Another Unholy Alliance In Catholic Health Care?

By Gail Besse

Why would a thriving Catholic hospital endanger its ethical mission by teaming up with a medical conglomerate that supports abortion, contraception, the morning-after pill and human embryonic stem cell research?

And how does the Diocese of Manchester, New Hampshire, justify the claim that its hospital, Catholic Medical Center (CMC), will retain its Catholic integrity in a proposed affiliation with Dartmouth-Hitchcock Health (DHH)?

While pro-life Americans nationwide battle the Obama administration juggernaut – working to defend doctors’ conscience rights and to exclude abortion from national health care – some in the “Live Free or Die” state are at odds with their own diocese.

It’s a situation described as “tragic and ironic” by members of New Hampshire Right to Life (NHRTL), an American Life League Associate group.  They say the diocese is poised to surrender the independence of its 330-bed hospital in a convoluted agreement that’s evidently meant to maintain ritual purity while “integrating” with the secular system.

Led by Kathleen Souza and Barbara Hagan, both Catholics and former New Hampshire state legislators, the pro-lifers have vowed to stop this “unholy alliance.” “Dartmouth is involved in abortions throughout the state, heavily involved in fertility research, embryonic stem cell research, selective reduction abortion – almost everything the Church is against,” said Souza.

DHH is a formidable presence in New Hampshire and eastern Vermont. It comprises the Mary Hitchcock Memorial Hospital and Dartmouth-Hitchcock Medical Center in Lebanon; and the D-H Clinic, which includes physician group practices in Concord, Keene, Manchester and Nashua. It’s affiliated with the Dartmouth Institute for Health Policy and Clinical Practice and Dartmouth Medical School.

Adding CMC to its regional system would give DHH a hospital presence 60 miles from Boston. But CMC and DHH are so opposed to each other on sanctity of life matters that this collaboration means the hospital will deviate from its underlying religious mission, according to the 25,000-member NHRTL.

“Catholic people built this hospital with their pennies and dimes,” Hagan said. “The bishop has the ultimate say over its fate, and he’s putting himself in the position of being undercut. His powers are either diluted or eliminated throughout the agreement.”

Souza and Hagan, on behalf of NHRTL and “the pro-life community in greater Manchester,” on August 11 filed a formal Memo of Opposition with the charitable trusts division of the New Hampshire attorney general’s office. They’ve submitted more than 500 pages of supporting documentation that they contend proves the venture violates both Catholic ethics and the law that protects the public trust regarding charities. And they’ve submitted a similar package to the National Catholic Bioethics Center (NCBC) for its opinion. 
“D-H doctors have testified in the state legislature against the diocese on end-of-life issues,” Souza explained. “Their chief palliative care doctor helped get legislation passed that led to the state issuing a dangerous ‘living will’ called the New Hampshire Advance Directive.

“Dartmouth refers girls to Planned Parenthood in Manchester, where we have a picket going five days a week. If you partner with D-H and give them credibility, it’s a weak moral argument to say, ‘They do it under a different roof, so we won’t be culpable,’” she said.

Manchester Bishop John McCormack and the attorney general’s office have final say over the plan, which both CMC and DHH hope to finalize by December 31, according to their affiliation agreement, dated July 22 of this year. The bishop has conditionally approved the proposal but says he’s still reviewing it. He declined to answer questions posed by American Life League about it, or to meet with several concerned pro-life actvisits, despite their repeated requests this spring.

According to a statement on (a web site unveiled July 22 to explain the plan), the goal is to “create an integrated healthcare delivery system that maximizes Manchester-based resources aimed at increasing access to enhanced quality patient care.” 

Bishop McCormack has stated, “As bishop, I am committed to preserve Catholic Medical Center to be a true Catholic healthcare institution, one that fulfills all the Ethical and Religious Directives for Catholic hospitals.”  He is referring to the U.S. Conference of Catholic Bishops’ Ethical and Religious Directives for Catholic Health Care. Part Six of this document, titled “Forming New Partnerships with Health Care Organizations and Providers,” provides norms for guiding the faithful through the dangers inherent in Catholic-secular hospital mergers and other minefields. It notes, “The risk of scandal cannot be underestimated when partnerships are not built upon common values and moral principles.”

But since the plan was announced, DHH officials have been consistent. There will be no curtailment of its reproductive health "services” such as contraception and abortion, according to repeated statements to the media provided by spokesman Jason Aldous and other DHH officials.

“Where’s the truth? Black can’t be white and white can’t be black,” said Souza. “A Catholic institution doesn’t only have an obligation to serve health care needs but also to preach the gospel,” added Hagan. “Partnering with an entity that stands in direct philosophical opposition is a breach of the Catholic community’s support and trust.D-H has no religious purpose – only charitable, scientific and educational.”

CMC, on the other hand, legally exists to carry on the work of the Church under its parent corporation, the Catholic Medical Center Healthcare System (CMCHS), which is a “juridic person” of the diocese under canon law.

