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Why is Washington paying Catholic hospitals to take away healthcare?

Guest Opinion: Catholic hospitals are buying up Washington's healthcare system and stripping end-of-life, contraception and maternity care. All with public funds.

Beginning January 23, all hospitals in Washington state will be required to submit their admission, reproductive, end-of-life and nondiscrimination policies to the Washington State Department of Health and post them on their websites.  Hospitals will have 60 days to develop and post the policies.  

Though the new requirement is a good start, it doesn’t go far enough.  It leaves too much room for hospitals driven by a religious mission to continue to mislead the public and regulators about what their policies are and it doesn’t address the fundamental problem of religiously-driven hospitals denying appropriate care to patients, many of whom have nowhere else to go. 

This is becoming more of an issue as Catholic health systems expand horizontally and vertically. In Washington state, they now control more than 40 percent of acute care hospital beds – a measure that increasingly serves as a useful proxy for the health care system more broadly, including hospitals, physician practices, labs and hospices.

The Catholic takeover of so much of Washington’s health care system has been deliberate and strategic. In recent years, the three major Catholic players in Washington state, Providence/Swedish, PeaceHealth and Franciscan, have been swallowing secular medical facilities at an unprecedented pace.

Catholic Health Initiatives, the parent organization of Franciscan, was formed many years ago as a result of a megamerger between three huge Catholic Health systems. As health care writer Lola Butcher documented in a recent article, its goal was to become a national health care ministry. Today, CHI owns 87 hospitals and has revenues of $12.5 billion. An entity of the Catholic Church, it reports directly to the Vatican.

As an entity of the Vatican, CHI is very clear that it does have a strategy for taking over hospitals, both in Washington and other states. Franciscan recently took over medical systems in Bremerton and Burien. CHI’s Senior Vice President for Strategy and Business Development discussed the broader takeover strategy with Butcher for her health care management industry article.

Until advocates raised the alarm last spring, Catholic Health Initiatives was also planning a "partnership” with PeaceHealth through its Franciscan health network.

According to Butcher, bringing new partners like PeaceHealth into the fold enables CHI to “enforce standards,”  which seems likely to include all of the Ethical and Religious Directives for Catholic Health Care (ERDs). Among other things, that means no contraception, no vasectomies or tubal ligations, no “direct” abortion – even in cases where a woman will almost certainly die – and no participation with Death with Dignity. Throughout the CHI system, adherence to the ERDs is a condition of employment. 

In many areas of Washington state, patients who need hospital care have no other choice for healthcare. On San Juan Island, for example, the new PeaceHealth hospital/medical center refuses to provide key reproductive health services or to refer terminal patients who want to exercise their rights under Washington’s Death with Dignity laws – even without the CHI partnership. That's despite receiving a direct subsidy from the local public hospital taxing district under an exclusive 50-year contract. 

In 2013, the American Civil Liberties Union wrote a letter advising the hospital district that its contract was unlawful and likely unconstitutional. In August, Attorney General Bob Ferguson weighed in with a formal opinion: Any hospital district that subsidizes maternity care, he wrote, must also subsidize other reproductive health services, including contraception and abortion.

“We don’t provide any maternity care,” PeaceHealth's San Juan Island hospital responded. This came as news to islanders, who had received prenatal and well baby care at the aging facility which the new, much bigger PeaceHealth facility replaced. 

PeaceHealth’s policy on San Juan Island of not treating pregnant women or new mothers, even as it has expanded care options to include plastic surgery and colonoscopies, is an example of the lengths to which Catholic hospitals can go to impose their will on others – even while taking state money. 


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Comments:

Posted Tue, Jan 7, 12:21 p.m. Inappropriate

Lot of hatred in this article. Not sure that she offered a solution other than it's her way or else. Which is what she's accusing the Catholic Church of doing.

Perhaps we should outlaw all private ownership of hospitals and make all that work in them government employees with the usually pay and wage schedules.

Djinn

Posted Tue, Jan 7, 4:07 p.m. Inappropriate

I sincerely hope a loved one of yours doesn't find herself with an ectopic pregnancy in a hospital that refuses to provide medically appropriate care for reasons of religion. Similarly, I hope none of my loved ones is ever refused a blood transfusion in a hospital setting in the midst of an emergency for reasons of religion.

You and the Catholic bishops are free to believe what you want. It's the act of imposing those beliefs on others that crosses a line. It's not about hatred; it's about having respect for the rights of others at a vulnerable time.

Monicah

Posted Wed, Jan 8, 4:13 p.m. Inappropriate

I missed it; where's the hatred?

busterg

Posted Tue, Jan 7, 12:59 p.m. Inappropriate

My heart goes out to the poor and downtrodden residents of San Juan Island, whom the Pope (probably in league with the Knights Templar and the Illuminati) forces to take a ferry ride to the mainland for an abortion. The moral to this story is clear: Unless you practice safe sex, don't get frisky on San Juan Island.


