Catholic hospitals under scrutiny
Observers question if facilities are performing birth-control procedures
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.