i'm your host valerie to rico today we're going to be talking about hospital mergers in two thousand and ten seattle swedish hospital announced an affiliation with the catholic health care corporation providence today swedish  division of providence in two thousand and twelve catholic peace health obtained a contract to build the only hospital in the san juan islands these two incidents are part of a broader trend an increasing number of washington counties have only hospitals that are affiliated with or run by religious organizations that includes the clinics and affiliated labs what does that mean for patien for doctors in catholic hospitals care is dictated in part by a set of religious directives that are approved by the bishops here with us tonight to talk about this is monica harrington who is the founder of catholic watch dot org thank you for joining us tonight great thanks for having me what are hospital mergers more broadly with the affordable care act hospitals and medical systems are under pressure to consolidate they need to have record systems that work across multiple systems etc so there's a larger trend for industry consolidation and the interesting thing about that is here in washington state we started with a large number of catholic health care systems and so as they consolidate become more powerful it means that the catholic presence the catholic controlled hospitals here in washington state become more powerful and they're reaching expanse nine or ten counties will have only catholic affiliated health care systems by the end of this year if all of the affiliations are approved is that right right i don't know the specific number and counties but what's interesting is by the end of the year the american civil liberties union estimates that forty seven percent of the hospital beds in the state will be subject to the control of a catholic bishop and what that means is that if the hospital  books now pending all go through and there's a catholic partner that's what we're likely to face and that's just unprecedented it's not happening anywhere else in the country at this very high level mergers among businesses happen all the time it's a part of kind of streamlining and getting efficiencies out of the system i think one of the examples is a hardware stores you know where there used to be a lot of little mom and pop hardware stores and now many of them are franchisees of a bigger chain so they can take advantage of supply lines and things like that shared marketing isn't that just the same thing happening here well it's really interesting i wish it were just about efficiencies but really what sort of what it's about is increasing the span of control for the catholic bishops the health care policies that they direct that sounds kind of paranoid well it would be paranoid if it weren't for the fact that real women are paying with their lives and with their fertility and so that's a big allegation can you tell me what you mean by that sure sure and in arizona just a couple of years ago there was a woman who was going to die if she didn't get an abortion and she went to a catholic hospital and then none there who was in charge of the ethics committee decided that an abortion would be appropriate and so she got her abortion and everybody agreed that the abortion was necessary to save her life well the bishop in the area disagreed and said that her life she should not and had an abortion her life shouldn't have been saved and a lot of people i think read about that story and i thought oh it's just one crazy bishop but what later happened is that all of the catholic bishops across the united states affirm that decision saying that that woman's life should not have been saved she should have been granted an abortion and that's why you have cases like what just happened over in ireland where this poor woman who understood what was happening to her was begging for an abortion and she couldn't get when and she died while the world watched are they really going to go with what the bishops say that not all catholics agree with the bishop oh as a matter of fact most catholics don't agree with the bishops and that's really not the point the fact is that the bishops actually have control over these hospitals because all of the moral and ethical decisions ultimately are subject to their review and in years past when you had nuns running the hospitals kind of independent of the bishops you might have what some people think of as feisty nuns and they would guarantee that certain services would be up would be offered well the nuns are dying out that average age of and then in america right now is over seventy and the bishops are asserting their control and the people who are taking over these hospitals report to a board of directors and to the local bishop and so if you're making millions of dollars running a hospital and part of your salary depends on making the bishop happy to do you really think that's what it's about yet in some cases absolutely but it's also about very conservative religious people believing that they have the right to impose their morals and values on other people i have no problem with the catholic bishops they can believe what ever they want to believe and they can shout from the bully pulpit in that in the churches on sundays or whenever they want to and talk about what people should do that absolutely is protected by our constitution the problem becomes when they run hospitals and medical facilities that the rest of us fund and impose their moral view on those institutions but you're talking about catholic hospitals don't they fund the catholic hospitals would be nice the fact is that all hospitals right now government funding makes up a huge proportion of their funding so if you look at a typical catholic hospital today by  far a huge percentage of that funding comes from the government the next challenge comes from private pay patients the types of people who work for through their insurance companies so the types of people who work for microsoft or boeing or amazon et then the rest are the people who pay out of pocket