholics for a Free Choice, and says that when patients enter a hospital that has merged with a Catholic institution, chances are, they'd find some things have changed.
Kissling: They would not have access to family planning, to contraceptives. They would not have access to condoms or to education about condoms. They wold not have access to sterilization. They would not have access to most treatment for fertility. And they would not have access to abortion. Although abortion is the least of the services that we are worried about.
Safer: Do you think that most people know this when they go into one of these hospitals?
Kissling: No, we know that most people don't know this.
Safer: When a Catholic hospital merges with a non-Catholic hospital, the Catholic partner often insists that religious doctrine be one of the terms of the deal. The patients may have no indication that anything has changed. In Elizabeth, N.J., Elizabeth General merged with St. Elizabeth's and its name was changed to Trinitas. The biggest change, of course, was no more abortions, sterilizations or birth control counseling.
Over the past 10 years there have been more than 120 mergers and alliances between Catholic and non-Catholic hospitals; in nearly half of them, certain services were reduced or eliminated.
Kissling: I mean let's take the case of emergency contraception, the morning after pill for women who have been raped. Catholic hospitals by and large do not provide this. And in many cases the hospital doesn't even refer. I mean you would think that there would at least be a regulation or a law which requires you to
tell that woman where she can go to get it. There is no such regulation.
Safer: What about cases of abortion, where the continued pregnancy will threaten th woman's life?
Kissling: In many of the mergers, what the Catholic partner has said to the non-Catholic partner is don't worry, if the pregnancy is threatening to the life of the woman, of course we will provide the abortion. But I know of several cases where doctors have said my patient must have an abortion, and they've said, "No, no, these women have not yet reached a life threatening stage."
Safer: Something like that happened in Manchester, N.H., to Kathleen Hutchins. When her non-religious Elliott Hospital merged with the nearby Catholic Medical Center, Hutchins didn't give it much thought, until she began to develop complications in the early stages of her pregnancy. After she was examined by her doctor, she was given some bad news.
Kathleen Hutchins: He said that my water had broken, and he gave the fetus a 2 percent chance of survival. And another physician told me the same thing. How was the fetus going to survive? I was 14 weeks along with no water now.
Safer: Was there any indication that your health was at risk?
Kathleen Hutchins: Yeah, they said there was a possibility of me getting an infection, possibly a hysterectomy or possibly dying if I had went through this pregnancy.
Safer: So you decided what?
Kathleen Hutchins: To abort the pregnancy.
Safer: Elliott Hospital did allow abortions in cases of medical necessity. So Hutchins' doctor, Wayne Goldner, made an official request to the head of his department.
Dr. Wayne Goldner: She said, "I don't think I can get this through. I don't think we can perform this at the hospital without running into interference by the church and the board. And if you can, and you don't want to make this a major scene, can you please send her somewhere else?"
Safer: But the closest hospital he could send her to was 80 miles away, and she had no means of getting there so Dr. Goldner tried once again to schedule an abortion. Hospital officials said no.
Dr. Wayne Goldner: They said, "Just wait for her to get infected and bring her right in." I said, "Well, the whole purpose of this is not to get infected, to avoid the problem."
Safer: They were willing to take the risks?
Dr. Wayne Goldner: When I made it clear to them that I would make this public knowledge, they called me up and said "Can you change the diagnosis so we can get her in under something else?" I said, "Are you asking me to lie?" "Well, not lie, just change it a little bit. Say that she's infected. Does she have a fever?" I said, "No." "Is, isn't she infected?" I said, "No." I said, "She's not." I am not going to alter the records so you can slip this around the church policy." But that's what I was asked to do.
Kathleen Hutchins: They basically told me to sit at home and wait, and see what happens.
Safer: They told you to go home and wait, wait for wht?
Kathleen Hutchins: Just wait for basically the fetus to die inside of me, and then something could be done about it.
Safer: That was something that both Ms. Hutchins and Dr. Goldner were unwilling to do. In the end he hired a car and driver to take her the 80 miles for an abortion. He says that religious doctrine clearly interfered with his patient getting the best medical care.
Dr. Wayne Goldner: Kathleen drove over an hour and a half to be seen by a doctor who she didn't have any relationship with, nobody there to hold her hand, nobody there to take care of her, and, and support her. That's the travesty. Does it interfere with (the) doctor-patient relationship? Absolutely.
Safer: In a letter to 60 Minutes, the lawyers for the hospital say Goldner did not follow policy in confirming his diagnosis. Dr. Goldner says that's not true and besides, four of his partners agreed that an abortion was a medical necessity. The issue generated a community protest, and the merger of the two hospitals was ultimately dissolved.
