Catholic hos­pi­tals un­der scru­tiny

Ob­servers ques­tion if fa­cil­i­ties are per­form­ing birth-con­trol pro­ce­dures

Modern Healthcare - - The Week In Healthcare - Joe Carl­son

Af­ter re­cent con­tro­ver­sies in Ore­gon and Texas where Catholic hos­pi­tals were caught per­form­ing sur­gi­cal birth-con­trol pro­ce­dures that vi­o­late bish­ops’ eth­i­cal prin­ci­ples, ob­servers say they be­lieve other Catholic hos­pi­tals are prob­a­bly do­ing the same thing.

And that may not be en­tirely sur­pris­ing, given the fi­nan­cial and pa­tientsafety pres­sures brought to bear on Ro­man Catholic hos­pi­tals by pa­tients, physi­cians and in­sur­ers seek­ing ac­cess to pro­ce­dures for­bid­den by Catholic ethics, such as tubal lig­a­tions. Catholic hos­pi­tals ac­count for about 5.6 mil­lion in­pa­tient ad­mis­sions an­nu­ally.

The con­tro­versy has led to more scru­tiny across the coun­try, af­ter news last month that one of Ore­gon’s largest hos­pi­tals ended its 92-year his­tory as a Catholic in­sti­tu­tion and a scathing ex­pose in July 2008 that ac­cused two dozen Catholic hos­pi­tals in Texas of per­form­ing more than 9,600 ster­il­iza­tions deemed un­eth­i­cal in four years’ time.

“I sus­pect it’s fairly wide­spread. It cer­tainly was wide­spread in Texas,” said the Rev. Gavin Vaverek, pro­moter of jus­tice for the Dio­cese of Tyler (Texas), which took action to end the prac­tices at its two Catholic hos­pi­tals af­ter they were iden­ti­fied as per­form­ing tubal lig­a­tions in the re­port, which was pub­lished on the Web site Wik­iLeaks. “I don’t think there’s any rea­son to think that Texas would have been dif­fer­ent from the rest of the na­tion.”

One of the most com­mon sce­nar­ios where a Catholic hospi­tal would face pres­sure to per­form a tubal lig­a­tion is when a woman de­liv­ers a baby via ce­sarean sec­tion and then re­quests to have her “tubes tied” at the same time. Crit­ics say pa­tients may face less of a risk of com­pli­ca­tion by do­ing a sin­gle surgery, in­stead of hav­ing a sec­ond pro­ce­dure for the tubal lig­a­tion. How­ever, Catholic ethi­cists say this sce­nario is ex­pressly for­bid­den by the U.S. Con­fer­ence of Catholic Bish­ops be­cause it ren­ders a func­tion­ing hu­man or­gan non­func­tional for the sole pur­pose of pre­vent­ing preg­nancy.

The Rev. Robert Vasa, bishop of the Dio­cese of Baker, which in­cludes cen­tral and east­ern Ore­gon, an­nounced in Fe­bru­ary that 261-bed Cas­cade Health­care Com­mu­nity St. Charles Med­i­cal Cen­ter in Bend, Ore., could no longer be con­sid­ered truly Catholic be­cause it had been per­form­ing sur­gi­cal ster­il­iza­tions in vi­o­la­tion of the U.S. bish­ops’ eth­i­cal and re­li­gious di­rec­tives for hos­pi­tals.

As a re­sult, Vasa an­nounced the dio­cese was can­cel­ing its spon­sor­ship of the hospi­tal, al­though the bishop noted that the de­ci­sion would re­sult in few changes out­side of the dis­con­tin­u­a­tion of Mass in the church chapel. “In our sec­u­lar cul­ture most do not rec­og­nize the ex­treme grace of our Lord’s real pres­ence, but I sus­pect his ab­sence from the chapel will be deeply felt,” Vasa wrote in a March 8 col­umn in the Catholic Sen­tinel.

