Tag Archives: Catholic Health Initiatives

Federal Judge Ruling on Catholic Pension Funding Requirements Raises More Questions

Catholic health care systems are now able to operate pension funds free of federal funding requirements, according to a rulling handed down December 8 by the U.S. District Court for the District of Colorado.

According to a Bloomberg news report, Judge Robert E. Blackburn wrote that a plan can be a church plan “in one of two ways – by being established and maintained by a church or association of churches, or by being maintained by a qualifying organization that is controlled by or associated with a church.”

The practical implication of the ruling is that Catholic health care ministries now have a distinct competitive advantage over other non-Church health care entities that are required to meet federal pension funding requirements.

What’s more interesting is to consider the written decision in the context of other issues that apply in a health care context.

In the decision, Blackburn said that “the Catholic Church itself (not unlike other established religions) is a huge conglomerate that operates in various forms and formats, including corporate ones.”

Later, he also said that “regardless of the personal convictions of any single employee, both CHI and the DB Plan Subcommittee are animated by and bound by Catholic doctrines in the performance of their duties.”

Furthermore, he says, The “First Amendment creates a protected zone for churches to decide these issues of religious [*11] doctrine free from government intrusion. This protected zone includes: (1) a church’s law and doctrine; (2) a church’s religious mission; and (3) a church’s polity, administration, and community. . . . The First Amendment “plainly forbids” courts from inquiring into this departure-from-doctrine claim.”

Then, in a discussion of whether or not a First Amendment challenge would survive, he cites the three-pronged “Lemon test,” and makes the following points:

  1.  For a law to have forbidden “effects” under Lemon, it must be fair to say that the government itself has advanced religion through its own activities and influence.”
  2. A principle (of Lemon) is violated “when accommodation of a religious practice or principle imposes burdens on non-adherents they would not otherwise be required to bear.”
  3. The third and final prong of Lemon inquires whether a statute requires “excessive government involvement in religious affairs, including whether such involvement is a continuing one leading to an impermissible degree of entanglement”.

We need to consider these issues in the context of health care itself and and especially when public funds are being used (sometimes exclusively) to fund services that are then restricted by doctrine.

Is a government contract that turns over 97% of all public funding available for a 50-year period to a Church entity “advancing religion through its own activities and influence”?

Is it a violation of Lemon when a Church entity that receives government funding imposes restrictions on patients and physicians who have no other practical options?

And how do we resolve these issues without entangling government in doctrine, especially when the essence of Catholic doctrine in a health care setting is all about how health care services – which are heavily regulated – will be delivered?

One answer might be that no federal or state funding should be allowed for the delivery of any health service that is governed by religious doctrine.

And for any of these discussions, one needs to consider what will happen when the State is called upon to fund services through religious entities that are small in number now but likely to grow.  For example, should a Muslim health system that treats diabetics receive government funding if patients are required to fast during Ramadan?  Should they received government funding if women are not allowed to be seen by male physicians or if women physicians are not allowed to see male patients?  And who should make the decisions?  Physicians? Clerics?

According to Beckers’, seven or the ten largest nonprofit health care systems are Catholic.  The long-term implications of encouraging and supporting even more government funded, religiously-based health care institutions are not well understood.  But we all need to be paying attention.


CHI/Franciscan Takeover of Harrison – Overview and Q&A

On May 1, 2014, I’ll be appearing on a panel in Port Townsend alongside Harrison CEO Scott Bosch and representatives from LegalVoice and the American Civil Liberties Union to discuss issues related to religion and health care.  In preparation for that conversation, I wanted to provide background about Harrison Hospital, which was taken over by CHI/Franciscan in 2013.

Can you explain the organizational structure?

In August, 2013, Harrison Hospital in Bremerton, WA became part of the Franciscan Health System and thus part of Catholic Health Inititatives, an ultra-conservative Catholic health care ministry with $12.5 billion in revenue which reports directly to the Vatican, is technically an entity of the Catholic Church, and which requires all employees to follow the Ethical and Religious Directives for Catholic Health Care as a condition of employment.

