Author Archives: catholicwatcher

ACLU Sues Michigan Hospital Chain over Miscarriage Mismanagement

The American Civil Liberties Union has filed suit against Trinity Health, a Catholic health care ministry, asserting that at least five women suffered serious harm after being denied emergency abortions while they were miscarrying.  You can read more about the case here:

and here from the National Catholic Reporter.

And here is a quote from another story about this same case:
“A hospital policy like the Directives that limit what physicians can tell and offer our patients and prohibits us from providing our patients with the best possible care is extremely dangerous,” said Dr. Timothy Johnson, chairman of OB/GYN at the University of Michigan.

The Catholic Bishops and Your Health Care: Tulsa Public Radio Interviews Monica Harrington

MonicaH profileTulsa Public Radio general manager Rich Fisher recently interviewed CatholicWatch founder Monica Harrington about the intersection of religion and health care, and especially how Catholic bishops are imposing their “moral authority” over taxpayer-financed health care.

From the Tulsa Public Radio overview:

“From pharmacists who refuse to dispense Plan B drugs (which prevent ovulation) to legislation designed to limit a patient’s end-of-life or euthanasia options, there’s no shortage of controversial topics in America today when it comes to religion/morality overlapping with science/medicine. On this edition of ST, we discuss such a topic as we confront certain practices of some Catholic hospitals. Our guess is Monica Harrington, an ardent critic of such hospitals who thinks they are unfairly — and illegally — imposing their moral values upon their patients (and are doing so in institutions that, while private, are also heavily financed with taxpayer dollars).”

You can read more and listen to the audio recording through this link:  Tulsa Public Radio Interview with Monica Harrington

Catholic Health Initiatives Facing Financial Heat: Will Employee Pensions Pay the Price?

As the financial health of Catholic Health Initiatives (CHI) suffers in the wake of its aggressive growth strategy, will its employees pay the ultimate price, giving up pensions they thought were secure?

Catholic Health Initiatives, which runs hospitals in 17 states, and claims to treat more than 46 million people, saw its bond rating downgraded by Standard & Poors last month.

The Catholic health care ministry, which took over several hospitals and medical clinics in Washington State last year, including Bremerton’s Harrison Medical Center and the Highline Medical system, appointed a new CEO earlier in the month.  Citing poor financial results, the system says it will lay off 1500 people by the end of this month. According to Modern Health Care, operating performance in Washington State declined by $60 million “because of CHI’s investment in new EHR systems and disruption caused by their installation.”

A Standard & Poor’s director says that CHI’s financial troubles are a “huge hole to dig out of.”

Another bond rating system, Fitch, revised its outlook from stable to “negative,” saying that The Outlook Revision to Negative from Stable reflects “continued challenges in improving overall core operating performance, which was affected heavily by losses in certain market-based organizations (MBOs).”

The new lowered bond rating means that borrowing expenses for CHI/Franciscan are likely to rise even as it tries to dig itself out of the “huge hole.”

So what are the implications for employees and patients of CHI/Franciscan in Washington State?

Despite rosy recruiting language that promises a healthy future and competitive benefits, CHI is likely to look for all kinds of ways to make up the hole it now finds itself in, including looting the pensions of its current and past employees.  Very recently, Providence Health was sued by its employees for underfunding its pension plan, raising the broader question of how employees at Catholic institutions will fare as pension liabilities outstrip the Church-run systems ability or willingness to pay down the line.  A similar lawsuit faces CHI.

Keep in mind that Catholic Archdioceses made a regular practice of declaring bankruptcy to avoid having to pay victims who were victimized by pedophile priests.

Looting the pensions of its current and previous employees would seem to fit squarely within the character of an institution that uses bankruptcy and money transfers as tools to shield assets from child abuse victims.

No wonder Providence, CHI, and other Catholic entities are fighting in the courts for their  “right,” as Church employers, to underfund pensions for the employees they claim to value.

Update:  Here’s a link that summarizes current status of one of the lawsuits against CHI.  Net is that the judge said that fiduciaries (including the CHI trustees) can be sued as individuals for breach of duty for underfunding pension assets. 




