The Struggle to
Keep Hospitals Catholic
Connecticut provides a case study of
the formidable challenges Catholic bishops face as they try to preserve
doctrinal control over the provision of care in historically Catholic
medical institutions. These pressures come not only from state and federal
regulators, but also from structural financial pressures that are pushing
more hospitals of all types toward consolidation, often in profit-driven
Southern New England remains an
impressively Catholic place, but it’s no longer a sort of Catholic Utah. As
recently as 1990, a majority of the populations of Connecticut, Rhode
Island, and Massachusetts identified as Catholic and there was considerable
deference in routine life to Catholic preferences. Now, only about 38
percent of Connecticut’s population identifies as Catholic.
Dwindling numbers in the pews translate
into bigger difficulties supporting Catholic institutions of all kinds. But
very expensive health care institutions, which already rely on massive
Medicare and Medicaid funding, are particularly hard to hold on to. And when
the reputational catastrophe of the clerical sexual misconduct scandal is
factored in, the result has been less deference to the views of church
leaders in the public realm. This is so despite the massive presence of
Catholics among elected officials.
This challenge is especially daunting
to the current generation of politically and theologically conservative
bishops, many of whom would like to recapture some of the dogmatic ground
lost in the recent past. Their concerns range from the virtually universal
flouting of the church’s ban on contraception among married Catholics; to
the broad failure to mobilize effective opposition to abortion; to, most
recently, the legitimation of same-sex marriage in states like Connecticut.
church’s ultimately unsuccessful struggle in 2006 and 2007 to exempt
Connecticut’s Catholic hospitals from a new state mandate that all hospitals
offer emergency contraception to rape victims provides a backdrop to the
bishops’ 2012 mobilization against the Obama administration’s mandate that
Catholic institutions serving the general public—hospitals, nursing homes,
schools and universities, and social service agencies—provide employees with
health insurance that covers contraceptives.
The emergency contraceptive drug called
Plan B received FDA approval in 1998 and rapidly became part of the
treatment protocol in American hospitals for rape victims and for those who
wished to take a contraceptive after sexual intercourse. The drug was so
popular that in the midst of the Connecticut controversy, it was approved
for over-the-counter use by adults.
According to the manufacturers, the
drug, which has higher levels of hormones than ordinary contraceptives,
functions in two ways: by preventing ovulation and, secondarily, by
preventing the attachment of a fertilized egg to the uterus. Plan B,
however, does not disrupt already established pregnancies. It is most
effective when taken soon after unprotected intercourse.
During the early 2000s, the standard
protocol for rape victims in all of Connecticut’s hospitals, including the
state’s four large acute-care Catholic ones, included an offer of Plan B to
those being treated for rape. The hospitals were permitted to ask if a
patient already had an established pregnancy.
But in January 2006, the two bishops
whose dioceses include Catholic hospitals decided that they were
uncomfortable with the established standard. In order to prevent the
possibility of abortion, Archbishop Henry Mansell of Hartford and Bishop
William Lori of Bridgeport (who as Archbishop of Baltimore would later lead
the charge against the Obamacare birth control mandate) said they would
require their hospitals to take an additional step and administer a separate
test to determine if the patient was ovulating, in order to prevent any
possibility of violating church teaching against abortion.
While both Mansell and Lori were
relatively new appointees to their diocesan positions, neither was
noticeably more conservative than his predecessor. But the two agreed on the
importance of staking out distinctive Catholic values in their hospitals.
By March, the Hartford Courant
was reporting opposition to the bishops’ position in the legislature and
from Connecticut attorney general Richard Blumenthal, who told a legislative
hearing on March 6 that, like other public institutions, Catholic hospitals
received very large public subsidies and could be required to provide Plan B
to patients without violating the religious freedom of the church.
The chair of the state’s Permanent
Commission on the Status of Women also weighed in, saying it was reasonable
“to expect a hospital to act like a hospital.” Leslie Gabel-Brett told the
hearing it was “unfair to require victims to wait or to travel to another
hospital,” especially since Plan B works most effectively within the first
72 hours after intercourse.
Gov. John W. Roland and the state’s
victim’s advocate (who was also a Catholic deacon) then weighed in on the
side of the bishops and no bill was reported from committee before the end
of the 2006 legislative session.
The following year, proponents of the
bill were better prepared. They told reporters they had majorities in both
houses of the legislature committed to requiring all hospitals to offer Plan
B to rape victims, but said they were open to negotiating how to do that
with the bishops. One proposal, used in other states, was to authorize
Catholic hospitals to contract with third parties to provide the medication.
And for a brief moment, that appeared
to provide a way forward. Mansell told a rally at the state Capitol on March
22 that he wanted to reach a “mutually respectful” solution. “The current
debate on Plan B and our Catholic hospitals must be resolved by a solution
that respects the legitimate needs of the rape victim, yet allows the
Catholic hospitals to operate according to a manner respectful of the
religious beliefs and values,” he said.
