Hospital mergers tread a fine line between religion and economics.
When merger talks broke down this spring between two non-profit hospital systems in Rhode Island, negotiators on each side blamed one issue: reproductive health services.
The local Catholic hospital network demanded that its secular counterpart, Lifespan, stop performing abortions, tubal ligation, vasectomies and in vitro fertilization if a deal was to proceed. When Lifespan refused, negotiations fell apart.
“The feeling was that we could not arrive at an agreement that we thought would be acceptable to the Vatican and the church with respect to what services were performed within the Lifespan system,” said R. Otis Brown, a spokesman for St. Joseph Health Services of Rhode Island.
“Our financial involvement in Lifespan would be seen as supporting procedures that were in conflict to church teachings.”
These failed negotiations are not unique.
Non-profit hospitals with religious affiliations are forming alliances nationwide to compete with large for-profit companies and gain leverage with managed-care companies in contract talks. Disputes over reproductive health services have unraveled at least five mergers within the last two years.
“Hospitals which historically have been competitive and have had very different philosophies are suddenly looking at each other as merger partners,” said Lois Uttley, director of MergerWatch, a New York group that monitors religious hospital mergers. “That is when they need to begin working out these difficult ethical issues.”
In Dallas, the major religious-based hospital networks aren’t allowing their denominations’ sharply differing views on abortion and other reproductive issues to get in the way of working together. In preparation for a joint operating agreement between Texas Health Resources and Baylor Health Care System, an ethics panel has concluded that each hospital should maintain control over its religious destiny and set medical practices consistent with its beliefs.
Texas Health, the largest hospital system in North Texas, includes Presbyterian Healthcare Resources, Harris Methodist Health System and St. Paul Medical Center, which is Catholic. Baylor is affiliated with the Baptist General Convention of Texas.
“We’re not out looking at how we can solve all the differences that have come up by creating one way of believing or one way to focus our faith-based organization,” said Steve Mason, executive vice president of Texas Health and chairman of the joint ethics committee.
“What we’re looking at is the synergy that we can develop by coming together . . . to create a much stronger spiritual influence as well as a physician influence in our community.”
Combined, Baylor and Texas Health would control 22 hospitals and more than $3.2 billion in assets. The groundbreaking partnership, which would stop short of an outright merger, would create one of the largest non-profit systems in the country.
Under such an arrangement, the systems would retain control over their assets but would jointly make strategic decisions and combine certain operations such as purchasing and public relations.
While the systems have worked together on such projects as CareFlite air ambulance and a North Texas laundry cooperative, they have to resolve religious and ethical issues before establishing more formal ties.
“We have a track record in non-ethical programs that has allowed us to work together pretty well,” said Boone Powell Jr., Baylor’s president and chief executive, referring to services that don’t involve moral conflicts. “The delicate question is: Can you work with other organizations to develop some broad-based community benefits yet recognize the fact that there are going to be some differences?”
The four religious denominations represented by Baylor and Texas Health have similar views on patient care and ethics. None of them allows fetal tissue research or condones assisted suicide. At the same time, all the hospitals abide by do-not-resuscitate orders for dying patients and allow genetic screening with some limitations.
The key differences among the four denominations include abortion and other reproductive health services. Baylor and St. Paul do not perform voluntary abortions, while Harris and Presbyterian do. Baylor allows abortions in cases of rape, incest, fetal abnormalities or danger to the mother. St. Paul does not.
None of the hospital systems plans to veer from its practices unless mandated by the government or a change in its church’s teachings.
“At each of the institutions where there is a practice that is sanctioned by the church, that (practice) would continue,” said Douglas D. Hawthorne, president and chief executive of Texas Health.
