The Catholic Health Association recently posted a column defending the unConstitutional subsidy agreement between PeaceHealth, owners and operators of the new medical center/hospital on San Juan Island, and the local public hospital taxing district. As a San Juan Island property owner, I pay taxes that directly support PeaceHealth, which describes itself as a Catholic health care ministry and which imposes religiously-based restrictions on patient care.
There are several things media should know about the San Juan Island case:
Many funders who gave money to the hospital did not know that their money was going to support Catholic health care. Donations from islanders were made to the San Juan Island Community Foundation which in turn made a donation to PeaceHealth. I have spoken to many funders who are angry that their donations are being used to support a Catholic institution that restricts reproductive and end-of-life care.
When islanders raised concerns about potential religiously-based restrictions during public hospital district meetings, they were advised that there were no substantive issues and if they still had issues, they could speak to one of the nuns at PeaceHealth. This is part of the public record.
More than 300 islanders signed on to a letter asking the hospital district commissioners what legal protections were in place in the contract to protect the rights of islanders in the face of religiously-based restrictions. (Note: their lack of an effective response was one of many reasons the American Civil Liberties Union got involved.)
The previous San Juan Island clinic was losing money. The current PeaceHealth Peace Island Medical Center is losing a lot more money. The total annual loss at PeaceHealth’s new facility (charges minus payments and reimbursements) for its first year was more than $3 million dollars. Supporters of the new facility, including Tom Cable, who was quoted extensively in the Catholic Health Association post, predicted that the first year loss would be $257k.
According to the report from PeaceHealth, in its first year of operation, more than 12,000 patient visits were recorded at PeaceIsland Medical Center, which means after Medicare and Medicaid payments and reimbursement, insurance payments, and payments from patients who paid directly, the average loss –and the “subsidy” from taxpayers and PeaceHealth to offset that “loss”– was $250 per patient visit. This is likely unsustainable, and PeaceHealth has the contractual right to terminate the contract for financial reasons. Which means the residents of San Juan Island may ultimately face even more difficult decisions about what should be done with an overbuilt, financially unsustainable medical facility near the center of town.
Costs for patients, and especially for working islanders, have gone up dramatically. There have been several letters to local media concerning cost issues, so many that a local island resident with decades of experience in the health care industry started tracking and documenting them.
PeaceHealth does not provide ANY maternity care to patients. If they did, then according to Washington’s Attorney General, the hospital taxing district would be required under the provisions of the Washington State Reproductive Privacy Act, which was enacted by voters, to provide a subsidy to support other reproductive health services, including access to contraception and abortion. Note that pregnant women and new mothers were treated on a subsidized basis at Inter Island Medical Clinic before the deal with PeaceHealth was on the table.
In a public meeting, Sister Kathleen Pruitt of PeaceHealth said, in response to a question about whether PeaceHeath follows the Ethical and Religious Directives for Catholic Health Care, “We will not disobey the bishop.”
When Nancy Steiger of PeaceHealth says that abortion services “typically wouldn’t be found in a facility the size of Peace Island Medical Center,” she’s lying. PeaceHealth physicians provide a broad range of services at the island facility, from primary care services to more specialized services, including cancer care treatments and even colonoscopies. The idea that a health care facility of that “size” shouldn’t be expected to provide reproductive health services, including access and referral to abortion is absurd. At the previous facility, there were no restrictions on abortion, and physicians were free to do what they believed best to meet the needs of patients.
San Juan Island residents voted overwhelmingly for Washington’s Death with Dignity Law; their 75% support was the highest in the state. PeaceHealth physicians are restricted from participating with the law or providing direct referrals to Compassion & Choices, the entity that helps terminal patients exercise their rights under the law.
Many San Juan Island residents, including Dr. John Geyman, former department chair of the University of Washington’s Family Medicine program, opposed the hospital because they felt it was the wrong solution to a very real set of problems.
What are the lessons to be learned from the situation on San Juan Island?
1) A comprehensive community health care needs assessment should have been done which identified the actual needs of San Juan Islanders and cost-effective ways of meeting those needs.
2) Compliance with the Reproductive Privacy Act should have been a given, not an opportunity for anyone to try to engineer an end-run around voter intent and State law.
3) The contract should have been subject to an open process whereby community members could discuss and evaluate various proposals. Instead the process was led by private citizens and there was no formal Request for Proposal process.
4) When a medical facility is losing money; building a larger, more expensive facility with the idea that a higher government reimbursement rate (and funding from wealthy donors) will make it work is probably not a good idea. The contract with PeaceHealth gives them an out if reimbursement rates change substantively and of course reimbursement rates are subject to change because the government should be looking for ways to save money.
5) Finally, no one should ever be able to use taxpayer funds to support a religious ministry. It is unConstitutional and deeply offensive that islanders should be required to support a faith-based facility overseen by bishops who believe birth control is immoral, abortion (even when a woman’s life is at stake) is intrinsically evil, same-sex marriage is an abomination, and access to Death with Dignity is never, ever allowed.
As Thomas Jefferson once said, “All persons shall have full and free liberty of religious opinion; nor shall any be compelled to frequent or maintain any religious institution.”