Analysis Health Systems

Kentucky Governor Firmly Rejects Hospital Merger with Catholic Health Initiatives

Rev. Matthew Westfox

Kentucky Governor Steve Beshear said January 9, 2012 for the second time in two weeks that he was rejecting a hospital merger of the publicly-funded University Hospital with a Catholic-oriented consortium, Catholic Health Initiatives (CHI).

Kentucky Governor Steve Beshear said January 9, 2012 for the second time in two weeks that he was rejecting a hospital merger of the publicly-funded University Hospital with a Catholic-oriented consortium, Catholic Health Initiatives (CHI).

The rejection of the Kentucky merger marked a welcome success story for people supporting reproductive options and it shows how concerned citizens, working together, can have a real impact in their communities. It also sends a clear message to Washington D.C. policymakers that ordinary Americans do not want their health care options limited by singular religious views.

The Kentucky Religious Coalition for Reproductive Choice and others objected to the restrictions on reproductive health care that would have resulted from the merger. Particularly affected would have been the needy, for whom University Hospital is the main source of care.

The proposed hospital merger – or its rejection – didn’t generate much attention outside Kentucky, but it was big news in the state. The plan, first raised in the early summer of 2011, involved merging two hospitals in Louisville and one in Lexington into a single entity under the majority control of CHI, a Denver-based chain. In addition to University Hospital, which had been built with public funds, the others joining in the merger plans were Jewish Hospital and St. Mary’s HealthCare in Louisville and St. Joseph Hospital in Lexington.

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CHI indicated that it would operate under the Ethical and Religious Directives (ERD) of the Roman Catholic Conference of Bishops, and all of the merging hospitals would be required to conform to the ERDs, even if they or their patients did not subscribe to Catholic beliefs. This created a significant problem for reproductive health care since the ERDs prohibit or restrict a range of medical procedures related to reproductive health, including abortion (even when medically necessary), family planning, contraception, emergency contraception, tubal ligation, vasectomy and stem cell research. Employee health care options at these hospitals would have been similarly curtailed, regardless of employees’ personal religious beliefs.

The Board of the Kentucky Religious Coalition for Reproductive Choice (KRCRC), a state chapter of the Religious Coalition for Reproductive Choice (RCRC), headquartered in Washington D.C., voted unanimously in December to take a stand opposing the merger. In a letter to the editor, KRCRC wrote that the Catholic Ethical and Religious Directives were not compatible with providing the full range of reproductive health care services to the area’s citizens. The letter said:

[W]e cannot condone a hospital merger that will restrict reproductive health care services to those who need it most, at our public hospital, based on the ethical dictates of the Catholic religion.

RCRC has long supported women’s moral right to make decisions about childbearing according to the dictates of their conscience and religion. RCRC reaffirmed this commitment in November 2011 in a statement to a congressional subcommittee on health, noting:

“Institutions operating with public funds and serving the public should not be allowed to impose beliefs about health care on entire communities and all of their patients. This is especially critical in communities where a religiously affiliated institution is the only or main service provider.”

RCRC also said:

It is important to note that many religions support a woman’s right to access reproductive health care, including abortion and contraception, as a matter of free exercise of conscience protected under the law.

Community advocates in Louisville, including The American Civil Liberties Union of Kentucky, Planned Parenthood of Kentucky, the Women’s Political Caucus, Presbyterians Affirming Reproductive Options, and the Presbyterian Church (USA) (whose denominational offices are in Louisville) voiced their opposition to the hospital merger, as well. Local leaders and activists began a community awareness campaign, disseminating information about the ramifications of the merger and holding forums in the city. KRCRC and other groups emailed their members, urging them to contact the governor with their opposition to the merger.

Many of the negotiations for the merger were conducted in private, away from public participation. Publicly, officials of University Hospital and other partners argued that they could not survive financially without the merger. However, more questions began to be raised when it was learned that CHI would have a controlling majority of votes on the board of the new corporation.

As objections grew, CHI promised to make compromises. But many of them simply did not meet the needs of the community.  For example, CHI offered that a woman who wanted tubal ligation following delivery could be transferred to a local hospital in another part of town – an area inaccessible to most economically-disadvantaged people. In addition, the mere fact that a woman was being sent to the other hospital would interfere with her right to confidential medical care. The merging group also said that emergency contraception could be not provided to rape survivors in an emergency room unless the victim was tested first to make sure that she had not been pregnant before she was raped.

Attorney General Jack Conway and the State Auditor Crit Luallen expressed concerns in the fall about the merging partners’ secret negotiations and a lack of transparency about future operating plans. Nonetheless, the movement toward the merger marched forward, with the deal likely to be sealed in early January, 2012. The final say-so related to the participation of University Hospital lay in the hands of the governor.

