Hospitals losing Catholic identity

Stacy J. Willis

Saturday, Sept. 2, 2000 | 3:50 a.m.

When the Las Vegas area's only Catholic hospital completed a new branch in Henderson this summer, there was a disagreement about the opening ceremony.

Some St. Rose Dominican Hospital administrators said there should be two ceremonies: one secular event for local politicians and dignitaries, and a separate event led by the Catholic monsignor and the nuns.

"But I said I wouldn't do it separately," said Monsignor Patrick Leary, head of the Las Vegas Diocese. "I didn't think it was a positive sign that they wanted to do it separately, so we did one ceremony. The nuns worked very hard in this hospital for many years, and I don't want to see that legacy hijacked."

But that legacy -- the Catholic identity of Catholic hospitals -- has been increasingly challenged by the competitive health care industry across the nation.

Is today's Catholic hospital "Catholic" in name only? Or does the Catholic hospital embrace a religious moral standard that distinguishes it from its secular competitors? Does it provide more charitable care than other hospitals? Is it run primarily by Catholic leaders and is it loyal to the mission created decades ago by the founding nuns and priests?

The answers to these questions show a trend toward the loss of Catholic identity in the church-affiliated hospitals across the nation. In fact, the St. Louis-based Catholic Health Association launched a project this summer aimed at rejuvenating the Catholic identity in its more than 623 member hospitals.

"There is a need to strengthen the relationships between health care administrators and the dioceses," said the Rev. Michael D. Place, association president and CEO.

In 1980 49 percent of administrators in the nation's Catholic hospitals were non-Catholic or Catholic laypeople rather than church officials. By 1998 that number had risen to 91 percent, according to the CHA.

In some cities the dioceses have developed programs to strengthen their links to local Catholic hospitals. For example, in Michigan, the diocese funds a full-time liaison between the diocese and Catholic hospitals, Place said.

Leary, who is shepherding the 425,000 Las Vegas Catholic community until a new bishop is assigned, is "very concerned" about St. Rose's Catholic identity. He gives the hospital administration a "C" grade in staying true to its Catholic mission.

"Am I comfortable with the administration of this hospital? I think it is challenged. It bears watching in the future. I think we're just beginning to really understand that there is a drift away from the Catholic identity," Leary said.

What identity?

Mass is conducted five days a week in the chapel at St. Rose. Nuns roam the hallways, and statues of saints grace the property.

Catholic health care is rooted in New Testament accounts of Jesus' acts of healing the poor and sick. Inspired by their faith, religious men and women have pursued that healing mission around the world.

A habit-wearing nun from the Adrian Dominican Sisters was the first chief administrator of what was, 53 years ago, dubbed Rose de Lima Hospital in Henderson. The nuns bought the troubled hospital from the government for $1, assumed its debts, and promised to stay for 25 years. In addition to the first hospital chief executive, the bulk of original administrators were Dominican sisters, said Vicki Dalesandro, an Adrian Dominican nun and the current director of Mission Services at St. Rose.

Today St. Rose's CEO is not Catholic, nor are the majority of hospital board members, nor board members of parent company Catholic Healthcare West, according to Dalesandro. And a nationwide decline in the number of nuns and a shortage of priests does not bode well for Catholic leaders' participation levels at St. Rose. However, CEO Rod Davis, a member of the Church of Jesus Christ of Latter-day Saints, said "more than 50 percent of the senior staff" still subscribes to the Catholic faith.

But a Catholic hospital need not be run by Catholics, and it is illegal to consider religion when hiring, Dalesandro said. Thus a shared vision of charity and service among administrators of different faiths may suffice to keep the Catholic mission alive, she said.

Still, such a mission is common to many hospitals, Catholic or otherwise. So what distinguishes a Catholic hospital from other hospitals?

"I like to use this parable," Place said. "When you walk into a Jewish deli, how do you know it's a Jewish deli? A deli is a deli is a deli. But you just know it's Jewish."

Davis' answer was similarly intangible:

"There are committed and dedicated people at every hospital. But in a Catholic hospital, there seems to me to be a deeply held value system culturally engrained."

Practically, a Catholic hospital is different from a secular hospital in a number of ways.

Perhaps most evidently, Catholic hospitals do not provide reproductive services nor perform abortions, in accordance with religious beliefs about the sanctity of life.

Additionally, Catholic hospitals are supposed to adhere to a set of mission principles called the Ethical and Religious Directives for Catholic Health Care Services, a publication of the United States Catholic Conference.

Those 70 directives range from stating that hospital services must be guided by the moral tradition of the church, to being open to employee collective bargaining, to prohibiting medical experimentation.

Additionally, a Catholic hospital "should distinguish itself by service to and advocacy for those people whose social condition puts them at the margins of our society," the directives list says.

Many people have the impression, then, that the Catholic hospital provides more free care to patients who can't afford to pay than do other secular for-profit and other nonprofit hospitals.

