4-26-07, 1:30 pm

During this time of soaring health care costs and federal health care program cuts, mergers between religious and secular facilities threaten to further constrict health care services. The situation is particularly acute when Catholic hospitals merge with public and secular facilities. Formerly secular hospitals are more and more obliged to follow the dictates of the increasingly conservative Council of Catholic Bishops. This means that the public is denied access to health care services proscribed by a religious entity. In a nation founded on the principle of separation of church and state, this situation is unacceptable.

Catholic hospitals comprise the single largest group of nonprofit hospitals in the United States, representing approximately 17 percent of hospital admissions each year. These hospitals operate according to “The Ethical and Religious Directives for Catholic Health Care Services,” issued by the National Conference of Catholic Bishops. The directives ban all “homologous artificial fertilization,” abortion in all forms, the promotion of contraceptive practices, and all forms of sterilization. In the event of a merger, secular facilities that formerly offered these services may be forced to discontinue them.

How did this situation arise? Catholic hospitals benefit from substantial financial backing of the Catholic Church. This often gives the Catholic partner in a planned merger an advantage. Besides that, the secular hospital may have Catholic or otherwise conservative and religious board members. Such people may agree with Catholic strictures; others may accept restrictive policies when given the choice between conforming to Catholic doctrine or closing down completely.

It is true that some Catholic facilities perform reproductive health care services under different labels, or through loopholes in Catholic doctrine. Some merged Catholic/secular hospitals move their reproductive services offsite. These “separate but equal” clinics offer some of the services banned in the merged hospital, but do not enjoy the full use of hospital resources and facilities.

Besides that, they are sometimes difficult for some patients to reach. Separate women’s health clinics are targets for anti-abortion activists. Besides that, some Catholic hospitals claimed they would set up separate women’s health clinics as part of a partnership agreement, and never did so, according to an exposé in Ms. magazine several years ago. Separate and unequal facilities are no solution to the problem.

In the end, when push comes to shove, Catholic hospitals will terminate reproductive services if they appear to bend church doctrine too far. It is a matter of survival for them, as they cannot afford to lose Catholic sponsorship.

Historical Background

The Roe v. Wade decision in 1973 gave women the constitutional right to have abortions. During the years since 1973, states have progressively enacted laws making access to abortion more difficult. Twenty-two states have passed “conscience clauses.” These provisions allow individual medical providers, insurers and facilities to refuse to provide services that they find morally reprehensible.

Such services may include reproductive health care and counsel on issues such as fertility, birth control or “safe sex.” In 1997, Congress passed a conscience provision that allows Medicaid managed care plans to refuse counseling or referral for services to which they have a moral or religious objection.

That means, all health care providers and insurers, including those connected to the federal government, must bow to the religious views of a small percentage of the population. This violates the separation of church and state, and seriously curtails access to much-needed health care.

And who is hurt most? Women who need or want abortions for one. Poor women who depend on hospitals for reproductive care when local doctors will not take Medicaid also suffer. Rape victims who are denied access to the morning-after pill are other examples. Gay and lesbian issues come into play when access to safe-sex counseling and reproductive services are forbidden to them. End-of-life rights surrounding a person’s choice to die with dignity are at stake. And it can be reasonably estimated that merged hospitals will not allow procedures in the future that involve products of stem-cell research. This adds Alzheimer’s patients and paraplegics to the list. And all of that is besides the impact on doctors who need to offer their patients a full range of health care options.

In some cases, all workers in merged hospitals are obliged to sign agreements to follow the Conference of Catholic Bishops’ directives. This merging of religious and secular institutions therefore imposes the rule of religious doctrine on all people employed by or seeking health care services from the only facilities available in many communities. This merging of church and state is offensive, repugnant and cannot be tolerated.

New York State

The state of New York is a case in point. Citing health care costs and imminent Medicare cuts, the New York State “Commission on Health Care in the 21st Century,” commonly called the “Berger Commission,” issued a summary of recommendations in November 2006. The commission recommended the closure of nine hospitals in New York, and a “reconfiguration” of 48 others. The commission was given unprecedented power by former New York Governor George E. Pataki, and the state legislature. The Bush administration promised $1.5 billion over five years for rapid implementation of the report.

What will this mean for the people of New York, and by association, of the United States? The closures and mergers will result in displaced hospital workers, and jeopardize the health of people receiving treatment at the targeted hospitals.

Many of the mergers and conversions are between government-owned and private institutions. In Buffalo and Syracuse, this will result in mergers of hospitals regardless of the fact that their employees are organized in different unions, and have different governing structures.

A situation in Kingston, New York, has inspired debate about all of these issues. The Berger Commission mandated the merger of Kingston Hospital and Benedictine Hospital. Benedictine, a Catholic hospital affiliated with the Benedictine Sisters, is obliged to obey Catholic doctrine in all matters. Members of the Kingston community fear serious cutbacks in health care options following this merger.

In 1997, local activists nixed the planned merger of Northern Dutchess, Kingston and Benedictine hospitals. A group, which called itself PMS (Preserve Medical Secularity) successfully mobilized the Mid-Hudson Valley. Their efforts are detailed in a widely distributed video documentary about hospital mergers and how to fight them. Stories like this one provide a ray of hope. The Mid-Hudson group is reviving its campaign against the new state-mandated merger. Other communities need to do the same.

Currently, the Memorandum of Agreement between Kingston and Benedictine hospitals includes a statement that the hospitals “will continue as separate and distinct corporations, each with its own board of directors and corporate missions.” The agreement states that a new “corporate parent” will oversee both Kingston and Benedictine hospitals. The new board of directors will consist of six members from each of the two hospitals. The language is vague, though, and there is no guarantee that reproductive services will continue unabridged in the merged institution.

Call to Action

Handing the reigns of our health care system over to religious bodies is morally wrong, and should grate on the nerves of every American. This trend must stop. This is a call for everyone to research the issue in his or her own community. The actions of the Berger Commission ultimately touch all people in the state of New York. Similar mergers and closures throughout the nation touch all people. We must stop this dangerous trend.

Is your local hospital at risk? Find out. Read your local newspapers. Search for your hospital on the Internet. Is it part of a planned merger? Talk to your family, friends, neighbors and your fellow workers and colleagues. Write to your state and federal legislatures. Joint efforts are most effective. Many organizations will give you advice on how to organize to fight a merger. MergerWatch (MergerWatch.org), Planned Parenthood and the ACLU are three examples. We must stop this dangerous trend and preserve comprehensive health care for all people in the United States.

--Anna Bates is a contributing editor of Political Affairs. Send your letters to the editor to

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