Catholic Bishops Clamp Down on Tubal Ligations; Swedish is Likely Target

In the Seattle area, Swedish Medical Center, which was taken over by Providence a few years ago, currently says it does tubal ligations. However, according to a new article posted in ProPublica, the Catholic bishops are clamping down on tubal ligations in situations where a formerly secular medical facility has come under Catholic control.  Prior to its takeover by Providence, Swedish was the largest independent nonprofit health system in the Seattle area and still claims to be “the most popular” place in Western Washington to give birth.

The likely implication for Swedish (and other health systems in Washington now under the control of the Catholic bishops) is that tubal ligations will no longer be allowed.

This means that a woman who delivers at a Swedish facility and who is committed to getting a tubal ligation (which is the most popular contraception method for women who have completed their families)  will have to undergo the unnecessary pain and expense of an additional separate surgery at a separate facility after her body has healed from childbirth.

For Seattle-area employers who provide comprehensive health care benefits, this means they’ll be footing the bill not just for the additional surgery but also for the additional recovery time associated with a completely separate surgical procedure.

Will Seattle-area employers, including private employers like Microsoft, Starbucks, Amazon, Costco, Nordstroms, Google, and Facebook, stand by while access to important health care services is systematically cut off throughout the largest maternity health care sytem in the state?  Will they willingly pay the extra costs of additional surgery and recovery times for their employees who deliver at Swedish and then decide to undergo a tubal ligation elsewhere?

Will the taxpayers who are subsidizing Medicaid births willingly pay for an additional surgery and recovery for Medicaid patients who choose to deliver at Swedish simply because the Catholic bishops have decided the procedure can’t be performed at the largest maternity network in the state?

Will anyone anywhere be able to stop Catholic bishops from using our tax dollars and private health dollars to impose their will on patients across the state?


One Year After AG Opinion, No Maternity Services on San Juan Island

One year after Washington State’s Attorney General issued a formal opinion related to hospital taxing districts and their obligation to provide appropriate care to pregnant women, pregnant women around the state are finding some Public Hospital Districts refusing to support maternity care services.

Here’s how that happened on San Juan Island.

San Juan Island lies in the NW corner of Washington State and is accessible only by ferry, boat or air.  The island has one hospital, PeaceIsland Medical Center, a critical access hospital which also provides primary care.  PeaceIsland is owned and operated by PeaceHealth, a Catholic health care ministry that says it follows the Ethical and Religious Directives for Catholic Health Care, a 43-page set of doctrinal rules promulgated and enforced by the U.S. Conference of Catholic Bishops.

PeaceIsland Medical Center receives a public tax subsidy, paid for by island residents, of approximately $1.5 million a year.  The contract between PeaceHealth and the public hospital district ensures that 95-97% of all funds available through the hospital taxing district’s levy authority over the next 50 years will go to PeaceHealth.

Islander concerns about whether the public hospital taxing district on San Juan Island was violating the Reproductive Privacy Act led to a request for a Formal Opinion by the Attorney General.  His formal opinion, issued in August 2013, essentially said that any public hospital taxing district which supports maternity care must also provide substantially equivalent support for abortion and contraception services.

PeaceHealth responded to the AG’s opinion by clarifying that it “provides NO maternity care” on San Juan Island, which in its view, meant that the public hospital taxing district was under no obligation to provide support for contraception or abortion either.

In policies submitted to Washington’s Department of Health in March, 2014, PeaceHealth further said that “PeaceHealth does not allow direct abortions. PeaceHealth does allow the indirect termination of a pregnancy as a result of a direct intervention against a maternal pathology to save the life of the mother.”

PeaceHealth’s position on abortions is consistent with the ERDs: In Catholic hospitals, physicians can never terminate a pregnancy “directly,” but under certain circumstances, such as when a fetus is encased in a tumor, they can treat a “pathology” that threatens the life of a mother, thereby causing an “indirect” termination of a pregnancy.  Where no pathology exists and the danger to a woman is the pregnancy itself, no pregnancy termination is allowed.  Women who want or need a pregnancy termination, no matter the cause, are expected go elsewhere.

When PeaceIsland Medical Center is incapable of meeting the emergency needs of a patient, those patients are typically flown off-island for advanced care via a publicly-subsidized air transport service.  On the San Juan Island Emergency Services website, patients are advised that “Due to changing and severe weather patterns, however, sometimes helicopters and planes cannot fly or can be significantly delayed because they are on another call.”

