St. Vincent Regional Medical Center: Merger questions linger, despite promises

Many worry medical choices will be limited under Christus partnership

Anne Constable | The New Mexican

12/21/2007 - 12/22/07

St. Vincent Regional Medical Center officials are meeting privately with physicians and health providers to assure them that the proposed partnership with a Catholic health system will not reduce medical choices available to the community.

After one such meeting, Rick Adesso, CEO of La Familia Medical Center, said, hospital president Alex Valdez "reassured us, and the handout he provided goes out of its way to say there will be no change in services provided. Alex was emphatic."

But such comforting statements haven't laid the issue to rest.

Many Santa Feans say they are uneasy about the partnership and in particular about how it might affect deeply personal matters such as access to reproductive-health services and end-of-life decisions.

Will tubal ligations continue to be available to women following a C-section? Will the Catholic hospital honor all advance health directives? Will doctors in St. Vincent-owned physician practices still be able to prescribe birth control?

"I have a million questions," said Martha Edmonds of Planned Parenthood of New Mexico in Albuquerque. "If I lived in Santa Fe, I would be a little freaked out if that were the only hospital and I ended up there in a permanent vegetative state."

Lobbyist Linda Siegle, who also met with Valdez and heard the assurances, said, "I'm still concerned because the devil is always in the details."

"A lot of good people — hospital board members, administrators — they feel like the language they're putting in that contract is going to provide all the protection and assurances we in the community and they want," Siegle said. But, she added, "We've only known about it a month. We have to get more information out in the community that these protections are going to be there and they're going to be solid."

Joan Sanford, director of the New Mexico Religious Coalition for Reproductive Choice, worried that, "If people cannot access the health care they need or want according to their own religious beliefs, then they will have to go elsewhere." In this economy, and especially during a time of crisis, a trip to Albuquerque or Farmington "is not really something we want people to have to do," she said.

Dr. Justina Trott, executive director and medical director of Women's Health Services, said she received the same verbal assurances from Valdez as other members of the medical community. She said she is concerned about what would happen if a new bishop were appointed, state law changes or Catholic directives are modified.

"Really, what this contract is about is, 'Are there sufficient safeguards to ensure there will be no unilateral changes in policy?' " she said.

"My main concern is that people have autonomy of what they would like in terms of health care within the limits of the law," Trott added.

Protecting services

St. Vincent and Texas-based Christus Health have signed a letter of intent and are planning to announce a decision regarding the partnership in February.

If the deal is finalized, St. Vincent would become a Catholic hospital and be subject to the church's Ethical and Religious Directives, which prohibit abortion, contraceptive counseling, fertility treatments, elective tubal ligations, vasectomies and euthanasia.

All 72 of the directives will ultimately be interpreted by the diocesan bishop, Archbishop Michael J. Sheehan, who has given his blessing to the partnership.

In order to insulate Christus from involvement in procedures that conflict with Catholic health directives, St. Vincent plans to create a separate nonprofit called SVH Supportco. Everything associated with procedures such as tubal ligations following C-sections and vaginal deliveries, which are currently available at St. Vincent, would flow through this entity, according to Valdez. They will continue to be performed in the same surgical suite where they currently take place, he said.

According to Valdez, the agreement allows St. Vincent to terminate the partnership if a change in state law or in the Catholic directives would make it impossible for St. Vincent to "continue to function as a community hospital providing the full scope of service we currently provide."

In an interview Wednesday, he said that either party could also "unwind" the agreement in the event of an impasse.

If that were to happen, Supportco would buy out Christus' interest in the partnership after a determination of its fair market value.

In addition to revenues from tubal ligations and other sterilization procedures, Supportco will have the balance of Christus' initial contribution to St. Vincent after the $37 million in debt is paid off. That could amount to tens of millions of dollars, Valdez said. The new nonprofit will also have the investment funds currently owned by St. Vincent Regional Medical Center, which he also estimated at tens of millions of dollars.

"The mere interest generated will be more than enough to assure there will always be enough funds to meet the expenses from any procedure," Valdez said.

Archbishop Sheehan stressed Wednesday that "the vast majority of the activity at the hospital is perfectly morally appropriate." And he is satisfied that the Vatican would approve of the arrangements made to "carve out" sterilization services.

Sheehan said that he has consulted two ethicists with the Catholic Health Association and a priest/ethicist with Christus who "told me the arrangement does indeed separate out those aspects that would be problematic and that they believe we are on the right track."

Sheehan said he had also talked to people at other hospitals in Tyler and Lubbock, Texas, who have made similar partnerships and, "We think it will be successful here, too."

Addressing concerns

As the number of Catholic hospitals in the U.S. has grown in recent years — to more than 600 — access to reproductive services nationwide has shrunk, according to Catholics for a Free Choice.

For example, although the church's health-care directives allow rape victims to receive emergency contraception if it can be shown that the woman has not conceived, not all Catholic hospitals follow this practice.

