Catholic health systems, healthcare — February 23, 2015 at 6:43 pm

How the expanding reach of Catholic health systems is restricting access to care


Religious doctrine can trump medical standards and interfere with patients’ rights to make their own decisions.

If you want to be sure you and the people you love have access to the complete spectrum of healthcare services, you’d better know who owns your hospital.

It’s not always obvious, but it’s important. Because one in six hospital beds in the United States is affiliated with a Catholic health system, according to the ACLU of Michigan. Let that sink in: one in six hospital beds.

Catholic health systems are governed by the Ethical and Religious Directives for Catholic Health Care Services (“the Directives”), which means that religious doctrine can override medical standards of care or patient wishes.

To be clear, no one is saying Catholic health systems are bad or that they should not continue their longstanding mission of caring for the communities they serve. But what’s becoming increasingly problematic is that Catholic health systems are buying up or partnering with secular hospitals at an increasingly rapid rate — or joining forces with other Catholic health systems — leaving entire geographic regions of the United States with no choice for care but a Catholic-sponsored or -affiliated hospital.

“As an organization we respect and advocate for religious freedom,” says Brooke Tucker, staff attorney for the ACLU of Michigan. “But we also advocate for and respect the rights of everyone to have healthcare according to medical standards and not religious beliefs. There’s no reason that these principles can’t work in tandem.”

To give you a sense of the rapid expansion of Catholic-sponsored or -affiliated hospitals, consider this: In December 2013, the ACLU published a report on the rise of Catholic health systems and the impact on reproductive health nationwide. In 2011, about one in nine hospital beds was affiliated with a Catholic health system. As of February 2015, that figure is one in six.

Between 2001 and 2011, the number of Catholic-affiliated or -sponsored acute care hospitals increased by 16%, a far greater increase than any other type of non-profit hospital. In 2011, the 10 largest Catholic-sponsored health systems together controlled 330 acute-care hospitals — about one-third of all the hospitals and beds in the 25 largest systems. According to the ACLU, if these 10 Catholic systems were viewed as one, they would make up the largest health system in the country.

When religious doctrine overrules standards of medical care

Hospital mergers aren’t unique to Catholic health systems. Mergers and acquisitions are a way to boost earnings in an industry with shrinking profit margins. But the religious doctrine applied to Catholic health systems is where things get problematic, especially if there’s no other hospital in the area.

This is quickly becoming the reality in Michigan. Ascension Health and Trinity Health — two of the country’s biggest health systems, Catholic or otherwise — joined forces in 2014 to create Together Health Network. With this new alliance, 75% of Michigan’s population is 20 minutes from either a network hospital or physician, said Rick O’Connell, president of Trinity Health Division and executive vice president of CHE Trinity (now Trinity Health), cited in Modern Healthcare.

So what happens if there’s no other hospital a patient can go to — especially in an emergency? That’s already the case in communities across the country, according to the ACLU report.

At Catholic-sponsored and -affiliated hospitals, ethical and religious directives can take precedence over medical standards of care.

The religious Directives that govern Catholic-affiliated hospitals are very clear about what is not permitted. The following Directives were published in the ACLU’s December 2013 report:

  • Catholic health institutions may not promote or condone contraceptive practices.
  • Abortion (that is, the directly intended termination of pregnancy before viability or the directly intended destruction of a viable fetus) is never permitted.
  • Direct sterilization of either men or women, whether permanent or temporary, is not permitted in a Catholic health care institution.
  • The free and informed health care decision of the person … is to be followed so long as it does not contradict Catholic principles.
  • Prenatal diagnosis is not permitted when undertaken with the intention of aborting an unborn child with a serious defect.
  • Heterologous fertilization (that is, any technique used to achieve conception by the use of gametes coming from at least one donor other than the spouses) is prohibited because it is contrary to the covenant of marriage, the unity of the spouses, and the dignity proper to parents and the child.

The Directives state that hospital staff and physicians with admitting privileges must adhere to the Directives. What’s more, when non-Catholic hospitals affiliate with Catholic-sponsored hospitals or health systems, they are usually asked to adopt all or some of these religious restrictions.