Recently, in testimony before the San Juan County Board of Health, Dr. Michael Edwards, who chairs the San Juan Public Hospital District Board, said that in 2013, there were 32 weather-related “turndowns” because of “known icing conditions.”

Dr. Edwards did not specify whether any of those “turndowns” involved a pregnant woman.

In that same May 21st meeting, Dr. Edwards and Jim Barnhart, the administrator for PeaceIsland Medical Center, affirmed that PeaceHealth provides no prenatal care on San Juan Island, even though it is a Critical Access Hospital which also provides primary care, cancer care, surgeries, and colonoscopies.

According to Barnhart, PeaceHealth employs no physicians with the background and/or training to appropriately treat pregnant women and there are currently no plans to hire a primary care physician who can provide prenatal care.  In an announcement made after the May 21st meeting, PeaceHealth said that the five most recently-hired physicians include three emergency room physicians, an internist, and a surgeon.

When asked about the Ethical and Religious Directives and how they impact patient care, Jim Barnhart said, “I can’t comment on how a document may impact an individual physician….I’m not an expert on the ERDs.”

Although PeaceHealth does not provide prenatal care, PeaceHealth does lease space to an ob-gyn and a midwife from off-island, who can see patients on an appointment basis.  (Anyone leasing space in the PeaceHealth facility is also required to abide by PeaceHealth rules.)

According to Barnhart’s testimony, PeaceHealth is also not prepared to handle a D&C procedure, which the Mayo Clinic defines as a procedure to remove tissue from inside a woman’s uterus. According to the Mayo Clinic, “Doctors perform dilation and curettage to diagnose and treat certain uterine conditions — such as heavy bleeding — or to clear the uterine lining after a miscarriage or abortion.”

When asked what happens when a woman faces a pregnancy-related crisis during a time when air transport is not available, Barnhart said that “Phone calls are made to obstetricians and other specialists on the mainland” to guide the available staff.

At this point, Dr. Michael Edwards, perhaps wanting to build support for more air transport services and funding said, “I just want to raise the issue of continuing dependence on air transport and….all you need are two bad things happening simultaneously, and you’ve got a disaster.”

So now, we have a situation on San Juan Island where: 1) none of the doctors on staff at the only hospital provide care regularly to pregnant women, 2) the physicians at the only hospital are expressly forbidden from ever “directly” terminating a pregnancy and are unprepared to do a procedure commonly done in conjunction with a miscarriage; and 3) air evacuation is frequently unavailable because of other calls or, as happened more than 30 times in the last year, because of “known icing conditions.”

The situation on San Juan Island is dangerous in the extreme.  All it will take for a woman to pay the ultimate price is a pregnancy-related crisis in bad weather where on-island physicians are ill-prepared and/or afraid to act for fear of violating the ERDs and the policies PeaceHealth submitted to WA’s Department of Health.

Which raises a question:  When a vendor and a government agency (in this case PeaceHealth and the public hospital taxing district) deny services to pregnant women in order to avoid compliance with WA’s Reproductive Privacy Act, and in the process create foreseeable and extreme danger to pregnant women, who should be held accountable?

(A video of the May 21 testimony given before the San Juan County Board of Health by the chair of San Juan Island’s public hospital district and the chief administrator of PeaceHealth is available here.)


UW Medical Students, Grad Students Question PeaceHealth Partnership

More than a thousand UW medical students and other grad students are questioning how the University of Washington’s deepening relationship with PeaceHealth will affect medical training and clinical services over time.

PeaceHealth is a Catholic health care ministry that requires its physicians and other staff to follow the Ethical and Religious Directives for Catholic Health Care (ERDs).  The students have asked UW officials to clarify the terms of its agreement with PeaceHealth and to ensure that UW students and staff are never subject to the ERDs.

The students’ letter says  “….we are concerned that PeaceHealth’s involvement in WWAMI (the UW’s five-state training area) programs and activities will limit teaching and provision of comprehensive reproductive health care, including contraception services, abortion care, pregnancy options counseling and end-of-life care, including Death with Dignity discussions and options.” 

