In Pennsylvania, organizing by community members and medical professionals helped defeat a merger between a Catholic hospital and a secular hospital system, thereby ensuring that women's reproductive health care services are still offered.
Written by Annamarya Scaccia for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.
When Rita Poley created the "Stop the
Abington Hospital Mergerâ Facebook page, she had no idea what would
happen next.
For the 69-year-old Elkins Park, Pa. resident, it was a way to
connect with other Montgomery County community members outraged by the abruptly
announced partnership between the secular Abington
Health (AH) and the Catholic-affiliated
Holy Redeemer (HR), both located in the metro Philadelphia area.
The Facebook page, created July 3--a week after the merger was
revealed--was a means to initiate debate about "the horrible situation
that was now present in our community."
That horrible situation? The creation of a new regional health
system formed between Holy Redeemer and Abington Health (which
encompasses its flagship hospital, Abington Memorial Health (AMH) and
Lansdale Hospital in Hatfield Township, as well as two area outpatient
facilities), would
mean total elimination from the hospital system of abortion care,
even as Abington Health still claimed to remain a secular institution.
Abington Health doctors and community members claim they were not
consulted about this decision--or the partnership--before it was
announced.
"This is just very, very, very close to my heart, this issue," says
Poley of her passion to fight against the partnership and its
implications for women's reproductive health care. Poley, director and
curator of Elkins Park's Temple Judea Museum of Reform Congregation
Keneseth Israel for the last 13 years, came of age during the fifties
when "these battles were being fought. I had friends from college who
had to endure back alley abortions."
But what began as a suggestion from her 44-year-old daughter Nomi
Saunders turned into the straw that broke the camel's back.
And all in a matter of over two weeks.
"In the 15 years we've been doing this, this is the fastest merger
defeat we've ever seen," says Sheila Reynerston, advocacy coordinator
for the New York-based MergerWatch
Project. "It was 20 days. That's incredible."
A Swift Change
On July 18, after an emergency hospital board
meeting, both Abington Health and Holy Redeemer released
a joint statement announcing that the merger was dead.
Together we had a bold vision that we believe would have served
our community well. While we are disappointed, we believe this decision
is in the best interest of both organizations.
Why the merger fell apart in the end is at this point only a matter
of speculation, but Poley and others involved in the campaign against
the partnership believe it had a lot--if not all--to do with the
grassroots efforts in the Montgomery County community. After all, the
Facebook page had 1,470 likes as of July 20, 10,000 community members were
sporting "Stop the Abington Hospital Merger" pins, and a Change.org
petition against the merger received more than 6,100 signatures.
(Linda Millevoi, spokesperson for Abington Memorial Hospital responded
to an RH Reality Check inquiry about the end of the merger
delining further comment, and did not respond to requests for further
clarification as of press time).
"I had no idea what was going to happen but I knew if anything was
going to happen, we had to have a way to come together," says Poley.
"Facebook really is the 21st century town square."
Poley, who heard the news while conducting a tour at the museum,
also cites her talk with Abington Memorial Hospital's Executive Vice
President and Chief Operating Officer, Meg McGoldrick, on July 13.
According to Poley, when McGoldrick called her to inquire about a
sit-down meeting to discuss an accommodation, in which AMH would
establish an off-site facility for abortion services, Poley refused.
Instead, she informed McGoldrick that everyone involved in the campaign
was developing strategies that would help end the merger. "I told
herâ¦it was going to get much worse, and I think she heard me," she
asserts.
"The movement created by the community against this merger was
unprecedented," says Reynerston, who attended a meeting with
campaigners, along with representatives from Catholics for Choice and
American Civil Liberties Union (ACLU) the night of July 17. "There was
so much good use of social media and in such a short amount of time. It
was quite clear that the community was very unhappy."
"It was an impressive show of dissent against an ill-planned
proposal," she adds.
Another factor that can be attributed to the suspension was the
overwhelming number of letters of discontent--most of which Poley
posted to the Facebook page--that swamped the inboxes of the Abington
Health administration. One such letter, sent July 3 by eight local
Rabbis to Abington Health President and Chief Executive Officer
Laurence M. Merlis wrote of the merger:
While we respect Catholic teachings that regard a fetus as a
potential life, and understand that a Catholic hospital would refuse to
provide abortion services, we are deeply concerned that this decision
imposes a Catholic religious worldview on the entire communityâ¦In
making the decision to no longer provide abortions at AMH, you are in
effect saying that one religious tradition's teachings should take
precedence over all others. Should AMH commit to this path
and refuse to perform abortion services, it would seriously
undermine its status as a community hospital in any meaningful
sense of the term.
