Manchester, Disunited, by Gail Besse in NOR

Manchester, Disunited
January-February 2010
By Gail Besse

Gail Besse is a Boston freelance writer. Her work has appeared in daily newspapers and national Catholic media. please support Gail, and New Oxford Review

As medical practices grow more hostile to the sanctity of life, Catholic-secular hospital affiliations can become ethical minefields. The Diocese of Manchester, New Hampshire, could be facing one now, with its proposed alliance between its Catholic Medical Center and Dart mouth-Hitchcock Health, a secular conglomerate. Since February 2009, when plans for a "regional healthcare delivery system" were unveiled, prolifers have been waving red flags.

According to Kathleen Souza of New Hampshire Right to Life, "Dartmouth is involved in abortions throughout the state, heavily involved in fertility research, em­bryonic stem-cell research, selective-reduction abortion — almost everything the Church is against." The diocese is in danger of surrendering the independence of its 330-bed hospital, she said, in a convoluted agreement that integrates it with Dartmouth-Hitchcock.

But John McCormack, the bishop of Manchester, counters that, although he gave preliminary approval to the affiliation in July so the review process could start, he won't sign off on the deal if it violates Catholic ethics. "I am committed to preserve Catholic Medical Center to be a true Catholic healthcare institution, one that fulfills all the Ethical and Religious Directives for Catholic hospitals," he said in a statement posted at www.AHealthierTomorrow.org, a website promoting the plan.

These directives were set forth in the U.S. Conference of Catholic Bishops' 2001 document, "Ethical and Religious Directives for Catholic Health Care." A section of the document on "Forming Partnerships with Health Care Organizations and Providers" reads like an ethical roadmap for such ventures. It is careful to note, "The risk of scandal cannot be underestimated when partnerships are not built upon common values and moral principles."

Although abortions are not performed at Dart mouth-Hitchcock's medical-group practice in Manchester, they are performed at affiliates in other cities. Dartmouth-Hitchcock is clear that its members won't curtail such current reproductive "health services," said spokesman Jason Aldous. Dartmouth-Hitchcock also promotes end-of-life protocols that violate Catholic ethics. "If you partner with Dartmouth-Hitchcock and give them credibility, it's a weak moral argument to say, ‘They do [abortions] under a different roof, so we won't be culpable,'" said Souza.

"A Catholic institution doesn't only have an obligation to serve healthcare needs but also to preach the Gospel," added New Hampshire Right to Life's Barbara Hagan. "Partnering with an entity that stands in direct philosophical opposition is a breach of the Catholic com munity's support and trust. Dartmouth-Hitchcock has no re li gious purpose — only charitable, scientific, and educational."

Dartmouth-Hitchcock encompasses two hospitals in Lebanon and group medical practices in four New Hampshire cities. It is affiliated with the Dartmouth Institute for Health Policy and Clinical Practice and Dartmouth Medical School. A partnership with Catholic Medical Center would give Dartmouth-Hitchcock a hospital presence 60 miles from Boston.

Catholic Medical Center (CMC) would receive more Medicaid and Medicare revenue from an affiliation with Dartmouth-Hitchcock Medical Center, a teaching hospital in Lebanon, according to Andre Martel, a former state senator and leader of the ad-hoc "Save CMC" movement. Martel testified at one of three public hearings last fall that CMC is thriving — with a $99 million surplus — so it could easily continue independently, without a secular partner.

The hospital's roots go back almost 120 years. In the 1890s Manchester Catholics scrimped and saved in order to build two hospitals, both run by religious sisters: Sacred Heart on the city's east side and Notre Dame on the west side. In 1978 the two hospitals combined into CMC. And now it is "being handled like a financial asset rather than a sacred trust," said former state representative David Welch.

Led by Souza and Hagan, both former state legislators, the 25,000-member New Hampshire Right to Life has filed a "Memo of Opposition" with the New Hampshire attorney general and submitted more than 500 pages of documentation contending that the merger violates both Catholic ethics and charitable public-trust laws.

The medical boards of both CMC and Dartmouth-Hitchcock must sign off on a final affiliation agreement. Federal and state anti-trust approval is also needed. Ultimately, Bishop McCormack and the New Hampshire attorney general's office have final say over the plan, which could still be amended.

