{"id":2426,"date":"2024-02-20T23:32:54","date_gmt":"2024-02-20T23:32:54","guid":{"rendered":"https:\/\/healthynewsusa.com\/?p=2426"},"modified":"2024-02-20T23:32:58","modified_gmt":"2024-02-20T23:32:58","slug":"the-powerful-constraints-on-medical-care-in-catholic-hospitals-across-america","status":"publish","type":"post","link":"https:\/\/healthynewsusa.com\/?p=2426","title":{"rendered":"The Powerful Constraints on Medical Care in Catholic Hospitals Across America"},"content":{"rendered":"

\n\tRachana Pradhan and Hannah Recht<\/span><\/p>\n

Nurse midwife Beverly Maldonado recalls a pregnant woman arriving at Ascension Saint Agnes Hospital in Maryland after her water broke. It was weeks before the baby would have any chance of survival, and the patient\u2019s wishes were clear, she recalled: \u201cWhy am I staying pregnant then? What\u2019s the point?\u201d the patient pleaded.<\/p>\n

But the doctors couldn\u2019t intervene, she said. The fetus still had a heartbeat and it was a Catholic hospital, subject to the \u201cEthical and Religious Directives<\/a> for Catholic Health Care Services\u201d that prohibit or limit procedures like abortion that the church deems \u201cimmoral\u201d or \u201cintrinsically evil,\u201d according to its interpretation of the Bible.<\/p>\n

\u201cI remember asking the doctors. And they were like, \u2018Well, the baby still has a heartbeat. We can\u2019t do anything,\u2019\u201d said Maldonado, now working as a nurse midwife in California, who asked them: \u201cWhat do you mean we can\u2019t do anything? This baby\u2019s not going to survive.\u201d<\/p>\n

The woman was hospitalized for days before going into labor, Maldonado said, and the baby died.<\/p>\n

Ascension declined to comment for this article.<\/p>\n

The Catholic Church\u2019s directives are often at odds with accepted medical standards, especially in areas of reproductive health, according to physicians and other medical practitioners.<\/p>\n

The American College of Obstetricians and Gynecologists\u2019 clinical guidelines<\/a> for managing pre-labor rupture of membranes, in which a patient\u2019s water breaks before labor begins, state that women should be offered options, including ending the pregnancy.<\/p>\n

Maldonado felt her patient made her wishes clear.<\/p>\n

\u201cUnder the ideal medical practice, that patient should be helped to obtain an appropriate method of terminating the pregnancy,\u201d said Christian Pettker, a professor of obstetrics, gynecology, and reproductive sciences at the Yale School of Medicine, who helped author the guidelines.<\/p>\n

He said, \u201cIt would be perfectly medically appropriate to do a termination of pregnancy before the cessation of cardiac activity, to avoid the health risks to the pregnant person.\u201d<\/p>\n

\u201cPatients are being turned away from necessary care,\u201d said Jennifer Chin, an OB-GYN at UW Medicine in Seattle, because of the \u201cemphasis on these ethical and religious directives.\u201d<\/p>\n

They can be a powerful constraint on the care that patients receive at Catholic hospitals, whether emergency treatment when a woman\u2019s health is at risk, or access to birth control and abortions.<\/p>\n

More and more women are running into barriers to obtaining care as Catholic health systems have aggressively acquired secular hospitals in much of the country. Four of the 10 largest U.S. hospital chains by number of beds are Catholic, according to federal data from the Agency for Healthcare Research and Quality. There are just over 600 Catholic general hospitals nationally and roughly 100 more managed by Catholic chains that place some religious limits on care, a KFF Health News investigation reveals.<\/p>\n

Maldonado\u2019s experience in Maryland came just months before the Supreme Court\u2019s ruling in 2022 to overturn Roe v. Wade<\/em>, a decision that compounded the impact of Catholic health care restrictions. In its wake, roughly a third of states have banned or severely limited access to abortion, creating a one-two punch for women seeking to prevent pregnancy or to end one. Ironically, some states where Catholic hospitals dominate \u2014 such as Washington, Oregon, and Colorado \u2014 are now considered medical havens for women in nearby states that have banned abortion.<\/p>\n

KFF Health News analyzed state-level birth data to discover that more than half a million babies are born each year in the U.S. in Catholic-run hospitals, including those owned by CommonSpirit Health, Ascension, Trinity Health, and Providence St. Joseph Health. That\u2019s 16% of all hospital births each year, with rates in 10 states exceeding 30%. In Washington, half of all babies are born at such hospitals, the highest share in the country.<\/p>\n