"As a Rabbi, I don't look at this as a political issue, I look at
this as a moral issue," says Rabbi Lawrence R. Sernovitz of Old York
Road Temple-Beth Am in Abington, one of the letter's signers. "The
moral issue is [that] women should have the right to have the services
that they need in their own community⦠To take away the rights of women
for a financial decision is not appropriate if you are serving the
greater community."
The Doctors Didn't Buy It
But it wasn't just the local clergy or citizens that were dismayed
by this secular-religious partnership and subsequent elimination of
abortion services. Over 200 AMH-affiliated doctors, including residents
of AMH's Obstetrics and Gynecology Department, met
July 11 and unanimously opposed the planned merger, says Dr. Sherry
Blumenthal, a 22-year Abington Health OB/GYN physician, Womencare
Obstetrics and Gynecology P.C. partner, and chair of the Pennsylvania
section of American Congress of Obstetricians & Gynecologists
(ACOG).
Dr. Blumenthal was on vacation during the meeting but attended by
phone (she notes in a July 19 follow up email that she was away during
most of the campaigning but was still actively involved). She also
authored a letter dated June 29 speaking out against the merger, and
was one of the most outspoken of the Abington Health physicians. In her
letter to Merlis, she wrote:
It is apparent that this was not a medical decision, but a
financial one. Abington Memorial Hospital, by agreeing to certain
religious concessions in its merger with Holy Redeemer Hospital, is
showing disrespect for the medical rights of women, their autonomy to
choose when to have children, and how many children to have.
"The concept of the merger itself is not a problem for the
physicians or the community in the sense that most [doctors] understand
that health care systems are greatly challenged in terms of finances,
and this will become worse in the future," she says. "The problem with
this merger is the compromising the secular nature of Abington Hospital
with the Catholic theology."
According to July 24 post on the Stop the Abington Hospital Merger
Facebook page, a letter from Abington Health has been emailed to a
number of merger distracters further explaining the choice to call off
the partnership. The letter, which was attributed to both Merlis and
AMH Board of Trustees Chair Robert M. Infarinato, states:
While the affiliation made sense from many perspectives, we were
unable to resolve a number of difficult issues, including clinical
differences related to reproductive health...
We are grateful for the long-standing support of our community,
and we respect and value the views and opinions of those who care
deeply about our organization, including members of our medical staff,
our patients, our employees, our volunteers, our donors and so many
other members of our community.
As noted above, however, community members say they had no knowledge
of the partnership before its announcement, directly contradicting the
claim by Abington Health that the company "respects" the opinions of
those its employs and serves. Second, Dr. Blumenthal notes that AMH's
OB/GYN department, as well as most of Abington Health's 1,400-plus
doctors, were left out of consultations about the medical impact of the
potential merger. According to the physician, Dr. Joel Polin, chair of
the OB/GYN department, was the only one informed of the decision
originally, yet was denied the opportunity to voice his concerns at a
board meeting scheduled to vote on the matter. Abington Memorial
spokeswoman Millevoi, however, believes that there is a "misperception"
on whether the announcement on the proposed merger indicated it was a
"done deal."
"What the boards agreed to was the signing of the letter of intent,
which was in fact, never actually signed," she wrote in an email.
"On the day of the announcement, our chief of staff, Dr. John J.
Kelly, called and met with a variety of constituents, including
physicians. Contact with these various constituents were unable
to be made until after the official announcement due to confidentiality
requirements."
Dr. Blumenthal has a different take of the overall situation. "I
believe the talks were done in secret because the administration did
not think that stopping abortion would be as big an issue or so
controversial and they may also not have wanted to know this. They
grossly miscalculated," she wrote in the follow up email before the
June 24 letter was distributed. She was on the beach with her
four-year-old grandson when she heard of the cancellation, and felt
"relief and affirmation."
"Without medical input, the extent of the issue and the fears of
where one prohibition might lead were trumped by financial concerns and
fear of future financial constraints--the latter are real concerns.
They might not have proceeded if they asked the medical staff and
community first, so it is a bit of a âCatch-22.'"
Religion Over Health Care
According to a
February 28 New York Times editorial, "Women's Health Care at
Risk," 20 mergers between secular and Catholic-affiliated hospitals
were announced over the span of three years, with more to be expected.
It's an upsurge, claims the editorial that is "threatening to deprive
women in many areas of the country of ready access to important
reproductive services." In fact, notes the piece, late last year, Kentucky
Governor Steve Beshear rejected a merger between secular and Catholic
hospitals--University Hospital, Jewish Hospital, St. Mary's
Healthcare, and St. Joseph's in Lexington--citing concerns about "loss
of control of a public asset and restrictions on reproductive
services."
