Catholic Church Sponsored Acute Care Hospitals: Staying The Course? Sorry, It Will Not Happen!

Yes, the Catholic Church, via religious orders of women and men, for the most part, has sponsored acute care hospitals throughout the United States of America for well over 150 years. Yes, Catholic acute care hospitals have been a very significant and truly important reflection of a traditional mission of the Catholic Church and its ministry to the sick. I “speak” from “on-the-job” experience, having been associated with Catholic health care institutions for well over four wonderful and most enjoyable decades. These many years include Catholic hospital administration, over fifteen years with the Catholic Hospital Association, professor of hospital administration at Saint Louis University, and many years of service as a chairman of the boards of a number of Catholic health care and higher educational institutions. Service with the Federal Government, U.S. Army, a publicly traded for-profit hospital company and now a professor emeritus at a local university round out, for the most part, my career profile. So, let me say at the offset, I believe that I have benefited greatly, personally and professionally, through my long association in and with the Catholic health care Apostolate, and for this opportunity to serve, I am most thankful. I am not a theologian or a canon lawyer.

Now the very tough to deal with question(s) at hand; (1) what is my prediction for the future of Catholic hospitals as Catholic Church related institutions; (2) what is the basis leading to my conclusions about that future? The following analysis and set of conclusions, from my prospective, is more reflective of an informal essay as opposed to a disquisition on the subject of Catholic hospitals past, present and future. No attempt will be made to identify or analyze the many social, political, religious, cultural or economic challenges Catholic hospitals have had to deal with in the past, are wrestling with today or can anticipate for tomorrow. Rather a few “big” questions to be raised, some honest responses to the “big” questions in the mind of the reader of this brief paper intermingled with some one-liners reflecting my thinking in terms of the “whys” of my questions and answers will serve my purpose. My first “big” question is: If Catholic hospitals did not exist today, would the Catholic Church, for necessary fulfillment of its mission and ministry, establish or in any manner bring into existence Catholic hospitals? If the answer to that question, in the mind of the reader of this brief essay is an unconditional yes, than I suggest that he/she read no further. There is no sense in wasting your valuable time as I would just “be watering a dry stick” as far as the readers consideration about the future of Catholic hospitals in terms of pragmatic analysis, defined conclusions and possible valid predictions are concerned.

If the answer to the above “big” question is no (for whatever reason), then one must admit that there is a rather high probability that the Catholic hospital, as a continuing and significant part of Catholic Church mission and ministry is for the future at least, not (relatively speaking) a high Catholic Church priority. Thus, as an opportunity for exiting a sponsored Catholic hospital situation(s) arises, it should not be resisted or postponed. And further, it is time for Catholic Church leadership of dioceses and religious orders to recognize that a planned and organized curtailment in the number of Catholic hospitals is in order. Why is this writer’s conclusion to the above “big” question a “no”? A brief explanation is in order.

The context for the “no” conclusion goes back to July 1965 when in the U.S. Congress, the House and the Senate passed a bill which established Medicare, a social insurance program designed to provide older adults with comprehensive health care coverage at an affordable cost. Of course, a “sleeper” in this Medicare legislation was a provision for health care coverage for the poor labeled Medicaid. This was a water-shed event insofar as the future significance, sustainability and uniqueness of the Catholic hospital Apostolate are concerned. Have Medicare and Medicaid results solved all the problems for the elderly, disabled or poor in the United States? No, but that is not the point relevant for this discussion. Once the Federal Government got into the health care delivery financing “game”, as sure as night follows day, one must recognize a future by the safe prediction that can best be reflected by the concept, “he who pays the piper calls the tune”! The context for major decisions and regulations in the health care delivery system in the U.S. had been determined and established by the Medicare legislation!

Again, all the individual political, social, economic, religious and cultural challenges for Catholic hospitals which were predicted before and realized since Medicare became operationally the law of the land as far as health care delivery was concerned, are not the major focus for this paper. Oh yes, there was the “conscience clause” and related efforts to protect religious scruples but in effect the “die had been cast” insofar as freedom of the Catholic hospital to support, live and minister guided by its Catholic culture. Of course, Medicare was a “cost based” system of reimbursement in the beginning (until DRG’s) and the leadership of sponsoring religious orders and Catholic hospitals were happy with the large additional cash flows. Most, but not all, became staunch advocates for staying the course up to and including the present day. The warnings were there! As a guiding principle, once a National Government moves into an “area” providing for the financing of defined social services already being provided, even in part, by the Catholic Church or Catholic Church institutions, it is a clear signal for the Catholic Church to plan a move out and put in place an organized and well planned reallocation strategy for owned resources to other ministries a reasonable period of time. The Catholic Church must remain independent and not allow any part of its mission or ministry activities to be determined or guided by internal or external forces hostile to Catholic Church beliefs.

Most of the arguments in favor of maintaining Catholic Church affiliated hospitals post-Medicare were and are based upon “rear-view mirror” thinking and analysis resulting in incorrigible optimistic projections that are very naïve. The main problem was not how to disengage in an orderly manner from a mission and ministry that had failed but rather how to bring about a necessary change from a very successful mission and ministry. The challenge regarding the future of the largest number of Catholic hospitals fell mostly on the leadership of the hospital sponsors, the religious orders of women and men. During the 1960’s and 1970’s and indeed right up to the present time, religious orders have been dealing with many challenges in addition to what to do about their hospitals. One of the clear signals early on to the religious orders regarding the future of their hospital Apostolate was that few, if any, women or men were inclined to join a religious order attracted by the opportunity to have a professional career serving in a hospital. Hospital care was to become a commodity in the United States. Of course, there would be high quality and low quality within the emerging Medicare influenced commodity based hospital industry. But, as mentioned earlier, the cash flow resulting from the Medicare cost based reimbursement era was very good.