\u201cWe had many instances where people would have to get in their car to drive to us while they were bleeding, or patients who had had their water bags broken for up to five days or even up to a week,\u201d said Chin, who has treated patients turned away by Catholic hospitals.<\/p>\n

Physicians who turned away patients like that \u201cwere going against evidence-based care and going against what they had been taught in medical school and residency,\u201d she said, \u201cbut felt that they had to provide a certain type of care \u2014 or lack of care \u2014 just because of the strength of the ethical and religious directives.\u201d<\/p>\n

Following religious mandates can be dangerous, Chin and other clinicians said.<\/p>\n

When a patient has chosen to end a pregnancy after the amniotic sac \u2014 or water \u2014 has broken, Pettker said, \u201cany delay that might be added to a procedure that is inevitably going to happen places that person at risk of serious, life-threatening complications,\u201d including sepsis and organ infection.<\/p>\n

Reporters analyzed American Hospital Association data as of August and used Catholic Health Association directories, news reports, government documents, and hospital websites and other materials to determine which hospitals are Catholic or part of Catholic systems, and gathered birth data from state health departments and hospital associations. They interviewed patients, medical providers, academic experts, advocacy organizations, and attorneys, and reviewed hundreds of pages of court and government records and guidance from Catholic<\/a> health institutions and authorities<\/a> to understand how the directives affect patient care.<\/p>\n

Nationally, nearly 800,000 people have only Catholic or Catholic-affiliated birth hospitals within an hour\u2019s drive, according to KFF Health News\u2019 analysis. For example, that\u2019s true of 1 in 10 North Dakotans. In South Dakota, it\u2019s 1 in 20. When care is more than an hour away, academic researchers often define the area as a hospital desert<\/a>. Pregnant women who must drive farther to a delivery facility are at higher risk of harm to themselves or their fetus, research shows<\/a>.<\/p>\n

Many Americans don\u2019t have a choice \u2014 non-Catholic hospitals are too far to reach in an emergency or aren\u2019t in their insurance networks. Ambulances may take patients to a Catholic facility without giving them a say. Women often don\u2019t know that hospitals are affiliated with the Catholic Church or that they restrict reproductive care, academic research suggests<\/a>.<\/p>\n

And, in most of the country, state laws shield at least some hospitals from lawsuits for not performing procedures they object to on religious grounds, leaving little recourse for patients who were harmed because care was withheld. Thirty-five states prevent patients from suing hospitals for not providing abortions, including 25 states where abortion remains broadly legal. About half of those laws don\u2019t include exceptions for emergencies, ectopic pregnancies, or miscarriages. Sixteen states prohibit lawsuits against hospitals for refusing to perform sterilization procedures.<\/p>\n

\u201cIt\u2019s hard for the ordinary citizen to understand, \u2018Well, what difference does it make if my hospital is bought by this other big health system, as long as it stays open? That\u2019s all I care about,\u2019\u201d said Erin Fuse Brown, who is the director of the Center for Law, Health & Society at Georgia State University and an expert in health care consolidation. Catholic directives also ban medical aid in dying for terminally ill patients.<\/p>\n

People \u201cmay not realize that they\u2019re losing access to important services, like reproductive health [and] end-of-life care,\u201d she said.<\/p>\n

\u2018Our Faith-Based Health Care Ministry\u2019<\/strong><\/p>\n

After the Supreme Court ended the constitutional right to abortion in June 2022, Michigan resident Kalaina Sullivan wanted surgery to permanently prevent pregnancy.<\/p>\n

Michigan voters in November that year<\/a> enshrined the right to abortion under the state constitution, but the state\u2019s concentration of Catholic hospitals means people like Sullivan sometimes still struggle to obtain reproductive health care.<\/p>\n

Because her doctor worked for the Catholic chain Trinity Health, the nation\u2019s fourth-largest hospital system, she had the surgery with a different doctor at North Ottawa Community Health System, an independent hospital near the shores of Lake Michigan.<\/p>\n

Less than two months later, that, too, became a Catholic hospital, newly acquired by Trinity.<\/p>\n

To mark the transition, Cory Mitchell, who at the time was the mission leader of Trinity Health Muskegon, stood before his new colleagues and offered a blessing.<\/p>\n

\u201cThe work of your hands is what makes our faith-based health care ministry possible,\u201d he said, according to a video of the ceremony Trinity Health provided to KFF Health News. \u201cMay these hands continue to bring compassion, compassion and healing, to all those they touch.\u201d<\/p>\n