Throughout the fall, letters to the editor of the Louisville Courier-Journal ran heavily against merger in an increasing crescendo. On December 17, 2011, a poll was released showing that 49 percent of 502 respondents opposed the merger and 41 percent favored it after hearing arguments for and against the merger.

But the real turning point came on December 18, 2011 when the Louisville Courier-Journal published an editorial, insisting in no uncertain terms that the governor should reject the merger “for fundamental reasons that go to the heart of the American law and experience.” The editors wrote that the merger of the University Hospital with CHI would undermine the separation of church and state and would harm indigent patients. It opposed turning over a publicly-built facility…

“to a religious group that limits standard medical care based on religious dogma. That is a classic breach of the wall between church and state so eloquently articulated by Thomas Jefferson and so painfully secured by the brave souls who founded this nation….. In a public hospital, decisions about treatment should be made between the patient and her doctor. There is no room for an uninvited clergyman in the room when those determinations are being made.”

On December 30, Governor Beshear announced that he was rejecting the merger to protect taxpayer property. “University Hospital is a public asset with an important public mission,” the governor said. If the merger were to take place, “the public would have only indirect and minority influence,” he said.

Within a week, Jewish Hospital, St. Mary’s Healthcare and Lexington’s St. Joseph Hospital announced they would merge with CHI without University Hospital. But the fight over University Hospital wasn’t yet over. CHI said it would come back to the governor with other adjustments. On January 9, 2012, Gov. Beshear held firm. He said that he would work to find other solutions to shore up University Hospital’s finances, but that the merger discussions were over.

The community coalition that had organized against the merger finally breathed a sigh of relief. The steady and clear articulation of citizens, working together with the reproductive justice and civil rights communities, to oppose this merger secured an important victory.

Elected officials and policymakers in the nation’s capital also should take note: Americans do not want their health care decision making, including about reproductive health, pre-empted by a religious institution.

News Religion

Hospital Illegally Refused Sterilization Procedure, Pro-Choice Group Charges

Jason Salzman

The Center for Reproductive Rights, in a March 4 letter sent to St. Anthony Summit Medical Center on behalf of the patient, Jennifer Versailles, stated that the Catholic hospital's denial of the tubal ligation procedure violates state and federal laws mandating pregnancy related care.

A Catholic hospital in Colorado’s central mountains has refused the request of a staff doctor to perform a tubal ligation, a sterilization procedure, after a cesarean section that took place on Tuesday.

The Center for Reproductive Rights (CRR), in a March 4 letter sent to St. Anthony Summit Medical Center on behalf of the patient, Jennifer Versailles, stated that the Catholic hospital’s denial of the tubal ligation procedure violates state and federal laws mandating pregnancy related care.

It also constitutes sex discrimination, the letter charged.

James Corbett, Centura Health’s senior vice president for community health and values integration, did not address Versailles’ case when asked for comment, but he alluded to the hospital’s faith-based directives.

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“We cannot discuss specifics about a patient due to federal patient privacy laws,” Corbett wrote in a statement to Rewire. “St. Anthony Summit Medical Center is among the Centura Health hospitals which adhere to the Ethical and Religious Directives for Catholic Health Care Services (ERDs).”

It is CRR’s “understanding” that St. Anthony’s refusal to perform the procedure is based on the ERD directives, which are promulgated by the U.S. Conference of Catholic Bishops, according to the letter from CRR, a national reproductive freedom organization.

The ERD directives state that sterility procedures on men or women are “not permitted in a Catholic health care institution,” unless treatment of an illness would dictate otherwise and alternative remedies are not available.

“We uphold our faith-based mission and strongly respect the patient-physician relationship,” Corbett wrote in his statement.

Autumn Katz, CRR senior staff attorney, told Rewire that this case proves this wrong.

“They say that they value a doctor-patient relationship, but policy suggests otherwise,” Katz said. “This is absolutely interference in a very disturbing way in the doctor-patient relationship, because this is the care that Jennifer’s doctor and she have decided is best for her health. The hospital for other reasons is denying her ability to access that care.”

Corbett wrote that the hospital facilitates the doctor-patient relationship by encouraging alternatives.

“In instances where a patient cannot obtain a requested elective procedure at a Centura Health hospital under Catholic sponsorship, we encourage the patient and physician to work together for a solution,” Corbett wrote.

Asked to explain why Versailles didn’t have the tubal-ligation procedure at a different hospital, Katz said, “My understanding is [Versailles] felt that the safest course for her was to do it at this hospital. That’s the hospital where her doctor practices and where she’s delivered her prior two children. She was not willing at the last minute to find a new doctor and travel, under what could be precarious conditions, to a different hospital where she could have had the tubal procedure.”

