On March 10, West Suburban Medical Center hosted a celebration and a mass to mark the anniversary of the acquisition of the hospital by Resurrection Health Care (RHC).
Many concerns were raised prior to the acquisition, ranging from reproductive health services and charity care, to end-of-life issues, and even decorating.
So, 16 months since the Sisters of the Holy Family and the Sisters of the Resurrection took over, how much has the largest employer in Oak Park changed?
Here's a look at some of the more controversial topics that surfaced during the takeover debate:
In the months prior to the takeover by Resurrection, a coalition of the American Civil Liberties Union of Illinois, the MergerWatch Project, the National Women's Law Center, doctors and clergy members, warned that RHC would follow the Ethical and Religious Health Care Directives of the Roman Catholic Church. The result, according to an ACLU statement, would be that "a West Suburban Hospital operated by Resurrection Health Care may be:
?Banned from distributing, or even discussing, the use of condoms or contraceptives as a means of preventing pregnancy, HIV/AIDS, or sexually transmitted diseases.
?Barred from providing survivors of sexual assault access to emergency contraception as a means of protecting against pregnancy as a result of a violent, sexual assault.
?Prohibited from performing tubal ligations and infertility treatments (including in-vitro fertilization).
To address some of these concerns, West Sub enhanced its partnership with the PCC Wellness Center, 14 Lake Street in Oak Park.
Since 1993, the PCC Community Wellness Center has been an independent not-for-profit corporation organizationally independent of West Suburban Hospital.
According to Bob Urso, the CEO of PCC, what the board of West Suburban Hospital did just prior to its acquisition was to give $1.2 million in cash, $2.8 million in the form of real estate, capital improvements and forgiveness of debt, and control over its medical staff to PCC.
What they created was a partnership between two independent entities with each providing services and/or compensation to the other. For example, PCC physicians have admitting privileges at West Sub and do much of the care at the hospital for patients who have no doctor on staff, but they are paid for their work at the hospital by PCC.
West Sub reimburses PCC for the work its physicians do.
"The generosity of the board at West Suburban prior to the merger saw the benefit and the value to structure this arrangement," said Urso, "and it has created, I believe, a win-win relationship."
Although contraceptives are not sold at the hospital, they are available two blocks away at the clinic.
Regarding a ban on discussing reproductive health care options, Mark Loafman, the Chief Medical Officer at PCC, said, "While we [PCC physicians] are at the hospital there is no prohibition against counseling patients and educating them regarding all options?#34;birth control, family planning and even abortion. What we cannot do is prescribe or provide those services on site. There has been no interference with the doctor-patient relationship."
Dr. Debra Stulberg, a West Sub resident who at the time of the merger vocally opposed it, said PCC doctors may have the freedom to discuss family planning, but employees of West Sub itself do not.
She claimed that if you work for RHC you can neither discuss nor provide information on family planning other than abstinence.
A communication from RHC states, "Catholic hospitals can and do provide emergency contraception to rape victims as well as a full range of other support services."
Dr. Loafman clarified what this means.
"Our experience is that we can provide the service when needed. When the emergency room doctors make a decision that they cannot treat a rape victim because the Catholic ethical directives prohibit their doing so, we are on call to provide the service. It has not come up that often, and when it has it's been a seamless provision of services. Coming to PCC for care is an inconvenience, but it's not preventing the care from happening."
Regarding post-partem tubal ligations, Dr. Loafman and Dr. Stulberg disagreed on what they saw happening.
"We knew we had to make an arrangement for tubal ligations," said Loafman. "We do not do surgical procedures like tubals on site at the clinic. We do have an arrangement with Bethany Hospital on the West Side of Chicago that has been going very well. Having to be transported from West Suburban a day after giving birth is a barrier, but my observation, honestly, is that there has been a small reduction in the number of tubal ligations happening. There is nothing structural on the part of Resurrection getting in the way."
Dr. Stulberg, however, disagreed.
"The arrangement with Bethany may look good on paper," she argued, "but to make arrangements for your one-day-old baby to be cared for while you're having a surgical procedure under anesthesia creates a real barrier, especially if you are breast feeding."
Lorie Chaiten from the ACLU contended, "It's just not working. There are too many barriers. Women don't know how to work the system and wind up getting pregnant again."
End of Life Issues
Merger Watch also was concerned that the Catholic Ethical Directives would prevent patients from being allowed to die with dignity by having, for example, feeding tubes removed.
Since the merger, "end-of-life decision-making policies, such as honoring living wills are governed by Illinois law and were unchanged as a result of the transition," said Ellen McBride, a Catholic lay person who is Coordinator of Spiritual Services.
Patients and staff at West Suburban do have access to an Ethics Committee whose purpose, according to McBride, is "to provide the best possible care for the patient and to ensure that the clinical decisions that we make protect the dignity and sanctity of each patient's life. In the Resurrection Health Care system, anyone can ask for an ethics consult."
