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Catholic hospitals face myths, mergers

Special to the National Catholic Reporter
Newark, N.J.

Their names alone imparted a good portion of their identity: Sisters of Mercy, Daughters of Charity, Bon Secours -- sisters and dispensers of health and hospital care in the United States for more than a century. But today the hospital and health care institutions founded by these women and other religious like them stand threatened.

The threat comes not only from a marketplace that competes fiercely for patients, staff and reimbursements, but also from the fact that in a restructured health care environment, Catholic identity risks taking a back seat to bottom-line considerations.

Late last month some 60 lawyers, bishops, priests, nuns and hospital and diocesan administrators gathered at Seton Hall University’s Law School here to share their concerns and see how they can survive in an era of joint ventures, mergers and acquisitions.

St. Joseph Sr. Jean de Blois told them not to wait until they are in negotiations with a potential partner to think about who they are as Catholic health care providers. Instead they should begin their discussion of self-identity now, urged de Blois, who is vice president of mission services for the St. Louis-based Catholic Health Association of the United States.

She also cautioned them not to assume that their colleagues on the negotiating team would be “intimately well versed in knowing the data of who you are and not just what you won’t do.” Everybody knows and has known for years what Catholic hospitals don’t do, de Blois said, naming the proscriptions against abortion, doctor-assisted suicide, tubal ligation, sterilization, in vitro fertilization and other reproductive interventions.

However, too few know what an institution’s hopes and dreams are; what its policies are for hiring, firing and managing employees; and how it performs clinical care. The major challenge for many working in the field is that “we don’t know what it means to be Catholic in health care,” de Blois said. But “when you take Catholic gospel principles and speak them in English, they’re very appealing,” she said. “They’re not just Catholic values, they’re human values.”

These values include having a mutual understanding of the vulnerable and basing employee relations on trust rather than manipulation, she said.

They also encompass effective pain management and believing in the pastoral and spiritual welfare of patients as well as in their physical and psychological care.

The successful negotiator will see Catholic ethical statutes and religious directives in a positive light and will seek to expand upon them in the negotiations, de Blois said. Too often Catholic negotiators “saddle” themselves with a narrow view of Catholic identity rather than asserting “what we’re about, what we expect and what we’re looking for in a health care partner.”

Despite being the largest private not-for-profit system in the United States -- counting some 550 hospitals in 48 states, which employ 679,000 staff members and treat more than 74 million patients yearly -- Catholic health care is still seen in a negative or fearful light by many, she said. De Blois said that in recent restructuring talks in a number of states, several “myths about who people think we are” surfaced:

  • Money goes to the Vatican from earnings in the Catholic facility.
  • Daily Mass is required of all employees.
  • All meetings must begin with prayer.
  • The prohibition against doctor-assisted suicide means that a Catholic hospital will let no patient die.
  • Women are allowed to die in childbirth in order to save the baby.
  • The local bishop’s authority over the hospital means that he will run health care and will be involved in decision-making sessions between doctor and patient.

De Blois said Catholics need to “ferret out” these myths if they are to succeed in their new arrangements.

De Blois told NCR she was hopeful that the ministry of Catholic health care would survive “merger mania,” funding cuts and even the growing obsolescence of hospitals now that three quarters of all surgery is done as outpatient procedures and home health services for Medicare patients have contributed to a significant drop in hospital admissions.

How Catholic health care providers continue to deliver integrated quality services across the continuum of life to the communities they seek to serve remains the church’s greatest health care challenge, she said, adding that “lay leaders will carry us into the future.”

Finding appropriate members for hospital boards must remain a top concern of Catholic institutions, advised Oblate Fr. Francis Morrisey of St. Paul University in Ottawa. He warned that within a decade, the church could lose its hospitals, clinics and rest homes -- not from competitive forces outside, but “from within.”

“Lots of our board members are put there because they’re successful in business or pious, but they have no idea about Catholic ethics and have a great gap in their Catholic knowledge,” he said. Yet they are the ones making “the delicate decisions,” he said.

Morrissey, a canon lawyer, said that programs need to be initiated for prospective board members so that their leadership role within the church can be clearly identified and supported.

Morrissey also noted that canon law isn’t “the doctrinal arm” of the church but rather its practical law. How it is interpreted may vary in different states and sees, and church law must remain flexible if it is to serve 1 billion Catholics worldwide, he said. Morrissey said he knows of only four nations whose bishops have issued ethical criteria for health care procedures but said that the local bishop is the interpreter of such criteria in every diocese.

Bishop James McHugh of Camden, N.J., said that neglecting to involve the bishop in restructuring negotiations is a recipe for failure. By virtue of the bishop’s role as governor of the diocese, as teacher and as a prophetic voice in the community, he needs to be kept abreast of negotiations and his counsel needs to be heeded, McHugh said.

McHugh interpreted the rush of mergers, affiliations and buying and selling of institutions to a “nervousness” on the parts of CEOs and boards. In the aftermath of such “courtships and arranged marriages,” he held that it is vital that Catholic health care continues to live by Catholic moral principles and continues its mission to the poor and to migrants.

Fr. Dennis Brodeur of SSM Healthcare in St. Louis said that most of the ethical issues in hospital management are part of the practical management of the institution. Questions of management style, rates of compensation from top executive to janitor, the transfer or loss of pension funds, conflicts of interest, the resolution of grievances, patient care and how the institution pursues social justice in the community are key components of the negotiation and of how Catholic the new entity will be, he said. Catholic social teaching informs all these questions, he said.

National Catholic Reporter, November 20, 1998