In 1999, Catholics for a Free Choice surveyed the emergency departments of 589 Catholic hospitals and found that 82 percent do not provide emergency contraception. Three years later, an Ibis Reproductive Health report on 597 ERs affiliated with the church found that just 23 percent of them supplied EC to rape victims — and often only after repeated requests.

In many cases, referral is grudging. The 1999 study showed that, of the hospitals that deny emergency contraception, only 22 percent provided women with the names and telephone numbers of other providers. Of the 55 percent of hospitals that didn't provide contraception in the 2002 study, less than half provided referrals.

Many Catholic hospitals give the woman a pregnancy test as well as a test to see if she is ovulating and at the greatest risk of becoming pregnant. Emergency contraception is not permitted under the directives if either test is positive.

In New Mexico, emergency rooms are required to offer emergency contraception to victims of sexual assault, and St. Vincent complies. Valdez said that it does not give victims an ovulation test and does not intend to do so in the future.

In an interview Wednesday, the hospital president and the archbishop addressed other questions raised in Santa Fe about the future of health care.

Both Valdez and Sheehan said that St. Vincent will continue to permit abortion to save the life of the mother. According to Sheehan, the directives permit termination of a fetus upon "sound medical judgment."

State law also prohibits health facilities from interfering with the physician-patient relationship, Valdez said. Doctors at Rodeo Family Medicine, Harkle Road Family Medicine and other physician practices owned by St. Vincent will continue to be able to prescribe birth control and fertility services. They will not be associated with Supportco, he said.

The church's broad interpretation of what constitutes euthanasia also worries New Mexicans who fear that, in the future, St. Vincent would not abide by an advance health directive in which a person has expressed a preference not to be kept alive by a feeding tube.

The church would apply a potential benefits/burdens analysis, said Lois Utley of Mergerwatch, a group that monitors hospital consolidations. "If a feeding tube would offer no real benefit, but a great burden, then perhaps it could be refused," she said. But, "The Catholic hospital might say it would not honor the decision if it is contrary to Catholic moral teaching."

In New Mexico, state law requires hospitals to comply with such directives — or transfer the patient to another facility where their wishes will be met. But Siegle said that many people less sophisticated in health care decision-making would not have the resources to sue the hospital to enforce a directive. And moving a critically ill person could be a problem. "Where are they going to go in Santa Fe? There is no place," she said.

In response to a question about how St. Vincent would deal with these cases, Sheehan said, "There is a presumption for nutrition and hydration in the directives, but that presumption can be overcome if, based on sound medical judgment, it is futile to continue. A lot depends on the circumstances. There is no ironclad rule that the feeding tube must be left there all the time."

Neither Valdez nor the archbishop said they anticipated problems related to the role of domestic partners in making health care decisions or the hospital's role in facilitating surrogate parenthood. Insurance for St. Vincent employees, which includes domestic partner coverage, would not change either, according to the hospital.

Amy Yeager, New Mexico coordinator for Resolve, a national infertility group, said St. Vincent has been "great" in the past, but, she added, "I have had to work with Catholic hospitals, and it hasn't been easy. I know how bad it can be."

Yeager said that it is important that a newborn's medical records are in the name of intended parents who need the hospital's support in finalizing the child's original birth certificate. Elsewhere, Catholic bishops "don't support any of this stuff, so they won't participate," she said. At Catholic hospitals, staff often quiz a surrogate mother about whether she really wants to give up the baby and sometimes won't provide wristbands for intended parents or allow them to make decisions for the newborn's health, Yeager said.

Valdez said that none of this has been a problem in the past — or will be in the future. And in a statement, St. Vincent board chairman David Gunderson said, the board "includes people of many different faiths and political opinions. As its chairman, I can affirm that the board's first concern in even considering partnership options was appropriately serving this very diverse, culturally rich community."

Valdez also confirmed Wednesday that the hospital will continue to qualify for all federal state and local support, including county indigent funds.

Public input

Successful consolidations involving Catholic health facilities take years and involve extensive community dialogue, say experts like Utley.

"The community needs to be engaged, given the opportunity to voice concerns, ask questions, have them answered before the final papers are signed. I guess I would urge all parties to take their time," she said this week.

"Fine-tuning" can be done, she said, "if hospitals make a point of reaching out to the community seeking feedback and listening to it."

Valdez said this week that the hospital would schedule a public forum next month to answer questions.

But with the final decision looming, Sanford also warned, "I think we need to take a really long careful look at this. I think maybe the hospital is moving too fast."

Contact Anne Constable at 986-3022 or aconstable@sfnewmexican.com.

STATE STATUTES ON EMERGENCY CONTRACEPTION

• N.M. Stat. Ann. § 16.19.26.9 authorizes a pharmacist to administer emergency contraception drug therapy in accordance with protocols established by the Board of Pharmacy. The statute also requires that the pharmacist complete a course in emergency contraception drug therapy.
  

• N.M. Stat. 24-10 D-3 requires hospitals that treat victims of sexual assault to provide written and oral information about emergency contraception and provide the contraception to patients who request it.

Emergency contraception normally prevents ovulation or fertilization; it cannot terminate an established pregnancy.