And this was the case of Abington Health and Holy Redeemer. In
addition to the elimination of abortion services, AMH physicians and
the Montgomery County community feared that other reproductive health
services banned under the United States Conference of Bishops' Ethical
and Religious Directives for Catholic Health Care Services would
have been affected down the line.
"Abortion is one issue, obviously the issue that matters most to the
OB/GYN department, but there are other reproductive issues that are
extremely important as well," says Dr. Blumenthal. "The concern about
women's health care is obviously huge and complex."
According to a July 12 statement emailed by Millevoi, only 48 out of
the 17,575 abortions performed in the five-county Philadelphia region
were provided by Abington Memorial Hospital in the 12 months ending in
March. But the types of abortions performed by AMH are often not viable
in an outpatient setting. Instead, notes Dr. Blumenthal, most pregnancy
terminations were high risk or second trimester abortions either to
save a woman's life or due to fetal chromosomal or other fetal
anomalies. And these types of procedures, she says, are safer performed
in a hospital setting.
In the same statement, Abington Health claims that it would have
still provided "the full range of reproductive health optionsâ¦including:
- Contraception counseling and services
- Tubal ligations
- Vasectomies
- Infertility services
- Emergency contraception for rape victims and others
- All necessary measures to preserve the health of the mother,
including those that may result in terminating a pregnancy"
But just because it's in writing doesn't make it true, especially
since all of these services are forbidden in the Catholic
directives--and that's exactly what doctors and residents were afraid
of.
Reynerston points to a case last year in Sierra Vista, Arizona to
illustrate this very real possibility. According to the MergerWatch
advocacy coordinator, in April 2010, the independent secular Sierra
Vista Regional Health Center (SVRHC) announced that it would partner
Carondelet Health Network, a Catholic health system, in a two-year
trial affiliation. As part of the alliance, which required SVRHC to
follow the Catholic directives, tubal ligations at the time of
cesareans would no longer be performed--and SVRHC went as far as to put
a full-page ad out to the community stating what services were still
available, one being miscarriage management, says Reynerston. Yet,
three months after the announcement, a woman who was rushed to the
emergency room for miscarrying the second of her twins (she miscarried
one of her two 15-week twins at home prior to the visit), was forced to
be transferred to an acute care facility 80 miles away. The reason? The
attending physician who determined that pregnancy termination was
necessary because the remaining twin could not survive checked with
administration knowing that SVRHC was now under Catholic rule, and was
told treatment was not possible at the hospital.
The case, states Reynerston, was used in a
complaint filed with the Arizona Attorney General delivered in
November 2010 against the affiliation. In April 2011, Sierra Vista
Regional Health Center discontinued
the partnership (in a July 9th article in The Sierra Vista Herald, SVHRC
announced they were looking to partner again to build a new
multi-million dollar facility but will not consider
religiously-affiliated entities).
MergerWatch Director Lois Uttley believes the problem with the type
of proposed partnership between Abington Health and Holy Redeemer is
that the interpretation of the Catholic directives is up to the local
bishop or archbishop. In the case of Philadelphia, Archbishop Charles
J. Chaput of the city's Roman Catholic Archdiocese, formerly Denver's
prelate, is "quite conservative," says Uttley. (According to a
July 2011 interview with the National Catholic Reporter, Archbishop
Chaput alluded that it was "hypocritical" for pro-choice Catholic
politicians to receive communion and that "a relationship between two
people of the same sex is not in line with the teachings of the church
and the teachings of the Gospel, and is therefore wrong.") She adds
that MergerWatch worried he would insist the reading of the abortion
ban would be "broader than Abington Hospital officials might want it to
be."
And this means that, in addition to the services Abington Health
claimed would still be provided, other services such as treatment of
ectopic pregnancies and miscarriages could have eventually been
restricted due to Archbishop Chaput's interpretation.
The Financial Side
In the New York Times editorial, health care system
partnerships are often driven by "shifts in health care economics," in
which "some secular hospitals are struggling to survive and eager to be
rescued by financially stronger institutions, which in many cases may
be Catholic-affiliated."
But for Abington Health, this is not the case. Unlike Holy Redeemer,
Abington Memorial Hospital received
a Fitch Rating of "A," with an outlook of "stable." Among the key
rating drivers, which included good market position (AMH "maintains a
leading market share in a competitive service area," states Fitch),
solid liquidity, and above average debt burden, there sis sustained
probability. Writes Fitch:
After a drop in profitability in fiscal 2010, Abington's operating
performance improved in fiscal 2011 with a 2.1 percent operating margin
mainly due to its cost reduction initiatives. This trend has been
sustained through the 11 [months] ended May 31, 2012 (interim period)
with a 1.9 percent operating margin.
