Seething Battle Continues Over Catholic Takeover of Hospitals in Denver

Backroom deals, multiple lawsuits and $600 million dollars mark the Sisters of Charity attempt to force religious medical directives on non-sectarian medical centers in Colorado.

A controversial move to transfer operational control of three secular Denver-area hospitals to a Catholic healthcare system expected to take place on December 31 appears to be on hold pending federal approval.

The unexpected delay by the Federal Trade Commission to bless the transaction may provide local critics with a last gasp effort to continue fighting the deal. Community members and medical professionals contend the transfer would unfairly subject comprehensive reproductive health and end-of-life care to church doctrine over patients' needs. The Catholic church considers abortion, contraception, elective sterilization and termination of invasive life support as "intrinsically evil" and refuses to provide these medical services or respect patients' advance directives.

The disputed takeover in Denver exemplifies the very serious implications for the 127 non-denominational hospitals that succumbed to merger fever with cash-flush Catholic health care systems in the 1990s. According to a study by Catholics for Choice, half of merged secular-Catholic hospitals suspended most or all of their reproductive health care services. Eighty-two percent denied emergency contraception to rape victims -- and more than a third refused to provide a referral.

But for some tax-exempt, nonprofit hospitals co-owned by secular and church interests, there was little more than a wink and a nod to church mandates on care. Comprehensive reproductive healthcare services quietly remained available.

These practices received higher scrutiny in 2001 when the U.S. Conference of Catholic Bishops revised its Ethical and Religious Directives for medical care to address "misinterpretation and misapplication of the principle of cooperation with other-than-Catholic organizations." In other words, the church would no longer turn a blind eye to reproductive health and end-of-life care at its secular partner facilities that did not meet strict Catholic orthodoxy.

MergerWatch.org notes several examples of broken promises by Catholic healthcare systems to preserve reproductive health services at non-religious hospitals it acquired through mergers. Typical reasons included newly installed diocesan bishops with more dogmatic views on medical directives or the Vatican overturning decisions made by previously autonomous bishops.

More importantly, the local hospital policymaking was a little noticed precursor to the bare knuckles strategy on recent display with the church's relentless lobbying for the 2009 Stupak and Nelson amendments to further restrict access to abortion care via publicly-subsidized health insurance plans. At the same time, the Catholic Archdiocese of Washington, D.C., threatened to end social service programs for tens of thousands of poor residents if the city council approved a same-sex marriage ordinance.

Now, the Denver hospital takeover is offering a glimpse of the intense pressure being brought to bear by the church on its healthcare partners. The Vatican's renewed insistence on complete doctrinal influence on patient care is bolstered by very real threats to hold desperately needed institutional capital funds hostage until its theological demands are met.

And that once delicate balance between serving patient needs and adhering to strict Catholic medical directives is unraveling in plain sight.

Another Example of Follow the Money

Exempla Lutheran in Wheat Ridge, Colo., and Exempla Good Samaritan Medical Centers in nearby Lafayette have been sponsored by the Community First Foundation, the former fundraising arm of Lutheran Medical Center, and the Kansas-based Sisters of Charity of Leavenworth in a complex joint partnership since 1997. The two organizations formed the non-sectarian Exempla Healthcare System to manage the hospital operations of the medical centers founded from the ashes of two former Lutheran facilities and St. Joseph Hospital, a 130-year-old institution in the city of Denver, which is wholly owned by the Sisters of Charity.

With the three Denver hospitals in need of major infrastructure investments to keep pace in a highly competitive health care market, the Sisters of Charity began flexing their muscle by demanding complete say in day-to-day operations. The Catholic health system complained to the Kansas Business Journal that without administrative control it could not borrow money needed for capital improvements.

Namely, that would mean the ouster of Exempla and its non-sectarian medical policies.

Not surprisingly, the ultimatum raised the hackles of community members, patients and healthcare professionals at the Exempla-run hospitals. The initial offer sought to buyout Community First's co-membership in Exempla for $311 million with the Sisters of Charity committing an additional $300 million in capital improvements to the hospitals - a deal the charitable foundation readily agreed to as a way to plump up its sagging recession-battered assets and its growing distaste for the healthcare business.

The Community and Politicians Fight to Protect Women's Healthcare

The Exempla board and a citizen group filed lawsuits in 2008 to block the sale citing, in part, concerns that non-sectarian medical policies would end under a Roman Catholic healthcare system. Community members formed Save Lutheran Medical Center and produced a petition signed by more than 9,000 local residents to reject the deal.

But it was all for naught.

Two years of lawsuits resulted in a June 5 binding arbitration agreement that nullified the cash payment to Community First as a violation of state law since the community, not the foundation, owns the assets of the tax-exempt, nonprofit hospitals.

But in a blow to reproductive health advocates, Arbitrator William Meyer determined that the takeover could still occur as long as nothing of value exchanged hands between the foundation and the Sisters of Charity. He also disregarded the religious medical directive argument claiming that the founding documents of the two Lutheran hospitals didn't require them to remain secular.

While the cases played out in court and behind closed doors in the private arbitration hearing, Colorado state lawmakers worked to minimize the damage of losing hospital-based reproductive healthcare services.

Issues of religious doctrinal interference in physician-patient decision making came to a head in 2007 when Gov. Bill Ritter signed a law requiring hospitals and pharmacies to provide sexual assault victims information about emergency contraception. However, a conscience clause was added to the bill in order to get conservative Democrats on board after heavy lobbying by the Colorado Conference of Bishops.

Likewise, during the 2009 legislative session, the state passed a landmark Birth Control Protection Act to legally define contraceptive treatments, procedures and devices to stem future challenges to health insurance benefits or from "personhood" laws devised to give fertilized eggs civil right protections.

Though, again, the Catholic church forced a compromise to exclude mifespristone, or RU-486, and other federally approved pharmaceuticals that induce abortion.

Yet, despite the efforts of pro-choice lawmakers there are no safeguards in place to mandate other hospital-based reproductive health services, like sterilization or abortion, or in end-of-life care procedures that require the removal of feeding tubes or ventilators at tax-exempt, nonprofit facilities.

An 11th-Hour Reprieve Wrapped Up in Red Tape

Since the summer arbitration ruling, Community First and the Sisters of Charity have forged a new deal that keeps the foundation on as a co-partner but exempts it from any fiscal responsibility for the mounting $2.1 billion in capital needs at the three hospitals. The duo will then transfer control of Exempla to the Sisters of Charity, putting it in complete charge of the hospitals' administration.

Critics of the latest deal pinned their hopes on a 2008 state law that requires the state attorney general to review nonprofit hospital transactions that could substantially change hospital services the public has come to expect. Despite that law, Colorado Attorney General John Suthers, an anti-choice Republican, said in November there was no need to hold a hearing on the Sisters of Charity deal because it was now merely a change in bylaws and not a merger.

Meanwhile, the two partners continue to finalize the phasing out of Exempla's independence. A new board of directors, comprised of an equal number of appointees by Community First and the Sisters of Charity, was announced December 13.

The last remaining obstacle to the church's imposition of religious directives on care is the Federal Trade Commission which must approve the deal.

A decision was expected by year-end but has not yet been made public. An FTC spokesperson could not be reached for comment about the delay.