Posts Tagged ‘hospital mergers’

Hospital Mergers: A Brewing Storm

Monday, February 3rd, 2014

By Thalia Syracopoulos, Co-President of Seattle NOW and a PSARA member 

In February 2012, Swedish Medical Center and Providence Health Systems of WA formed an “affiliation,” which potentially changed the availability of reproductive and end-of-life health care access. The only publicly announced change was that elective terminations of pregnancy would no longer be done at Swedish Hospital, or its affiliated campuses.

In response to an outcry from people concerned about the negative impact of this affiliation, Governor Inslee directed the state’s Department of Health to adopt new rules requiring that any hospital changing control through sale, affiliation or merger must seek a Certificate of Need [CON] review. The new CON was made public in December 2013 and will go into effect on January 23, 2014.

Surprisingly, the rules have nothing to do with whether or not the hospitals will provide or deny care. The new CON only requires that hospitals make information about what health care they do/do not deliver widely available to the public.

Governor Inslee also directed the WA Department of Health to provide a report on “Access to Care” in WA State in order to address the concerns of supporters of end-of-life services, reproductive rights, and the impact on our LGBT community. The preliminary report, documenting care through 2011, was issued in December 2013, and it is more reassuring than one might have anticipated.

While acknowledging that there were some data limitations, “our preliminary findings for those services assessed do not appear to suggest that communities predominately served by religious hospitals are experiencing barriers to care.”

It also specifically discussed the Swedish-Providence affiliation:

“…it is important to note that the affiliation Swedish has with Providence differs from other hospitals’ affiliations – and, in fact, Swedish considers itself a secular institution. While under the provisions of their affiliation they have agreed to not perform elective terminations, Swedish retains the right to perform an abortion if the mother’s life is at stake or if the fetus has a fatal anomaly; their physicians also retain the right to participate under the provisions of DWD when caring for terminally ill patients.”

This would be reassuring if it were true. However, in February 2013, The Stranger reported about a Seattle woman, 24 weeks pregnant, who came to Swedish Hospital because she was miscarrying and bleeding profusely. Swedish refused to perform an abortion and only acted to save the mother’s life after the fetal heartbeat had ceased. Fortunately, in this instance, the mother survived.

This lends credence to the information published in Catholic Watch-keeping watch on Catholic health care that the affiliation is now led by a 19-member board, with 5 members from Swedish and 14 from Providence. The board directs both Swedish and Providence.

“It’s been just over a year since Providence, …took over Swedish Medical, the largest nonprofit hospital system in the Seattle area. What’s the result? Swedish is now operated as a brand within Providence, and reports up through the Providence system, with oversight from the Catholic bishops. Prayers are held before management meetings. And abortions are no longer allowed, although Providence officials say they have been done when a woman’s life is in danger.”

The “oversight from the Catholic Bishops” refers to the “Ethical and Religious Directives for Catholic Health Care Services” [EDS].

Presently, in WA and OR, 30-37% of all hospital admissions are to Catholic hospitals. In King, Pierce and Spokane Counties, 50-99% of the hospitals are religiously affiliated. Whatcom, Skagit, Snohomish, Stevens, Cowlitz, Franklin, Kitsap and Walla Walla Counties have no non-religious-affiliated hospitals available to their residents.

Most of the affiliated or merged hospitals are public hospitals that receive considerable public funding. In addition to the tax breaks to which all nonprofit institutions are entitled, these hospitals also receive taxpayer dollars via public insurance programs like Medicare and Medicaid, as well as myriad federal programs that provide extra subsidies for such things as indigent care and medical research.

Attorney General Ferguson was asked to give an opinion regarding a San Juan County public hospital which had entered into an agreement with PeaceHealth, a Catholic health care corporation, to construct and operate a hospital. At issue was the providing of Termination of Pregnancy [TOP] and contraceptive care.

Attorney General Ferguson cited RCW 9.02.100 and .160 which were adopted as part of Initiative 120 (I-120) in 1991.

Accordingly (1) Every individual has the fundamental right to choose or refuse birth control, and (2) Every woman has the fundamental right to choose or refuse to have an abortion, except as specifically limited by RCW 9.02.

In August of 2013, Attorney General Ferguson rendered the following conclusion:

A public hospital district that provides, directly or by contract, maternity care benefits, services, or information to women, through any program administered or funded in whole or in part by the district, must also provide the substantially equivalent benefits, services, or information required by RCW 9.02.160 and .100. 

Such opinions are not legally binding. For now, the major concern is whether persons whose only access is to a religiously affiliated hospital are able to receive regular or emergency care that is forbidden by the EDS.

WA’s Death With Dignity Act (2008) “permits terminally ill, competent adult WA residents medically predicted to die within six months to request and self-administer lethal medication prescribed by a physician.” No physician who is bound by the directives of the EDS can honor that request if his private office is in a building owned by a religiously affiliated hospital.

Abortion is legal in WA State, but it is only one of the many services that may no longer be available at these institutions. The EDS states not just that contraception in any form cannot be provided, but education about any form of contraception is prohibited. The only exception to that rule is that married couples can be informed about “methods of natural family planning.” In vitro fertilization cannot be provided even to a heterosexual married couple. Artificial fertilization, even using a married man’s sperm to impregnate his wife, is also forbidden. Assistance for surrogacy in any form is not available.