But beyond the needlessly combative tone of this piece, it only discusses half of a pending crisis in the availability of health care in this country. That's because there are two bureaucratic behemoths engaged in a "strategic takeover" of our health car system, in order to "enforce standards." The other is the federal government. Ms. Harrington's piece is long on fear mongering but short on solutions. There will be a hospital shortage in the years to come as one of the unintended consequences of "Obama Care". Smaller hospitals will need to either close or merge to gain the economies of scale necessary to meet ever more unrealistic price-control mandates. So what is the author's solution? Eliminate the largest, and therefore potentially most efficient provider of hospital services, or... What?

dbreneman

Posted Tue, Jan 7, 1:44 p.m. Inappropriate

The implications of this extend beyond women's health and end-of-life issues to all health and medicine. As science and medicine advance to use stem cell and gene-based techniques, the faith-based policies of the Catholic Church will be in direct conflict with these advances. If the current "standards" are maintained, there is a very real probability that beneficial treatments won't be made available to patients who find themselves in a medical facility affiliated with the Catholic Church. Think this is hyperbole? Ask any doctor - especially those who deal with cancer and immune system diseases.

buttercup

Posted Tue, Jan 7, 4:21 p.m. Inappropriate

Thanks for this comment - I'd encourage physicians and researchers who are working on new areas of medicine and who are concerned about this issue to contact the ACLU of Washington. It's helpful for people who are working on policy, legal issues, and advocacy to understand the full breadth of potential treatments at risk, and of course, the ACLU knows how to respect the privacy of people who contact them.

Monicah

Posted Wed, Jan 8, 3:25 p.m. Inappropriate

If Catholic hospitals don't provide the services that people want, there will be other hospitals that will. It may be that over time, Catholic hospitals will come to specialize only in those services that are compatible with Vatican teaching. In fact, many hospitals may in time come to specialize (to achieve the economies of scale I mentioned above) just as medical practices specialize. We already see this taking place with institutions like the Fred Hutchinson Cancer Center at the UW. But Catholic versus "secular" hospital care isn't a new issue. My grandfather (born in 1903) used to joke "I'd never go to a Catholic hospital. They're so eager to get me into Heaven they may try to get me there sooner than I want." The alarmist tone of this article makes it sound as though this is a new and immediate issue, even a crisis. It's not. The author would have done readers a favor by taking a more measured approach to the issue.

dbreneman

Posted Wed, Jan 8, 7:47 p.m. Inappropriate

The medical market/economy differs fundamentally from markets for services and products in which the components necessary for competition (e.g., information and choice) are present and available to consumers. Significant capital costs also mean that medical facilities are not easily or quickly added to fulfill market needs. Add to this the fact that medical decisions are often highly emotional and decisions are frequently made under tight time constraints so that one relies heavily on the advice of doctors - who, if they want to keep their affiliation with a Catholic hospital, may be unable to provide patients with advice that conflicts that Catholic beliefs or goals.

It would be great if the medical economy allowed meaningful choices and operated in a more open fashion so that patients could enjoy the benefits of real competition - but it doesn't and it is hard, if not impossible, to see how it gets there given the unique nature of the medical market. Patients could begin to screen their doctors based on their hospital affiliation but this is impractical and basically recognizes that the regulating authorities have failed in their obligations.

The equation of medical decision making + nature of the medical economy + medical options governed by the goals and views of a faith-based organization ≠ best for patients. If the Catholic hospitals want to be the best hospitals bar none which would require making all medical options available to all patients, great. If not, it is hard to understand how all patients can be assured that they will receive the best medical care at a Catholic-affiliated institution - especially as science marches forward and forward and forward. Put another way ... If Catholic hospitals control or influence a number of hospital beds and services that exceeds their percentage of the population, the non-Catholic population faces an unfair burden in securing medical care that would otherwise be available to them.

buttercup

Posted Tue, Jan 7, 3:40 p.m. Inappropriate

Isn't the solution simple? If you want public money you have to honor the laws of the land without picking and choosing the health services that fit your moral compass. No one is suggesting outlawing private ownership of hospitals, that comment was just silly. No one is forcing Peace Health to take public funds. Needlessly combative tone? Tell that to patients, with or without health insurance, not to be devastated when they have to schedule two medical appointments to receive family planning medical services: One with their doctor at Peace Island Medical Center on San Juan Island to confirm a pregnancy, and then another off island and at their own expense to confirm the same thing in order to make a referral for a legal abortion-should they choose to terminate the pregnancy. Oh, and don't forget the third trip in order to have the procedure done. No worries if you can't afford the $50 bucks, fuel, a day off work and other expenses that will result when women are having to travel off island to make some of the most difficult decisions they will ever make. Never mind that they are paying for a health care system that refuses to care for them when they need it most. What Peace Health is doing on San Juan Island is not trivial and not just inconvenient; it is relegating women to third class health care--and sometimes no health care-- during their reproductive years. This is not what the tax payers on the island signed up for when the notion of a new, and better, hospital was introduced. Hatred? Combative? Clearly these are not the personal issues of some of the previous writers. No, you are hearing from one more person who is understandably pissed off that the Catholic Church is forcing its agenda on the citizens of San Juan Island and the state and getting away with it.

selaines

Posted Tue, Jan 7, 4:41 p.m. Inappropriate

“We don’t provide any maternity care,” PeaceHealth's San Juan Island hospital responded. This came as news to islanders, who had received prenatal and well baby care at the aging facility which the new, much bigger PeaceHealth facility replaced.

