There may not be much reason for optimism in American health care now, but one hope arises in Orange County, California, where a prestigious hospital says it’s fed up with the Catholic Church’s restrictions on health care.
The Hoag Memorial Hospital in Newport Beach, which was established as a Presbyterian institution in 1952, demanded to break away from its partnership with the Catholic hospital system in 2012.
The agreement was controversial from the start, partly because Catholic partners imposed a ban on abortion on doctor Hoag even though they had been promised that the agreement would not have an impact on their practice.
Usually, in a hospital merger there are two sides to the negotiating table. When one of the partners is the Catholic system, there is a third party outside that has long-term influence – bishops.
Lois Uttley, MergerWatch
Now Hoag’s management has awakened, if it is too late, the effect on the patient.
“It is increasingly clear that Presbyterian beliefs, values and policies have been compromised because of restrictions in the larger Catholic system, and that these constraints impose on the correct implementation of Presbyterian beliefs, values and policies,” Hoag said in lawsuit aimed at dissolving the partnership with Providence Joseph Health, which manages 51 hospitals and hundreds of other medical facilities in seven western states.
The more stringent regulations enforced by Catholic bishops in affiliated hospitals, the lawsuit added, “signifies the possibility, if not the possibility, of growing gaps on key issues that also affect the delivery of care” by Hoag.
The lawsuit was filed May 4 in the Orange County High Court, after it became clear that Providence would reject the hospital’s efforts to dissolve the partnership. Providence stressed that Hoag’s actions would “negatively impact patient care, reducing the resources and medical expertise available to Orange County.”
This case could mark the end of a dirty chapter on California health care, and a beacon for those who care about the encroachment of the spread of discriminatory Catholic doctrine into American health care practices.
Hoag’s entry into the Catholic health care system was born in an atmosphere of deception.
In August 2012, Hoag and then St. Joseph Health System, a Roman Catholic chain with five hospitals in Orange County, announced a corporate partnership in which the two entities would “maintain each other’s identities and affiliation trusts – each Presbyterian and Catholic. “
At that time, Hoag’s medical staff repeatedly and explicitly assured that nothing in their practice would change because of the partnership. Conversely, only a few weeks after the agreement was made final in early 2013, abortion was banned in Hoag.
Hoag Chief Executive Robert T. Braithwaite and later Chair Gary McKitterick made the situation worse by implying that they ended abortion in the hospital because Hoag doctors did not do enough to maintain “clinical excellence” in the procedure, and therefore patients had better have them done in another place.
The Hoag OB / GYN staff rightly regard it as an insult. Eight Hoag OB / GYNs wrote an open letter in response informing Braithwaite and McKitterick that they did not know what they were talking about. “We are experts in providing a complete array of reproductive family planning services’ which they consider lacking in Hoag,” they wrote.
The truth, as I reported at the time, was that St. Joseph had made an abortion banning the terms of the partnership agreement.
According to Richard Afable, who had negotiated the agreement as Hoag who was then the CEO and was the CEO of the partnership and executive of St. After its completion, Hoag’s adherence to the prohibition of St. Joseph to have an abortion is “sacred … demanded of ourselves and whoever we are [St. Joseph] will work with. “
“They really did,” recalled Jeffrey Illeck, an OB / GYN in Orange County who signed an open letter.
Many in the local community also objected, partly because of Hoag’s history as an independent local institution. “If you live in this area, you go to Hoag,” said Lynne Riddle, a retired federal bankruptcy judge and resident of Newport Beach who was among critics of the deal.
The ban on abortion in Hoag underscores the reluctance of Catholic hospitals to compromise religious rules. This is set in Ethical and Religious Directives for Catholic Health Care, issued by the US Conference of Catholic Bishops, which prohibits abortion, the distribution of contraceptives and sterilization procedures such as tubal ligation in Catholic hospitals.
Non-Catholic affiliations are generally subject to the “Statement of Shared Values” which also prohibits abortion. Both gave authority to the local bishop for medical treatment at the facility. Both also limit the final choice of life for patients.
The inherently discriminatory nature of the directives helped sink the proposed affiliation between UC San Francisco and Dignity Health, the main Catholic chain, last year, and has been an obstacle in several other arrangements.