Ectopic pregnancies may not be surgically terminated in advance of life-threatening complications even though lack of timely treatment may result in permanent sterilization or death for the mother. Pregnancy complications cannot be treated until there is no fetal heartbeat even if delaying treatment risks the death of the mother. It appears that this was the reason that the woman reported in The Stranger did not receive care in the early part of her miscarriage.

According to the EDS, a tubal ligation or vasectomy can never be done, although the “Access to Care” report by the Department of Health states that they are done.

For now, we can only be vigilant and hope that all legal and appropriate care is provided to all who seek it. But we should remember that while the Attorney General’s Opinion is not legally binding, it may well carry weight if a lawsuit for denial of care is brought.

If you, or anyone you know, has been denied care or provided care only after the EDS requirements have been met, contact the author of the “Access to Care” report, Joe Campo, at joe.campo@OFM. wa.gov. Send a copy of your report to Governor Inslee and Attorney General Ferguson.

Maybe we can get the care we are legally entitled to without a loss of life.

Hospital mergers threaten reproductive choice and end-of-life care

Thursday, April 4th, 2013

By Mike Andrew 

In the past year, ten hospital mergers have been initiated in Washington state, which may result in private Catholic healthcare organizations taking over formerly public hospitals.

Concentration of medical services in the hands of fewer and fewer providers is never a good thing, and in this case the mergers threaten basic patient rights, including reproductive choice and end-of-life care.

The ACLU has threatened to file suit to block the latest merger, reported in February, on the grounds that hospital policies should “be based on medical ethics and state law, not religious doctrine.”

At issue is the decision of Skagit County hospital commissioners to hand over operations of their United General Hospital to the Catholic PeaceHealth group for the next 50 years.

“We are deeply concerned that PeaceHealth’s religiously-based policy of restricting access to reproductive and end-of-life healthcare services violates the Washington constitution and state law,” ACLU says in a letter to the Skagit commissioners dated February 8.

“As a government entity, the Skagit Public Health District No. 304 is bound by the Washington Constitution. The Washington Constitution provides that no public money or property shall be used to support any religious establishment.” (Article 1, Section II) The letter goes on to say, “By providing an annual subsidy to PeaceHealth and charging only nominal rent to lease United General Hospital and other public health facilities to PeaceHealth, the Hospital District is impermissibly supporting the religious restrictions on reproductive and end-of-life services.”

The letter also states that the United General Hospital merger would violate the state’s Reproductive Parity Act, which empowers every individual “with the fundamental right to choose or refuse birth control,” and every woman the right to have an abortion.

Catholic hospitals now account for more than 12% of health-care institutions in the United States, according to the Catholic Health Association of the United States, which means that roughly one in eight Americans seeks treatment at one. In the Northwest, our percentage of Catholic hospitals is much higher — 44% and growing.

Three of the largest health-care systems in the Northwest — PeaceHealth, Providence Health and Services, and Franciscan Health System — are Catholic entities, and they’re busy making new deals in our state. According to MergerWatch, a nonprofit that tracks Catholic hospital mergers across the country, PeaceHealth currently operates nine Northwest hospitals and 73 medical centers.

Already, nearly half of all patients who seek hospital treatment in this state will go to a Catholic hospital, whether they know it or not. For example, Swedish Medical Center, Seattle’s largest non-profit health care provider, has been working in partnership with Providence, a Washington-based Catholic institution, for the last year. Providence now operates 32 hospitals in Alaska, California, Montana, Oregon, and Washington.

As a condition of this relationship, Swedish agreed to stop performing abortions except in emergency situations where the mother’s life is at immediate risk. Fortunately for Seattle women, Swedish will refer patients to a Planned Parenthood clinic in a neighboring building, but not all Catholic-operated hospitals are so liberal.

The problem is not that Catholics have religious views that may or may not be shared by patients who seek treatment at Catholic hospitals. The real problem is that, unlike public hospitals, church institutions incorporate their religious views into Ethical and Religious Directives (ERDs), drafted not by medical prfessionals but by Catholic bishops, that determine who gets what kind of treatment.

The church monitors the implementation of these directives through hospital ethic committees overseen by regional bishops like Seattle Archbishop Peter Sartain, and doctors are required to accept his direction.

“Any partnership… must respect church teaching and discipline,” one directive states.

“Catholic health institutions may not promote or condone contraceptive practices,” another directive says, and “Abortion… is never permitted.”

Common medical procedures like vasectomies and tubal ligations are also prohibited. Egg and sperm donors are deemed “contrary to the covenant of marriage,” surrogate motherhood is prohibited because it denigrates “the dignity of the child and marriage,” and doctors at Catholic hospitals cannot help infertile couples conceive artificially — using their own eggs and sperm — because test-tube babies “separate procreation from the marital act in its unitive significance.”

PeaceHealth CEO Nancy Steiger also stated flatly that she would not assist terminally ill patients who ask for help in dying with dignity and a minimum of pain.

“Patients experiencing suffering that cannot be alleviated should be helped to appreciate the Christian understanding of redemptive suffering,” Steiger said.

These regulations not only contradict standard medical practices and the rights of patients, but also the clear will of Washington citizens. In 1970 Washington voters decided to legalize abortions, three years before Roe v. Wade, and we have consistently upheld a woman’s right to access abortion services since then.

In 2008, 59% of Washington voters approved a statewide “Death with Dignity” initiative.

Sen. Kevin Ranker has introduced a bill that would require new or expanding hospitals to prove that they provide for all women’s health care, family planning, and end-of-life services. SB 5586 has 11 co-sponsors.