Fears of a Catholic monopoly dominate talk of hospital mergers
Washington is one of the least religious states in the country, but when it comes to health care, it has some of the fastest growing religiously-affiliated hospitals, partly because so many hospitals are merging.
The trend has some communities worried about losing access to certain medical procedures—if they’re not allowed under church teachings.
The issue is flaring up now in scenic Skagit County, the land of tulip farms and fishing boats.
Skagit has three hospitals, all of them public, supported by taxpayers. One, United General in Sedro-Woolley, recently agreed to be taken over by the PeaceHealth Catholic hospital chain, which already controls all the hospitals to the north in the Bellingham area.
Now, Skagit’s other two hospitals are looking to merge with a bigger network, along with a hospital in neighboring Snohomish County.
The process offers a rare glimpse inside the hospital mergers, which have been taking place across the country, as the three small hospitals have agreed to an unusual degree of transparency. They’ve published many of the financial and policy details on their websites, and invited the public to testify in open meetings during April.
The testimony was one-sided. Hundreds of people turned out in Arlington, Mt. Vernon and Anacortes, hammering away on one point:
“I urge Island Hospital not to affiliate with a faith-based hospital,” says Hal Rooks of Anacortes.
“Certainly, I don’t go to the hospital to go to church,” says Phyllis Dolph of Anacortes.
Even though not one person stood up in Anacortes to defend Catholic hospitals, that doesn’t mean they don’t have support. They’re respected within the medical community for providing quality medical care, and the trend toward medical mergers has empowered the three main Catholic chains in Washington:
- PeaceHealth, headquartered in Vancouver, with a regional network based in Bellingham, expanded to the San Juan Islands, in addition to Skagit.
- Providence, headquartered in Renton, last year affiliated with Seattle’s Swedish Medical Center.
- Franciscan Health System, based in Tacoma (but a division of Catholic Health Initiatives of Colorado), in April took the reins at Highline Hospital in Burien and is currently working out the final details to run Harrison Medical Center in Bremerton.
PeaceHealth and Providence are bidding to manage Island Hospital in Anacortes, Skagit Regional Health in Mt. Vernon, and Cascade Valley Hospital in Arlington.
Two secular networks are also bidding—the University of Washington medical system, and Virginia Mason of Seattle.
Why should they merge?
“Health care reform and the economics of health care are bringing this tidal wave of change,” says Skagit CEO Gregg Davidson. His hospital is okay financially today, but it needs help preparing for what’s coming, thanks in part to the federal health care law.
For example, hospitals have made money for years by billing you for every procedure, every minute of a doctor’s time, every scalpel and bandage. But soon they’ll get paid a lump sum from your insurance company or the government. If you’re a diabetic, they have to figure out how to keep you healthy, or risk losing money if you keep coming back to the hospital.
“We must change,” says Clark Todd, the publicly-elected chairman of Skagit’s board. “But how far can one hospital standing alone—by itself, without the resources that are going to be required—continue to function over the next five years?”
They’ll need help finding efficiencies and adding expensive new electronic record systems, he says.
The doctor says: My dying patients need me
From the executive suite, the choice is about infrastructure, and recruiting doctors to small communities. From a doctor’s standpoint, there’s more at stake.
“My practice would be significantly affected,” says Dr. Deborah North, who has a primary care practice with Skagit Regional in Mt. Vernon, and sees a full range of patients, from young to elderly.
“I feel strongly about this. I feel strongly about religion not being appropriate in dictating case management, whether it’s a case of a mother’s life, in the case of possible fetal demise, or the death with dignity.”
Catholic medical systems must comply with a document called Ethical and Religious Directives, published by the U.S. Conference of Catholic Bishops. It limits not only abortions, but under what circumstances a woman could have her tubes tied, a man could undergo a vasectomy, or patients be offered end-of-life choices.
North is one of the only doctors in the area who participates in the Death with Dignity Act, and sees part of her job as helping patients through the process of dying. She’d be restricted as an employee of Peace Health or Providence.
“All the internists are within the medical center,” she says, because the physician practices were purchased a few years ago by the hospital, as part of the wave of mergers. “So, I’d be the only internist outside the medical center.”
Details often fall in a gray area of tolerance
These details can be finessed, so all services available today will be there in the future, says Nancy Steiger, the regional director of PeaceHealth.
“It would really depend on the relationship we had, both with the medical center and with its physicians. So, I think, TBD,” she says.
In its proposal, PeaceHealth says it is looking for new ways it can have secular partners.
When it comes to birth control, currently, PeaceHealth basically takes a don’t-ask, don’t-tell approach.
“PeaceHealth respects the sanctity of the physician-patient relationship, and we don’t interfere,” says Steiger. It’s a private conversation, she says.
In fact, she says, Catholic hospitals, most of which were founded by nuns who were willing to serve where for-profit systems wouldn't, has unique strengths.
“What I love about faith based health care is that mission to care for people who are the most vulnerable, and to care for everybody,” she says.
Planned Parenthood blames the Archbishop of Seattle
Still, it’s hard to pin down exactly what might happen in these areas of controversy. Anecdotes abound.
Linda McCarthy of Mt. Baker Planned Parenthood, which serves Bellingham and Mt. Vernon, says she had a wake-up call last year in her relationship with PeaceHealth.
Planned Parenthood relies on PeaceHealth to perform all its lab tests. Last year, McCarthy says PeaceHealth, under pressure from Seattle Archbishop J. Peter Sartain, called her about canceling lab services.
“We had a tolerant bishop for many years, and now we don’t have a tolerant bishop,” says McCarthy.
PeaceHealth backed off, and still provides laboratory services with the understanding that the most of the medical care provided by Planned Parenthood falls under basic health services.
“And yet, these longterm contracts are in place,” says McCarthy, adding those contracts often extend 30 to 50 years into the future.
MacCarthy is worried that whatever falls in a gray area of tolerance today may not remain there in the future as church leadership changes.
And that’s why so many people in Skagit county scrutinizing the fine-print of the bids to operate their public hospitals.