Although the proposed agreement between St. Vincent Regional Medical Center and Christus Health has the endorsement of the archbishop, consolidations involving Catholic health care systems elsewhere have not always proceeded smoothly.

"If you want to partner with a Catholic health system or facility, a community hospital has to find ways to protect the reproductive health services in particular from any involvement on the part of the Catholic partner," said Lois Utley of Mergerwatch, a New York-based organization that tracks hospital mergers. "You can have separate funding streams for those services that are not acceptable to Catholic theologians," she added. But, "It has to be done carefully."

Utley said she worked with Brackenridge Hospital, an acute care facility in Austin, Texas. The city wanted to turn the hospital over to an outside manager and subsequently chose Seton Healthcare Network, a Catholic system, over other bidders. The local bishop approved a plan to allow city-paid workers to provide reproductive health services so that neither the funding nor the delivery of services went through Seton.

But the Vatican overruled the plan, Utley said. In the end, the city took back the fifth floor of the hospital, where it set up the Austin Women's Hospital and engaged the University of Texas Medical Branch to run it. It also spent millions of dollars to construct a separate elevator that went up the outside of the building to deliver patients to the fifth floor.

"The Vatican felt the first arrangement did not have enough distance, but the second was acceptable," Utley said.

But in 2002, the president of St. Mary's Hospital in Amsterdam, N.Y., pulled the plug on a proposed partnership with a nonsectarian hospital in nearly Gloversville after opponents objected to the idea of a single religious perspective controlling health care in the community. Under the deal, contraception services and sterilizations were to continue at Nathan Littauer Hospital, but according to Mergerwatch, the hospital's officials refused to confirm that maternity services would remain there. Activists warned that the rural community would lose many reproductive services.

Another merger also fell apart, initially, because of community opposition. In the late 1990s, Kingston and Northern Dutchess hospitals tried to merge with Catholic-run Benedictine Hospital in Kingston, N.Y. But Kingston's agreement to follow the Catholic ethical and religious directives, including a ban on abortions, led to protests. Northern Dutchess later merged with a nonsectarian hospital in Poughkeepsie, N.Y. This year the other two hospitals reached a compromise. Kingston is going to build a separate ambulatory surgery center in its parking lot where abortion and sterilizations will take place, Utley said. Emergency contraception and postpartum tubal ligations will continue within Kingston, with the approval of the local bishop.

The arrangement "shows there is some room for accommodation," Utley said.