Via Nina Martin of ProPublica comes word that America's Catholic bishops are moving toward tightening religious restrictions on physicians and nonsectarian hospitals that join with them in mergers and partnerships.
This can't be good news for anyone concerned about the state of women's healthcare. That's where medical practice and Catholic doctrine are most frequently in conflict. And it's happening as Catholic hospitals are playing a more influential role in the American healthcare system.
The Affordable Care Act encourages and facilitates hospital mergers; many of these deals involve Catholic health systems as dominant partners. A joint study last December by the MergerWatch Project and the ACLU reported that 10 of the nation's largest hospital systems were Catholic-sponsored in 2011. From 2001 to 2011, the study found, the number of beds in Catholic hospitals rose by 13%, the largest such change of any category of hospital except the for-profit sector. In Washington state, one quarter of all hospitals are Catholic-affiliated, and in some communities around the country, patients have no other choice.
None of this would matter if the church did not try to impose religious directives on the practice of medicine. But that's what it has been doing. Doctors and patients in Orange County saw the process in action last year, after Newport Beach's Hoag Memorial Hospital Presbyterian, one of Orange County's leading medical centers, merged with St. Joseph Health System, a Catholic chain.
Despite being assured for months that nothing in their medical practice would change as a result of the deal, Hoag doctors were abruptly informed in May 2013 that abortions would henceforth be banned -- a restriction imposed at St. Joseph's insistence.
The MergerWatch/ACLU report and other sources document numerous instances of interference by religious prelates in medical decisions, especially those in which emergency terminations of pregnancies are indicated to save the mother. In Bartlesville, Okla., doctors at a hospital acquired by a Catholic system were forbidden to prescribe any contraceptives, if they were to be used as birth control. (After the rule provoked a public outcry, it was rescinded.)
The abortion ban and these other restrictions reflect the "Ethical and Religious Directives for Catholic Health Care Services," issued by the U.S. Conference of Catholic Bishops. The ERDs forbid abortions even in cases of rape or incest and forbid or sharply restrict access to contraceptives, sterilization procedures, in vitro fertilization or the use of sperm or egg donors. It limits hospitals' compliance with patients end-of-life directives.
To put it simply, if you're concerned about insurance executives or the government getting between you and your doctor, how do you feel about a bishop taking their place?
This week, the U.S. bishops voted 213 to 2 to revise the ERDs to make them more applicable to merger and business partners of Catholic health systems. The vote was in response to a mandate from the Vatican requiring that "Catholic health care institutions neither cooperate immorally with the unacceptable procedures conducted in other health care entities with which they may be connected nor cause scandal as a result of their collaboration."
That's bound to complicate merger deals, which are complicated enough already: Women's clinics at some Catholic-controlled hospitals have had to be designated secular zones, so doctors can practice without interference. Whether that would still be allowed under the revisions isn't clear.
The bishops' action may place new pressures on public officials with jurisdiction over such deals. Officials haven't always met their obligations to the public interest when Catholic hospitals take over non-Catholic institutions. California Atty. Gen. Kamala D. Harris approved the Hoag/St. Joseph merger even after learning that the abortion ban would be imposed.
A year later, when evidence emerged that Hoag and St. Joseph officials might have misled her over the consequences of the deal, Harris imposed stricter terms. "Abortions" were redefined so that not all such procedures would come under the ban. It was made clear that Hoag can't interfere with physicians performing procedures in their own offices, even if those are located on Hoag premises. Hoag's commitment to maintaining women's reproductive services at the same levels as before the merger was lengthened to 20 years from 10. And Hoag permanently committed itself not to be bound by the ERDs.
But that doesn't fully remedy the damage this merger did to women's rights in California where abortions are, after all, legal. As a result of the merger, women's ability to obtain a legal procedure in a leading hospital has been permanently eroded.
As more Catholic health systems attempt to acquire secular hospitals, the threat to the unfettered practice of medicine will increase. It's up to public officials to monitor this trend, and stop it in its tracks.