According to Moody's, however, Holy
Redeemer has $86 million of outstanding rated debt as of December
2011, receiving a Baa2 rating and an outlook of "negative"--the same
rating and outlook it
received from Moody's in December 2010, when it had $110.9 million
of total rated debt. One of Holy Redeemer's challenges, writes Moody's,
is "ongoing pressure on operating cash flow." The Catholic health
system had an 8.1 percent operating cash flow margin the 2011 fiscal
year, "with challenged operating performance during the first three
months" in the 2012 fiscal year. There was also a $588,000 operating
deficit during the three months ending in September 2011.
"It doesn't make sense that Abington Hospital, being the financially
stronger partner, would agree to any restrictions on its services in
order to partner with Holy Redeemer," says Uttley of the failed
partnership. "Each hospital should be able to maintain its own ethical
policies and current service provisions."
As Dr. Blumenthal notes, Abington Health partnering with another
hospital in the geographical area would position the system to become a
stronger health care force. But she also finds it suspicious--and
perplexing. "The structure of the board of the merged institution would
be 50/50 [and] this makes no sense," she says. "Why is Holy Redeemer
being allowed to dictate certain conditions of the merger based on
Catholic religious principles?"
Abington Health did not return a request for clarification on this
issue.
And Then There Were the Residents
The other issue the unsuccessful merger presented
was its effect on residency training in Abington Memorial Hospital's
OB/GYN department. According to the Accreditation
Council for Graduate Medical Education's Obstetrics and Gynecology
program requirements:
No program or resident with a religious or moral objection shall
be required to provide training in or to perform induced abortions.
Otherwise, access to experience with induced abortion must be part of
residency education. This education can be provided outside the
institution. Experience with management of complications of abortion
must be provided to all residents. If a residency program has a
religious, moral, or legal restriction that prohibits the residents
from performing abortions within the institution, the program must
ensure that the residents receive satisfactory education and experience
in managing the complications of abortion. Furthermore, such residency
programs (1) must not impede residents in the programs who do not have
religious or moral objections from receiving education and experience
in performing abortions at another institution and (2) must publicize
such policy to all applicants to those residency programs.
Abington Health did not responde to a request for comment on how
this training would have been handled if the partnership with Holy
Redeemer was implemented. "Most of us came to this program because we
were looking for a program that provided these types of services that
would be cut off by the merger," says Cari Brown of Easton, Pa., a
second year resident in AMH's OB/GYN department. "In this particular
situation, our treating and our ability to provide these services are
potentially being compromised because of a religious belief that I
would estimate the majority of our residents do not or have not
subscribed to."
Brown, who along with 19 other residents released a letter on July
11 disapproving of the merger, says she only applied to AMH's OB/GYN
program because of the advanced abortion services it offers. If the
merger would have grown feet, instead of being squashed over two weeks
after its announcement, then that education, she says, would be
severely limited.
But it's the Victory that Matters
"Can you believe they never spoke to the doctors?" Poley asks with
astonishment. "It makes you think, doesn't it?"
"The fact that they had to do it in secrecy and announce it from
the cloak of secrecy says it all," she continues. "What were they
thinking? They had to know they were going to meet up with resistance.
They just had no idea of what the extent of it would be."
And that resistance is thought to have brought the affiliation to a
halt.
Reynerston says the campaign against the merger possessed two key
attributes in successfully bringing it down: opposition by the the
surrounding community and by the medical community. "Without community
support and without doctor support, proposals tend to fail and that's
exactly what happened," she says.
When Reynerston heard the news, she just finished a call with
Abington advocates and was completing a follow up email when an
involved resident sent out a mass email announcing the merger's
termination. "It was really great. It was a great moment," she says.
For Brown, now that the merger has been called off, she looks
forward "to continuing to offer patients the complete range of
reproductive health-care options, and supporting them through the
joyful, as well as the challenging, moments that they and their
families may encounter."
"I hope our community never needs to face a situation of putting
one groups' religious doctrine ahead of evidence based medicine again."
Rabbi Sernovitz believes that Abington Health and Holy Redeemer's
July 18 decision "speaks volumes about the power of the people to make
change and to pursue social justice."
And Poley, exhilarated by the news, felt "happy and lucky to be
living in this community where these great people came together and
caused this to happen."
But what happened in Montgomery County from July 3 to July 18 is
more than about the cessation of a potentially problematic and harmful
merger. It's a striking example of how powerful and effective
grassroots organizing can be when assertively tackled.
"This campaign is going to be a great working example for other
communities in the future when we no doubt have to face another
[merger]," says Reynerston.
"Communities across the nation can now look to Abington,
Pennsylvania for proof that it does make a difference when people stand
up and speak out about a hospital merger that could have an impact on
health care."