But it is not unusual, even though it has never happened before, for church rules to create divisions between existing partners, as happened in Hoag.
In 2010, a nonsectarian hospital in Tucson dissolve the two-year trial merger with the Catholic system a year early, after The administrator has refused doctor’s permission to make emergency stops for patients who have miscarriages. The woman must be taken to hospital 80 miles away. (He survived.)
Catholic practices have given a greater shadow to US health services as the Catholic hospital system developed. In 2016, according to the non-profit MergerWatch, 4 of the 10 largest hospital chains in the US were Catholic, accounting for 1 out of every 6 hospital beds for acute care.
Providence St. Joseph is the fourth largest Catholic system and the seventh largest hospital chain overall, according to Lois Uttley, formerly director of MergerWatch and currently director of the Women’s Health Project at Community Catalyst, a health advocacy group.
“Usually, in a hospital merger there are two sides to the negotiating table,” Uttley told me. “When one of the partners is a Catholic system, there is a third party outside that has long-term influence – bishops.”
California approves Hoag-St. Joseph’s partnership in 2013 marked a low point in the tenure of the era’s attorney general, Kamala Harris, basically waving a deal with insufficient guarantees of Hoag’s independence.
Harris requires that Hoag maintain all existing women’s health services for at least 10 years – except for “direct abortion” (a term derived from Catholic doctrine that has no medical significance).
This can end as long as the “alternative provider” can be accessed somewhere within the Hoag service area, which stretches 50 miles along the coast from Long Beach to Dana Point and inland as far as Anaheim.
In March 2014, about a year after its initial agreement, Harris revised the agreement, extend the maintenance period to 20 years and state explicitly that Hoag will not be subject to ethical and religious direction. The new agreement ended his investigation into Hoag’s alleged non-compliance. St. Joseph joined Providence Health that was far greater in 2016.
In its official response to the Hoag suit, Providence stated, “Our relationship has been strong since 2012.”
But it’s hard to imagine how anyone could write or distribute that sentence with a straight face.
The Hoag suit and the June 2019 resolution adopted by the Hoag council outline the chapters and dissatisfaction verses that grew in hospitals with affiliates starting as early as 2015.
“The benefits that Hoag agreed to give some degree of autonomy … were never achieved,” the lawsuit said. “The note, further, details significant frustration with the lack of progress” towards Hoag’s goal to strengthen its services to local residents.
The lawsuit said “repeated investigations from Hoag Council members related to failure to achieve meaningful goals.” It became clear to the Hoag council that Providence’s aim was to maintain the hospital in its system as a “prisoner affiliation.”
Rather than being a member of a partnership dedicated to local community health services, Hoag found himself reduced to another entity in a large regional system.
Last June the council, in consultation with heirs George Hoag – a former J.C investor. Penney and the executive whose family foundation helped launch the hospital – vote unanimously to free the hospital from Providence and become just a “voluntary partner” of the big system.
What will happen next in Hoag is still unclear. Providence said it would challenge Hoag’s right to leave the partnership. “As a legal matter, affiliates are permanent,” Erik G. Wexler, CEO of the Southern California Providence unit, told me via email, “and Hoag has no unilateral right to disaffiliate without the consent of the other party.”
The case shows that “it is difficult for hospitals to break away from agreements that look very sweet at first,” said Amy Chen, a senior lawyer for the National Health Law Program.
In addition, rebuilding services may be more difficult than destroying them. Hoag management has not yet mapped the road map of services or approaches that will change after independence again.
“We have not been told that we will be able to have another abortion,” Illeck said, “but I consider that part of what we can do again.” The change will also dispel long-standing uncertainty about how Catholic influence in Hoag can develop.
“One of our fears when all this is happening is, you are taking our abortion right now, but what will happen in five or 10 years? Now, that doesn’t matter. “
If Hoag succeeds, it will be a blow to health care that is not burdened by religious or ideological constraints.
“It’s very important,” said Riddle, “that everyone really feels how important it is to have a medical system that respects who you are and what your needs are and with your doctor who decides what treatment is best for you.”
