DENVER– In the next few months, as the Kansas-based Sisters of Charity of Leavenworth Health System assumes control of two hospitals in the metro area formerly run by Exempla Healthcare, nearly 40 percent of hospital beds here will be run under directives approved by the National Conference of Catholic Bishops. Abortions will be limited to cases where the mother is at risk of death. Reproductive services will also likely be severely curtailed, as will end-of-life care, regardless of legal advance directives authored by patients.
It’s the latest chapter in a long-running deal that is quietly altering health care here.
In October, the Exempla board voted to give the Sisters of Charity operational control of its Lutheran Medical Center in Wheat Ridge and Good Samaritan Medical Center in Lafayette. Exempla’s Saint Joseph Hospital in Denver already operated according to Catholic principles.
Then in January, the Exempla board, under the direction of Sisters of Charity President and CEO William Murray, shook up executive leadership to smooth the transition. Five Exempla executives were fired, most of whom objected to the way the deal was moving to limit medical choices for patients.
The right to follow the ERDs
Jeanette DeMelo, spokesperson for the Archdiocese of Denver, told the Colorado Independent that hospital owners have the right to determine what services are offered and how care is delivered.
“The United States Constitution gives us that right, absolutely,” she said.
She acknowledged that not all Catholic hospitals in the country follow the Bishops’ directives to the letter but added that “if they call themselves a Catholic hospital, they are supposed to follow the[m]. Each hospital is responsible for the implementation of the [directives].”
The Church directives were approved and published in a fifth edition this past November. They are known as the Ethical and Religious Directives for Catholic Health Care Services, or the ERDs.
DeMelo said bishops in each area work with hospitals to oversee implementation.
Spokespeople for Exempla and for the individual Exempla hospitals said the directives are followed at each of the hospitals.
“[Sisters of Charity] fully adheres to the ERDs. We are embarking on an ERD orientation program for Exempla hospitals, and once clinicians and staff have a full understanding of the ERDs, they will be implemented,” said Christine Woolsey, interim vice president for communications and marketing at Exempla.
She compared the ERD to a corporate philosophy or vision. “Both for-profit and non-profit health care has a guiding philosophy that shapes the kind of care it gives. The important element is respect for persons and being clear about the vision and values that shape the scope of care.”
She said the ERD is not a “compliance document but rather a set of guidelines.”
An ‘outrageous abuse of power’
Ed Kahn, special counsel to the Colorado Center on Law and Policy, told the Colorado Independent that the ERD represents an “outrageous abuse of power.”
“Medical decisions need to be made for medical reasons, based on the best current practices, not on religious or philosophical grounds,” he said.
He said the ERD forbids hospital staff from discussing contraception or abortion with patients, even in the case of rape victims, and notes that Exempla’s Lutheran Medical Center is the only hospital in Jefferson County.
“What if you are unconscious when you are taken to the hospital, or simply don’t know one hospital from another?” he asked.
“The ERD is a great infringement on the civil liberties of patients and their families. Hospitals, no matter who owns them, operate in the public interest and are supposed to serve the public health. If we allow this, what would stop another hospital from determining that all male babies should be circumcised? We would never stand for that,” Kahn said.
Kahn said he is hopeful legislation will be introduced this year that would force hospitals to honor end-of-life directives and would dictate that hospitals make medical decisions based on medical rather than religious or philosophical grounds.
State Senator Linda Newell, D-Littleton, said she does not know of any relevant legislation currently in the works and added that she doesn’t expect there to be any such legislation introduced this session.
“You have to respect that if this is their hospital, and that they have certain rights on how to run the hospital. On the other hand, you could have a patient not knowing they are going to a hospital that won’t honor their advance directive, and that isn’t right. You could have a rape victim taken to the hospital who won’t be advised of the choices that should be available to her, and that is very scary.”
Newell, vice-chair of the Senate Health and Human Services Committee, also noted that some insurance plans limit people’s choice of hospitals and that in some cases people simply need to get to the closest hospital.
“It’s possible someone could die while trying to find another hospital,” she said.
Reading the directives
The Ethical and Religious Directives for Catholic Health Care Services makes it clear that care provided at Catholic hospitals should be infused with a sense of religious mission. The document is studded with terms such as “health care ministry” and “Catholic moral values.”
The ERD dictates that abortions will only be performed at Catholic hospitals in the event that the mother’s life is in imminent danger. It also says that no emergency contraception shall be offered to rape victims. Likewise, tubal ligations and vasectomies will not be performed.
Abortion is only one of numerous issues the ERD addresses. It says reproduction through any means other than sexual intercourse between a married man and woman is wrong.
“Reproductive technologies that substitute for the marriage act are not consistent with human dignity. Just as the marriage act is joined naturally to procreation, so procreation is joined naturally to the marriage act,” it says.
“The moral teachings that we profess here flow principally from the natural law, understood in the light of the revelation Christ has entrusted to His Church,” says the ERD.
These teachings come into play with regard to the treatment of those at the end of life, as well, when a dying patient’s wishes, even those put forth legally in a durable power of attorney or advance directive may be ignored if they conflict with Catholic values.
Quoting from the ERD, “The institution … will not honor an advance directive that is contrary to Catholic teaching.”
Catholic teaching shall also be provided to patients who are suffering and likely to die. “Patients experiencing suffering that cannot be alleviated should be helped to appreciate the Christian understanding of redemptive suffering,” the ERD instructs.
Health reform playing out on the ground
In addition to the three Exempla hospitals, Centura Health in partnership with Catholic Health Initiatives and the Adventist Health System, manage St. Anthony’s Hospitals in Denver and in Westminster. These hospitals also follow the ERD. These five hospitals account for approximately 39 percent of the hospital beds in the Denver metro area.
Centura Health and Adventist Health System operate Littleton Adventist Hospital and Porter Adventist Hospital, both of which are faith-based as well, bring the total number of religious hospital beds to just over half of all those in the metro area.
Local Adventist spokespeople didn’t respond to calls for comment, but nationally many Adventist hospitals perform at least some abortions and provide rape and incest victims with emergency contraceptives.
Susan Hebert, senior vice president of mission and ministry at Centura Health, wrote in an email that the Catholic hospitals within Centura also follow the ERDs. “These facilities and programs are committed to following (the ERDs),” she said.
According to Catholics for Choice, about 30 percent of Americans receive care at a Catholic facility in any given year, and about 20 percent of hospital beds nationally are in Catholic hospitals.