October 18, 2013 — A wave of mergers between Catholic hospitals and secular, publicly funded hospitals in Washington could limit patients' access to abortion, contraception and fertility treatments, ProPublica reports.
According to the American Civil Liberties Union, nearly half of the state's hospital beds could be subject to Catholic influence or control by the end of 2013. ProPublica reports that the deals were forged "in near secrecy, with minimal scrutiny by regulators," because of the ways the agreements were structured.
Compared with other states, Washington has relatively liberal laws regarding abortion rights, assisted suicide and gay rights, but activists are raising concern that Catholic influence on the state's health care system could jeopardize patients' ability to exercise those rights.
Kathy Reim -- president of Skagit's Parents, Families and Friends of Lesbians and Gays -- said that the situation is "the perfect storm." She added, "We are the only state that has all these rights and privileges available to our citizens. Yet many of our hospital beds are being managed by a system that, for the most part, cannot and will not honor these rights and laws."
Catholic hospitals' health care services are guided by the Ethical and Religious Directives for Catholic Health Care Services. The ERD's 72 directives explicitly ban abortion and sterilization services and restrict other forms of care, such as emergency contraception, in vitro fertilization, artificial insemination, surrogate pregnancy and assisted suicide.
However, the guidelines are not hard-and-fast rules, and a 2012 University of Chicago study found that 52% of ob-gyns affiliated with Catholic providers reported having conflicts over the religious policies that govern their medical care.
Pressure To Merge
Increased mergers and other affiliations between hospitals are a trend throughout the industry, not just among Catholic facilities, ProPublica notes. However, the "dilemma" is that the approximately 630 Catholic hospitals in the U.S. account for a substantial portion of admissions -- 15% annually -- and "are not independent entities," ProPublica reports.
"It's harder than ever before for independent health-care organizations to thrive without alliances," according to Tim Strickland, a spokesperson for the Catholic health system PeaceHealth. Changes under health care reform are the primary driver behind the need for alliances, according to ProPublica.
In Washington, that pressure -- coupled with the Catholic health system's historical ties to the state -- has made partnerships with Catholic hospitals attractive to community hospitals that might otherwise close.
However, the alliances often escape the scrutiny of state regulators because the agreements are structured as "affiliations," "partnerships" or "collaborations" rather than as "mergers." The state's process for evaluating hospital mergers only applies if there is a sale, purchase or lease of an existing hospital, but the alternately structured deals usually stop short of that line, ProPublica reports.
Sheila Reynertson of the not-for-profit MergerWatch said that Washington has seen at least 10 completed or proposed Catholic-secular alliances over the past three years, which is more than anywhere else in the country. She added that three of the state's five largest health care systems are Catholic.
Impact on Patients
According to ProPublica, the secular partners in these arrangements have largely been required to compromise, even though Catholic hospitals in Washington generally have been more willing than those in other states to accommodate their secular partners' concerns.
For example, Strickland noted that PeaceHealth allows its affiliates to dispense birth control and perform abortions to save a woman's life because the health system "strongly respects the patient-physician relationship."
However, Swedish Health Services last year stopped offering elective abortions after it partnered with Providence Health & Services, despite numerous accommodations in the agreement designed to protect Swedish's autonomy. Instead, Swedish donated about $2 million to Planned Parenthood to build a clinic adjacent to the health system's main Seattle hospital.
Mary Kay Barbieri -- co-chair of the Skagit Valley group called People for Healthcare Freedom -- said there is a "very worrisome" possibility that the Catholic hospitals could decide to take a harder line in interpreting the ERDs or merge with a stricter Catholic system.
According to ProPublica, patient rights might find some protection from a new opinion issued by state Attorney General Bob Ferguson (D) that requires all public hospitals that offer maternity services to also offer birth control and abortion. In addition, Gov. Jay Inslee (D) this summer directed the state Department of Health to update its hospital merger oversight process (Martin, ProPublica, 10/17).