NEWS FEATURE: Catholic hospitals struggle with new controversies over charity care

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c. 1999 Religion News Service

UNDATED _ Already jarred by controversies over the availability of birth control and abortion, the nation’s Roman Catholic hospitals are facing a more unsettling question: Have they strayed from their mission to serve the needy?

Keeping pace with the mergers-and-acquisitions trend in the health-care industry, many Catholic hospitals have taken over non-Catholic institutions that dispense so-called”reproductive services.” Because church doctrine forbids procedures such as sterilization, the newly merged health-care systems have incited protests by reproductive-rights advocates, especially in communities where Catholic health care dominates.

Now, new questions are driving more deeply to the heart of the Catholic health-care ministry, founded in the 19th century upon a mission of care for the poor.

The latest wrangling has surfaced at Catholic Healthcare West, one of the largest health systems in the country. A leading union of health-care workers has accused the San Francisco-based system of turning its back on patients who lack health insurance.

Officials of Catholic Healthcare West acknowledge the rate of free care for the uninsured has dropped, overall, in the 48-hospital system. But they also called attention to their financial support for community causes like programs to aid battered women.

The Service Employees International Union, which is waging an organizing battle at Catholic Healthcare West, began circulating a study in May on charity care at the health system. The findings draw a dim picture of U.S. health care in general, said union executive vice president Eliseo Medina.”Here we have people (in Catholic health care) who have historically made it their mission to serve the poor and the uninsured. If they’re abdicating on their responsibility, then it has tremendous implications for all of us,”he said.”It’s very bad news that the Catholics seem to be retrenching from their historic mission.” Meantime, a national survey has touched a tender nerve with its finding that Catholic hospitals dispense no more charity care than other hospitals, on average. The figures were contained in a broader annual profile of the health-care industry published by Modern Healthcare magazine.

Last year, Catholic facilities offered charity care at a rate slightly lower than that of other nonprofit hospitals, and appreciably lower than other religious hospitals, according to the survey. Predictably, Catholic hospitals were more open-handed than the for-profit sector when it came to free medical care.

An official of the Catholic Health Association, the national umbrella group of Catholic hospitals, said even if the survey offers an accurate picture, it is still unfair to judge Catholic hospitals by how much free medical care they provide.”Charity care is only part of the charitable contribution a hospital makes, only part of what it does for the poor,”said Julie Trocchio, an association representative in Washington.

In the rough health-care marketplace, Catholic hospitals have not been immune to the pressures to cut costs and restructure services. To stay competitive, many Catholic systems have acquired or formed alliances with other hospitals and clinics, including secular facilities.

In the Modern Healthcare survey published May 24, five Catholic hospital systems ranked in the top 10 of all health systems in the United States, as measured by the number of hospital beds. Catholic hospitals dominate the religious health sector.

On the reproductive-services front, some Catholic hospitals have chosen to stick to their guns and ride out the controversies. Others have walked a doctrinal tightrope, allowing sterilization and other such procedures to continue in clinics legally or just physically separate from hospital grounds.

While that has aroused attention, the issue of charity care is liable to become more agonizing for church leaders, say those who follow the trends. Catholic hospitals not only have their historical roots in service to the poor, but also are leaders today in the fight for national health-care reform and universal insurance coverage.

Abortion and sterilization have actually become the”easier issues”for Catholic health care, said an attorney who has helped negotiate hospital mergers, and who is also a nun.

Sister Melanie DiPietro, a partner in the Pittsburgh law firm Buchanan Ingersoll, said the greater challenge is to flesh out religious teachings about service to the poor in an increasingly competitive market.”I can make a contract that says `no abortions,’ and you know what you bought. But it’s very difficult to say in a contract, `We’re going to serve the poor.’ What does that mean?”she said.”It’s really an issue of judgment and discretion, and that’s why it’s more difficult,”DiPietro added.

Catholic Healthcare West pleaded financial woe in explaining the findings by the Service Employees union. Last year, the health system posted a net operating loss of $32 million. Still, overall, the system recorded profits of $73 million last year because of income from investments.

According to the union study, Catholic Healthcare West’s rate of spending on charity care has dropped by more than one-half in the past seven years. The report says the health system now devotes less than 1 percent of its net patient revenues to free care.

That falls below national averages for all kinds of hospital systems, including for-profit corporations.”As a Catholic, I really expect much more from my church than what they’re doing in this case. It’s tremendously disappointing to me personally,”said Medina of the Service Employees. The union has 1.2 million members, half of them in the health-care sector.

In a damage-control memo sent to California legislators, Catholic Healthcare West denounced the study as”highly inflammatory and inaccurate”and an”insult”to the nine religious orders of nuns that sponsor the system, which is managed by lay executives.

At the same time, when asked about the study, Catholic Healthcare West vice president Marilyn Morrish said the statistics”are probably reasonably accurate, but the story they tell isn’t.” She said the hospital chain spent $177 million last year on”community benefits”including job training, housing and shelters for battered women.”Charity care is but one piece of what we’re doing in the community to discharge our responsibility,”said Morrish.

(BEGIN OPTIONAL TRIM)”Community benefits”was also the thrust of the response by national Catholic health-care leaders to Modern Healthcare’s survey.

Trocchio said many Catholic hospitals plow their charitable spending into social projects like affordable housing and job training, rather than only direct care for the uninsured. It depends on the needs in a given community, she said.

Asked if Catholic hospitals should give more than average care for the needy, Trocchio said,”We’d expect Catholic hospitals to be more responsive to the poor. (But) to say they should give more charity care is too narrow.” In addition to charity care, Modern Healthcare’s May 24 edition carried a chart on”community benefits”including all charitable works, from grants to community agencies to health education programs. By that measurement as well, the survey found Catholic hospitals offered about as much as other nonprofit hospitals.

Further, the Service Employees study found Catholic Healthcare West’s rate of spending on”community benefits”has fallen by 38 percent since 1992. Morrish did not challenge the figures.


Few if any hospitals offer a reliable accounting of such”community benefits,”said Alan Sager, a professor of public health at Boston University.”Claims by all hospitals regarding their community benefits have to be eyed skeptically _ all hospitals,”said Sager, when asked specifically about Catholic hospitals.”A lot of these activities are really disguised marketing,”he said. He pointed to community health fairs, for example, that are at least partly promotional.

Why don’t hospitals concentrate their charitable efforts on patients who need medical care but can’t afford it?”They fear that if they serve some patients, ambulance drivers and uninsured people will start driving up and flooding the hospital,”said Sager.”So they have to adopt a really rigid, negative, unwelcoming posture.” DEA END BOLE

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