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Church, Medicine and Women

Multi-billion 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? Morley Safer reports on 60 Minutes that in sometimes that may not be the case.

Mergers Can Reduce Services

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.

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.

"They would not have access to family planning, to contraceptives. They would not have access to condoms or to education about condoms. They would not have access to sterilization. They would not have access to most treatment for fertility. And they would not have access to abortion," says Kissling.

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 gives an example. "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."

Necessary Procedure Denied

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. 14 weeks into her pregnancy her water had broken and her doctor gave her fetus a 2 percent chance of survival.

"They said there was a possibility of me getting an infection, possibly a hysterectomy or possibly dying if I had went through this pregnanc," says Hutchins.

So Kathleen Hutchins decided to abort the pregnancy. But Elliott Hospital told her physician Wayne Goldner to send her some place else. 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.

"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," recalls Dr. 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 m not going to alter the records so you can slip this around the church policy.’ But that's what I was asked to do."

In the end Goldner hired a car and driver to take Kathleen the 80 miles for an abortion. He says that religious doctrine clearly interfered with his patient getting the best medical care.

"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," says Goldner.

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.

A Higher Authority

Says 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."

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." "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," says Father Place. Furthermore, he argues that no hospital meets a patient's every need.

"Every hospital does not provide every service. And that's, that is the state of health care in this country."

Values that are embodid 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 to determine how strictly the directives will be applied to newly affiliated hospitals. In theory, if not in practice, the Vatican ultimately decides.

Serving Poor Populations

Father Place maintains that the effect of mergers is minimal compared with the church's long history of providing health service to the poor. 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. 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.

"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," says Campos.

Not anymore, the hospital said no to the procedure.

The year before the takeover, tubal ligations were routinely performed 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.

"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 tht? But, as long as they're the only game in town, they can dictate what they want to do and still earn money," explains Dr. Sacco.

Frances Kissling sums it up. "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.

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