Seething Battle Continues Over Catholic Takeover of Hospitals in Denver

Wendy Norris

An ongoing battle over the takeover of Denver hospitals by Catholic institutions threatens total loss of hospital-based reproductive health care. A Federal Trade Commission ruling offers the last chance to separate health care from ideology.

Backroom deals, multiple lawsuits and $600 million dollars
mark the Sisters of Charity attempt to force religious medical directives on
non-sectarian medical centers in Colorado.

A controversial move to transfer operational control of three
secular Denver-area hospitals to a Catholic healthcare system expected to take
place on December 31 appears to be on hold pending federal approval.

The unexpected delay by the Federal Trade Commission to
bless the transaction may provide local critics with a last gasp effort to
continue fighting the deal. Community members and medical professionals contend
the transfer would unfairly subject comprehensive reproductive health and
end-of-life care to church doctrine over patients’ needs. The Catholic church
considers abortion, contraception, elective sterilization and termination of
invasive life support as "intrinsically evil" and refuses to provide
these medical services or respect patients’ advance directives.

The disputed takeover in Denver exemplifies the very serious
implications for the 127 non-denominational hospitals that succumbed to merger
fever with cash-flush Catholic health care systems in the 1990s. According to a
study by Catholics
for Choice
, half of merged secular-Catholic hospitals suspended most
or all of their reproductive health care services. Eighty-two percent denied
emergency contraception to rape victims — and more than a third refused to
provide a referral.

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But for some tax-exempt, nonprofit hospitals co-owned by
secular and church interests, there was little more than a wink and a nod to
church mandates on care. Comprehensive reproductive healthcare services quietly
remained available.

These practices received higher scrutiny in 2001
when the U.S. Conference of Catholic Bishops revised its Ethical and Religious
Directives for medical care to address "misinterpretation and
misapplication of the principle of cooperation with other-than-Catholic
organizations." In other words, the church would no longer turn a blind
eye to reproductive health and end-of-life care at its secular partner
facilities that did not meet strict Catholic orthodoxy. notes several examples
of broken promises by Catholic healthcare systems to preserve reproductive
health services at non-religious hospitals it acquired through mergers. Typical
reasons included newly installed diocesan bishops with more dogmatic views on
medical directives or the Vatican overturning decisions made by previously
autonomous bishops.

More importantly, the local hospital policymaking was a
little noticed precursor to the bare knuckles strategy on recent display with
the church’s relentless lobbying for the 2009 Stupak
and Nelson amendments
to further restrict access to abortion care via
publicly-subsidized health insurance plans. At the same time, the Catholic
Archdiocese of Washington, D.C., threatened
to end social service programs
for tens of thousands of poor residents if
the city council approved a same-sex marriage ordinance.

Now, the Denver hospital takeover is offering a glimpse of
the intense pressure being brought to bear by the church on its healthcare
partners. The Vatican’s renewed insistence on complete doctrinal influence on
patient care is bolstered by very real threats to hold desperately needed
institutional capital funds hostage until its theological demands are met.

And that once delicate balance between serving patient needs
and adhering to strict Catholic medical directives is unraveling in plain

Another Example of Follow
the Money

Exempla Lutheran in Wheat Ridge, Colo., and Exempla Good
Samaritan Medical Centers in nearby Lafayette have been sponsored by the
Community First Foundation, the former fundraising arm of Lutheran Medical
Center, and the Kansas-based Sisters of Charity of Leavenworth in a complex
joint partnership since 1997. The two organizations formed the non-sectarian
Exempla Healthcare System to manage the hospital operations of the medical centers
founded from the ashes of two former Lutheran facilities and St. Joseph
Hospital, a 130-year-old institution in the city of Denver, which is wholly
owned by the Sisters of Charity.

With the three Denver hospitals in need of major
infrastructure investments to keep pace in a highly competitive health care
market, the Sisters of Charity began flexing their muscle by demanding complete
say in day-to-day operations. The Catholic health system complained to the Kansas
Business Journal
that without administrative control it could not borrow money
needed for capital improvements.