I'm surprised that "well baby care" was provided at the aging facility but I'll take your word for it. A more sympathetic way to put the Hospital's position is that they provide health care but do not do abortions… no matter who pays for it (I have always thought the application of "healthcare" to the abortion procedure was brazenly Orwellian). A hospital that has moral standards that are not coincident with the dominant culture seems like something we could accommodate in our freewheeling, untethered and allegedly tolerant political culture but such is not the case. If the healthcare system pays for methadone does that mean a doctor has to prescribe it? you seem to be saying that the patient has the right to insist on a particular remedy and if it is paid for by the government then the care facility, doctor, nurse, etc. must do it. I think that's a leap of a particular kind of faith that should be unwelcome in a free society.

kieth

Posted Tue, Jan 7, 5 p.m. Inappropriate

"Aging" in this context was describing the building that previously housed the Inter Island Medical Center, which served islanders of all ages, including of course pregnant women and new mothers.

The irony, of course, is that many of the same physicians who worked at that facility now work at PeaceHealth, but at PeaceHealth they are prohibited by contract from violating Catholic rules. And yes, as a property owner on San Juan Island, I do expect that elected officials will obey the law, which in this case, means respecting the provisions of the Reproductive Privacy Act (RPA), which voters enacted through the Initiative process. The RPA requires that government funding not be used to discriminate among a person's reproductive choices, so if you fund a facility that provides maternity care, you also have to fund contraceptive and abortion services.

Moreover, I expect the state to enforce the provision of the Constitution that says no public funds can be used for the support of any religious establishment. PeaceHealth and other Catholic health care ministries claim to be religious institutions when it suits them (e.g., for example to avoid having to comply with regulations that apply to nonprofits, but not to religious institutions), but they also insist on their right to government funding. They can't have it both ways. As religious institutions whose religious mission is "infused" (I'm borrowing that word from the Franciscan attorney who said it while arguing before WA's Supreme Court) in everything they do, they are legally prohibited from taking taxpayer funding. Certainly, it makes no sense to me that I should have to pay taxes to support a religious agenda that I don't agree with. Especially when that agenda compromises the health of people I care deeply about.

Monicah

Posted Tue, Jan 7, 5:16 p.m. Inappropriate

How many pregnancies could there possibly be in San Juan County? And an even tinier number would want to seek an abortion .... Seems like the small number of those who want to end their pregnancy could easily go off island to a different hospital. Perhaps even catching a ride on Sound Transit once off island. Just $4 a ride, with taxpayers subsidizing the actual cost of more than $44 per mile.

Seems like taxpayers get screwed right and left.

Posted Tue, Jan 7, 5:31 p.m. Inappropriate

I don't know how you managed to link transportation and busses into this conversation, but I've got to hand it to you for creativity. In that spirit, perhaps we should put all pregnant women on busses and let the Catholic bishops decide where they go...

Or maybe we could just insist that public officials obey the Constitution and State law, and ensure tax-subsidized care be based on lawful, evidence-based medical care.

Monicah

Posted Tue, Jan 7, 7:56 p.m. Inappropriate

You've got to widen your reading Monica. Crosscut readers read voraciously, and bring comments from one article to the next, because everything is linked in terms of transportation, taxes and good governance (and health).

Pregnant women are quite able to ride ferries and buses. They even get to ride in cars from what I hear.

Posted Thu, Jan 9, 3:04 p.m. Inappropriate

"I don't know how you managed to link transportation and busses into this conversation, but I've got to hand it to you for creativity. In that spirit, perhaps we should put all pregnant women on busses and let the Catholic bishops decide where they go…"

I sure got the impression that convenience to the abortion service was a large part of the author's argument so I don't think that comment was justified (nor the snarky "creativity" comment). We all should remember that the government has no money, it uses our taxes to fight wars, battle drug dealers and terrorists as well as fund abortions. When protesters pointed out that they did not want their taxes to fund wars, especially the undeclared category, they receive considerable respect and rightly so. We could even say they were making a moral argument, sometimes inspired by religious belief, sometimes not. (as I remember, Daniel Ellsberg was a Catholic). Critics of the anti war movement made the same argument as Ms. Harrington, "the war is national policy, endorsed by our President and a majority of Congress…. get out of our way". A procedure which, as I understand it, is opposed by a majority of Americans as a matter of moral principle does not deserve the zealous promotion that Ms. Harrington seems bent on providing.

kieth

Posted Thu, Jan 9, 4:30 p.m. Inappropriate

Support for abortion rights is at an all-time high, with 70% of Americans saying that Roe v. Wade shouldn't be overturned. Most Americans understand that abortion is a deeply personal decision and they trust women and their doctors to make it without the oversight of religious clerics or anyone else.
http://www.salon.com/2013/01/22/support_for_abortion_rights_at_an_all_time_high/

And yes, abortion should be accessible around Washington state, because although you will never need an abortion, a woman who is working a full-time job and often raising a family shouldn't have to drive hours away for a safe, legal procedure that Washington voters proclaimed (though the Reproductive Privacy Act) is a private health care decision.