Frances Kissling: Medical decisions about reproductive health care in Catholic hospitals or non-Catholic hospitals that merge with Catholic hospitals are made by religious authorities, not doctors. Now doctors are beginning to understand that - that this is a challenge to their medical judgment and their conscience.
Safer: And there are other examples - reports of pregnant women suffering from cancer who requested abortions after doctors told them it would probably increase their chance of survival. Even though the chemotherapy and radiation might harm or kill the fetus, their requests for abortions were denied.
Father Michael Place: We cannot attack human life - either the life of the unborn or the life of someone at the end of life. And we honor our understanding of human sexuality.
Safer: Father Michael Place, head of the Catholic Health Association, a group that represents Catholic hospitals nationally, says that no organization should have to provide medical procedures to which it is morally opposed, and the law supports him, with something called the "conscience clause." Furthermore, Father Place argues that no hospital meets a patient's every need.
Father Place: Every hospital does not provide every service. And that's, that is the state of health care in this country.
Safer: Women's health services are a fairly basic kind of medicine that virtually all hospitals provide.
Father Place: All services are not provided everywhere. All women's services are not provided everywhere. We provide a full range of services that are commensurate with our values.
Safer: Values that are embodied by the "ethical and religious directives" - a series of rules adopted by U.S. bishops which maintain a theological basis for Catholic health care. It is up to the local bishop t determine how strictly the directives will be applied to newly affiliated hospitals. In theory, if not in practice, the Vatican ultimately decides. Even so, in some cases, services continue, very quietly.
In Austin, Texas, after Breckenridge Hospital was taken over, a discreet facility was set aside for elective female sterilizations, until the Vatican was tipped off by a local church activist. A letter from the Vatican to the local bishop ordered that sterilizations, tubal ligations, cease immediately.
So there is only one set of rules open to interpretation by the bishop?
Father Place: Application, I think is the better phrase. They are not able to be fudged if that's what you're suggesting. We work within a set of principles.
Safer: But fudging does go on, doesn't it?
Father Place: No, no. I think that's an absolutely inappropriate description.
Safer: But, this is a set of canons that absolutely dictate, that override in effect, best medical advice by a person's doctor.
Father Place: They have to do with the, the sacred dignity of a person. We have a whole set of expectations which relate to how we care for persons as sacred individuals with dignity.
Safer: Father Place maintains that the effect of mergers is minimal compared with the church's long history of providing health service to the poor.
Father Place: Why are we present to the poor? Because we are obliged to be there. That's who we are.
Frances Kissling: It seems to me as a Catholic that if you say you are interested in the poor, we know that it is poor women who disproportionately use hospitals to get what many of us go to our private doctors' offices for. So they hurt the very population, poor women, that they claim they want to help.
Safer: Many Catholic hospitals are located in poor areas like Gilroy, Calif. Catholic Healthcare West, the largest hospital system in California, recently bought South Valley Regional Hospital, closed down (its) own hospital and renamed South Valley, St. Louise. It became the hospital in the area, few in Gilroy understood that the takeover would limit care - people like Zina Campos, recently off welfare, who, at the age of 34, scheduled a tubal ligation to prevent further pregnancies following the birth of her ninth child. She is also a grandmother.
Zina Campos: I have plenty of children. I don't regret any of my children. But I have plenty of children to take care and I have the choice to say, "I do not want to
have any more children. I want a tubal ligation." I have that choice.
Safer: Not anymore, the hospital said no to the procedure.
Campos: St. Louise never thought about how we live 35 miles away from any hospital here. This is a rural community....We need to be able to have services.
Safer: The year before the takeover tubal ligations were routinely performe on scores of women at South Valley. The procedure is a simple one and is the most commonly used method of contraception in the United States. In simply practical terms, people in the area no longer have a choice of hospitals. The entire ob-gyn staff protested the change. They were led by Dr. Francis Sacco, a Catholic himself.
Dr. Francis Sacco: Catholic Health Care West will say, "Well, you can go to another facility. You know, you know, there's facilities within 35 miles." But I ask you, you know, is that reasonable for a doctor to leave the community, go 35 miles, is it reasonable for the patient to do that? But, as long as they're the only game in town, they can dictate what they want to do and still earn money.
Safer: Father Place refused to comment on individual cases. Ms. Kissling believes that overall Catholic hospitals do a good job, but that many working in the system feel their hands are tied.
Frances Kissling: I think that the main motive of most people who are involved in Catholic health care is to provide good health care to people. I know that there are many within the church who agree with the kinds of positions that we take. And if they had their own choice, they would provide these reproductive health services. But the church is increasingly conservative. The Vatican is looking over their shoulders. And they can't even do what they would want to do to help women.
Since 60 Minutes completed this story, the diocese of San Jose has issued a pastoral response which states that in certain rare and special situations, tubal ligations could be performed at St. Louise Hospital. At least three of the procedures have taken place.