and then there is a set of people who can afford to pay their bill and in fact all of the other people the government the private pay patients all of us subsidize the care for those people so the actual percentage that comes through tasks like this if it coffers is tiny tiny somebody said five percent or less is that yeah i believe it's i believe significantly less than five percent and if you actually run through the numbers again it's a it's a small fraction and in many cases what's interesting is that donors here in washington state are donating have donated to these institutions because they support health care so up on sand island for example the community out there raised ten million dollars for us federal and i've spoken to one hundred of those donors and most of them had no idea they were funding a catholic institution that was going to impose catholic values and moral believes on patients regardless of what they believe i would guess that's really surprising to most people to hear that that the funds aren't actually coming from the catholic church people think of catholic hospitals as catholic charities essentially right as they're these they're that's what religions do they do good in the world they kind of take in money they give money to poor people they give money to sick people you know the kinds of people that use is said to take care of and now what you're saying is that in actuality these are public public funds coming through publicly approved accommodations around and intended to serve the general public yet it's absolutely stunning to me i i own property up on sand when i went and each year on my tax bill there is a line item that i paid to support that hospital up there with that money ninety five to ninety seven percent of the tax dollars that i pay in any given year that passed directly on to peace and peace house gets to decide what policies it wants to implement in running that hospital a law absolutely it's totally against the law it's against the constitution what is the washington state constitution say about this so in section eleven the washington state constitution it's amazingly clear what it says is that no public money shall be used for the support of any religious establishment and what's fascinating to me about this is so many people who've been working in the health care field and who've been working as patients rights advocates actually have not really been aware of the full force and power of section eleven of the constitution and we are now in the process of making our public officials very aware in the american civil liberties union the a c l u is a very active we've got a constitutional crisis and it's time for people to address it wouldn't a lot of people say well these aren't actually religious institutions there's a hospital well the catholic hierarchy the bishops the cardinals the catholic hospitals themselves but they actually call themselves our catholic health care ministries catholic health care ministries right so i get to fund a catholic ministry which is really interesting to me having grown up catholic and understanding what that means as a as someone who grew up catholic give me give me some context so i am the eighth child in a very catholic family my mother was head of the altar society my father taught lot of catholic university and had a private family law practice they happen to be very progressive catholics so my father wrote the no fault divorce law in in oregon and my mother was quietly pro choice because she knew women who died from botched abortions i saw in the impact of catholic policy on people of my parents generation and i was determined that it wouldn't happen to me what were some of the impacts that you saw well as it turns out my mother didn't want eight children in fact she was pregnant ten times in the first twelve years of her marriage and the reason she was pregnant ten times is because according to the culture in which she grew up and she was born in one nine hundred sixteen a woman was not allowed to use birth control and so my mother tried the natural family planning method that the catholic doctors recommended and as a result she was pregnant ten times in twelve years it just sounds like a nightmare well mom at times said that we were a nightmare but the target that was my mother it wasn't the life that she wanted and she should have had a choice about that my child i'm very comfortable saying that my mother should have had the right to decide to have fewer children i'm the oldest of six children so i maybe isn't as an eldest it's easier to say you know it would have been great if mom had access to contraception right but right but i remember it wasn't until i was a mother that i had two thoughts one is wow it's entirely possible that mom was sane before she had all of us right and the second thing though more seriously was it was i thought what would mom have done with her life what might she have been right she was a nurse maybe she wanted to be a doctor she said when she was younger that was a dream of hers right i mean right and i think my mother was a brilliant woman she astonished me with how smart she could be about certain things i had a career in the high tech industry and my mother was so well read  what was going on in the technology industry i she loved talking about it she was curious about everything i did she could have had a different life and i'm not going to say a better life it would have been a different life but ultimately i feel like that choice that decision up to a woman but we're talking about contraception and we're talking about hospitals and i think most people would say hospitals you know don't hand out contraception so really are we off topic  it's really interesting well it's important to understand that when we're talking about hospitals it's almost a proxy for the broader health care system so up on san juan island that hospital is actually a hospital slash medical center that sees people for  primary care needs for basically it should be for all of their health care needs so this is the catholic piece health hospital that was