Trinity Health declined to answer detailed questions about its merger with North Ottawa Community Health System and the ethical and religious directives. \u201cOur commitment to high-quality, compassionate care means informing our patients of all appropriate care options, and trusting and supporting our physicians to make difficult and medically necessary decisions in the best interest of their patients\u2019 health and safety,\u201d spokesperson Jennifer Amundson said in an emailed statement. \u201cHigh-quality, safe care is critical for the women in our communities and in cases where a non-critical service is not available at our facility, the physician will transfer care as appropriate.\u201d<\/p>\n

Leaders in Catholic-based health systems have hammered home the importance of the church\u2019s directives, which are issued by the U.S. Conference of Catholic Bishops, all men, and were first drafted in 1948. The essential view on abortion is as it was in 1948. The last revision, in 2018, added several directives addressing Catholic health institution acquisitions or mergers with non-Catholic ones, including that \u201cwhatever comes under control of the Catholic institution \u2014 whether by acquisition, governance, or management \u2014 must be operated in full accord with the moral teaching of the Catholic Church.\u201d<\/p>\n

\u201cWhile many of the faithful in the local church may not be aware of these requirements for Catholic health care, the local bishop certainly is,\u201d wrote Sister Doris Gottemoeller, a former board member of the Bon Secours Mercy Health system, in a 2023 Catholic Health Association journal article<\/a>. \u201cIn fact, the bishop should be briefed on a regular basis about the hospital\u2019s activities and strategies.\u201d<\/p>\n

Now, for care at a non-Catholic hospital, Sullivan would need to travel nearly 30 miles.<\/p>\n

\u201cI\u00a0don\u2019t see why there\u2019s any reason for me to have to follow the rules of their religion and have that be a part of what\u2019s going on with my body,\u201d she said.<\/p>\n

Risks Come With Religion<\/strong><\/p>\n

Nathaniel Hibner, senior director of ethics at the Catholic Health Association, said the ethical and religious directives allow clinicians to provide medically necessary treatments in emergencies. In a pregnancy crisis when a person\u2019s life is at risk, \u201cI do not believe that the ERDs should restrict the physician in acting in the way that they see medically indicated.\u201d<\/p>\n

\u201cCatholic health care is committed to the health of all women and mothers who enter into our facilities,\u201d Hibner said.<\/p>\n

The directives permit care to cure \u201ca proportionately serious pathological condition of a pregnant woman\u201d even if it would \u201cresult in the death of the unborn child.\u201d Hibner demurred when asked who defines what that means and when such care is provided, saying, \u201cfor the most part, the physician and the patients are the ones that are having a conversation and dialogue with what is supposed to be medically appropriate.\u201d<\/p>\n

It is common for practitioners at any hospital to consult an ethics board about difficult cases \u2014 such as whether a teenager with cancer can decline treatment. At Catholic hospitals, providers must ask a board for permission to perform procedures restricted by the religious directives, clinicians and researchers say. For example, could an abortion be performed if a pregnancy threatened the mother\u2019s life?<\/p>\n

How and when an ethics consultation occurs depends on the hospital, Hibner said. \u201cThat ethics consultation can be initiated by anyone involved in the direct care of that situation \u2014 the patient, the surrogate of that patient, the physician, the nurse, the social worker all have the ability to request a consultation,\u201d he said. When asked whether a consultation with an ethics board can occur without a request, he said \u201csometimes it could.\u201d<\/p>\n

How strictly directives are followed can depend on the hospital and the views of the local bishop.<\/p>\n

\u201cIf the hospital has made a difficult decision about a critical pregnancy or an end-of-life care situation, the bishop should be the first to know about it,\u201d Gottemoeller wrote.<\/p>\n

In an interview, Gottemoeller said that even when pregnancy termination decisions are made on sound ethical grounds, not informing the bishop puts him in a bad position and hurts the church. \u201cIf there\u2019s a possibility of it being misunderstood, or misinterpreted, or criticized,\u201d Gottemoeller said, the bishop should understand what happened and why \u201cbefore the newspapers call him and ask him for an opinion.\u201d<\/p>\n

\u201cAnd if he has to say, \u2018Well, I think you made a mistake,\u2019 well, all right,\u201d she said. \u201cBut don\u2019t let him be blindsided. I mean, we\u2019re one church and the bishop has pastoral concern over everything in his diocese.\u201d<\/p>\n

Katherine Parker Bryden, a nurse midwife in Iowa who works for MercyOne, said she regularly tells pregnant patients that the hospital cannot perform tubal sterilization surgery, to prevent future pregnancies, or refer patients to other hospitals that do. MercyOne is one of the largest health systems in Iowa. Nearly half of general hospitals in the state are Catholic or Catholic-affiliated \u2014 the highest share among all states.<\/p>\n

