It’s been just over a year since Providence, which reported a surplus of $363 million in 2011 (revenue minus expenses), took over Swedish Medical, the largest nonprofit hospital system in the Seattle area. What’s the result? Swedish is now operated as a brand within Providence, and reports up through the Providence system, with oversight from the Catholic bishops. Prayers are held before management meetings. And abortions are no longer allowed, although Providence officials say they have been done when a woman’s life is in danger.
Over time, insiders predict that the Swedish brand will completely disappear and all medical staff will be subject to the Catholic bishops’ Ethical and Religious Directives.
Before the deal was finalized and subject to regulatory approval and criticism from local advocates, Swedish was very careful to say that the deal was an “affiliation” and it insisted that its “secular” identity would be maintained. However, as The Seattle Times reports, once the deal was complete, Swedish was completely absorbed into Providence. Within months, legal staffs were completely intermingled, the ethical director and the communications director were working for both “brands,” and eventually, CEO Rod Hochman, who had been running Swedish prior to the deal’s completion, became the CEO of Providence, taking over for John Koster, whose 2011 pay totaled $6.4 million.
Where Swedish patients once could be assured that the physicians who handle high-risk pregnancies would always put a woman’s life and health first, now patients are coming to realize that the ultimate decision about when or whether an abortion is “elective” or necessary is now subject to the approval of Archbishop J. Peter Sartain, the Seattle-based cleric tasked by the Vatican with making sure the nuns adhere to Catholic doctrine.
In February 2013, Seattle’s The Stranger published an article that outlined the story of “Mary,” a Swedish patient who said, “I was past 24 weeks when doctors at Swedish told me I was miscarrying…they said they couldn’t save the fetus but it still had a heartbeat, so there was nothing they could do. They had to wait for the heartbeat to stop.”
Mary told The Stranger she demanded an abortion but was basically told her options were to “wait for nature to take its course” or unhook herself, crawl out of bed, and find another hospital. “It was a nightmare,” she says. “It still is.”
The Swedish case demonstrates a brilliant execution of the Catholic hierarchy’s strategy to take over secular health care institutions and impose Catholic religious doctrine on the health care all of us pay for. Here’s the playbook as deconstructed from the evidence now available.
1) Always minimize the nature of the planned transaction. Deny that a takeover is what’s happening, e.g., call it “an affiliation” even when internally the plan is to merge the entities completely into a Catholic organization overseen by the Catholic bishops.
2) Meet with advocates ahead of time and manage them aggressively to ensure they don’t speak out in ways that attract media attention. If possible, divide and conquer by offering time-limited concessions to advocates most likely to voice opposition.
In the second half of 2011, as the deal was moving toward completion, Swedish brilliantly reached out to Planned Parenthood NW and offered to site a Planned Parenthood Clinic adjacent to the Providence/Swedish facility prior to the merger’s completion and to seed it with a seven-figure grant. When meeting with other health care advocates late in 2011, the Vice President of External Relations for Swedish invited the head of Planned Parenthood to also attend. By doing a deal with Planned Parenthood in ultra-liberal Seattle, Swedish brilliantly managed the “PR problem” of too many health care advocates who were unsettled by the Catholic “affiliation.” If advocates criticized the deal, Planned Parenthood was used as a defense tactic/smoke screen. After ten years, the timeline for working cooperatively with Planned Parenthood runs out.
3) Continue to position the acquired entity as a secular brand externally until all potential for criticism of the new business deal is gone. Assure donors that “Swedish hasn’t changed,” while internally you start changing policies to reflect Catholic ownership and control. Maximize donor contributions by underplaying the Catholic identity for as long as possible. Communicate to donors that funds will be used to underwrite charity care to minimize any concerns that funds will be used to advance religious doctrine. BTW, doing this also protects against “donor intent” legal challenges that may focus on whether donor dollars were impermissibly diverted for religious purposes against the wishes of a donor.
4) Start changing the hiring practices for key positions to reflect the Catholic ownership/control. Make sure that legal, communications, and ethics positions are filled by people who know they will be reporting up through a Catholic management chain; make “a thorough understanding of Catholic theology” a core requirement for these positions.
5) Reward the CEO of the formerly secular institution with a high-paying, high-visibility role within the Catholic parent’s structure to ensure that he/she prioritizes the new relationship over any previously made commitments to donors and/or patients. Demonstrate through example that executives who embrace the new Catholic identity will be well compensated.
6) Be careful not to put any of the new religiously-based medical policies into writing where they can be studied and evaluated until AFTER all news of the deal has been fully absorbed. This can take years. In the meantime, ask staff to consult with “ethics” experts internally for any questions they may have so that the policies don’t have to be in black and white while they’re in transition. Instead of posting religiously-directed policies directly on the website, cite internal ethics experts. A reasonable timeframe for putting the complete “takeover” strategy into effect, phasing out previously secular brands, and committing to full adherence to the bishops’ Ethical and Religious Directives for Catholic Health Care is approximately five years from start to finish.
7) If problems are cited by patients or the media (e.g., the “Mary” case discussed by The Stranger), cite privacy concerns as a reason that you cannot comment.