built on sand want to island right ago right in friday harbor it just actually opened this last november and so that's a hospital where people would expect to get their primary care their urgent care they can do overnight hospitalization and you know extraordinary circumstances so that when we talk about hospitals what we're really talking about are these larger hospital networks the hospital systems it just turns out that the way our medical system has evolved hospitals are the hub of the system so when those go catholic what typically happens is that the labs around them go catholic the physician practices there's a requirement that they honor their directives in order to get privileges etc up in bellingham last year the catholic bishop asked the piece south folks no and it's my understanding that that's the first time in the us where the head of a planned parenthood has just said no outright to a demand from a catholic bishop saying yes yes same one who's been assigned to crack down on the nuns yes and so he's our bishop here in seattle and so when people look at this situation in washington state they have to understand that we have the guy who's been tasked by the vatican with cracking down on the and and if anybody thinks that this this archbishop isn't going to enforce those rules over time i suspect he's a very smart man and very determined and what he's going to do he took a long term view i think of the whole providence swedish situation and i expect that to continue to transform over and become more catholic over time but they're very purposeful about what they're out to do and what the what are they ought to do they're out to control health care policy and across the country through their ownership and control of catholic health care systems so what's th goal you mentioned directive early right right so the directives are really interesting there's actually a there's a forty three page document called the ethical and religious directives for catholic health care and in this that i came it there are prescribed rules for how everybody who works for a catholic institution has to operate in these roles no abortions right right they forbid no contraception but most catholics use contraception yet ninety eight percent of catholic women use contraception so the interesting thing to me is that these catholic bishops are trying to impose their rules through the health care system when they can't get their own flock to agree with them on health care matters i might view as bishops concentrate on your own flock talk to them however you want to reach out to them as they go to mass etc you can say whatever you want it's a free country you can express your religion however you want in church and in the public square what you cannot do is impose your role through publicly funded institutions what are these rules give us some examples right so we've talked about no contraception no vasectomies no tubal ligation which is the most common form of permanent sterilization for women and that a month that happens in hospitals because the best rhyme often is when a woman has a child and has just given birth and she knows she's finished right right so about one in  ten women will decide that she wants a tubal ligation at that point so it's a very common thing that's done just after the delivery of a baby and it makes sense because you don't want to have to do a separate surgery in order to do a tubal ligation so what happens if she has a baby  providence what now happens is a woman has to arrange for a second surgery at an uncapped facility so it's really outrageous and that's not even the most outrageous what is the most outrageous well going yet so to me let's talk about the very special directive against extra uterine pregnancy so a topic pregnancies right right so this is this is a pregnancy that's developing in the fallopian tubes it can't live right if they're not if it continues to grow it can rupture and kill the mother right right right that consequence of an ectopic pregnancy that isn't that with medically is typically it's the death of a woman a topic pregnancies are very very dangerous and in fact it with the danger of a topic pregnancies that cause the c e o up and planned parenthood to basically say no you have to do our lab tests because you only only lab in this area for a lot of reasons state actually support it and they had to know whether a woman had a life threatening right right because time is at the essence you have to deal with that right away in the standard treatment for women who has an ectopic pregnancy is to administer a drug that is functionally flashes the non viable embryo from her body that is the standard prescription but it's not what you'll hear if you go to a catholic hospital that follows the directive strictly so with those catholic hospitals do is they tell you my gosh i'm sorry you have an ectopic pregnancy it's very dangerous now we have to take out your fallopian tube but you have to take out your fallopian too right so they don't even tell a woman that there is another option when they do is they arrange for surgery she goes in and she comes out her fallopian one of her fallopian tubes is just gone and most women have no idea what just happened to them there they're feeling grateful because their lives were saved they don't know that if they got into a secular facility they could have just had an injection right and they'd have both of their fallopian tubes and body would actually be intact in a fact what's happening in catholic hospitals to women in ways that none of us can see is that a medical problem that can be dealt with very easily with a drug that doesn't require surgery doesn't require essentially ripping out a part of a woman's body in a catholic hospital that gets transferred into a surgery where a fallopian tube is removed that amuse yourselves crazy if you want to say sounds crazy because because you're talking about an embryo that could never grow into a person if you write even a god you have to believe that god didn't intend that embryo to grow into a person because he's right in the wrong place