Monicah

Posted Thu, Jan 9, 5:54 p.m. Inappropriate

Salon? c'mon Monicah. Gallup says "illegal under any circumstances" 20%.

"legal under any circumstances" 22% (not an all time high)

"legal under certain circumstances" 52%;

I am glad that I was not aborted and I hope you feel the same way (about yourself, not about me).

kieth

Posted Tue, Jan 7, 6:17 p.m. Inappropriate

Here's a question I haven't really seen answered: why are these hospitals being taken over by Catholic systems in the first place?

Posted Tue, Jan 7, 7:51 p.m. Inappropriate

"Taken over"? It's a simple business model that allows for growth, Benjamin.

Free money isn't growing on trees any longer.

Posted Tue, Jan 7, 7:53 p.m. Inappropriate

Great question. Public policy has encouraged consolidation and even monopolies with the idea that efficiencies of scale will lower costs and integrated systems will result in better patient outcomes. Plus, intuitively, no one wants to pay for duplication: In a less populated area, why have two labs that can process medical tests requiring expensive equipment and specially trained staff, when one can handle all the needs for that area? Plus, the IT and records management requirements of the ACA are very costly for smaller entities....IT has been a big factor in the drive for consolidation.

Logically, it all makes sense, but unfortunately it breaks down in reality. E.g., in Bellingham, the Catholic bishop decided in 2012 that the PeaceHealth lab that had been processing patient lab tests for Planned Parenthood patients for ten years should no longer do those lab tests and so he "requested" that PeaceHealth quit doing them, leaving Planned Parenthood without a good alternative. (An outcry put the request on ice for the time being.) BTW, PeaceHealth St. Joe's in Bellingham gets a special Bellingham city tax break, not available to other nonprofit providers, BECAUSE it's a religious hospital.

And in a conversation last year with senior UW officials, I heard directly that because the the three big religious providers operate at a surplus and thus have cash reserves, they can come into a community with cash for immediate capital improvements and for exec salaries - something that UW will never be able to do politically. So, although UW wanted to expand into Skagit Valley and Cascade Valley, e.g., the UW couldn't put together a competitive offer with upfront incentives.

So we have a situation where consolidation is happening throughout the industry, the existing power players in the NW happened to be Catholic (more than a hundred years ago, nuns came out to the frontier to open hospitals - many of them thought that a life of service on the frontier was more compelling than raising a family, plus they operated largely independently of any oversight), and one of our biggest players (UW Medicine) can't compete because it can't go into communities with the upfront capital Catholic players have accumulated over the years in part because of their privileged status, which affects the cost of doing business.

What's new in the last several years? 1) The bishops are becoming more aggressive and asserting their authority over the nuns, with Archbishop Sartain having been appointed directly by the Vatican for leading the task. (The nuns are dying out anyways - the peak year for nuns was 1965; perhaps not so coincidentally the same year contraception became legal for all married people, which of course gave young Catholic girls more options than having a large family or becoming a nun); 2) Control of Catholic hospitals passed from aging nuns to highly paid executive management with both financial and "moral" bottom line responsibilities. These CEOs ultimately report to the local bishop and/or The Vatican on "moral" issue and are expected to expand both the business and the ministry. BTW, the recently departed Providence CEO made $6.4 million in one of his final years and the Swedish CEO who delivered Swedish to Providence took his job; and 3) Consolidation and integration has become the industry norm with most players seeking to deliver higher end medical care with its higher revenue potential and reimbursement rates.

The NYTimes did a good article on the effects of consolidation on health care costs - the bottom line, after hospitals merge, costs rise substantially because of the concentration of market power and the ability to raise prices: http://www.nytimes.com/2013/06/12/business/examinations-of-health-costs-overlook-mergers.html?pagewanted=1&_r=0

BTW, this is exactly what played out on San Juan Island. Where previously the island had a smaller facility that provided a simpler menu of services at reasonable cost, subsidized by taxpayers, the island now has a beautiful new medical center (that restricts services for religious/moral reasons), more access to high end treatments for cancer, etc., and much higher prices for typical office visits and urgent care visits because of "facility fees" and the need to staff a high-end emergency department that says it has to treat all comers as though they might have a life-threatening emergency. One island father, e.g., wrote in to the local paper complaining after the bill for his son's stitches was almost $1300 when previously, it would have been a couple of hundred dollars or potentially even less. And all of this is being subsidized directly by taxpayers.

So what the state needs is a broader, ongoing conversation about what our public policy health goals should be and how best we can achieve them. And the private sector, especially large employers, needs to figure out how to contract with providers/insurers care in a way that results in better health outcomes, respects the rights of the individual, and doesn't lead to an endless upward cost spiral. And again, we have to do it all, while respecting the Constitution and laws like the Reproductive Privacy Act and the Death with Dignity Act.