That encouraged the legislature to move
forward with a state mandate allowing third-party contractors to get
involved, but when the bishops abruptly declined to support the new bill the
state senate overwhelmingly approved it.
The Courant’s Mark Pazniokas
reported that Mansell and Lori, “after consulting with bio-ethicists said
that they could not agree to the compromise because the hospitals would have
to contact the third parties who would administer the drug.” This came
despite the news that Catholic bishops in New York and New Jersey had
accepted similar policies.
Most of the bishops’ supporters in the
legislature then moved behind the Plan B mandate. “What I struggle with is
this,” State Sen. David Capiello, a Republican from Danbury, told Pazniokas.
“If I was a Catholic in New York, this would be OK. But as a Catholic from
Connecticut, this is not OK. I could not get my arms around that.”
The bill was adopted 32-3 in the Senate
and moved to the General Assembly, where Speaker James Amand received a
phone call from the archbishop while standing at the podium to announce the
final 113-36 vote for passage.
The Courant strongly supported
the new law. Catholic hospitals, it editorialized, “receive public money and
they treat patients of all religious affiliations. Women, especially after a
trauma, should not have to shop around in the dead of night for help.”
The struggle ended oddly several months
later, when the state’s bishops announced that Catholic hospitals would
conform to the law without the use of third party contractors.
“The administration of Plan B pills in
this instance cannot be judged to be the commission of an abortion because
of such doubt about the way that Plan B and similar drugs work and because
of the current impossibility of knowing from the ovulation test whether a
new life is present,” their statement read. “To administer Plan B without an
ovulation test is not an intrinsically evil act.”
Behind the skirmishing over the role of
Catholic doctrine in the administration of the dioceses’ hospitals lay their
increasingly shaky futures as Catholic institutions.
With financial pressure growing on all
hospitals to hold down costs, Catholic hospitals are among those most
vulnerable to consolidation, as a national analysis published on November 30
in the New York Times reported. Many hospitals are now competing to
buy doctors’ practices to capture the business of their patients, and by and
large the Catholic hospitals don’t have the money to compete.
In Connecticut, two of the four
hospitals involved in the Plan B controversy are already in deep financial
crisis. St. Raphael’s Hospital in New Haven is moving rapidly toward
consolidation with Yale New Haven Hospital. St. Mary’s Hospital in Waterbury
recently abandoned efforts to merge with Waterbury Hospital and jointly sell
their business to a for-profit chain, which had offered to construct a new
hospital for the consolidated operation.
Once again Mansell played the key role
in blocking the merger because of concerns about how to handle contraceptive
services in the new hospital.
In 2011, the two Waterbury hospitals
announced that they wanted to merge and strike an agreement with LHP
Hospital Group of Plano, Texas. LHP would then have constructed a new $400
million for-profit institution, with 80 percent of the venture owned by LHP
and 10 percent each by the two hospitals.
The Courant reported on October
14 that, after a year of negotiations, Waterbury Hospital had decided it
would be “impossible to comply with Catholic directives on birth control.”
“We confronted numerous challenges and
obstacles that made it difficult for both of the hospitals in Waterbury to
remain true to their respective missions,” said Darlene Stromstadt,
Waterbury Hospital’s chief executive officer.
The hospitals and LHP attempted to
agree on the development of a separately incorporated “hospital within a
hospital” that would provide reproductive health services not condoned by
Catholic doctrine, but Mansell would not agree to allow that under a single
roof. No abortions would have been allowed at the merged hospital.
Proponents of the merger argued that
the “hospital within a hospital” model was working and had received the
approval of local Catholic bishops in Troy, New York, where a group of
Catholic and non-Catholic hospitals had consolidated in 2009. But Mansell
did not agree.
“If you’ve seen one merger, you’ve seen
one merger,” said St. Mary’s chief operating officer Chad Wable in a June 24
story in the Courant. “Every city’s a little different and has
The particular sticking point was tubal
ligation surgery, which prevents all possibility of future pregnancy in
patients. The surgery is often performed after Caesarian sections, because
that is the safest and most convenient time to do so. Waterbury Hospital
currently performs about 250 tubal ligations a year.
The construction of a satellite
surgical facility off the new hospital campus was also considered, but it
proved impossible to imagine how surgical patients could be safely moved.
The failed merger triggered concern from state officials that both hospitals
might fail financially, leaving Waterbury with no acute-care hospital at
Two weeks after publically abandoning
the merger talks, Waterbury Hospital announced its merger with the
Tennessee-based for-profit chain Advantage Health Care systems, which now
also includes St. Vincent’s Hospital in nearby Worcester, Massachusetts.
So Mansell chose to risk losing one of
his three Catholic hospitals rather than accepting a compromise that other
Catholic bishops had agreed to.
The choice was less stark in New Haven,
where Yale-New Haven will continue to operate St. Raphael’s as a
free-standing institution that follows all Catholic healthcare directives.
Yale-New Haven’s officials noted, however, that all employees of the
consolidated hospitals will receive health insurance that covers the full
range of reproductive healthcare services, from birth control through