"This study examines the practices of Catholic hospitals and their adherence to the Ethical and Religious Directives (ERD) for Catholic Health Care Services issued by the U.S. Conference of Catholic Bishops. If divergence of practice exists among Catholic hospitals, such diversity may pose judicial and political problems for providing protection under the conscience clauses. Catholic hospitals in seven states—California, Illinois, Indiana, New Jersey, New York, Texas and Washington—were studied to determine if diversity of practice existed in the provision of direct female sterilizations....Eighty-five or 48% of these hospitals provided a total of 20,073 direct sterilizations in violation of the ERD....diversity of practice resulting from varied interpretations and applications of the ERD exists among hospitals, and within hospital systems and dioceses. An analysis of the conscience clauses illustrates that Catholic hospitals are in jeopardy of defending themselves against judicial challenges and could strip themselves of the ability to mount a political front to aid in defending the conscience clauses."
Introduction
"The Catholic Church has declared some procedures—such as direct abortion, direct sterilization, and euthanasia—to be immoral....Scholarly journals, press reports, and statements from Church authorities raise questions about the uniformity with which Catholic health care providers interpret and adhere to the Church’s teaching. Until recently, it has been difficult for interested groups to evaluate actual practices of Catholic hospitals because individual patient records are protected by confidentiality laws. Secure techniques for data collection and processing of hospital data evolved within the last two decades which allow research without compromising patient confidentiality....If the data reveals a significant divergence in interpretation and application of Church teaching among Catholic hospitals, this would indicate that, practically speaking, no uniform Catholic practice exists. The absence of a unified Catholic practice would raise the question: can an institution or an individual claim Catholic identity as a legal basis for conscientious objection?.... this research focuses on procedures for direct sterilization. A direct sterilization is one that induces sterility when no underlying or pathological illness is present and is an explicit violation of official Church teaching."
"In July of 2008, Our Sunday Visitor Newsweekly (OSV), a national Catholic newspaper reported on allegations of widespread practice of tubal ligations in Catholic hospitals in Texas. The author, Ann Carey, based her reporting on a compilation of statistics from the Texas inpatient hospital public use data files completed by a group of medical researchers investigating the occurrence of direct sterilizations and legally induced abortions occurring from 2000-2003 [Note: Ann Carey's incredible pieces included
"Leonard Nelson, in Diagnosis Critical [another incredible work!], examines two specific Catholic hospital systems, Providence Health System and Ascension Health, and reflects upon their struggle to maintain Catholic identity. Nelson states that in some instances these systems have entered into arrangements through mergers and acquisitions of non-Catholic facilities which have put them in the position of providing procedures in violation of the ERD. William Bassett in an article in the Journal of Contemporary Health Law Policy expresses his concerns that the legal requirements being imposed by mergers and acquisitions may undermine the prohibition of immoral procedures in Catholic hospitals....
"In 2010 an issue arose that illustrated not only the problem of some Catholic hospitals performing illicit procedures, but also the problems that arise from divergent interpretations of the ERD. Bishop Thomas J. Olmsted of the Diocese of Phoenix, Arizona earlier in that year excommunicated a religious sister at St. Joseph’s hospital, amember of the Catholic Healthcare West system, for assenting to a direct abortion in violation of ERD 45. In an open acknowledgement of contrary interpretations of the ERD, Daughter of Charity, Sr. Carol Keehan, CHAUSA president and CEO, stated that the hospital was in compliance with the ERD concerning the abortion [Gee, where have we seen Sister's name before?]. In subsequent investigations of St. Joseph, the Bishop learned that the hospital had violated other provisions of the ERD and had been performing direct sterilizations. As a result, he removed the Catholic status of the hospital....
"A diversity of practice has the potential to affect judicial challenges against individual Catholic hospitals or systems of Catholic hospitals, and to affect the ability of Catholic institutions to present a united political position on issues affecting conscience clause legislation."
CHAPTER THREE
Direct Sterilizations in Catholic Hospitals in Seven States across the United States:
Analysis and Summary of Findings....
