MSFC Update - May 2005

The Church in the Exam Room and the Classroom: What Every Medical Student Should Know About Catholic Hospital Mergers
By Debra Stulberg, MD

When I was interviewing for Family Medicine residencies, I asked every program director about the possibility of getting trained to provide abortions. I ranked West Suburban Hospital first because it had a strong reputation in women’s health and a diverse patient population.

During my internship year, I learned that the hospital was having financial difficulties and had been looking for a merger partner. It was not until one on-call night that I realized what this meant. Sitting down to dinner, my attending turned to me and said, “So, it looks like we’re going to be working for the Pope.” He explained that our hospital had been in talks with Resurrection Health Care, a large Catholic system with eight other hospitals in the Chicago area.

The following day, I got in touch with the director of the MergerWatch project (www.mergerwatch.org), who promptly planned a conference call with women’s health advocates from around Illinois and the country. Before I knew it, we had an active coalition of health care providers, advocates, and community members organizing to have a say in the hospital’s future.

Over the course of the next year, our coalition hosted community forums, raised awareness through the media, worked with local elected officials, and did everything we could to stop the merger. In the end, by working with the state Attorney General to apply pressure, we got the hospital to agree to some minor compromises to save services, such as the provision of emergency contraception to rape victims treated in the ER. But since Resurrection acquired West Suburban over a year ago, I’ve seen many services lost to our patients, and just as many learning opportunities lost to the residents and medical students who train there.

What I have learned in the process is that the impact of Catholic health care mergers nationwide is much larger than I ever knew. All Catholic hospitals are governed by a document called the Ethical and Religious Directives for Catholic Health Care Services (www.usccb.org/bishops/directives.shtml). This document is very clear on what the non-Catholic hospital has to do in the case of a merger: “Any partnership that will affect the mission or religious and ethical identity of the Catholic health care institutional services must respect church teaching and discipline.” Furthermore, strict enforcement of these rules is required.

So what does that mean for patients and the services they can get? Of course, abortion is strictly prohibited under these Directives. So is sterilization, surrogate motherhood, most forms of infertility treatment, and certain standard-of-care treatments for ectopic pregnancy. Doctors and nurses are gagged from providing contraceptive counseling. Rape victims who are treated in the emergency room may not necessarily be offered emergency contraception to protect themselves from getting pregnant as a result of the rape. And patients near the end of life may not always have their advance directives honored.

During my residency, I was lucky to get my abortion training electives done just before the Catholic hospital took over. But nationwide, the effect of Catholic healthcare on medical education must not be ignored. For every patient who cannot access the reproductive health services she needs, there are medical students and residents being denied the opportunity to learn, and countless future patients whose doctors are not adequately prepared to care for them.

Debra Stulberg, MD, is a 3rd year resident in Family Medicine, and an MSFC Board Member.