THE VIRGINIAN-PILOT
Copyright (c) 1996, Landmark Communications, Inc.
DATE: Sunday, May 12, 1996 TAG: 9605120138
SECTION: FRONT PAGE: A1 EDITION: FINAL
SOURCE: BY MARIE JOYCE, STAFF WRITER
LENGTH: Long : 145 lines
As Maryview Medical Center, a Catholic hospital, arranges to buy rival Portsmouth General Hospital, it grapples with an ethical question: How can it provide the services Portsmouth residents expect while staying true to the tenets of the Catholic faith?
Around the country, similar deals between Catholic and nonsectarian institutions have required flexibility and negotiation.
They also have upset groups that support access to abortion and birth control and fear Catholic influence in these arrangements will limit medical services.
Portsmouth's Maryview is part of the Maryland-based Bon Secours Health System, affiliated with the Daughters of Wisdom religious order. Portsmouth General, which they expect to buy and shut down over the next 18 months, is owned by the nonsectarian Tidewater Health Care of Virginia Beach.
South Hampton Roads' other Catholic hospital, DePaul Medical Center in Norfolk, which is affiliated with the Daughters of Charity, struggled with the same issue last year, when it formed an alliance with local insurance companies.
Catholic hospitals are run mostly by lay people. However, almost all are sponsored by Catholic groups. At DePaul and Maryview, representatives of the sponsoring orders help govern the hospitals. The hospitals must answer to the local bishop.
``We are expected to operate in a fashion consistent with the philosophy and teaching of the Catholic Church,'' said Kevin P. Conlin, DePaul's chief executive officer.
The Roman Catholic Church is America's largest private, non-profit health-care provider; 624 hospitals accounted for roughly 16 percent of all hospital admissions in the United States in 1993. In South Hampton Roads, 22 percent of all licensed beds in acute-care hospitals belong to Maryview and DePaul.
Catholic hospitals' treatment policies in general include:
No sterilization surgery. If a woman wants sterilization immediately after delivery, she must arrange to have the baby at a non-Catholic hospital. Portsmouth General currently allows these procedures.
No birth control. Family doctors whose practices are owned by DePaul may not prescribe it.
Treatment of rape victims. If the victim is not pregnant yet, Maryview and DePaul emergency rooms may administer treatment to prevent fertilization. They may not do anything to prevent a fertilized egg from implanting in the uterus or to cause an abortion.
At Portsmouth General, hospital policy currently doesn't make distinctions about whether the egg has been fertilized or implanted.
No abortions. Abortions are not routinely done at most hospitals, but they are sometimes performed under special circumstances. Portsmouth General, like many other nonsectarian hospitals, does abortions when the pregnancy puts the mother's health at risk.
In the case of a fatal birth defect, non-religious hospitals typically will do an abortion. Catholic guidelines say the hospital should induce labor at a point when the child is most likely to survive birth and be baptized.
There is one instance in which Catholic hospitals will allow the death of a fetus. If the mother needs immediate treatment for a life-threatening injury or illness, like uterine cancer, the hospitals will do it, even if the treatment will kill the fetus.
These differences didn't matter when there were lots of hospitals and lots of patients.
But times have changed. Managed care cuts hospital visits. As hospitals shrink and consolidate, Catholic institutions face a choice: Affiliate or die.
In Portsmouth, Maryview and Portsmouth General each operate with about 40 percent of their beds empty. For years, the regional Health Systems Agency has been urging them to consolidate.
DePaul, Norfolk's only independent general hospital, competes with powerhouses Sentara Norfolk General and Sentara Leigh. It was a matter of survival to work with health maintenance organizations owned by Tidewater and Trigon Blue Cross Blue Shield of Richmond.
Now that consolidation is happening in Portsmouth, Maryview is looking for a way to continue some services people can get now at Portsmouth General.
Maryview plans to find another company to run a sterilization clinic downtown, probably in Portsmouth General facilities. But it will bill separately, and not a dime will go into Maryview's coffers.
The arrangement shows ``a willingness to be open to solutions that will meet the needs of the health care community,'' said Nora M. Paffrath, senior vice president of operations at Maryview. There will be no accomodation made for abortions.
The alliances between hospitals can be compared to treaties between countries, said Russell E. Smith, a priest from a Catholic think tank in Massachusetts. France and Germany may arrange to share electricity. That doesn't mean they agree on education policies.
``We are not sectarian. We are not going to pull apart from the world,'' said Smith, who acted as an adviser to DePaul last year. ``We form these alliances precisely so we don't do what our conscience won't allow us to do.''
It's not the first time that Maryview has accomodated other viewpoints. Maryview officials have worked on AIDS prevention in the schools. While the hospital emphasizes celibacy, it works alongside groups that recommend safe sex.
``We understand the difference in people's values and we respect those,'' said Drema Hymon, who works on community relations for Maryview. ``We're able to still be who we are.''
Nevertheless, advocates of reproductive rights get nervous when they see arrangements like that in Portsmouth, which won't have a non-religious hospital within its city limits. In upstate New York, family-planning groups recently sued to undo the merger of a Catholic and nonsectarian hospital, saying it would limit access to some services.
Deals like Maryview's are deceptively tolerant because even hospitals in national Catholic chains must answer to the local bishop, said Frances Kissling, president of Catholics for a Free Choice. The Washington-based group, which is not a church institution, works for reproductive rights.
``The ability of a Catholic hospital to make permanent agreements with the community is limited and circumscribed, and the bishops change,'' she said. Maryview officials have kept in contact with Bishop Walter F. Sullivan of the diocese of Richmond during negotiations.
Observers question how much of an issue this will be in South Hampton Roads, which still will have nine general hospitals.
``Urban Tidewater's a very compact area. . . I don't view that as reduced geographic access since Norfolk is just a hop, skip and jump away,'' said Paul M. Boynton, executive director of Eastern Virginia Health Systems Agency, a state-funded group that regulates hospital expansion here.
And the sale of Portsmouth General hasn't alarmed local abortion-rights advocates.
``We're always concerned about access to health care, particularly when it comes to reproductive issues,'' said Suzette Caton, spokesperson for the Hillcrest Clinic in Norfolk, which performs abortions. ``We'd like to see tubal ligation and birth control (available) in all hospitals.'' But most local doctors practice at more than one hospital.
Maryview officials point out that many services aren't performed at all hospitals in South Hampton Roads. Maryview doesn't offer open heart surgery, either.
Officials at Maryview fear that discussion of their differences will overshadow the great variety of important work they do - the cures and comfort.
``Too often. . . the public emphasizes the minimal issues,'' said H. Wayne Jones, Maryview's acting chief executive officer.
Catholic hospitals' mandates cover much more than issues of birth control. They're expected to follow Christian values in everything from their employment practices to patient care.
And their overall goal is simply to follow Christ's example in healing the sick - something they can't do if the market forces them to close their doors, said Smith.
KEYWORDS: HOSPITALS CATHOLIC CHURCH HAMPTON ROADS by CNB