right so it's so surely like nobody is going to nobody's going to listen to this well the problem is that people do listen to it so the bishops are asserting their will in many ways across the country we've seen increased political activity from them they don't even shy away what often happens is that women have no idea that there is an alternative topic basically the bishops believe and there's catholic theology to support this notion that the sex isn't good unless it's done for the purpose of procreation and there's lots of documents that people can read if they want to dive into this a little bit further don't tell my husband yeah it actually makes for fascinating reading one of the things that i often tell people is i've been married for twenty three years and i don't think i've ever had sex in a way the bishops would approve so don't tell your husband either huh right right yeah apparently being on birth control is and i have been throughout my married life  that is something that the bishops think is immoral so my sex life has always been immoral because i'm one of those people who's always been very careful and intentional about pregnancy most people would say that is you know so much about the well being of the mother being so crucial to how well a tile does in society so if a girl gets pregnant in high school there's only a two percent chance that show go on and get a college degree by the age of thirty we need for our young women to be on birth control and tell such time as it makes sense for them to have children and that's a decision that they should make but they should make it consciously and we should support their right to make it consciously so so this these celtic hospital murders really the big problem is about reproductive health it's not it's a huge problem but it's not the only problem and there's another area that people i've talked to are hugely concerned about here in washington state by a large margin i think it was fifty nine percent we approve of the death with dignity act in some cases it was as high as seventy five percent so  what the ethical and religious directives of the bishops for bed is any participation with death with dignity and so what happens in catholic facilities is that they won't even tell you anything about the law they won't tell you that it exists they won't tell you how to exercise your rights under the law they just pretend it doesn't happen and they for bad their staff and physicians to participate at all how about patient directives oh no don't don't don't resuscitate me no feeding tubes no extraordinary measures right patient directives are absolutely fine as long as they don't conflict with catholic dogma so they're saying that there is ship's directives tromped the patients are absolutely absolutely and one of my other  favorite directives i like to call the terri shy about directive after the terri schiavo case for most of us were appalled that somebody could be kept on a feeding tube long after it seemed to make sense given what her husband said this woman wanted and just her belief system it's just crazy that the bishops in essence doubled down and said that when someone sent a persistent vegetative coma regardless of whether they've signed any directive regardless of how many people it's been witnessed by the requirement in catholic hospital is that that patient be kept on a feeding tube so that would be a violation of my ethics to say that that resources that could be going to take care of a poor sick child or two i mean there's a so many other things those resources could do part of it a lot of people don't understand the reasons behind all of this but there is a concept in catholic theology about suffering where suffering is seen as a very good thing because suffering brings you closer to god and that's fine on a personal level if that's what you believe bad right right and so anything that you can do to alleviate pain and suffering i think is a positive contribution but ultimately really what this amounts to is it should be the patient's choice it should be the patient's right what can people do about this so we're at a point right now where there are a lot of policymakers who need to figure out how we transition from the boiling frog situation that we've been man where we've allowed these catholic institutions to become such an anarcho part of our health care system we are going to to have extricate ourselves from that being mindful of the constitution being mindful of the fact that it's illegal to spend public money towards a religious mission and given that these are health care ministries and they absolutely have a religious mission it seems pretty clear cut to me so you should speak out to your public officials and encourage them to move quickly to get us to a point where patient rights are honored for their specific officials are there specific places they can go to most important players in this are governor jay inslee and attorney general  policy levers that are going to be so critical as this conversation and debate and transition move forward and the a c l u of washington you said is leading the charge from an advocacy standpoint i understand they have a web page up its a c l u desh wall is that right right if you do a search for a c l u of washington you'll find the website and people can contribute their stories they've got an excellent powerpoint presentation you say they have a form for people to tell their own stories if they write in religious interference right in their health care decision making right right and they're hearing interesting stories all the time and i do expect this to be litigated because our constitutional rights are so important and they cannot be ignored just because some people think it's convenient you've had religious interference in your health care decisions either in your private clinic with your doctor or in a hospital setting it sounds like now is the time to talk about it you want that change to be one where patient rights are honored in hospitals receiving public funding thank you thank you for joining us and thank you for having me