Hospital mergers and reproductive health care. (SPECIAL REPORT).

Across the country, a growing trend of hospital mergers reflects an effort by health care facilities to consolidate in order to reduce costs, eliminate empty beds and compete successfully for managed care contracts. When hospitals merge or otherwise affiliate, there is always a possibility that the combined institution will decide not to continue certain services that had been offered by one of the hospitals prior to the consolidation. But when one of the hospitals is a Catholic institution, the continued provision of comprehensive reproductive health care becomes a major issue, because Church rules prohibit Catholic hospitals from providing and making direct referrals for a wide range of reproductive health services. (*) As a result, when a Catholic hospital consolidates with a nonsectarian institution-as more than 100 did in 1994 (1)--it often insists that the new entity adhere to the Church's health care policies.

"This reorganization of health care constitutes one of the most serious and least visible threats to women's access to comprehensive reproductive health services in years," warns Janet Gallagher, director of the American Civil Liberties Union's (ACLU's) Reproductive Freedom Project. (2) These mergers "are a hidden crisis," agrees Lois Uttley, director of communications and development for Family Planning Advocates, a statewide advocacy group in New York. (3) Reproductive rights advocates say the impact of restrictions on these services is especially severe in small towns and rural areas, where a merger could result in a Catholic facility's becoming the only provider of hospital based services in the community.

Two recent experiences illustrate the possible consequences of mergers involving Church-run institutions. In May 1996, a Catholic health care facility in Troy, New York, agreed, as part of an out-of-court settlement, to provide referrals and follow-up for family planning and contraceptive sterilization services. This settlement brought to a close the nation's first case to challenge the merger of a sectarian and a nonsectarian hospital that would have led to the combined institution's eliminating both reproductive health services and direct referrals for such care. In Great Falls, Montana, meanwhile, the August 1996 merger between a Catholic and a community hospital has resulted in the elimination of inpatient abortion services in the city.

The Troy Case

The events in Troy, New York, are an example of how a merger can adversely affect access to comprehensive reproductive health care when a community does not demand continuation of services and when the state fails to ensure their availability. The merger involved St. Mary's Hospital, a Catholic institution, and Leonard Hospital, a nonsectarian facility that also operated a network of primary care clinics; together, the hospitals served a financially and medically needy population in a three county, largely rural area. Leonard's clinics provided reversible contraception, and the hospital provided vasectomies; staff referred women who requested abortions or tubal ligations directly to providers of those services, which included private doctors and a clinic in Albany. St. Mary's, on the other hand, offered no family planning services other than natural family planning, and provided no referrals for these services or for abortions.

In April 1994, Seton Health Systems applied to the Public Health Council, an arm of the state health department, for permission to operate a hospital formed by the merger of St. Mary's and Leonard. Seton, which is run by the same religious order that operated St. Mary's, made it clear from the outset that it would abide by Church policy on reproductive health care.

Although the Public Health Council has ultimate authority for approving the establishment of a new hospital, other agencies have advisory responsibilities. One of these bodies is the regional Health Systems Agency. In June 1994, that agency's executive committee reviewed Seton's application and recommended that approval be conditional on the development of "a formal plan regarding transition of those primary health care services currently offered by Leonard Hospital facilities (e.g., full range of reproductive health care services), which may be altered due to the philosophy of Seton Health Systems." (4) Despite that recommendation, the Public Health Council unanimously approved Seton's application by voice vote on July 29, 1994, without any discussion of Seton's responsibility to provide contraceptive or abortion services or referrals.