The reorganizational structure is intricate enough that in November the state hired a law firm, to be paid for by CMC and Dartmouth-Hitchcock, to unfold its complexities. Souza likened it to "Russian nesting dolls" in that when one layer opens, another is revealed. For example, one section of the agreement, posted online, stipulates that most decisions are "expected" to originate locally by CMC and its Dartmouth-Hitchcock Manchester affiliate. But another section calls for Dartmouth-Hitch cock to become the new "sole member" of CMC's parent company, which means that the diocese basically relinquishes the hospital's independence.

A Dartmouth-Hitchcock Leadership Council, composed of officials from all regional members, could wield final say over CMC finances and appointment of its trustees and president.

While the plan does stipulate that Catholic directives be followed, it acknowledges elsewhere that sometimes they might not be. In those cases, CMC officials on the Leadership Council could "recuse [themselves] and have no involvement in such issues." Hagan asked quite pointedly whether this approach resembles Pope John Paul II's exhortation to "stand up and proclaim the Gospel."

Bishop McCormack has requested three ethical reviews, but has drawn fire for not releasing the findings. "Keeping these reviews secret is more than monumentally bad public relations," the Manchester Union Leader editorialized on November 24. "If he doesn't [release the reports], this deal will be tainted forever by the secrecy."

Diocesan spokesman Kevin Donovan responded to that charge in a December 10 e-mail. "The opinions from Catholic ethicists are advisory and not definitive," he said, and were meant to remain confidential. Also, the final agreement may change before it reaches the bishop, so previous analyses would be outdated. "When the bishop reaches his determination, he will clearly indicate the reasons for his decision," Donovan said.

Hagan is hopeful that once the bishop studies the whole package, he'll conclude the affiliation is "an ethical impossibility."

This localized controversy has national implications. "Washington is dying to squelch conscience protections," said Colleen McCormick, a Manchester anesthesiologist with a degree in medical ethics. "Once Catholic entities have physicians who have no problems with the Culture of Death, rights of conscience will be easier to overcome."

According to a leading bioethicist, Catholic-secular hospital mergers are possible "as long as the Catholic healthcare provider is clear about the meaning of its Catholic identity and remains intent on upholding that identity in all negotiations and arrangements leading to the merger and subsequent to its realization."

To avoid problems in Catholic-secular hospital mergers, parties would be wise to specify in writing the actual terms of ethical practice required, suggested Fr. Tadeusz Pacholczyk, director of education for the National Catholic Bioethics Center.

His advice was followed in Rhode Island, where the Diocese of Providence under Bishop Thomas Tobin recently merged St. Joseph Health Services with the secular Roger Williams Medical Center. On October 29 the Rhode Island attorney general approved the new holding company, CharterCare Health Partners.

"You can't assume the pieces will come together, so we discussed everything," said Msgr. Paul Theroux, vice-chairman of St. Joseph's board. "We wrote in reserved powers for the bishop in terms of preserving Catholic identity. We were upfront with Roger Williams, and they were willing to make some concessions. They agreed never to perform abortions, euthanasia, or embryonic cell destruction. It's written into the bylaws of CharterCare. They agreed they would not accept funding for embryonic stem-cell research. If others joined in the future, they'd also be bound by these restrictions."

Roger Williams can perform sterilizations, which the Church opposes, as long as St. Joseph's neither participates in nor profits from them.

In Manchester, Bishop McCormack's next move will be a monumental one — one that could have national and historic implications. For all who care about the increasingly tenuous future of Catholic health care, it is a situation that bears watching — and praying about.

"It is spiritual warfare that we're engaged in," said Elizabeth Breuder, vice president of New Hampshire Right to Life. She was among a group of Catholics holding a prayer vigil outside CMC on December 8, the Feast of the Immaculate Conception, the Union Leader reported. Breuder held a banner of Our Lady of Guadalupe, patroness of the unborn. "We're just begging our protectress to make sure the affiliation will not go through and that our hospital will remain Catholic and become more authentically Catholic," she said.