The decision by a Roman Catholic healthcare system to fire a stubborn local board as a way of greasing a joint venture with Columbia/HCA Healthcare Corp. should not be viewed as an act of healthcare heresy.
In fact, the annals of MODERN HEALTHCARE are dotted with examples of power struggles between local hospital boards and system directors. In the end, the system usually wins. Although such domination is hard for local boards to swallow, loss of autonomy is the price of system admission.
In the case of Sisters of Charity of St. Augustine Health System, or CSA, the decision was made to oust the local board of Timken Mercy Medical Center in Canton, Ohio, because of its reluctance to support a deal with Columbia.
The 50-50 joint venture would link the nation's largest investor-owned hospital company with a four-hospital Catholic system that generated $376 million in 1994 revenues. The agreement comes at a time when Catholic leaders are questioning the church's future in healthcare.
But the real controversy in Canton surrounds control over a local hospital. To the board, Timken Mercy is a community asset that has long been supported by the Timken family and other leading citizens of Canton. To CSA, the hospital is the most profitable component of a successful healthcare system that last year netted $18.1 million.
That financial success allows the sisters to carry out a charitable mission. The partnership with Columbia would cushion CSA against the high risk of operating in today's healthcare market, while plowing hundreds of millions of dollars into foundations in the communities CSA serves.
The foot-dragging by the Timken Mercy directors prompted CSA to dismiss the 12 local representatives on the 17-member board a day before the May 17 deal was announced. While the hospital's heart is in the community, its roots are in CSA's Cleveland headquarters.
The Canton case also underscores the tenuous relationship between local boards and system trustees. In some cases, local boards are left feeling like a rubber-stamp group that can do little but advise the system on community matters. System trustees, on the other hand, believe that broad powers are needed to deal with clinical integration, budgeting and partnerships that are the lifeblood of the organization. Systems rarely exercise their reserved powers to dismantle local boards, but in the case of CSA the decision was an embarrassing yet necessary move.