New Jersey Catholic Hospitals
"Fifteen Catholic hospitals were identified in the state of New Jersey. Of these, eight reported births....seven of the hospitals, 87.5% of the total, have diagnostic codes of V25.2 indicating that 867 women received a diagnosis for sterilization....Saint Peter’s University Hospital, owned by the Diocese of Metuchen, was the only hospital that did not have any codes for sterilizations [Kudos to Mr. Ron Rak, President & CEO of Saint Peter's, who was one of the presentors at the February 11 Health Care Conference at St. Charles Borromeo Seminary. St. Peter's is also home to the Gianna Center.]....The state of New Jersey is divided into five dioceses. Four of the dioceses had hospitals performing sterilizations. The only diocese which did not have hospitals
performing sterilizations was Metuchen" ["Bishop David M. O'Connell of the Trenton Diocese said in an e-mail that he had talked to hospital administrators and had 'been assured that procedures at Lourdes Medical Center of Burlington County were in compliance'" (Philadelphia Inquirer, 2/20/12).].
Analysis of Catholic Hospital Systems with Additional Hospitals outside the Study Area
"It is worth evaluating the practices of those health care systems included in the study which also operate in states outside the study area. The practices of such systems may be reflected in the other states in which they operate....Catholic Health East, the next system listed, has 34 hospitals. Its headquarters are in Newtown Square, Pennsylvania in the [Arch]Diocese of Philadelphia. It is sponsored by six religious orders. Catholic Health East operates in eleven states of which New Jersey and New York were included in the study. Four of its hospitals were studied and of them three reported V25.2 codes. This represents 75% of the hospitals reviewed."
CHAPTER FOUR
The Possible Consequences of Divergent Practices among Catholic Hospitals....
"The diversity in the practice of providing direct sterilizations in some Catholic hospitals seems to be due to divergent interpretations of ERD since all hospitals assert that they are abiding by the ERD [emphasis added]. Repeated attempts on the part of the U.S. bishops and the Vatican over a period of 40 years to bring an end to alternate interpretations points to
a broader problem. The ERD do not establish transparent and accountable mechanisms for oversight. For example, there are no independent review boards to examine hospital policies or to ensure that ethics committees of hospitals are in accord with a uniform interpretation of the ERD.
"Currently, ethics committees are not required to report violations to anyone. A review of its judgments by ecclesial authority is not mandated, and there are no individual review boards to oversee their findings. If a violation is observed by a physician or staff member of a hospital, he or she is not now mandated to report the incident to anyone. In the current state of affairs, if the practitioner makes a formal complaint regarding a specific case to a local bishop, he or she risks violating HIPAA rules. Given these conditions, in the absence of any independent oversight mechanisms, the ERD cannot be enforced in a uniform way.
"Uniformity in interpretation and implementation remain elusive because the ERD lack best practice methods for establishing transparency and accountability. A point of comparison would be, for example, the mechanism implemented to protect minors from abuse. A best practices model would provide for the mandatory reporting of violations of the ERD to an independent review board with failure to report incidents leading to penalties or dismissal. Also, it would require the ethics committee of a hospital to be required to report all violations that come to their attention to an independent review board. The decisions of the ethics committee would also be mandatorily reviewed by an independent board. Another requirement would be that the hospital be required to report their patient diagnostic and procedure codes to an independent review board and ecclesial authorities on a periodic basis.
"Without oversight mechanisms in place, the lack of uniformity of practice among Catholic hospitals may pose a judicial risk to the hospitals if a legal challenge is made against a hospital to force the provision of sterilization procedures....Also at risk would be those individual health professionals who conscientiously object to involvement with procedures prohibited by the ERD when the Catholic hospital in which they practice allows those procedures....
"The lack of consensus between the USCCB and many hospitals represented by CHAUSA is already evident in recent cases in which they have publically promoted opposing views. For example, in the passage of the health care reform acts of 2010....While the USCCB vigorously opposed the passage of the Acts in their final form, CHAUSA publicly announced support for passage at a critical juncture in the political process. A representative of CHAUSA stood behind President Obama as he signed the Acts into law and received one of the signature pens as an expression of gratitude from the administration [Gee, would that have been Sister Carol Keehan?]."