Monicah

Posted Wed, Jan 8, 1:40 p.m. Inappropriate

That's what I thought. Regardless of whether one does or does not agree with the Catholic systems' position on these issues (I volunteered for I-1000, so I obviously don't), we wouldn't be having this problem if public policy weren't such that we are ceding the field to the Catholics. I'd rather have Catholic healthcare than no healthcare, and I think everybody else would too — and we musn't lose site of the fact that, as you note, they are the power players precisely because they came out in the early, early days when others wouldn't. Seattle's first hospital was Providence, after all.

I don't think it's productive to paint the Catholic systems as the enemy (this is one thing I disliked about the campaign I volunteered for)… it seems to me the best thing we could do would be to make availability of secular healthcare a matter of public policy, so that the issue of what the Catholic systems should and shouldn't have to do, while not eliminated, wouldn't be nearly as pressing.

Posted Wed, Jan 8, 2:25 p.m. Inappropriate

I'm guessing you'll never have an ectopic pregnancy:-)

I share my home with a practicing Catholic who happens to be a progressive on social issues and I deeply understand that individual Catholics, and in fact, the majority of Catholics, have socially progressive views. (By a large margin, Catholics in a NYTimes poll said they disagreed with the bishops on social issues and also agreed with the statement that the Catholic bishops are "out of touch.") The Catholics for Choice website has great information related to all of this and you can find the NYTimes article here: http://www.nytimes.com/2013/03/06/us/poll-shows-disconnect-between-us-catholics-and-church.html?_r=0

Rather than think of the Catholic hierarchy as the "enemy," which is a loaded term that takes us down all sort of unproductive paths, I think of the hierarchy as the opposition on issues I and many other Washingtonians - including Catholics - care deeply about, which includes reproductive health privacy and equity, the rights of dying people to make their own end-of-life medical decisions without religious interference, and the rights of gay people to marry and have their relationships recognized and supported in the public policy arena in the same ways that my own 23-year marriage has been recognized and supported.

If the bishops' power in the public policy arena were proportionate to their numbers or even to the success they have in influencing their own flock on these issues (why should public policy ever give special rights to religious leaders who can't get their own flock to agree with them?), then there wouldn't be an issue.

Also, please keep in mind that when these Catholic hospitals were started, there were no bishops' directives that controlled medical decisionmaking. The Bishops' Ethical and Religious Directives for Catholic Health Care didn't exist before the 20th century and they have evolved and become more conservative over time. It was only in 2009, e.g., that the bishops introduced a directive (I call it the Terri Schiavo directive) that essentially says tube feeding for someone in a persistent, vegetative state is required regardless of what the patient's own advance directive might say.

The Catholic bishops and their supporters are very strategic, and they are aggressively and successfully working to ensure that three Catholic bishops in Washington have hugely disproportionate influence in public policy decisions. They are the ones who insist on the right to impose their views on others, while using our tax dollars. It is they who are bringing the fight - as can be seen by their efforts to crack down on more progressive nuns, cut off birth control coverage for everyone who works for a Catholic institution, cut off lab services to Planned Parenthood (they've done this around Washington and Oregon and in other states as well) and through their insistence that Catholic hospitals, including those given direct tax subsidies, follow very conservative Catholic rules.

And the kicker is, they're doing this very stealthily and with our tax dollars, even though Catholic hospitals provide less charity care than the industry average (which again, the ACLU and MergerWatch reported on just last month). I was sensitized to these issues because of my upbringing and the fact that one of my sisters had a best friend who died after the Catholic hospital she entered for her newly diagnosed cancer refused to consider an abortion. So when Providence took over Swedish (where I got my medical care), I understood at a visceral level what's really at stake when Catholic hospitals control medical care for people who don't share their beliefs.

In order to move public policy forward with a view toward respecting the medical rights of all Washingtonians, it's important for people to understand the situation. The crisis has been building over time, but it's the actions of conservative, increasingly aggressive Catholic bishops that are bringing it it to a head now.

Despite what the bishops want people to believe, religious freedom is not and never has been about giving outsize power and influence to unelected religious leaders who want to impose their views on others. As Thomas Jefferson said “All persons shall have full and free liberty of religious opinion; nor shall any be compelled to frequent or maintain any religious institution."

Monicah

Posted Wed, Jan 8, 3:28 p.m. Inappropriate

"I'm guessing you'll never have an ectopic pregnancy:-)" — No, that's physically impossible, of course. But I do have a wife, and I have a sister, and sisters-in-law, and female cousins… I definitely care about how things affect other people in ways they can never directly affect me.

"Rather than think of the Catholic hierarchy as the 'enemy,' which is a loaded term that takes us down all sort of unproductive paths, I think of the hierarchy as the opposition on issues I and many other Washingtonians - including Catholics - care deeply about, which includes reproductive health privacy and equity, the rights of dying people to make their own end-of-life medical decisions without religious interference, and the rights of gay people to marry and have their relationships recognized and supported in the public policy arena in the same ways that my own 23-year marriage has been recognized and supported."

I do not disagree with you here. But many others do consider Catholics — and not just the hierarchy — the "enemy"… I don't think that can be denied, and while I am not accusing you of pandering to these folks (sincere apologies if that's how it seemed), I do know others are not above doing so.

"If the bishops' power in the public policy arena were proportionate to their numbers or even to the success they have in influencing their own flock on these issues (why should public policy ever give special rights to religious leaders who can't get their own flock to agree with them?), then there wouldn't be an issue."

