Can for-profit hospitals be Catholic? - Panel Discussion

National Catholic Reporter, Dec 5, 1997 by James Clifton

Yes. Hospitals's care of indigent has grown

I am a Catholic priest working in a hospital with a long Catholic tradition that is now majority-owned by Tenet Healthcare. So it is with considerable interest that I have been following the discussion occasioned by the proposed sale by St. Louis University of its hospital to Tenet. The central question has often been framed in a way that can only be answered through speculation about the future: Is :it possible for a hospital to maintain its Catholic identity and, especially, its commitment to indigent care after becoming part of an investor-owned group of hospitals?

I suggest that at least a modest amount of light can be brought to the discussion by examining what we have experienced during our 13 years as an investor-owned? Catholic teaching hospital.

Founded in 1870 by the Sisters of Mercy, the Creighton Memorial St. Joseph Mercy Hospital's earliest days in Omaha were marked by special concern for the poor and a dedication to training health care professionals in a Catholic environment. Before the turn of the century, the hospital was turned over to Franciscan sisters, who continued its tradition of caring for all who presented themselves at the hospital and its mission as the teaching hospital for Creighton University Medical School.

After sponsoring the hospital for more than 80 years, the Franciscan sisters dealt with advancing age and diminishing numbers of vocations in the early 1970s by establishing St. Joseph Hospital as a freestanding, not-for-profit hospital whose board of directors included representatives from Creighton University and the community at large. At that time, too, an advanced, one-million-square-foot new hospital and clinic building was already under construction--placed deliberately closer to the heart of Omaha's central city.

By the time the new building opened in late 1977, all of the city's public hospitals but St. Joseph and two others had moved to the suburbs. Shortly thereafter, the nearby county hospital closed its emergency room and eliminated many services. Having distinguished itself already by providing so much indigent care, St. Joseph was then asked to provide even more care for the underserved while also carrying the heavy debt incurred in building the new facility.

By the early 1980s, we faced two choices: Stop providing health care for the indigent or close our doors. The hospital's board recognized that a commitment to indigent care was constitutive both of Catholic health care and our own tradition, and that such service added an irreplaceable character to our medical education. Indeed, the board believed that there was no,reason for the hospital to continue if it could not remain true to its mission as an urban, Catholic teaching hospital with special concern for the poor.

Efforts to find a partnership with other Catholic hospitals were unsuccessful, partly because St. Joseph was seen as an undesirable partner precisely because of its extraordinary--and expensive--level of indigent care and support for teaching.

At that time, we were approached by American Medical International, one of the companies that has since become Tenet, with an offer to purchase both St. Joseph Hospital and its freestanding Center for Mental Health. Negotiations between the hospital's board, Creighton University and AMI resulted in the purchase of the hospitals by AMI in 1984 and the establishment of a Health Futures Foundation with the funds remaining after retiring the hospital's debt.

The hospital board and representatives of the university worked with the then-archbishop of Omaha to fashion contractual agreements that would preserve our Catholic character in perpetuity. AMI agreed that the hospital would be governed by a local board; that the hospital would adhere to the Ethical and Religious Directives for Catholic Healthcare Services, issued by the National Conference of Catholic Bishops; that pastoral care would be maintained at its traditional level; that AMI would continue the teaching role of the hospitals; that AMI would contribute $2 million over 10 years (to be matched by the Health Futures Foundation) to establish and endow a Center for Health Policy and Ethics at Creighton to serve the hospital and the region; and that the hospital would maintain its traditional level of indigent care. In addition, if a change in ownership at AMI meant that these characteristics were not to be honored, the university would have the right to purchase the hospital from AMI.

After 13 years--and after AMI merged with another company to become Tenet in 1995--how are we doing? Here is a brief rundown:

* The hospital has maintained or increased its support for training students in medicine, pharmacy, nursing and allied health professions.

* Our residency programs have held steady or grown.

* We have the highest ratio of chaplains-to-patients of any hospital in the region.

* We struggle each day to live more fully the Ethical and Religious Directives, and we have never experienced a conflict with AMI or Tenet related to our adherence to Catholic teaching. The archbishop appoints a delegate to one of our two boards, and we have an amicable and candid relationship with our local chancery. As director of pastoral care, I attend the meetings of the other board and report directly to our CEO in terms of my charge to oversee and ensure the religious character of the hospital.