Holy Redeemer Health System and Abington Health: Seeking to Serve the Community
On June 27, 2012, Abington Health and Holy Redeemer Health System made a historic, enthusiastic announcement that these two providers of health care planned to join forces to serve the best interest of the communities in northern Philadelphia and several suburbs. Their expressed aims were “meeting the needs of the communities we serve in the most efficient and effective way possible” and “committing resources to improve the health of the community including the vulnerable and the poor,” pursuing a “shared vision to come together . . . to better serve the community.”1 Yet on July 18, 2012, a mere three weeks later, they conceded that these bold efforts that “would have served our community well” had been halted “in the best interest of both organizations.”2 It is telling to note the best interest invoked in each statement. What caused the change from serving the best interest of the community (by working together) to safeguarding the best interest of each organization (by staying apart)?
The loudest voices opposing the partnership believed that Catholic “restrictions” on culturally and legally accepted medical procedures, specifically on direct abortions, would be an unacceptable form of imposition on a secular entity. Thousands of people, including some outside the community as well as some patients and community members, signed a petition opposing the partnership; indeed, some threatened to boycott the organization by going elsewhere for care.3 Many Abington Health physicians made their opposition to the proposed collaboration vividly clear,4 with several even signaling that they would cease to provide medical services through Abington Health if the proposed limitations on abortion were to materialize.5 It is surely legitimate for these individuals to make their thoughts known, just as pro-life witnesses have long voiced opposition to the provision of direct abortions at Abington Memorial Hospital, yet there is a certain irony that a physician would threaten to withhold his or her medical services from the local community because the organization withholds one disputed “service” (direct abortion) from the community. Clearly, a loss of physicians in various specialties would not aid community access to a full range of health care services, which is the good they contend would be violated. Should one procedure, which is ultimately a disservice to women and their unborn children, be allowed to trump the indisputably vaster array of health care services in this way?
It is truly regrettable that intense outside pressure seems to have caused these thoughtful and well-intentioned efforts at improving health care quality and delivery to fall apart. Some have even called for the resignation of Laurence Merlis, CEO of Abington Health,6 as if to suggest that visionary leadership working to find ways of respectfully collaborating with religious health care institutions were undignified and insulting to the community. How sad.
It is more unfortunate that much of the public and medical furor is based on misinformation and misunderstandings regarding the applications of the United States Conference of Catholic Bishops’ Ethical and Religious Directives for Catholic Health Care Services (ERDs), which are designed to protect patients’ dignity and rights and safeguard the integrity of the profession of healing. This lack of clarity is a real concern throughout the United States, especially as collaborative arrangements have increasingly become a trend in light of rising medical costs, the need for economies of scale, new regulations from the Patient Protection and Affordable Care Act,7 efforts to improve quality of care and access, and the future direction of health care, which will cease to be hospital-centric and will focus on “preserving and improving health across a range of services—from preventive care to physician care to home and long-term care.”8
Collaborative relationships with Catholic health care institutions always require respect for Catholic identity, but that respect does not always mean the cooperating partner must fully comply with the ERDs. Depending on how the collaborative arrangement is structured, it may or may not require restrictions on immoral procedures at the partner institution. For example, a true “merger” will always require full compliance with the ERDs, since the two institutions consolidate into one, but most proposed arrangements are only partnerships or other relationships that involve lesser degrees of institutional integration. These less radical initiatives allow greater respect for the identities of both institutions, Catholic and non-Catholic, so that they can work together in the vast majority of areas in which they share values, while retaining their key differences in other areas. Immoral procedures at the non-Catholic entity may or may not need to be ruled out based on the principle of cooperation with evil and concerns about causing moral scandal. If time and effort are duly devoted to exploring potential business models and proper contractual language, morally licit solutions may be found; however, fine distinctions are crucial. Regrettably, such careful attention is often of little interest to the broader public or the media. This is unfortunate for the many communities that would stand to benefit from such health care partnerships in manifold ways: more comprehensive and coordinated care, higher quality, lower costs, greater long-term health, better chronic disease management, and improved access to services across all ages and demographics.9
Make no mistake: both Abington Health and Holy Redeemer Health System will surely continue to work their hardest “to seek opportunities to enhance the health of the communities,”10 as they always have, independently. Yet a great opportunity for those communities to listen, learn, and engage in reasoned discussion about the actual prospects and consequences of a partnership—and the implications of the Catholic vision regarding the value of the human person and the art of healing—was sidelined by a harsh firestorm of public opposition that left little room for thoughtful exchanges about pros and cons. Surely the leadership of these two health systems, which has been contemplating a partnership for some time, at least deserved the opportunity to develop more details on the specifics of the proposed arrangement. Could it have ultimately worked out? Perhaps. Would it have pleased every single member of the community? Not likely—there is always someone left feeling dissatisfied with any change. But the essential question is this: Would it have been an improvement for the community as a whole in terms of health care access, quality, availability, delivery, efficiency, affordability, awareness, disease treatment and prevention, and the defining facets of medical care, making it worth the necessary sacrifices and challenges for each institution while respecting each one’s identity? The leadership at Abington and Holy Redeemer had the hope and courage to believe so and were working earnestly to find out. Now we will likely never know.
John A. Di Camillo, Be.L., NCBC Staff Ethicist
1 “Abington Health and Holy Redeemer Health System Announce Intent to Create Regional Health System,” Abington Memorial Hospital website, June 27, 2012, www.amh.org/forthemedia/2012/abington-health-and-holy-redeemer-health-system-announce-intent/.
2 “Joint Announcement from Abington Health and Holy Redeemer Health System,” Abington Memorial Hospital website, July 18, 2012, www.amh.org.
3 F. R. Savana, “Amid Opposition Abington, Holy Redeemer End Merger Plans,” Phillyburbs.com, July 19, 2012, http://www.phillyburbs.com/news/local/courier_times_news/amid-opposition-abington-holy-redeemer-end-merger-plans/article_203f58cc-e0fd-5e42-86cd-b320c5ea7c66.html.
4 M. McCullough, “150 Abington Physicians Decry Plan to Stop Abortions,” Philly.com, July 13, 2012, http://articles.philly.com/2012-07-13/news/32649361_1_abington-chief-executive-abortion-foes-joel-polin.
5 K. Heller, “Anger at Abington Hospital,” The Philadelphia Inquirer, July 8, 2012, A2.
6 T. Avril, “Abington Health, Holy Redeemer Call Off Merger,” July 19, 2012, Philly.com, http://www.philly.com/philly/health/20120719_Abington_Health__Holy_Redeemer_call_off_merger.html.
7 The proposed partnership, inappropriately called a merger, “had been sought in the belief that a larger, more efficient institution would be better equipped to cope with the federal health-care overhaul.” Avril, “Abington Health.”
8 Michael B. Laign, “Abington-Holy Redeemer Hospital Merger Would Have Been Good for Patients,” Philly.com, July 25, 2012, http://articles.philly.com/2012-07-25/news/32849212_1_health-systems-health-care-abington-health.