There are federal and state laws that allow care providers to refuse to perform abortions or provide sterilization services if it violates their conscience, and some hospitals and healthcare providers may interpret these laws broadly to allow for other religious refusals, too.

There’s also the vague language about following patient wishes as long as “it does not contradict Catholic principles.” There’s a lot of leeway in that language that could allow a provider to claim a particular medical service violated his or her conscience — even services not mentioned in the Directives.

Quietly restricting access to healthcare services

Catholic health systems that are buying up hospitals aren’t making a big noise about it. In fact, many members of the community would have no idea their local hospital must now adhere to the Directives — until they need care they simply won’t receive.

The case of Tamesha Means is a prime example of the dangers religious doctrine can pose to patient health. From the ACLU:

Tamesha Means rushed to Mercy Health Partners in Muskegon, Michigan, when her water broke after only 18 weeks of pregnancy. Based on the bishops’ religious directives, the hospital sent her home twice even though Means was in excruciating pain; there was virtually no chance that her pregnancy could survive, and continuing the pregnancy posed significant risks to her health.

Because of its Catholic affiliation and binding directives, the hospital told Means that there was nothing it could do and did not tell Means that terminating her pregnancy was an option and the safest course for her condition. When Means returned to the hospital a third time in extreme distress and with an infection, the hospital, once again prepared to send her home. While staff prepared her discharge paperwork, she began to deliver. Only then did the hospital begin tending to Means’ miscarriage.

‘They never offered me any options,’ said Means. ‘They didn’t tell me what was happening to my body. Whatever was going on with me, they discussed it amongst themselves. I was just left to wonder, what’s going to happen to me?’

Other than the fact that the hospital had a new name, Means had no way of knowing that she would not receive the same standard of care she’d received when she had three other children at the same facility.

The ACLU has filed a lawsuit on Means’ behalf charging that the United States Conference of Catholic Bishops (USCCB) — which writes the Directives — is ultimately responsible for the unnecessary trauma and harm that Means and other pregnant women in similar situations have experienced at Catholic-sponsored hospitals.

Religious liberty ‘turned on its head’

According to Tucker, the USCCB has claimed that they have a First Amendment right to make a care decision on the basis of faith. But what about a patient’s rights?

If it were a different healthcare procedure you would not be immune from a malpractice suit for deviating from the accepted medical standards. So when you have these two-tiered healthcare systems — one that’s being governed by religious teachings and one that’s being governed by medical standards — the patient doesn’t know when they’re going in, especially in an emergency situation, what standards they’re being governed by.

Secular hospitals have to adhere to certain safety standards that religious hospitals are exempt from if they say it violates their conscience. How is it fair for secular hospitals to be held to a different standard in order for them to be licensed, in order for them to call themselves a hospital?

“It just turns religious liberty on its head,” adds Shelli Weisberg, legislative director of the ACLU of Michigan.

Individual religious liberty has always meant the individual being free to maintain religious practices without interference. But this has grown into corporate personhood and the ability to impose their religion on everyone — including an individual walking into a hospital where they expect to get healthcare and instead they’re getting religious directives.

The impact on access to care goes beyond abortion services and birth control counseling. Catholic-affiliated or -sponsored hospitals routinely put women’s health at risk by denying medically appropriate care for miscarriages, dangerous ectopic pregnancies and sterilization by tubal ligation at the time of a Cesarean-section delivery. End-of-life decisions for both women and men could be impacted by the same Directives that affect reproductive care.

As Catholic health systems continue to acquire or partner with secular hospitals across the country, access to comprehensive care and the ability to make personal healthcare decisions is in danger.

“Even in a perfect world where every citizen knew who owned their hospital and what procedures they did and didn’t do, there are hundreds of thousands of citizens who don’t have a choice between hospitals,” Weisberg says. “Ethical and religious directives have no place in medical care.”

The ACLU of Michigan is seeking input about patient experiences at Michigan’s Catholic hospitals. If you have information to share, please email Brooke Tucker.

This is the first in a series at Eclectablog on the rise of Catholic health systems and what that means for patient care. Next up: A closer look at what’s happening in Michigan.

[Image credit: Photo by Kim Hill via Flickr.]