The partnership between Adventist Health and St. Joseph would set up a joint operating company, with each partner retaining management and control over its own facilities. Neither would be allowed to cause the other to violate its religious rules. The agreement would establish a process for resolving any religious conflicts over care. If no resolution were reached, either party could dissolve the joint operating company.
The Catholic partners in these proposed deals hope the way they’ve structured the agreements will convince Catholic religious authorities that they don’t violate the ERDs. They stress that the Catholic organization will maintain the religious care rules within its walls, and won’t control or profit from prohibited services provided by the partner organization.
John Haas, president of the National Catholic Bioethics Center, said the proposed agreement in Northern California appears carefully designed to avoid any kind of oversight or financing by St. Joseph of services provided in Adventist facilities that violate Catholic rules, thus avoiding “immoral cooperation with illicit activities.”
Pepe said his organization learned from the failed merger with Dartmouth-Hitchcock a decade ago to build in ironclad protections for continued adherence to Catholic rules.
“There will be clear prohibitions preventing other hospitals and corporate members from requiring Catholic Medical Center to do anything not consistent with the ERDs,” he said. “It’s structured in a way where our Catholicity will remain ad infinitum.”
For their part, the non-Catholic partners are striving to show secular advocacy groups that the deals will preserve access to women’s reproductive and other services prohibited under Catholic rules.
“We permit contraception, sterilization, in vitro fertilization, and we are LGBTQ-friendly,” said Jill Kinney, administrative director for communications at Adventist Health’s Northern California region. “We remain with our policies, they remain with theirs, and nothing would change.”
Dr. Joanne Conroy, Dartmouth-Hitchcock’s CEO, emphasized that patients in the new system, particularly obstetrics patients, will be fully informed about what services they can receive in what facilities, and will be given a choice in advance of where they want to go. Dartmouth-Hitchcock physicians and residents already practice at the Catholic Medical Center and know how to navigate the different care rules, she added.
“They do a really good job of identifying what patients’ views and desires are ahead of time,” Conroy said. “For those with a real affinity for Catholic healthcare, they make sure they deliver their OB care at Catholic Medical Center. For those who want something not covered there, we direct those patients to other facilities.”
But neither Catholic nor secular advocates are convinced, though the Catholic bishops in both locations have allowed the negotiations to go forward.
“The system board would approve budgets, and that puts Dartmouth-Hitchcock, an abortion provider, in control of the finances of Catholic Medical Center,” said Jason Hennessey, president of New Hampshire Right to Life. “As it stands now, we’re dead-set against this combination, which is not aligned with Catholic doctrine.”
The ACLU’s Burlingame was just as skeptical, pointing to the tough language in the Catholic ERDs on partnerships with non-Catholic providers.
“When they say they’ll allow Adventist to provide the same level of services as before, that seems in fundamental conflict with the new ERDs,” she said. “It’s essential these questions be asked and answered in a substantial way before the California attorney general moves forward with approving this deal.”
St. Joseph’s Klockenga insisted that the Catholic side wouldn’t control any of the joint operating company assets on the Adventist side, leaving Adventist’s care policies untouched. “The management of the JOC will be JOC employees, not employees of any Catholic organization,” he said.
He noted that other organizations that want to affiliate with the new St. Joseph-Adventist system could choose between joining the Catholic or Adventist side, as with Centura in Colorado. In addition, he said physicians in St. Joseph facilities, while forbidden to provide certain services, are free to refer patients to Adventist or other facilities where they can get those services.
Burlingame noted, however, that the ERDs specifically bar administrators or employees of Catholic institutions from making referrals for “immoral procedures.”
Another limitation is that Adventist Health, like St. Joseph, does not offer gender transition surgery or participate in physician aid in dying, according to Adventist’s Kinney.
The Seventh-day Adventist Church officially describes gender dysphoria as “an expression of the damaging effects of sin” and “strongly cautions transgender people against sex reassignment surgery and against marriage,” the ACLU noted in a recent letter to the California attorney general’s office challenging the Adventist-St. Joseph deal.
Adventist Health’s Kinney said her system does not discriminate based on sexuality or gender identity but that its hospitals are not equipped to provider gender confirmation treatment.
Back in Grand Junction, Community Hospital’s Thomas pointed to a new development that he believes confirms the wisdom of his organization’s choice to keep the hospital secular.
Physicians at the town’s largest independent OB-GYN group just applied for privileges at Community because officials at nearby St. Mary’s Medical Center recently said they will no longer permit tubal ligations as part of C-sections for women who don’t wish to bear any more children, Thomas said. St. Mary’s declined to confirm or deny this.
“That’s certainly disappointing for patients who need to deliver at St. Mary’s,” said Dr. Kara Danner, an OB-GYN employed by Community who was informed by St. Mary’s about the new enforcement of the Catholic rule against sterilization. “It doesn’t seem like the right thing to do to make women who have to have a C-section go through two separate surgeries when it could be done together.”
Thomas said all the OB-GYN physicians in town now have privileges at his hospital, which has boosted its finances. “The board is feeling pretty good about the decision to make sure there are options in town,” he said.