The National Catholic Bioethics Center, an ethics authority for Catholic health institutions, has said<\/a> that referrals for care that go against church teaching would be \u201cimmoral.\u201d<\/p>\n

\u201cAs providers, you\u2019re put in this kind of moral dilemma,\u201d Parker Bryden said. \u201cAm I serving my patients or am I serving the archbishop and the pope?\u201d<\/p>\n

In response to questions, MercyOne spokesperson Eve Lederhouse said in an email that its providers \u201coffer care and services that are consistent with the guidelines of a Catholic health system.\u201d<\/p>\n

Maria Rodriguez, an OB-GYN professor at Oregon Health & Science University, said that as a resident in the early 2000s at a Catholic hospital she was able to secure permission \u2014 what she calls a \u201cpope note\u201d \u2014 to sterilize some patients with conditions such as gestational diabetes.<\/p>\n

Annie Iriye, a retired OB-GYN in Washington state, said that more than a decade ago she sought permission to administer medication to hasten labor for a patient experiencing a second-trimester miscarriage at a Catholic hospital. She said she was told no because the fetus had a heartbeat. The patient took 10 hours to deliver \u2014 time that would have been cut by half, Iriye said, had she been able to follow her own medical training and expertise. During that time, she said, the patient developed an infection.<\/p>\n

Iriye and Chin were part of an effort by reproductive rights groups and medical organizations that pushed for a state law to protect physicians if they act against Catholic hospital restrictions. The bill, which Washington enacted in 2021<\/a>, was opposed by the Washington State Hospital Association, whose membership includes multiple large Catholic health systems.<\/p>\n

State lawmakers in Oregon in 2021 enacted legislation that beefed up powers to reject health care mergers<\/a> if they would reduce access to the types of care constrained by Catholic directives. The hospital lobby has sued to block the statute<\/a>. Washington state lawmakers introduced similar legislation<\/a> last year, which the hospital association opposes.<\/p>\n

Hibner said Catholic hospitals are committed to instituting systemic changes that improve maternal and child health, including access to primary, prenatal, and postpartum care. \u201cThose are the things that I think rural communities really need support and advocacy for,\u201d he said.<\/p>\n

Maldonado, the nurse midwife, still thinks of her patient who was forced to stay pregnant with a baby who could not survive. \u201cTo feel like she was going to have to fight to have an abortion of a baby that she wanted?\u201d Maldonado said. \u201cIt was just horrible.\u201d<\/p>\n

KFF Health News data editor Holly K. Hacker contributed to this report.<\/em><\/p>\n

\t\t\t\t\tClick to open the methodology\t\t\t\t<\/p>\n

\t\t\t\t\t\tMethodology<\/strong>\t\t\t\t<\/p>\n

By Hannah Recht<\/strong><\/p>\n

KFF Health News identified areas of the country where patients have only Catholic hospital options nearby. The \u201cEthical and Religious Directives for Catholic Health Care Services\u201d \u2014 which are issued by the U.S. Conference of Catholic Bishops, all men \u2014 dictate how patients receive reproductive care at Catholic health facilities. In our analysis, we focused on hospitals where babies are born.<\/p>\n

We constructed a national database of hospital locations, identified which ones are Catholic or Catholic-affiliated, found how many babies are born at each, and calculated how many people live near those hospitals.<\/p>\n

Hospital Universe<\/strong><\/p>\n

We identified hospitals in the 50 states and the District of Columbia using the American Hospital Association database<\/a> from August 2023. We removed hospitals that had closed or were listed more than once, added hospitals that were not included, and corrected inaccurate or out-of-date information about ownership, primary service type, and location. We excluded federal hospitals, such as military and Indian Health Service facilities, because they are not open to everyone.<\/p>\n

Catholic Affiliation<\/strong><\/p>\n

To identify Catholic hospitals, we used the Catholic Health Association\u2019s member directory<\/a>. We also counted as Catholic a handful of hospitals that are not part of this voluntary membership group but explicitly follow the Ethical and Religious Directives, according to their mission statements, websites, or promotional materials.<\/p>\n

We also tracked Catholic-affiliated hospitals: those that are owned or managed by a Catholic health system, such as CommonSpirit Health or Trinity Health, and are influenced by the religious directives but do not necessarily adhere to them in full. To identify Catholic-affiliated hospitals, we consulted health system and hospital websites, government documents, and news reports.<\/p>\n

We combined both Catholic and Catholic-affiliated hospitals for analysis, in line with previous research<\/a> about the influence of Catholic directives on health care.<\/p>\n

