For the second time in 14 months, Roman Catholic officials have closed a loophole that allowed tubal ligations to be performed at a Catholic Health Initiatives hospital.
Bishop James Sullivan, leader of the diocese of Fargo, N.D., recently sent a letter to Carrington (N.D.) Health Center, asking the 30-bed hospital to stop providing tubal ligations in a handful of cases in which a pregnancy could harm the patient.
In addition, the hospital acknowledged that its doctors were performing some vasectomies in the hospital-owned clinic. Neither procedure has been offered at Carrington since the first week in November.
"We really believe that our physicians understand and will respect the teachings and traditions of the Catholic Church and appreciate that these procedures may not be done in our facilities," said Joyce Ross, senior vice president for communication for the 69-hospital CHI system. "But we do understand when people may see the need to seek a procedure outside of our facilities."
Denver-based CHI witnessed a similar request at its St. Vincent Doctors Hospital in Little Rock, Ark., a little more than a year ago (Oct. 4, 1999, p. 17). The 308-bed hospital had leased a room near the labor and delivery department to about 30 individual doctors, who used it to perform elective tubal ligations.
The bishop of the Little Rock diocese initially approved the arrangement, which was meant to distance the hospital from the procedures, but the bishop asked the hospital to cancel the lease after church officials in Rome gave it the thumbs-down.
Carrington Health, meanwhile, believed it could offer the procedure in rare instances under a "pastoral exception" offered in 1984 by Sullivan's predecessor, said Brian McDermott, the hospital's president and chief executive officer. He estimated the hospital performed about 10 tubal ligations a year under the exception since 1994, when a doctor who moved to Carrington asked to perform them.
The exception, McDermott said, originally was granted in 1984 for Carrington's sister hospital, St. Ansgar's Health Center in Park River, N.D. Both hospitals are in the Fargo diocese and have been part of the same systems, first the Sisters of the Presentation of the Blessed Virgin Mary of Fargo and now CHI.
Until Sullivan's Oct. 31 letter, McDermott said, "We believed we were following the guidelines as communicated by the diocese. We will adhere to the bishop's decision."
The next closest hospital that performs the procedure is Jamestown (N.D.) Hospital, which is about 45 miles southeast of Carrington, McDermott said.
U.S. Catholic hospitals are prohibited from offering sterilizations, including tubal ligations for women and vasectomies for men, by the Ethical and Religious Directives for Catholic Health Care Services, updated in 1994 by the National Conference of Catholic Bishops.
The sterilization directive is consistent with longstanding Roman Catholic teachings, said the Rev. Gregory Schlesselmann of the Fargo diocese.
"They're trying to make that claim, saying that there's pastoral exceptions, but there are no instances in church teaching or church law that there can be pastoral exceptions to an intrinsically evil act," Schlesselmann said. "The end does not justify the means. It does not legitimize doing something intrinsically evil. You're mutilating a healthy organ."
If the tissue is diseased, for example, with cancer of the fallopian tubes, church teachings would allow a tubal ligation, Schlesselmann said. But the patients receiving these procedures at Carrington Health were potentially endangered by a pregnancy, rather than a disease of the fallopian tubes themselves, Schlesselmann said. Church-approved methods such as natural family planning can help a woman avoid a pregnancy, he said.
However, the archdiocese of San Jose, Calif., has allowed 93-bed St. Louise Regional Hospital in Gilroy to offer tubal ligations to some patients for whom another pregnancy would be a risk (Nov. 20, p. 12).
In making the ruling, the archdiocese considered the financial impact on the small hospital stemming from a loss of patients since late last year. That's when Nashville-based HCA-The Healthcare Co. sold the hospital, then-known as South Valley Hospital, to San Francisco-based Catholic Healthcare West.
St. Vincent Doctors in Little Rock also had been secular as recently as February 1998, when HCA sold the former Doctors Hospital to CHI.
Growth in the obstetrics department of St. Vincent Doctors has continued, but slowed slightly, since the lease ended April 1, said Scott Mosley, vice president of corporate development for the hospital's parent, St. Vincent Health System in Little Rock.
Mosley stressed that he couldn't attribute the slowdown to not offering tubal ligations, citing factors such as relationships with physician groups and seasonal fluctuations.
St. Vincent Doctors delivered 2,627 babies in 1999 and expects about the same number of deliveries this year, Mosley said.
C. Kemp Skokos, M.D., who headed the Arkansas Women's Health Center, the loose affiliation of independent doctors who were performing tubal ligations, has not noticed any difference among his patients. Patients' choice of hospital is almost always limited by their insurance carrier and its managed-care contracts, he said.
In addition, many women prefer to wait until they are sure their baby is healthy before undergoing an outpatient tubal ligation, Skokos said. Women were much more likely to combine a delivery and a tubal ligation 20 to 25 years ago, when families were bigger and many had made up their mind that their fourth or fifth pregnancy would be their last, no matter what the outcome, he said.
For those reasons, Skokos does not expect St. Vincent Doctors to see the dramatic drop in delivery volume that plagued the flagship of the four-hospital St. Vincent system, 657-bed St. Vincent Infirmary Medical Center, when it ceased performing sterilizations. The drop in volume led St. Vincent Infirmary to stop delivering babies in the early 1980s, Skokos said.
The Fargo ruling comes amid a furious debate over access to sterilization procedures and other services prohibited by Catholic doctrine when a secular hospital becomes Catholic or a secular hospital becomes a partner of a Catholic hospital. Moreover, the national bishops' conference is considering tightening the directives as they relate to partnerships, with a vote expected in June.
But Carrington has long been a Catholic hospital. It was founded by the city in 1911 but affiliated with the Sisters of the Presentation of the Blessed Virgin Mary of Fargo in 1941.
McDermott said the Fargo bishop's ruling will have almost no effect on Carrington Health's finances.
"This is a small issue. We will deal with it," he said."