“Ms. Versailles, in consultation with her doctor, Dr. Andrew Catron, has decided that immediate postpartum tubal ligation is in her best medical interest, given her age and prior medical history,” the CRR letter states. “Ms. Versailles has two young children—ages two and five, both delivered by C-section—and she and her husband do not wish to have more children.”

The letter points to an American College of Obstetricians and Gynecologists’ recommendation that postpartum tubal ligation should be considered an “urgent surgical procedure” because it reduces medical risks and obviates the need for an additional surgery with anesthesia.

St. Anthony Medical Center, located in Frisco, Colorado, is a member of the Centura Health hospital chain, formed by a 1996 merger of Adventist Health System and Catholic Health Initiatives (CHI) hospitals.

It describes itself on its website as a “faith-based, nonprofit health care network designed to manage and strengthen their hospitals and services.”

“We extend the healing ministry of Christ by caring for those who are ill and by nurturing the health of the people in our communities,” the website states.

The CHI network has been criticized for trying to dictate medical treatment in accordance with the religious guidelines of the U.S. Conference of Catholic Bishops.

After Catron requested permission to perform the tubal ligation in December, according to CRR’s letter, the Rev. Godwin Nnamezie of St. Anthony’s Ethics Committee wrote Catron an email stating, “Honestly, you know that we cannot do direct sterilization at this Facility. Procedures that induce sterility are only allowed when it is to cure or alleviate any serious illness of the patient.”

Katz said her organization hasn’t decided how it will respond.

“We will evaluate all options,” Katz said. “We will talk to Jennifer in the next few weeks and see how she is feeling. I don’t expect this to be an isolated incident. And it’s a danger to many women. It has repercussions beyond this procedure, for a hospital to dictate medical care from religious directives rather than what’s the best medicine for patients.”

News Abortion

Anti-Choice Kentucky Governor Launches Legal Assault on Planned Parenthood

Jenn Stanley

Gov. Matt Bevin has accused Planned Parenthood of providing "illegal abortions," even though the health-care organization has released documents showing that they were operating well within the law.

Kentucky Gov. Matt Bevin’s administration is suing Planned Parenthood of Indiana and Kentucky (PPINK) over abortion care provided in recent months.

Bevin, the newly elected and outspoken anti-choice Republican governor, last month vowed to shut down Planned Parenthood’s Louisville Health Center, claiming the clinic had violated the law by beginning to provide abortion care, despite the clinic having approval from the former governor’s administration.

PPINK temporarily ceased abortion care at that clinic while the matter was resolved. But on Thursday, the state Cabinet for Health and Family Services filed a lawsuit against PPINK, seeking more than $900,000 in fines.

“Although I am an unapologetically pro-life individual, I recognize and accept that there are some laws on the books that I do not necessarily agree with,” Bevin said in a statement. “However, we are a nation of laws, and my job is to ensure that they are followed regardless of my personal opinion.”

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He went on to accuse Planned Parenthood of “knowingly endangering their patients by provide illegal abortions.” PPINK officials maintain that they were operating within the law. They released documents this month that show Kentucky officials, under former Gov. Steve Beshear (D), authorized Planned Parenthood to provide abortion services at its Louisville clinic.

“We in no way, shape or form would contemplate offering abortion procedures in anything but a legal environment,” Planned Parenthood of Indiana and Kentucky CEO Betty Cockrum told Insider Louisville last month.

“PPINK followed longstanding protocol and received necessary authorization from the appropriate authority, the Office of Inspector General (OIG), to perform abortions at its facility while awaiting a site survey,” Judi Morrison, PPINK’s vice president of marketing and education, said in a statement. “All conditions for a survey to occur have been met. We ask that the executive branch continue the licensure process rather than continue to make politically motivated accusations.”

The Bevin administration alleges in the complaint that Planned Parenthood’s documentation of an emergency hospital and ambulance service was “a complete sham.”

“They appear to have been supplied intentionally in order to mislead the Cabinet into granting a license or to persuade the Cabinet to permit Planned Parenthood to begin performing abortions even before a license was granted,” the complaint reads.

Bevin ran on an anti-choice platform, and Republicans in the legislature have said that they’ve made it their mission to attack abortion rights as a way to “send a message to voters.”

Republicans have a majority in the state senate, and Democrats are trying to hold onto their narrow majority going into special elections in March. Kentucky has seen anti-choice laws passing through the legislature over the past two months, including a forced ultrasound bill that passed in the all-male Senate Standing Committee on Veterans, Military Affairs, and Public Protection.

The Louisville Planned Parenthood branch provided 23 abortions in December and January, according to WFPL radio.