Right. So why are we giving them outsize power, and what's the best way to go about changing this?

"The Catholic bishops… are the ones who insist on the right to impose their views on others, while using our tax dollars. It is they who are bringing the fight - as can be seen by their efforts to crack down on more progressive nuns, cut off birth control coverage for everyone who works for a Catholic institution, cut off lab services to Planned Parenthood (they've done this around Washington and Oregon and in other states as well) and through their insistence that Catholic hospitals, including those given direct tax subsidies, follow very conservative Catholic rules."

I certainly don't mean to defend their actions. Again, I want to know how best to get the government to change the situation.

"And the kicker is, they're doing this very stealthily and with our tax dollars, even though Catholic hospitals provide less charity care than the industry average (which again, the ACLU and MergerWatch reported on just last month). I was sensitized to these issues because of my upbringing and the fact that one of my sisters had a best friend who died after the Catholic hospital she entered for her newly diagnosed cancer refused to consider an abortion. So when Providence took over Swedish (where I got my medical care), I understood at a visceral level what's really at stake when Catholic hospitals control medical care for people who don't share their beliefs."

I understand that. I'm sensitized to these issues as well because of my parents' deaths. Neither was in a Catholic hospital and in neither case would I-1000 have applied, but it did make me think of end-of-life issues in a way I never had before (which is what led to my volunteering stint).

"In order to move public policy forward with a view toward respecting the medical rights of all Washingtonians, it's important for people to understand the situation. The crisis has been building over time, but it's the actions of conservative, increasingly aggressive Catholic bishops that are bringing it it to a head now."

Once people do understand the situation, will that be enough to get the state government to do what it should always have been doing? If this wasn't rectified when the Democrats had a majority in both houses, what can be done to rectify it given the current legislative makeup?

Amen to your Jefferson quote.

Posted Tue, Jan 7, 10:32 p.m. Inappropriate

They are taken over because it's easier than trying to overturn Roe v. Wade. This strategy has been carried out for some time now; we're just noticing it here in our state. Abortion will still be legal, just unobtainable; thus the Church (and other fundamentalist religious orgs which can't afford to buy hospitals) will get what they want and still have "cover".

sarah90

Posted Tue, Jan 7, 10:52 p.m. Inappropriate

I agree with you in many ways. But don't underestimate the fixation on controlling people at the end of life (they refuse to allow any participation with Death with Dignity or to honor Advance Directives that conflict with Catholic doctrine), their obsession with gay sex and gay marriage, and their desire to make contraceptives unavailable. It's not JUST about abortion, but abortion is the flag they wave to inspire their anti-abortion supporters as they push forward on all these other fronts too. And down the pipe are all of the new treatments derived from stem cell research that will be unavailable in Catholic hospitals.

Ultimately, it's about control and the belief that Catholic bishops should have the "moral authority" to make life and death decisions for other people. Here in Washington, they can't achieve at the ballot box what they can achieve by building a health care empire using tax dollars, and continuing to spread the myth that they should be given a pass because of their special status as a religious enterprise and especially their "charity" - when in fact, the percentage of charity care at Catholic hospitals is slightly lower than the industry average, as the ACLU and MergerWatch reported just last month.

Monicah

Posted Wed, Jan 8, 4:33 p.m. Inappropriate

Your argument that Peace Health care facilities will control people at the end of life and not allow them to use their Advance Directives makes no sense if the reason that Peace Health is growing in health care is because of financially lower costs to the public entities that chip in ... it's far cheaper to allow someone to die by granting them their Advance Directive wish to be "unplugged", it's far more expensive to continue to try everything to continue life, especially when the patient is already elderly.

Posted Tue, Jan 7, 8:04 p.m. Inappropriate

For those who would like a less colorful look at Peace Health and San Juan County. Not all levels of health care is able to be provided in very small communities. Peace Health does a valid job in what they do, and from my experience, no proselytizing, unlike certain writers.

http://sjcphd.org/

The San Juan County Public Hospital District is a junior taxing district of San Juan County, Washington located in the Town of Friday Harbor.

The District levies two separate property taxes to provide distinct health care services:

One levy is for subsidizing emergency and underfunded primary care for district residents through PeaceHealth Peace Island Medical Center in Friday Harbor.

The second levy helps to fund San Juan Island EMS and MedEvac which provides 9-1-1 advanced life support emergency medical response and critical care transport on the ground, marine, and in the air.

District boundaries include the Town of Friday Harbor, San Juan Island, and the islands of Brown, Pearl, Henry, Spieden, Stuart and Johns.

Posted Tue, Jan 7, 8:33 p.m. Inappropriate

Actually, common1sense, I see that you've drawn your information from the public hospital district site, which summarizes the essential terms of the contract inaccurately.

The subsidy is for healthcare services within the district, and there's no limit on what types of health services fall within the subsidy, although PeaceHealth is obligated to provide primary care hours and emergency room coverage. You'd think that "primary care" for the island's pregnant women might include prenatal care and reproductive health care, but PeaceHealth says no.

