Catholic hospital chains are growing the fastest Nonchurch institutions that merge with them usually ban abortions

Health care

March 15, 1998|By M. William Salganik | M. William Salganik,SUN STAFF

When nonsectarian Liberty Medical Center merged with Bon Secours Baltimore Health System a year and a half ago, it became a Roman Catholic hospital in every sense.

The signs of the change at the West Baltimore hospital ranged from prayers at the beginning of meetings to nuns counseling patients on a commitment to follow Catholic directives prohibiting contraception and sterilization.

On the other hand, when the Memorial Hospital of Cumberland joined two years ago with nearby Sacred Heart Hospital to form Western Maryland Health System, Memorial continued performing not only sterilizations but abortions.

Church doctrine outlaws in vitro fertilization and male and female sterilizations, such as tubal ligations and vasectomies.

As Catholic hospitals are merging or forming other affiliations with non-Catholic ones, the extent to which the non-Catholic partner agrees to follow church directives varies considerably.

But what is clear is that Catholic hospital systems are growing rapidly by merger and acquisition.

In its most recent annual study of hospital mergers, the trade journal Modern Healthcare found the two chains that grew fastest in 1996 were not the for-profit giants such as Columbia/HCA, but Catholic Healthcare West and Sisters of the Sorrowful Mother-U.S. Health System.

The issues around such mergers have come into sharper focus here as St. Joseph Medical Center conducts talks with its Towson neighbor, Greater Baltimore Medical Center.

Benjamin R. Civiletti, GBMC's board chairman, said if the board concludes a deal with St. Joseph, GBMC would stop doing abortions, although it would continue to offer such services as tubal ligations and in-vitro fertilization.

The potential deal has stirred apprehension because GBMC has a strong specialty in women's services, including in-vitro fertilization.

The product of a 1965 merger, GBMC is a descendant of the Hospital for the Women of Maryland and was designed from the beginning to offer "complete services for women -- there were no ifs, ands or buts," said Jeanne Baetjer, who was president of the Women's Hospital when the merger was negotiated and was the first president of GBMC's board.

Now, she said, "I think that's in jeopardy."

Beyond abortion, other services such as in-vitro fertilization might "die of neglect" over time, as the new, combined entity makes future decisions about budgets, hiring and adoption of new technology, said Cynthia L. H. Crawley. She chairs the current Women's Hospital board, which still exists as a charity, giving about half a million dollars a year to GBMC.

Civiletti argues that abortions are only a small part of the hospital's services, and that a GBMC-St. Joseph alliance could dominate the North Baltimore market and assure GBMC's mission far into the future.

The GBMC-St. Joseph situation echoes a debate being played out around the country as hospitals -- including the Catholic systems that dominate the large nonprofit chains -- continue combining at a rapid rate.

Large cash reserves

"All [the Catholic hospitals] do deals with non-Catholic hospitals, and they're all pretty aggressive," said Bruce Japsen, a reporter for Modern Healthcare. Many have large cash reserves, enabling them in some cases to outbid for-profit chains for acquisition targets, he said.

With about $2 billion in investments and cash, the Wall Street Journal said recently, the Daughters of Charity National Health System has become known as the "Daughters of Currency." In Maryland, the Daughters of Charity own St. Agnes Hospital in Catonsville and Sacred Heart in Cumberland.

One sizable national system -- although not among the top 10 Catholic chains -- is headquartered in Maryland.

The Marriottsville-based Bon Secours Health System, which operates 15 hospitals, including Bon Secours Hospital and Liberty in Baltimore, has doubled in size in the past four years and its annual revenue exceeds $1 billion.

Among the most aggressive systems, according to Japsen, is Catholic Health Initiatives, the parent of St. Joseph. Based in Denver, it was formed two years ago by a merger of the Franciscan Health System, the Sisters of Charity Health Care System and Catholic Health Corp.

From 60 hospitals and $3.5 billion in annual revenue at the end of 1996, it now has 69 hospitals in 22 states with annual revenues of $4.7 billion.

Abortion is not the major issue in the mergers, since relatively few hospitals do abortions anyway, said Frances Kissling, president of Washington-based Catholics for a Free Choice.

According to the Alan Guttmacher Institute, which studies reproductive health, only 7 percent of abortions nationally were done in hospitals in 1992, the last year for which it had complete data.

In contrast, 69 percent are done in specialized abortion clinics and 20 percent are done in general clinics and ambulatory surgical centers. In the Baltimore metropolitan area in 1992, 16 hospitals and 12 nonhospital providers performed 17,880 abortions.

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