Facing the loss of patients as well as revenue, a small Roman Catholic hospital in California has decided to permit tubal ligations on a limited basis to help keep itself afloat financially, MODERN HEALTHCARE has learned.
The case may be the first in which a struggling Catholic hospital has bent the canonical rules against such procedures in the name of money.
"If a Catholic hospital isn't able to address . . . certain (individual) cases, it will lose gynecological services, then begin to lose contracts, then viability, and could ultimately go out of business," said the Rev. Charles McDermott, vicar episcopal for theological and canonical affairs at the Archdiocese of Sacramento.
McDermott has played a key role in what he termed a close examination of reproductive policies at 93-bed Saint Louise Regional Hospital in Gilroy, Calif. It has been permitting some tubal ligations since mid-September. Five so far have been approved.
McDermott said area physicians requested the re-examination. The hospital is operated by San Francisco-based Catholic Healthcare West, which acquired Saint Louise, formerly known as South Valley Hospital, late last year from HCA-The Healthcare Co. for an undisclosed sum. CHW then merged South Valley's operations with the now-closed Saint Louise Hospital in nearby Morgan Hill, and turned South Valley into a Catholic institution.
In its last year of operation as a secular facility, Saint Louise performed 78 of the type of tubal ligations that could be permitted under the new policy, according to a CHW spokesman.
Catholic hospitals have long been barred from performing virtually all tubal ligations under the Ethical and Religious Directives for Catholic Health Care Services. The directives were published by the National Conference of Catholic Bishops and last updated in 1994.
CHW officials declined to comment on the changes or CHW's role in putting them into effect. However, McDermott confirmed that several high-ranking CHW officials participated in the decisionmaking process.
McDermott also said area physicians who practiced at the hospital before it was acquired by CHW lobbied the San Jose Archdiocese, which has jurisdiction over Saint Louise, to allow the policy change.
"It's in the secular best interest of the community for the change to be made," said Erik Cohen, M.D., a Gilroy obstetrician who stopped admitting patients at Saint Louise after it initially barred tubal ligations.
But Cohen, a vocal critic of CHW, said he doesn't intend to resume admitting patients to the hospital: "The change isn't sufficient enough to change my concerns."
McDermott was an adviser to the San Jose Archdiocese, which justified its decision in an 11-page report. The San Jose Archdiocese concluded the hospital risked an erosion of its patient base and "serious negative impact on the viability of the facility" if an accommodation wasn't made.
Saint Louise lost $7.8 million on net patient revenue of $24.6 million for the 12-month period ended Jan. 31, 1999, according to HCIA-Sachs, an Evanston, Ill.-based healthcare research firm.
CHW, California's largest hospital operator with 48 facilities statewide, lost $317.9 million on its operations for the fiscal year ended June 30 (Nov. 13, p. 18).
Of CHW's 48 hospitals, 13 operate within what is called a "community model," whereby they're not considered Catholic-oriented, so some forms of sterilizations are offered. Typically, these are secular hospitals that CHW has acquired in recent years. The remaining hospitals, including Saint Louise, are Catholic-oriented hospitals. Virtually all forms of sterilization are forbidden at these facilities.
Watchdog groups say the change represents a dramatic turn for a Catholic healthcare provider.
"I'm unaware of any other parallel situation," said Frances Kissling, president of Catholics for a Free Choice, a Washington-based advocate for liberalizing stringent Catholic doctrine toward reproductive issues.
"We felt on all sides of the community that this would improve access to services," said Susan Fogel, legal director for the California Women's Law Center, a Los Angeles-based reproductive rights lobby.
The organization had criticized CHW's curbing of reproductive services in Gilroy, a rural town about 30 miles south of San Jose, noting that residents had difficulty getting access to such services elsewhere.
"It represents the recognition of patient needs in Gilroy. Hopefully, it will be a model for other hospitals around the country," said Lois Uttley, director of Albany, N.Y.-based MergerWatch, which monitors access-to-care issues at hospitals that have been acquired by religious healthcare organizations.
Still, Saint Louise is far from performing the procedure on demand.
A review committee made up of medical and religious professionals, including McDermott, will consider requests for tubal ligations only if they're submitted at least a week in advance of the procedure. A tubal ligation must be considered "medically necessary" to ensure the patient's health--that is, a future pregnancy could endanger the mother's health.
The procedure also must be done in conjunction with a Caesarean section or with an "analagous" abdominal surgery performed under anesthesia. Financial and physicial burdens of traveling to another facility also are considered.
According to McDermott, the rationale that allows tubal ligations in some Catholic-owned hospital is that a patient would undergo additional health risks if she underwent the procedure at a secular facility later on, as it's more medically complicated to perform a stand-alone procedure.
The Washington-based Catholic Healthcare Association did not immediately provide comment.