One of the reasons the deal made sense to PeaceHealth is that it can get a 101% cost reimbursement from the government for Medicare patients, so a huge part of the financing for this hospital and the ongoing medical care being provided comes from the government in the form of a direct tax subsidy and Medicare and Medicaid reimbursements. Which means the higher cost structure should concern anyone who pays taxes or cares about our collective dollars being applied efficiently. You can read more about the Medicare reimbursement rates here: http://www.hrsa.gov/healthit/toolbox/RuralHealthITtoolbox/Introduction/critical.html

And the reason the ACLU and others got involved is because the 50-year agreement gives PeaceHealth complete discretion to decide what treatments are "moral." Anything that conflicts with Catholic doctrine is not subsidized, and yet, because the contract gives PeaceHealth 95-97% of all money available under the local hospital district's taxing authority, there's no room to pay any other provider who might provide such services.

BTW, the contract is available on the hospital district site for anyone who wants to dive into the details.

Monicah

Posted Wed, Jan 8, 4:36 p.m. Inappropriate

I don't see that you've contacted anyone from the Peace Health organization for your article. I wonder about that ...

At least I've provided information directly from the public hospital district site, which I would say is a good place for the public to start when seeking information about what health care is available on the small island of San Juan. Seems to me that the people who live there already know their health care choices will be much more limited than if they lived in any larger city. The savings afforded by the Peace Health model means that the patients who choose to go there, have more than they would have had with other providers.

That seems quite reasonable to me.

Posted Tue, Jan 7, 10:38 p.m. Inappropriate

If the contract indeed uses the word "moral", that in itself is an indication of the complete lack of separation of church and state. "Moral" is a term used in public only by religious organizations, and it means what they want it to mean. There is no legal meaning whatsoever and it has no place in a contract.

sarah90

Posted Wed, Jan 8, 10:25 a.m. Inappropriate

The rights PeaceHealth has under the contract include the right to choose all employees, who "shall meet PeaceHealth's established employment criteria," and to choose all subcontractors who might provide services in the facility. (These contractors are typically restricted by lease agreement from providing any services that violate PeaceHealth's mission and values.) It also has the right to all revenue, the right to approve all members of the governing board (which operates under delegated authority from PeaceHealth) that is supposed to oversee operations. It also negotiated a right of first refusal for any services not covered by the agreement and a non-compete for subsidized services (which means it would be difficult/impossible for the district to contract with and/or subsidize primary care providers who don't follow PeaceHealth's rules, e.g.), and right to review all tenants in District-owned property adjacent to the facility in order to avoid uses that would be "incompatible." It also gets 95-97% of all revenues available under the District's levy authority.

The district has the right to "recommend" services to PeaceHealth and to nominate members of the community board which are subject to the approval of PeaceHealth.

So PeaceHealth controls all services that might be offered in the facility either directly or through subcontractors (and on adjacent District-owned property), and gets 95-97% of available tax funds over the 50-year life of the agreement, and has effectively closed off any means for the district to contract with other providers who might provide services that PeaceHealth doesn't approve of.

And the District pays an annual subsidy, which started at just under $1.5 million a year and which will rise with the cost of medical inflation over the course of the agreement.

Monicah

Posted Wed, Jan 8, 1:44 p.m. Inappropriate

Thanks for excellent reporting on a very important social justice issue, and for your knowledgeable responses to comments.

I am particularly outraged by the acquiescence of the UW in the Catholic Church's agenda. The U is a public institution and should not be providing succor to a religiously driven, discriminatory 'health care' machine.

louploup

Posted Wed, Jan 8, 1:47 p.m. Inappropriate

One avenue for assessing and assuring community service is review and adjustment of nonprofit status. This is mainly a federal tax policy issue, but states do have authority to act as well.

Concerns about "access to care" aren't limited to maternity and reproductive medicine, but extend to equitable access to all kinds of medical services and procedures--and these access issues will grow significantly as technology sparks more, and more exotic and expensive, services.

Nonprofit status confers huge financial advantages on the organizations that qualify for, primarily, federal 501(c)(3) status, but there is little surveillance of initial applications and, especially, post-approval actions.

Nonprofits should be required to undergo regular financial and operational audits to show that they actually deliver benefits to their served communities that are consistent with what they gain. This is particularly applicable to "faith-based" hospitals and other provider or financial entities--as well as to some public hospital districts in Washington state, such as Valley and Evergreen, which have used their privileged positions to build highly profitable, highly competitive, billion-dollar enterprises that far exceed their original mandates.

With specific regard to the hegemony of Catholic systems, it is certainly time for another Reformation--this one focused on, and assuring, freedom from religious constraints that are made possible by regional monopolies.

Seneca

Posted Thu, Jan 9, 4:33 p.m. Inappropriate

How does the firing of the vice principal of Eastside Catholic High School relate to the employment practices of the Catholic hospitals? Do they also review the marital behaviors of their employees for conformity with religious criteria?

simorgh

Posted Thu, Jan 9, 9:14 p.m. Inappropriate

Franciscan Hospital System's attorney (and remember, Franciscan is part of Catholic Health Initiatives, which reports to the Vatican) argued before WA Supreme Court last Spring that Catholic hospitals shouldn't be subject to Washington's antidiscrimination laws because under Washington law, they are religious entities and not "employers."