The agreement calls for the diocese to basically relinquish the hospital’s independence, as DHH will become the new “sole member” of CMC’s parent company. A DHH Leadership Council, composed of officials of all its regional members, will have ultimate power over CMC’s finances and strategic planning, as well as the appointment of its trustees and president. “You can kiss control goodbye if you don’t have the votes on the board.” Hagan pointed out. “It’s a corporate shell game as far as I’m concerned.” Souza likened the legal reorganization to “Russian nested dolls.”

The agreement stipulates that Catholic ethical norms will be followed, but also acknowledges that all parties understand sometimes they may not be. In those cases, the Leadership Council gives representatives of CMC and its parent, CMCHS, the chance to “recuse herself or himself and have no involvement in such issues.” “Does that sound like Pope John Paul’s ‘stand up and proclaim the Gospel?’” Hagan asked. “They’ll walk away and not defend the faith.”

Among other issues raised in the Memo of Objections is the bishop’s “absence at the negotiating table.” The guidance the bishop’s been given comes from an ethicist who’s in the “compromising” position of also being a diocesan employee, the memo notes. Peter Cataldo is both pro-life director for the diocese and a CMC advisor. And although the bishop has said he’s consulted two other ethicists as well, he has declined to name them.
Another objection is the lack of public input during initial planning. CMC and DHH have been cooperating on joint ventures for more than five years, but the “holding company affiliation” (they’re not terming it a merger) was not publicized until February. A few talks between diocesan and hospital officials and invited pro-life leaders did take place this spring, but Souza said these were “more of a ‘dog-and-pony show’ than a serious exchange of information.”

“We complained to the bishop in writing following each meeting, repeating the same concerns each time,” she said. “Each reply from the bishop assured us that our worries were unfounded – but again – no answers were provided.”

Pro-lifers felt the clock was just being allowed to run out. “Mistrust on ethics will doom CMC's new affiliation,” predicted former Manchester alderman Rich Gerard in a July 27-August 2 Manchester Express column. Community forums will be held in the fall, but dates and locations have not been announced yet.

NHRTL also contends that Dartmouth will “rapidly devour CMC, engulfing all of New Hampshire and Vermont.” In a July 25 column in the Concord Monitor, former New Hampshire state representative Donald Welch agreed. “Dartmouth-Hitchcock Medical Center is a leader in health-care innovation and care, but its business model is predatory,” he observed. “It is not interested in being a bridesmaid.  “Catholic Medical Center would be an afterthought, its mission and glorious past notwithstanding.”

The hospital’s roots go back almost 120 years. In the 1890s, Manchester Catholics built two hospitals, both run by religious sisters: Sacred Heart on the city’s east side and Notre Dame on the west side. In 1978, the two hospitals combined into CMC.
In the 1990s, the hospital merged for a few years with Elliot Hospital of Manchester to form Optima Health, a venture that proved to be ill-conceived, unpopular and unsuccessful. The merger was dissolved; the hospitals continued independently and flourished.

“The successful campaign to save Catholic Medical Center from extinction appears not to be appreciated by Giles or her management team,” Welch said. “It is once again being handled like a financial asset rather than a sacred trust.”

Souza and Hagan – who helped expose problems inherent in Optima – contend the Manchester plan would create even more of a scandal than the unresolved situation in the Archdiocese of Boston, whose Caritas Christi health care system is still a player with an insurance company that refers women for abortions, contraceptives and sterilizations.

Following much negative publicity, in June, at the 11th hour, Boston Cardinal Sean O’Malley did nix the hospital system becoming an outright partner with the company, but he has yet to divulge details of the current plan. He has also declined to release the opinion he sought in March from the NCBC.

Colleen McCormick, an anesthesiologist with a graduate degree in medical ethics, has attended the Manchester talks. “Washington is dying to squelch conscience protections,” she observed. “Once Catholic entities have physicians who have no problems with the culture of death, rights of conscience will be easier to overcome. I think we should be withdrawing from any liaisons at all between Catholic and secular health care providers.”

Asked to comment on mergers in general, Father Tadeusz Pacholczyk, director of education for the NCBC, advised, “Such mergers can be pursued as long as the Catholic health care provider is clear about the meaning of its Catholic identity and remains intent on upholding that identity in all the negotiations and arrangements leading to the merger and subsequent to its realization. This means that the Catholic institution (and the merged institution later) will be bound by the provisions of the Ethical and Religious Directives. The possibility of scandal must be meticulously avoided.”

By contrast, Hagan said, in this case, the maze of legal documents stipulates that “the directives will be followed – except when they won’t.” She added, “We’re praying that the NCBC and the attorney general’s office will conclude, as we have, that this proposed affiliation is an attempt to do the impossible.”

In his 1995 encyclical, Evangelium Vitae (The Gospel of Life), Pope John Paul II was clear:

“[W]e are facing an enormous and dramatic clash between good and evil, death and life, the ‘culture of death’ and the ‘culture of life.’ We find ourselves not only ‘faced with’ but necessarily ‘in the midst of’ this conflict. We are all involved and we all share in it, with the inescapable responsibility of choosing to be unconditionally pro-life.” (Section 28)

Gail Besse is a Catholic freelance writer from Boston. Her work has been published in the National Catholic Register, Our Sunday Visitor and various Massachusetts secular daily papers and diocesan publications.