You can read more about the issues raised by UW students in this article by Seattle Times reporter Carol Ostrom.

Video: “Religious Doctrine, Medical Best Practice, and You”

Americans United for the Separation of Church and State recently sponsored a panel discussion focused on the growing encroachment of religious doctrine on WA’s health care system.  I was honored to give the opening presentation.  Also on the panel were experts from Planned ParenthoodVotes, the ACLU, and Compassion & Choices plus an ethicist from the University of Washington.


Boeing Employees Face Choice: Catholic or non-Catholic Health Care

Boeing recently announced that its employees will be able to choose from two Partnership Plan Accountable Care Organizations: UW Medicine or Providence/Swedish.

Because UW is a public institution, no religious restrictions are imposed on physicians or patients.  With UW Medicine, Boeing employees and their families will have access to the full spectrum of reproductive health care and end of life treatments at preferred rates.  They’ll also be able to participate in clinical trials and benefit from treatments that rely on embryonic stem cells.

Because Providence/Swedish is a Catholic health care ministry, employees who choose the Providence/Swedish option will be subject to care that is limited by Catholic doctrine as laid out in the Ethical and Religious Directives for Catholic Health Care.   Providence very clearly says that “As a Catholic health care organization, we require adherence to all Ethical and Religious Directives as a condition of medical privileges and employment.”  These ERDs forbid contraception,  “direct” abortion in all circumstances, research that relies on embryonic stem cells, and participation with WA’s Death with Dignity Law.

Swedish, which is a wholly-owned subsidiary of Providence, says it has less restrictive policies, but still follows Catholic doctrine in some circumstances, especially related to pregnancy and end-of-life care.  Before its takeover by Providence, e.g., Swedish allowed physicians and patients to make all decisions about whether a pregnancy could be terminated without religious oversight.  Now decisions relating to pregnancy termination are subject to review by a Providence ethics committee, and pregnancy terminations are allowed only in cases deemed an “emergency.”

This means that a woman who wants or needs a pregnancy termination must satisfy the “emergency” standard or go outside the Providence/Swedish ACO for care.  If a pregnant woman learns, for example, that her pregnancy has a serious fetal abnormality such as Trisomy 13, a chromosonal condition associated with severe physical and intellectual disabilities, she cannot get a pregnancy termination within Swedish because the diagnosis, while serious and tragic, does not meet the “emergency” standard.

Similarly, because Swedish has no hospice or nursing facilities and Providence forbids physicians from participating with Death with Dignity, patients who want to be able to exercise their rights under WA’s Death with Dignity Law will need to be extra careful, especially because of the Providence requirement that “privileges” require adherence to the ERDs.  Given all of this, it’s worth considering how many people within Washington State are likely to feel comfortable with health care that is restricted according to the Ethical and Religious Directives.

According to Pew research, about 16% of Washington residents are “affiliated” with the Catholic Church.   Pew doesn’t break down beliefs within a specific religion on a state-by-state basis, but nationally, about 19% of Catholics say that “There is only ONE true way to interpret the teachings of my religion.”  This would indicate that about 19% of the 16% of WA residents who are Catholic likely support the Ethical and Religious Directives for Catholic Health Care in their entirety.    This translates to about 3% of the residents of the State of Washington.    Given that 98% of Catholic women who have ever had sex have used birth control to prevent pregnancy, the 3% figure seems in the ballpark.

For now, it’s highly doubtful that many of the 97% of Washington residents (including Boeing employees) who don’t adhere to conservative Catholic teachings even know that the care they receive through Providence is severely restricted.  But, given the stakes, it’s important that they start learning and paying attention soon so they can make health care decisions that reflect their own values and priorities.



Archbishop Didn’t Know Sex with Children is a Crime

A law firm has released video of the deposition of St. Louis Archbishop Robert Carlson in which the Archbishop says that he didn’t know in the 1980s whether it was a crime for priests to have sex with children.

Here’s NBC’s take on the news:  St. Louis Archbishop Didn’t Know Sex With Children Was a Crime

Here’s the take by CBS who interviewed some of the survivors of sex abuse: SNAP: Archbishop Carlson’s Comments ‘Mind-Boggling,’ Shocking

And here’s the take from The American Conservative:  Bishop ‘Not Sure’ Child Molestation a Crime

Why should any of us care about this with respect to health care?