According to documents filed with Washington State on October 7, 2013, Harrison is now part of the Franciscan Health System. In a letter on Catholic Health Initiatives letterhead, CHI makes clear that Harrison is officially part of Franciscan:  “SJMGroup, a non-profit tax-exempt corporation became the sole corporate member of Harrison and a corporate member of FHS (Franciscan Health System).”

In a footnote, CHI said in the same letter that “Franciscan anticipates changing the name of SJMGroup in the near future.  We anticipate the new name will be Franciscan Health Ventures.”

Franciscan is wholly owned by Catholic Health Initiatives.  On the Franciscan 990 for 2011, the organizational structure for Franciscan is explained as follows:

1) The sole member has the power to appoint, replace, or remove the members of the board of directors; and

2) The sole member of the organization is Catholic Health Initiatives, a Colorado non-profit organization.

Why does Scott Bosch, CEO of Harrison, insist that Harrison is “secular”?

I don’t know.  Harrison is part of Catholic Health Initiatives, which reports to the Vatican and is part of the Catholic Church.  The description of it as a secular entity mystifies me.

Bosch has said that Harrison does not have to follow all of the ERDs.  Does that make it secular?

When an entity is controlled and owned by an entity of the Catholic Church, it is Catholic.  A Catholic entity, by definition, is not secular.

But what about the fact that Harrison still allows doctors to provide birth control?

Over time, Harrison’s policies will mirror the policies of its parent organization, Catholic Health Initiatives.  In a recent article, CHI Senior Vice President John DiCola made clear that it gradually brings all partners into the fold.  “It doesn’t happen overnight, but we have a lot of programs and communications that help staff in our markets understand who we are–not just what we do, but how we do it.  We also bring organizations into CHI by setting some standards and by enforcing those standards.”

What can people in Bremerton do?

Your hospital is now owned and controlled by the Catholic Church.  As we’ve seen in other hospitals and medical facilities around the state and the country, the policies will change over time, likely under the radar of members of the community.

The time to have intervened was before Harrison was taken over.

In order to get any relief now, we need a systematic fix that is appropriate for the scale of the problem.  And in order for that to happen, people need to show their outrage and demand change from politicians, business leaders, and through the legal system.

But haven’t other Catholic-secular partnerships worked out?  What about Swedish?

Swedish is a wholly owned subsidiary of Providence Health Systems. it reports up through a management chain that is controlled by the Providence board.  Insiders at Swedish report that the culture and rules at Swedish are becoming Catholic.  Two concrete examples of how policies and culture are changing:

1) At the time the “affiliation” (which became a takeover) was announced, Swedish said the only change was that it would longer do “elective” abortions.  Since then, the goalpost has moved, and now Swedish says it will only do “emergency” abortions.  Women who are diagosed with a severe fetal abnormality or who learn that their fetus will never be viable cannot get an abortion at Swedish because that is not considered an “emergency.”

2) The legal, HR, and ethics teams have been combined, and Swedish senior leadership now undergoes Catholic Faith Formation leadership training, which was specifically designed to inculcate lay leaders into the values and traditions of the Catholic Church.

In a recent comment posted to an Open Letter to Swedish Donors, the former Chief of Medicine at Swedish said, “I am appalled by the heavily Catholic influence now being expressed (at Swedish). A leading general hospital in the the community should not be under the control of a religious organization. We did very well as an independently run, highly professional institution.”

What do you think is going to happen?

I don’t know and it all depends on Washington voters and citizens.  Right now, Washington voters and citizens are complacent and it’s because so much of this is happening under the radar.  It’s quite likely the catalyst for a groundswell will be a story or stories so horrifying that people can no longer ignore the problem of medieval rules dictating patient care.  This was the case in Ireland, when an utterly preventable death of a young mother served as a catalyst to cause a nation to change its anti-abortion laws.

We’ve already seen that Catholic hospitals are willing to turn a miscarrying woman away and we’ve had situations here in WA where women’s lives and health have been put at risk. Perhaps one of them will end up being a plaintiff here.

