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.
The fact that the University of Washington, Washington’s largest public university system, recently signed a “groundbreaking,” “strategic” alliance with PeaceHealth is an ominous sign. The agreement includes record-sharing, joint clinical programs and joint training programs for University of Washington medical students.
During a regular October 2013 meeting of Ob-Gyn physicians and medical students, at which I happened to be a panelist, one UW student complained that no one at the UW seems willing to talk candidly about the PeaceHealth deal – including what it will mean for medical training over the longer term.
Ultimately, Washington policy makers, employers and voters are going to have to decide whether to continue supporting Catholic health systems that systematically deprive patients of legal, medically appropriate care.
The recent dismissal of a Catholic vice-principal in Sammamish proves that Catholic control of our healthcare system could also have broader implications for healthcare professionals. In that case, Seattle’s Archbishop J. Peter Sartain weighed in to ensure the departure of a gay, recently married employee.
Sartain and two other bishops hold similar power over all of Washington’s Catholic health care ministries, which now employ tens of thousands of people. In a case now in front of Washington’s Supreme Court, Franciscan recently argued that Washington law exempts religious entities from State antidiscrimination laws. If Franciscan wins that case, bishops could begin purging 40 percent of our health care system of anyone who refuses to adhere to Catholic doctrine – even in their personal lives.