Because Archbishop Carlson wields absolute “moral authority” over the medical policies and employment practices of Catholic institutions in his jurisdiction.  And the largest Catholic medical system in the country is headquartered in his region.  Ascension Health operates in 23 states and the District of Columbia and has more than “1,900 sites of care.”

Related to this, the Archdiocese in Portland, where I grew up, was the first to file for bankruptcy as a way of shielding assets from its victims.  Cardinal Dolan came up with a new way to shield assets when he moved $57 million into a cemetery fund, a move that is receiving scrutiny even now from Federal judges.


Will Genital Mutilation be Protected as a Form of Religious Expression?

The Catholic Church insists that it has the right to deny women and girls medically-appropriate treatment because of religious doctrine.  In Catholic hospitals and medical centers across the country, women are regularly denied access to contraception, abortion, fertility treatments, and other services that the Catholic bishops say offends their rights to religious liberty.

In the case of ectopic pregnancies, the bishops have a special directive that says: “In case of extrauterine pregnancy, no intervention is morally licit which constitutes a direct abortion.”

Note that this directive is in addition to the one that says: “Abortion (that is, the directly intended termination of pregnancy before viability or the directly intended destruction of a viable fetus) is never permitted.”

The National Catholic Bioethics Center says that the directive forbidding a direct abortion even in the case of an ectopic pregnancy means that the only morally acceptable way to terminate an ectopic pregnancy is to remove a section of the Fallopian tube:

“When an ectopic pregnancy does not resolve by itself, a morally acceptable approach would involve removal of the whole section of the tube on the side of the woman’s body where the unborn child is lodged. Although this results in reduced fertility for the woman, the section of tube around the growing child has clearly become pathological, and constitutes a mounting threat with time. This threat is addressed by removal of the tube, with the secondary, and unintended, effect that the child within will then die.

In this situation, the intention of the surgeon is directed towards the good effect (removing the damaged tissue to save the mother’s life) while only tolerating the bad effect (death of the ectopic child). Importantly, the surgeon is choosing to act on the tube (a part of the mother’s body) rather than directly on the child. Additionally, the child’s death is not the means via which the cure occurs. If a large tumor, instead of a baby, were present in the tube, the same curative procedure would be employed. It is tubal removal, not the subsequent death of the baby, that is curative for the mother’s condition.”

In Catholic hospitals around the country, physicians regularly remove the Fallopian tube when other methods are available.  The reasons for why physicians in Catholic hospitals do this are laid out pretty well in this article from the National Catholic Bioethics Quarterly.

Meanwhile, physicians who work in reproductive health care are clear that in the early stages of an ectopic pregnancy, medication that “stops the growth of the pregnancy and permits the body to absorb it over time” should be considered first.

So here we have a clear example where following the Directive that prohibits the use of drugs in the case of an early ectopic pregnancy results in the unnecessary mutilation of a woman.  The fact that the mutilation is internal and the rest of us can’t see it doesn’t in any way change what it is.

Which means we are already allowing religion to dictate that some women be mutiliated in situations where it’s not medically appropriate.

Genital mutiliation is also the mutilation of a women to satisfy religious doctrine.

Some physicians are already confronting demands for genital mutiliation here in the United States.  In fact, according to this article from the Journal of Medical Ethics, “in the city of Seattle in the United States, the Harborview Medical Center (knowing that if requests to have their daughters “circumcised” were not fulfilled, mothers would seek out the procedure in a non-medical environment) agreed to offer a compromise for the procedure. They offered to provide a procedure in which the labia or clitoris would not be touched, but a small incision in the clitoral prepuce would be made to draw some blood. Although this compromise would have satisfied some members of the community, opponents of female genital cutting prevented its provision.”

If we’re willing to say that religious liberty justifies the right of Catholic hospitals to mutilate women unnecessarily simply because a woman has an ectopic pregnancy, what’s to stop a medical facility that abides by different religious rules from forcing women to undergo female “cirumcision” to satisfy their religious freedom/expression.

We can’t argue that it’s wrong and unnecessary; we’ve already ceded that moral high ground.