Namely, that would mean the ouster of Exempla and its
non-sectarian medical policies.

Not surprisingly, the ultimatum raised the hackles of
community members, patients and healthcare professionals at the Exempla-run
hospitals. The initial offer sought to buyout Community First’s co-membership
in Exempla for $311 million with the Sisters of Charity committing an
additional $300 million in capital improvements to the hospitals – a deal the
charitable foundation readily agreed to as a way to plump up its sagging
recession-battered assets and its growing distaste for the healthcare business.

The Community and Politicians
Fight to Protect Women’s Healthcare

The Exempla board and a citizen group filed lawsuits in 2008
to block the sale citing, in part, concerns that non-sectarian medical policies
would end under a Roman Catholic healthcare system. Community members formed
Save Lutheran Medical Center and produced a petition signed by more than 9,000
local residents to reject the deal.

But it was all for naught.

Two years of lawsuits resulted in a June 5 binding
arbitration agreement that nullified the cash payment to Community First as a
violation of state law since the community, not the foundation, owns the assets
of the tax-exempt, nonprofit hospitals.

But in a blow to reproductive health advocates, Arbitrator
William Meyer determined that the takeover could still occur as long as nothing
of value exchanged hands between the foundation and the Sisters of Charity. He
also disregarded the religious medical directive argument claiming that the
founding documents of the two Lutheran hospitals didn’t require them to remain

While the cases played out in court and behind closed doors
in the private arbitration hearing, Colorado state lawmakers worked to minimize
the damage of losing hospital-based reproductive healthcare services.

Issues of religious doctrinal interference in
physician-patient decision making came to a head in 2007 when Gov.
Bill Ritter signed a law
requiring hospitals and pharmacies to provide
sexual assault victims information about emergency contraception. However, a
conscience clause was added to the bill in order to get conservative Democrats
on board after heavy lobbying by the Colorado Conference of Bishops.

Likewise, during the 2009 legislative session, the state
passed a landmark Birth
Control Protection Act
to legally define contraceptive treatments,
procedures and devices to stem future challenges to health insurance benefits
or from "personhood" laws devised to give fertilized eggs civil right

Though, again, the Catholic church forced a compromise to
exclude mifespristone, or RU-486, and other federally approved pharmaceuticals
that induce abortion.

Yet, despite the efforts of pro-choice lawmakers there are
no safeguards in place to mandate other hospital-based reproductive health
services, like sterilization or abortion, or in end-of-life care procedures
that require the removal of feeding tubes or ventilators at tax-exempt,
nonprofit facilities.

An 11th-Hour Reprieve
Wrapped Up in Red Tape

Since the summer arbitration ruling, Community First and the
Sisters of Charity have forged a new deal that keeps the foundation on as a
co-partner but exempts it from any fiscal responsibility for the mounting $2.1
billion in capital needs at the three hospitals. The duo will then transfer
control of Exempla to the Sisters of Charity, putting it in complete charge of
the hospitals’ administration.

Critics of the latest deal pinned their hopes on a 2008
state law that requires the state attorney general to review nonprofit hospital
transactions that could substantially change hospital services the public has
come to expect. Despite that law, Colorado Attorney General John Suthers, an
anti-choice Republican, said in November there was no need to hold a hearing on
the Sisters of Charity deal because it was now merely a change in bylaws and
not a merger.

Meanwhile, the two partners continue to finalize the phasing
out of Exempla’s independence. A new board of directors, comprised of an equal
number of appointees by Community First and the Sisters of Charity, was
announced December 13.

The last remaining obstacle to the church’s imposition of
religious directives on care is the Federal Trade Commission which must approve
the deal.

A decision was expected by year-end but has not yet
been made public. An FTC spokesperson could not be reached for comment about
the delay.

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