Of course, some of the most vulnerable people are the dying.  A volunteer from Compassion & Choices testified last Fall in Olympia about a patient who wanted to exercise his rights under Death with Dignity but instead ended up shooting himself. The volunteer believed it happened because the physicians in that area who work or need privileges at the increasingly powerful Catholic system no longer feel comfortable helping patients exercise their rights under the Death with Dignity law.

In addition to patient concerns, the workforce is at risk.  Here in Washington State, employees of religious instititutions are exempt from Washington anti-discrimination laws that were specifically designed to protect people on the basis of sexual orientation or marital status.   Now, if you’re gay or cohabitating and you work for a Catholic health care ministry, your job may be in jeopardy.

Some of the patient and employee stories have been made public by the American Civil Liberties Union and by reseachers and reporters who’ve been tracking these issues. Perhaps soon a patient or employee story will catch fire in social media and ignite the public to take action and demand that we no longer allow religious leaders to oversee and control the health care we all pay for.

But in the meantime, check out the ACLU’s website to learn more about what you can do and then do your part.  This problem isn’t going to be solved unless we work together to make it happen.

For Highline Patients: How the Bishops Control Your Health Care

The Franciscan division of Catholic Health Initiatives recently took over Highline Medical Center in the SW Puget Sound.  What few people in Burien, West Seattle, or on Vashon Island understand is that the Highline they’ve known is now part of an ultraconservative medical system that restricts birth control and other essential health services.

Spokespeople for Catholic health care institutions often try to say that the Bishops’ Ethical and Religious Directives don’t interfere with the confidentiality of the doctor/patient relationship.  Even where Catholic health systems acknowledge that they follow the Bishops’ Directives, they are cagey about how these directives are applied behind the scenes.  You will not find a policy statement on the web site of a Catholic health system that says:  “We don’t allow any of our physicians to prescribe contraceptives or to perform vasectomies or tubal ligations.”

Instead, the Catholic health systems speak in vague generalities publicly, while behind the scenes, they impose very strict and specific rules on staff.  As an example, as part of a proposed merger, Catholic Health Initiatives (CHI) recently circulated a document that outlined the conditions under which a doctor could prescribe contraceptives.  The document is valuable because it gives us insight into how restrictions are imposed on doctors and staff behind closed doors.

Here is part of what the policy statement said:

“Contraceptives with secondary indications may be ordered and dispensed but are required to reflect documentation of an indication of anything but a sole and primary purpose of contraception for dispensing.”

If you’re a woman undergoing care at a Catholic Health Initiatives hospital or medical facility, in order to satisfy the Catholic bishops, your doctor must come up with a diagnosis/rationale for birth control that means something other than “doesn’t want to get pregnant.”

And whatever diagnosis is invented then becomes part of your medical history.

In another section of the same document, physicians are advised that “Vasectomy, Laparescopy Tubal Ligation/Cautery/w Fallopian Ring, Bilateral Tubal Sterilization, and Hysterescopy, Ablation Endometrial or Ablation Hydrothermal w/Hysterescopy” are all forbidden because “Direct Sterilization is not contractually approved.”

Of course, Catholic hospitals are not this direct when communicating these policies to consumers, patients, or regulators.  Instead of publishing a list of forbidden procedures, CHI says much more vaguely that “The mission of Catholic Health Initiatives is to nurture the healing ministry of the Church by bringing it new life, energy and viability in the 21st century.”

It’s up to all of us to translate that verbiage into religiously-mandated policies that forbid the use of commonly accepted and medically appropriate health care procedures and medicines.

Recently, Franciscan/CHI posted a job listing for a neonatologist – the type of doctor who does ob/gyn care for women with high risk pregnancies.  A core requirement was that the doctor should be very familiar with the Ethical and Religious Directives for Catholic Health Care.  Of course, those directives require that a doctor never perform a direct abortion – even in circumstances where the woman will certainly die and the fetus is not viable.

Media can access the source document containing this physician instruction by contacting the site editor.