In a phone in­ter­view, Vasa said the for­merly Catholic hospi­tal’s ad­min­is­tra­tors had tried to jus­tify hun­dreds of tubal lig­a­tions per year through an ex­cep­tion in the bish­ops’ eth­i­cal di­rec­tives that al­lows for “in­di­rect” ster­il­iza­tions, where a sur­gi­cal pro­ce­dure in­tended to ad­dress some other med­i­cal con­di­tion leaves a woman infertile. The clas­sic ex­am­ples are surgery for can­cer of the uterus or fal­lop­ian tubes, or chemo­ther­apy treat­ments that af­fect fer­til­ity.

How­ever, at St. Charles Med­i­cal Cen­ter, Vasa said, ad­min­is­tra­tors ar­gued that the ster­il­iza­tions were in­di­rect be­cause the pro­ce­dures were nec­es­sary to pre­serve a woman’s over­all health by pre­vent­ing preg­nancy. “It’s pretty hard to in­ter­pret that as in­di­rect,” Vasa said. Asked whether he be­lieved the same logic was be­ing used at other Catholic hos­pi­tals across the coun­try, he said, “I have my sus­pi­cions, but not enough to act on.”

Vaverek said an ex­am­i­na­tion sim­i­lar to the one on Texas hos­pi­tals may be pos­si­ble at the na­tional level, al­though crit­ics noted that the amount of billing in­for­ma­tion avail­able to re­searchers varies widely be­tween the states. The Texas re­port was based on anal­y­sis of med­i­cal billing codes, which led crit­ics to say its anony­mous au­thors may have in­cluded pro­ce­dures that were eth­i­cal re­gard­less of how the ICD-9 cod­ing ap­peared.

Of­fi­cials at St. Charles did not re­turn sev­eral calls for com­ment, and of­fi­cials at sev­eral other Catholic hos­pi­tals and sys­tems de­clined to com­ment or did not re­turn calls. Of­fi­cials with the Catholic Health As­so­ci­a­tion could not be reached for com­ment be­fore dead­line.

Leonard Nel­son III, a law pro­fes­sor at Cum­ber­land School of Law at Sam­ford Uni­ver­sity in Birm­ing­ham, Ala., and au­thor of the 2009 book Di­ag­no­sis Crit­i­cal: The Ur­gent Threats Con­fronting Catholic Health­care, said hos­pi­tals face fi­nan­cial pres­sures to find ways to jus­tify per­form­ing tubal lig­a­tions over the church’s ob­jec­tions. While the sur­gi­cal pro­ce­dure it­self is not con­sid­ered too lu­cra­tive, health­care providers don’t want to alien­ate the kinds of pa­tients seek­ing the pro­ce­dures.

“Th­ese are young, healthy fam­i­lies, usu­ally with in­sur­ance, and they’re a good cus­tomer base. So they want to have a good re­la­tion­ship with them,” Nel­son said. “The health plans want the fa­cil­i­ties they con­tract with to pro­vide ser­vices like this to their in­sureds.”

Gerry Hee­ley, se­nior vice pres­i­dent for mis­sion and ethics at 18-hospi­tal Chris­tus Health, based in Irv­ing, Texas, ac­knowl­edged that hos­pi­tals can face pres­sure from non­staff physi­cians who per­form ob­stet­ri­cal surg­eries. Chris­tus is the owner of sev­eral hos­pi­tals iden­ti­fied in the Wik­iLeaks re­port. One com­mon so­lu­tion is to re­fer pa­tients to am­bu­la­tory clin­ics or physi­cians’ offices that are not di­rectly owned or staffed by the Catholic hospi­tal.

In ad­di­tion, stud­ies have over the years dis­proved the idea that a pa­tient would form an over­all opin­ion of a hospi­tal based on the avail­abil­ity of a sin­gle pro­ce­dure, he said. “The sin­gle pro­ce­dure typ­i­cally doesn’t dis­cour­age them from com­ing back,” Hee­ley said. “That has been used to ma­nip­u­late fa­cil­i­ties at one time or an­other, but the data don’t sup­port it.”

Vaverek: “I sus­pect it’s fairly wide­spread.”

Hee­ley says one so­lu­tion is to re­fer pa­tients else­where.

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