Births<\/strong><\/p>\n

To determine the share of births that occur at Catholic or Catholic-affiliated hospitals, we gathered the latest annual number of births by hospital from state health departments. Where recent data was not publicly available, we submitted records requests for the most recent complete year available.<\/p>\n

The resulting data covered births in 2022 for nine states and D.C., births in 2021 for 23 states, births in 2020 for nine states, and births in 2019 for one state. We used data from the 2021 American Hospital Association survey, the latest available at the time of analysis, for the eight remaining states that did not provide birth data in response to our requests. A small number of hospitals have recently opened or closed labor and delivery units. The vast majority of the rest record about the same number of births each year. This means that the results would not be substantially different if data from 2023 were available.<\/p>\n

We used this data to calculate the number of babies born in Catholic and Catholic-affiliated hospitals, as well as non-Catholic hospitals by state and nationally.<\/p>\n

We used hospitals\u2019 Catholic status as of August 2023 in this analysis. In 10 cases where the hospital had already closed, we used Catholic status at the time of the closure.<\/p>\n

Because our analysis focuses on hospital care, we excluded births that occurred in non-hospital settings, such as homes and stand-alone birth centers, as well as federal hospitals.<\/p>\n

Several states suppressed data from hospitals with fewer than 10 births due to privacy restrictions. Because those numbers were so low, this suppression had a negligible effect on state-level totals.<\/p>\n

Drive-Time Analysis<\/strong><\/p>\n

We obtained hospitals\u2019 geographic coordinates based on addresses in the AHA dataset using HERE\u2019s<\/a> geocoder. For addresses that could not be automatically geocoded with a high degree of certainty, we verified coordinates manually using hospital websites and Google Maps.<\/p>\n

We calculated the areas within 30, 60, and 90 minutes of travel time from each birth hospital that was open in August 2023 using tools from HERE. We included only hospitals that had 10 or more births as a proxy for hospitals that have labor and delivery units, or where births regularly occur.<\/p>\n

The analysis focused on the areas with hospitals within an hour\u2019s drive. Researchers often define hospital deserts as places where one would have to drive an hour or more for hospital care. (For example: [1] \u201c Disparities in Access to Trauma Care in the United States: A Population-Based Analysis<\/a>,\u201d [2] \u201c Injury-Based Geographic Access to Trauma Centers<\/a>,\u201d [3] \u201c Trends in the Geospatial Distribution of Inpatient Adult Surgical Services Across the United States<\/a>,\u201d [4] \u201c Access to Trauma Centers in the United States<\/a>.\u201d)<\/p>\n

We combined the drive-time areas to see which areas of the United States have only Catholic or Catholic-affiliated birth hospitals nearby, both Catholic and non-Catholic, non-Catholic only, or none. We then joined these areas to the 2021 census block group shapefile from IPUMS NHGIS<\/a> and removed water bodies using the U.S. Geological Survey\u2019s National Hydrography Dataset<\/a> to calculate the percentage of each census block group that falls within each hospital access category. We calculated the number of people in each area using the 2021 \u201cAmerican Community Survey\u201d block group population totals. For example, if half of a block group\u2019s land area had access to only Catholic or Catholic-affiliated hospitals, then half of the population was counted in that category.<\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

Rachana Pradhan and Hannah Recht Nurse midwife Beverly Maldonado recalls a pregnant woman arriving at Ascension Saint Agnes Hospital in Maryland after her water broke. It was weeks before the baby would have any chance of survival, and the patient\u2019s wishes were clear, she recalled: \u201cWhy am I staying pregnant then? What\u2019s the point?\u201d the […]<\/p>\n","protected":false},"author":1,"featured_media":2427,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3],"tags":[],"class_list":["post-2426","post","type-post","status-publish","format-standard","has-post-thumbnail","category-health-industry"],"_links":{"self":[{"href":"https:\/\/healthynewsusa.com\/index.php?rest_route=\/wp\/v2\/posts\/2426","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/healthynewsusa.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/healthynewsusa.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/healthynewsusa.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/healthynewsusa.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=2426"}],"version-history":[{"count":1,"href":"https:\/\/healthynewsusa.com\/index.php?rest_route=\/wp\/v2\/posts\/2426\/revisions"}],"predecessor-version":[{"id":2428,"href":"https:\/\/healthynewsusa.com\/index.php?rest_route=\/wp\/v2\/posts\/2426\/revisions\/2428"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/healthynewsusa.com\/index.php?rest_route=\/wp\/v2\/media\/2427"}],"wp:attachment":[{"href":"https:\/\/healthynewsusa.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=2426"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/healthynewsusa.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=2426"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/healthynewsusa.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=2426"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}