Cheryl James, an administrative Manager at the hospital, put it this way: "The Catholic stance on end of life issues is not that much different than what we practiced prior to this. It is not the official stance of the Roman Catholic Church to never pull a feeding tube. If you look at what the media says, they want you to think, 'Terry Schiavo?#34;oh no?#34;Catholics think everyone has a right to life forever.' And that is not the case. Catholic guidelines aren't like that. They are very much person oriented. Every case will be different. The media wants it black and white. Catholics see gray just like everyone else. Stopping feeding on one patient might not be ethically correct, and on another it could be OK."
A coalition of about a hundred labor unions, clergy, congregations, elected officials and community activists ran an ad prior to the merger last year, stating that Resurrection reduced the charity care it provided to .6 percent in 2003 by "implementing new restrictive policies." The coalition called for Resurrection to increase charity care by 2 percent, provide care based solely on financial need (not such restrictions as immigration status) and end lawsuits for collection of unpaid medical debt.
AFSCME?#34;the American Federation of State, County and Municipal Employees?#34;charged that RHC filed more than 2,000 collection law suits between 1999 and 2003. "Resurrection uses aggressive debt-collection tactics," AFSCME stated in a press release, "in some cases suing patients living below the federal poverty line."
Since that time, Resurrection Health Care has responded to the criticism with statements in a publication entitled A Guide to our Financial Assistance and Billing Process: "We want you to know: regardless of your ability to pay, urgent and emergency services are never refused nor delayed," the guide reads. Specifically, the document notes that the hospital offers financial counseling, and that, in some cases, it "can completely waive the cost of hospital bill for qualified patients."
In a press release on the internet RHC claims: "Nearly 20 percent of our total operating revenues during the past two years have supported free programs, free services and the difference between the true cost of care and government reimbursement. In 2004, we provided more that $174.5 million in free care." The press statement goes on to say Resurrection provides care to "everyone with compassion and respect, regardless of ability to pay, place of residents or any other factor."
It also notes that RHC places "no limit on the amount of charity care" it offers and has "respectful and reasonable" billing and collection procedures.
Mark Loafman put it this way: "Our mission at PCC is caring for the underserved and Resurrection has a strong commitment to that, probably more than the other health systems. Resurrection is writing off a significant amount of money. Some of the criticism is being used out of context by some people to promote their agenda."
Bob Urso added, "The relationship in terms of self-pay patients did not change when Resurrection Health Care too over West Suburban. It was good then, and it's still good now. I believe that Resurrection is very committed to providing services to underserved communities. If you look at where their hospitals are located, they provide those services."
How the hospital 'feels'
The news that a Catholic organization was taking over a community hospital elicited, in some people, scenes from Late Night Catechism or The DaVinci Code. Were priests going to be trying to convert vulnerable patients? How Catholic have the day to day activities at West Suburban Hospital become?
Decorating: Most every room in West Suburban Hospital now has a crucifix on the wall. On entering the main lobby, visitors are welcomed by a six-foot-high statue of Jesus with open arms. The chapel near the elevators on the first floor is no longer called All Faiths Chapel. It is marked as a Christian space only by a modest processional cross in front and an unobtrusive tabernacle in the back.The routine: "At 8:45 a.m., there is a short reflection which is chosen by a member of my staff [some of whom are not Catholic] and broadcast over the hospital PA system," Chaplain McBride said. "The only guideline is that they are spiritual."
Cheryl James added that every scheduled meeting in the hospital now begins with some kind of reflection or prayer. Who leads the reflection is up to each committee. Also, a mass is held every Friday at noon in the chapel.
How is the hospital staff reacting to the changes?
"I think it is business as usual for most employees," James said. "I think some enjoy the changes and even go to Mass, while for many others it's neither here nor there. It's just something different."Proselytizing: "Hospital chaplaincy is never about proselytizing/converting," declared Ellen McBride in an e-mail. "Our role is to meet each patient's individual spiritual needs. Chaplains are trained and skilled in responding to our communities' cultural and religious diversity."
Has West Suburban Hospital changed since Resurrection Health Care took over? Clearly, yes. Have the changes been for the better or for the worse? It depends, of course on your perspective and, where there are conflicting statements, who you believe. Those who argue that the net result has been positive cite the following:
West Suburban Hospital, Oak Park's biggest employer, is still open for business.
RHC is in the process of pumping $73.5 million into capital improvements.
Most services provided by the hospital have not changed.
Where there have been changes, RHC has made a good faith attempt to hook patients up with alternatives nearby in the community.
Given the dynamic and uncertain nature of the medical care industry, RHC is doing the best they can in terms of charity care and the collecting of bills.
And, of course, if you agree with Catholic moral teaching, the changes have consistent with your values. Those who contend that something major has been lost as a result of the takeover say:
It's always the poor who suffer. Women in particular are not getting the reproductive health care they need to break the cycle of poverty.
Resurrection Health Care is not "Catholic" enough. The sisters who own the system might take vows of poverty regarding their personal lives but in terms of their corporate governance, they are not very generous at best and in some cases exploitative of the poor.
The Catholic Church, as usual, is limiting my right to choose.