"We do provide more indigent care as a portion of our total revenue than any hospital in the area," Davis said. Six percent of gross revenue goes to indigent care, according to Davis' staff.

But by law, all hospitals in Clark County must provide indigent care and will be partially reimbursed by taxpayers. And state indigent care records show that St. Rose provides roughly the same amount of indigent care as other hospitals in the Las Vegas area, considering the variations in hospital size.

St. Rose filed records with the state saying it provided free service to 46 indigent care cases in the fiscal year ending June 30, according to Vern Manke, Nevada Division of Health Care and Financial Policy supervisor of cost management.

Those 46 cases amounted to $1,080,361 in unpaid medical bills covered by the hospital. In accordance with a statutory reimbursement formula, the county repaid St. Rose $461,185 of that, according to Manke.

St. Rose's original campus, Rose de Lima, has 143 beds. The new Siena campus that opened this year and was not accepting patients in fiscal 1999 added another 145 beds.

By comparison, for-profit Lake Mead Hospital, which has 198 beds, claimed 55 indigent accounts worth $1,627,878, and was reimbursed $563,611 in that same period. Mountain View, a 120-bed for-profit facility, claimed 25 indigent accounts worth $597,471, and was reimbursed $197,476. The Las Vegas Valley's largest hospital, 688-bed for-profit Sunrise Hospital and Medical Center, claimed 277 indigent care accounts worth $6,372,639, and was reimbursed $2,510,617, Manke said.

However, the industry term "indigent care" only reflects a certain portion of unpaid charitable care, according to Norma Rustivo, St. Rose spokeswoman. But the hospital declined to provide costs of other charitable expenditures.

Also critical to the assignment of the Catholic name to a hospital is the establishment of a relationship with the local diocese.

"In terms of actual management of the hospital, the diocese is not involved," Davis said. "But we certainly value that relationship."

The diocese has no legal authority over the hospital. Instead, administrators meet with the monsignor three or four times annually to update him on business in the hospital, Dalesandro said.

"Our influence is more in terms of sway," Leary said. "We could look at a situation at the hospital and say they're not being ethical or faithful to the mission."

Cases in point

With that in mind, the Las Vegas Catholic Diocese was dismayed last winter to find that St. Rose's administration had dropped the insurance plan that covered diocese employees.

"Suddenly all of the Catholic diocese employees couldn't go to the only Catholic hospital in the area," Leary said. "That's not what I call staying true to your Catholic identity. That does not show the conscientious attitude we would hope would be present among our hospital administrators."

Diocese officials complained to Davis. Davis sent a letter of explanation saying he didn't realize the insurer was the diocese's insurer when it was dropped in the course of routine business negotiations.

St. Rose administrators arranged to fix the problem and reinstate the insurance plan, but Leary took the episode as a sign that the hospital took for granted its relationship with the diocese. Another disagreement between the diocese and the hospital came this year when a Catholic obstetrician wrote a letter to Leary saying that he felt he was being treated unethically by St. Rose's administration.

Dr. James Barber, a young physician who had been recruited by the hospital in 1998, claimed that the hospital had asked him to use its subsidiary start-up billing service, Nevada Physician's Choice, as a condition of recruitment. Barber charged that the company subsequently mismanaged his billing, went out of business, and the hospital reneged on its agreement to repay Barber's business debts.

He appealed to the diocese for help, saying that in addition to costing him $191,000, the dispute had caused a crisis in faith.

"I am writing this letter to you out of desperation. I don't know where to turn ...," Barber wrote.

"Our family has been Catholic for more than 500 years. I attended Catholic schools, a Catholic university, participated in Catholic medical missionary service ...

"I feel betrayed and hurt and angry. I feel incredulous that a charitable nonprofit entity ... is allowed to conduct business in this fashion ... I feel that all of this dishonesty and corrupt business practice can only bring shame on the Catholic community ... "

One of the Catholic health care directives states that "decisions that may lead to serious consequences for the identity or reputation of the Catholic health care services, or entail the high risk of scandal, should be made in consultation with the diocesan bishop ..."

However, Leary said the diocese was not made aware of the hospital's plans to set up the billing service -- the failure of which has cost the hospital more than $2 million, drawn it into a heated and public debate, and led to litigation.

Leary said the situation with Nevada Physician's Choice and Barber "is not in line with the ethics expected of a Catholic hospital and needs to be corrected."

Davis would not comment on the specifics of the Barber lawsuit but said he "wouldn't want to be at odds with the diocese over this."

"But," he said, "We have a responsibility to be faithful stewards of the hospital's finances."

Those finances have been in limbo for several years. In the fiscal year ending in June of 1999, St. Rose reported a 32.8 percent decline in profits, compared to a statewide 7 percent average decline among hospitals.

Thus, Davis concluded, the mission of Catholic charitable care, of health care and religion, would be lost without first focusing on the bottom line.

"The Catholic identity of this hospital is very important to us. But the nuns have for decades had a saying about this business. It goes, 'No margin, no mission,' " Davis said.

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