If Franciscan wins that case, Catholic hospitals around the state will not be subject to Washington's antidiscrimination laws, and it's my expectation the local archbishop will start saying to hospital administrators, "Enforce Catholic doctrine" in the cases of employees within the Catholic hospital system who are seen to be violating Catholic doctrine even in their personal lives.

Monicah

Posted Fri, Jan 10, 3:16 p.m. Inappropriate

"Reports to the Vatican," a phrase you also use in the article, is vague and, in the context you give it, more than a little pejorative. What exactly is the relationship of Franciscan Health Care to the Vatican?

dbreneman

Posted Fri, Jan 10, 8:30 p.m. Inappropriate

It's a factual statement, and its veracity is supported by the web link, which you can click on.

Monicah

Posted Fri, Jan 10, 10:40 a.m. Inappropriate

I share the writer's alarm at what's going on with Catholic entities taking over medical care. I was raised Catholic but lost my attachment as I grew up and realized that Catholicism hates women--or at least was and remains determined to control their freedom to make their own choices for their bodies.

I became a lawyer as a second career, and not so many years ago I was shocked and disgusted (which just proves how remarkably persistent naivete can be) when I saw how zealously the Catholic hospitals defend even the most egregious medical negligence cases. I realize that the courts are meant to be non-religious forums for resolving disputes, but that the hospitals would take positions clearly at odds with the teachings I learned as a child simply to avoid taking responsibility for obvious wrongdoing, well that was a new Catholic low for me.

I support religious institutions' right to act consonantly with their belief, but I strenuously object to their machinations designed to impose their beliefs on those who don't share them. And I agree that no public money should support such institutions.

mspat

Posted Tue, Jan 14, 1:30 p.m. Inappropriate

I also do not think that any taxpayer money should go to any religious entity. If they create a secular entity then they have to follow the laws.

Further, I'd be willing to support the end of all 'non-profit' status. After playing with this idea with some friends, the one exception being clubs or community groups the handle under $10,000 a year. But, given that money is normally in the form of grants, I am sure that a financial method could be created that leavers out the 'non-profit' designation.

Posted Thu, Jan 16, 9:48 p.m. Inappropriate

Scary thoughts where a group can impose its views on others, as if they are omnipotent...and, it's particularly unsettling that they're essentially thumbing their noses at the law. It's yet another reason why I've become disenchanted with the Catholic religion. Thanks for the heads up, Monica.

bricsa

Posted Sun, Jan 19, 1:19 p.m. Inappropriate

And yet there remain those amongst us who refuse to believe -- or more likely are paid to refute -- the obvious evidence the political, military and ecclesiastical authorities are methodically turning the United States into a Bible-based Christian theocracy.

The war against women's rights is merely the leading edge of the theocratic onslaught. Women are specifically targeted because, according to the Abrahamic scriptures (Torah, Bible, Qur'an), women are the embodiment of all earthly evil.

For those who want to understand the magnitude of the threat, here are six references:

The Family: the Secret Fundamentalism at the Heart of American Power (Jeff Sharlet, HarperCollins: 2008). Pages 272-277, which documents pseudo-progressive Hillary Clinton's secret collaboration with the Christian fundamentalist fanatic Sam Brownback, are especially relevant to understanding the behind-the-scenes treachery that is enabling the Roman Catholic Church's effort to eliminate sexual freedom and end-of-life choices in the most radically secular state in the union.

American Fascists: The Christian Right and the War on America (Chris Hedges, Free Press: 2006). Particularly useful for its analysis of the psychological underpinnings of what should properly be labeled JesuNazism.

American Theocracy: the Peril and Politics of Radical Religion, Oil and Borrowed Money in the 21st Century (Kevin Phillips, Viking: 2006). A view of the theocratic threat from the perspective of a traditional conservative.

Theocracy Watch, http://www.theocracywatch.org/ A usefully encyclopedic website on many aspects of the theocratic threat, unfortunately limited by its allegiance to the Democratic Party and its refusal to document such outrages as the Clinton/Brownback collaboration cited above.

CatholicWatch, http://catholicwatch.org/ This site carefully monitors the Catholic Church's extra-legal abolition of reproductive and end-of-life rights by its takeover of health care in Washington state and elsewhere in the United States.

Military Religious Freedom Foundation, http://www.militaryreligiousfreedom.org/ This site monitors the deliberate imposition of Christian fundamentalism – complete with the characteristic Crusader mindset (“kill 'em all; let god sort 'em out") – on the U.S. military.

To date, no mainstream media source has dared address why Christian theocracy is being imposed on the United States even as Judaic theocracy is being imposed on Israel and Islamic theocracy on the Middle East and large parts of the Third World. The answer, of course, is social control. Capitalism can guarantee its profits only by capitalist governance – absolute power and unlimited profit for the One Percent, total subjugation for all the rest of us. History proves Abrahamic theocracy to be the most efficient mechanism for this purpose, particularly with its doctrines of divine-right management and disobedience of managerial edicts as sins against “god's divine plan.”

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