For-profit hospital companies entered or expanded within the industry and flourished, problems with regulations were slow to emerge and with very few exceptions, the leadership of most religious orders sponsoring Catholic hospitals decided to stay the course and let uncontrolled or unplanned events decide the future for their hospitals. The clock is running and it is only a matter of time before most religious orders direct and meaningful ministry related association with Catholic hospitals will come to an end. That leads me to my second “big” question and final set of conclusions: Will dioceses, or the laity, directly on an organized and defined basis assume the challenge of maintaining and sponsoring Catholic hospitals after religious orders, for whatever reason(s), are forced to back away in total from Catholic hospital involvement and sponsorship?

In response to the possible question that any diocese or other ecclesiastical authority will assume responsibility for and sponsorship of Catholic hospitals, I put the probability at very close to zero. Given the rather large set of problems and challenges facing most bishops heading up diocesan leadership teams today, all within a context of limited resources, the answer realistically has to be a loud and clear no way!

Regarding the possibility of the laity on an organized basis within the Catholic Church organizational structure, rescuing and maintaining Catholic hospitals as an integral part of the Catholic Church mission and ministry, it does not in my opinion, have a chance of happening at the required level of sustainability and credibility needed as a defendable Catholic Church activity over the long run. A couple of factors lead me to such a conclusion. Leadership activities postponed are usually abandoned. What do I mean by this comment? Yes, there was the Second Vatican Council and yes, there was a very positive and encouraging document on the role of the laity in the Catholic Church. But, the long term educational process and changes required to give real meaning to the “Day of the Laity” concepts from the Second Vatican Council in the Catholic Church structure and leadership openness required to bring the laity in as meaningful partners in Catholic Church decision making and resource allocation relative to mission and ministry have not been done in most situations in any defined, planned, or significant manner. The same necessary educational process required for the laity to be meaningful partners in religious order health care ministry decision making from a religious order focus has not happened either

This failure to educate the leadership bound laity within the Catholic hospital ministry from a Catholic Church and religious order focus is not really totally the fault of the leadership teams within Catholic hospital sponsoring religious orders. In large part, the failure to educate can be traced back to the hospital leaders themselves and their representatives at the national level. The Catholic Hospital Association abandoned its long standing leadership educational activities for the most part and assumed in the 1980’s and beyond, a more or less political-lobbying trade association set of activities on behalf of the Catholic hospitals. The separation from Saint Louis University by the CHA, for example, was probably the most visible aspect of the change in educational focus at the national level. Again, the desire to protect the “present situation” took over and planning for change via education for ministry of the laity at all levels from a Catholic Church or sponsoring religious order focus was for the most part put aside. Religious orders and their sponsored hospitals were left to wander from one strategy for survival to another.

Again, the political, social, cultural, religious and economic pressures on the local Catholic hospital continue to intensify. For one example of things to come, study the situation(s) and ramifications for Catholic hospitals in California. These pressures and challenges, as mentioned earlier, could have been and were anticipated before and for sure shortly after the Federal Government’s entry in 1965 to the financing of a large part of the healthcare delivery in the United States. The laity, however well meaning and willing are not prepared to assume and fulfill the well defined role within the Catholic Church carried on by religious orders as sponsors of Catholic hospitals during the past 150 plus years. Laity led affiliations, with sponsoring religious order support, on a logical, regional pattern with other than Catholic hospitals, have been tried and in most cases deemed unworkable based upon enforcement of “cooperation” related provisions of the Ethical and Religious Directives. The latest organizational strategy developed mostly by religious order leadership for maintaining their hospitals as Catholic is to fold the hospitals into bigger and bigger multi-state systems with all the negative ramifications for organizational accountability and decision making with a Catholic Church mission and ministry context will also fail over time.

Catholic hospitals will, for the most part, continue to exist as hospitals but authentic existence within American society as Catholic Church reflections of an acceptable ministry will eventually dissolve. The laity as educated and trained pastoral care professionals based in a parish setting and available to serve the sick within any local health care institution is perhaps the positive “light at the end of the tunnel” for continuing and expanding the Catholic Church mission and ministry thrust becomes more significant as home care and community based services grow within a continually evolving health care delivery context of increasingly required responsibility for one’s own health enhancement.

To ignore the dark clouds plainly visible on the horizon and to advocate bigger and more diffused hospital systems within a Catholic Church context is long term folly. Arguments based upon tradition or nostalgia for the status quo thinking and planning for the future of Catholic hospitals will implode as time passes. A planned exit to disengage and use the resources for other worthwhile and defendable ministries for the poor is called for. All of the above, of course, is only one man’s opinion regarding a complex and very difficult situation.

About the Author

Edward J. Spillane, Ph.D. is professor emeritus in the School of Business and Technology at Webster University. His professional career has included many years of service as hospital executive, hospital and nursing home board member, as well as chairman of the board of trustees of St. Louis-based hospital and nursing home facilities. Dr. Spillane is an expert in the areas of financial analysis, investments, and health care cost/administration.