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Communities fight for control of hospitals

Mergers are putting the Catholic Church in charge of more and more hospitals. Some communities are fighting back--and winning.

It took less than two weeks for the residents of Abington, PA., to stop a Roman Catholic hospital from decimating reproductive care at their community hospital.

In the summer of 2012, Rita Rosen Poley read an announcement of the merger in the paper and knew she had to act. “The possibility that women would be denied the rights to their own body was just inconceivable,” she told msnbc.

When Catholic hospitals take over secular ones, and in some cases when two hospitals affiliate more loosely, the employees of the formerly secular facility are bound by guidelines called Ethical and Religious Directives that prohibit abortions, emergency contraception for rape victims, and delay essential medical procedures until a woman’s life is in danger. They can also override directives for end-of-life care and allow discrimination against LGBT patients, all in the name of church doctrine. "What surprises most in these cases is that a hospital has 'saint' in the name but they don’t really know what that means," says Meghan Smith, a domestic associate at Catholics for Choice.

The thought of her community being subject to such health restrictions was too much for Rosen Poley. Despite a serious aversion to social media, after a conversation with her daughter, she started a Facebook page that quickly drew thousands of visitors and commenters. Facing a possible exodus of doctors and significant public opposition, Abington Memorial Hospital quickly abandoned the deal.  “They hadn’t counted on who their community was, who their customers were, who their doctors were. We’re a very active community.”

While the residents of Abington were able to protect themselves from a takeover that reduced their health care choices, other communities have not been so lucky. With ten completed or proposed affiliations between secular and Catholic hospitals in just the past three years, Washington has become the main battleground over hospital mergers. Nearly half of the state’s hospital could be affiliated with the Catholic Church by the end of the year.

"What's happening in Washington state is extremely troubling for anyone who cares about comprehensive access to services," Smith told msnbc. "Any time the ethical and religious directives are involved, we're placing bishops in charge of what health care is allowed," something Smith points out even most Catholics don't support.

According to polling done by Catholics for Choice and the American Civil Liberties Union last fall, 62% of the public-- and 59% of Catholics--did not believe a Catholic hospital should be able to refuse to perform an abortion that would protect a woman's life. A large majority of Catholics and non-Catholics alike also objected to the practice of denying access to contraception on religious grounds. "We have found time and again that the ethical and religious directives don't reflect, one, what Catholics want to see from our hospitals, and two, what communities expect their hospitals to provide," Smith said.

If three hospitals in Northwest Washington affiliate with PeaceHealth, a Catholic health care organization, there would be no secular hospital between Seattle and the Canadian border, says Mary Kay Barbieri, co-chair of People for Healthcare Freedom, a group that has been fighting the mergers. Barbieri began agitating when she overheard a health care provider mention a possible merger at a dinner party.

What started as a small meeting of activism-minded community members in Barbieri’s small town in advance of a community forum turned into People for Healthcare Freedom. While two of the three hospitals did sign agreements and are in the early stages of working out affiliations, Barbieri has no plans to let the issue drop. Despite assurances that the hospital would remain under secular control, “we can’t see why a big corporation would give our hospital millions of dollars without any control,” she told msnbc.

“What we keep finding is that even when hospitals think they’re trying to separate out protected services, the religious prohibitions have a way of creeping in," she said. "Why wouldn’t they? These are deeply held convictions.”

Agreements between Catholic and secular health care facilities have been happening for years, but the pace is quickening. As health care costs soar and hospitals endure negotiations with insurance companies, 2013 is on track to see a record number of mergers and affiliations. These agreements disproportionately affect low-income and rural communities; nearly a third of all Catholic hospitals are in rural areas, and there have been more than 140 agreements between religious and non-religious hospitals since 1997.

“Over the years we’ve figured out to intervene ahead of time to prevent the loss of services,” said Lois Uttley, the director of Merger Watch, a group that tracks hospital mergers and helps communities affected by them. Uttley founded Merger Watch in 1997, when a hospital merger in Albany cut off contraceptive coverage for low-income women there.  Since then, she has worked with communities around the country, including in Abington, to help them stop possible mergers and mitigate harmful consequences. So far, the group has managed to stop more than two dozen proposed mergers and force compromises in nearly two dozen more.

For Bruce Silva, an OB-GYN at a hospital in Sierra Vista, AZ, outside assistance was crucial. The National Women’s Law Center helped doctors there collect affidavits from patients who were affected after the doctors were forced to adhere to Catholic standards, and Merger Watch gave information and advice to activists like Dotti Wellman, who turned her house into a staging ground for daily protests outside the hospital.

With the nearest full-service hospital 90 miles away in Tucson, Silva knew the merger would be devastating for his patients. “We’re a rural hospital, most of my patients are poor,” he told msnbc. “If you can’t afford gas to my hospital, how are you going to get to Tucson?”

He also experienced firsthand the intrusion of doctrine into his practice. He could no longer do procedures like tubal ligations alongside a C-section: for that, he and the patients had to go to a separate facility.  “They were telling me to put my patients at more risk," he said.

It wasn’t just women at risk. Sierra Vista is a community with a large retirement-age population, so the question of how the hospital would handle aging and dying patients’ wishes galvanized Wellman and her friends. “Most of us were 70 and older,” she told msnbc of the protesters who picketed and descended upon hospital board meetings--to the dismay of hospital security.  “Very often we were accused of infringing on the rights of the board members.”

Silva says that the vast majority of the hospital’s staff was against the merger, although the OB-GYN staff was the most vocal. Many doctors left the hospital rather than submit to the changes. “It was a horrible feeling, getting up in the morning and looking in the mirror and feeling like I wasn’t practicing medicine,” Silva said.

In the end, after a year of protests, meetings, staff departures, and near constant scrutiny, the board announced in April 2011 that it would not proceed with the merger. Since then, a for-profit company bought the hospital and is currently building a new facility.

While the fight to save Sierra Vista Regional Health Center took a toll, Silva has no regrets. “In terms of what I’ve done in my life, it’s the thing I’m the most proud of,” he says now. “If we’d stayed with the Catholic group, we never would have gotten what we needed down here. It would have been a disaster.”