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Published: Saturday, 7/30/2011 - Updated: 2 years ago

Clinic's practices contradict doctrine

Lima hospital does tubal ligation

BY DAVID YONKE AND JULIE M. McKINNON
BLADE STAFF WRITERS
John Brehany, Catholic Medical Association executive director and ethicist, says eschewing profit doesn’t excuse unethical actions. John Brehany, Catholic Medical Association executive director and ethicist, says eschewing profit doesn’t excuse unethical actions.
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LIMA, Ohio — Despite church teaching that condemns all forms of artificial contraception, officials at a Catholic hospital in Lima have acknowledged that tubal ligation surgeries are performed at a nearby medical facility the hospital partially owns.

St. Rita’s Medical Center holds a 51 percent stake in the West Central Ohio Surgery & Endoscopy Center, an ambulatory surgery center near the hospital that performs tubal ligations, commonly referred to as having one’s “tubes tied,” as well as other same-day surgical procedures, documents show.

The nonprofit hospital earned $995,343 in revenue from the ambulatory surgery center in 2009, according to the latest annual forms St. Rita’s filed with the Internal Revenue Service.

But that amount does not include any revenue from tubal ligations because those funds are donated directly to a local charity before the hospital’s share is received, according to Jim Reber, chief executive of St. Rita’s Health Partners, which includes the medical center.

The arrangement with the hospital to donate tubal ligation revenue to charity was established when the for-profit surgery center opened as a joint venture with doctors, Mr. Reber said. He declined to name the charity but said it is not related to the Catholic Church.

Although St. Rita’s owns a majority share of the ambulatory surgery center, which was incorporated in 1998, it is not the general or managing partner, according to the annual IRS form, called a 990.

The ambulatory center is not a Catholic organization and cannot qualify for Catholic status because it is a joint venture with physician investors, hospital officials said.

The Catholic Church has been consistent in condemning all forms of contraception except natural birth control methods.

Pope Paul VI, in his 1968 encyclical Humanae Vitae (Latin for “Of Human Life”), delineated the church teaching on regulating birth control.

After condemning abortion under any circumstance, the pontiff stated that direct sterilization, which includes tubal ligation and vasectomies, is also immoral.

“Equally to be condemned, as the magisterium [teaching authority] of the Church has affirmed on many occasions, is direct sterilization, whether of the man or of the woman, whether permanent or temporary,” Pope Paul VI wrote.

The U.S. Conference of Catholic Bishops, in its 43-page publication, Ethical and Religious Directives for Catholic Health Care Services, or ERDs, also forbids direct sterilization in any Catholic health-care institution.

The Toledo diocese, which includes Lima, said in a statement this week that “Bishop [Leonard] Blair is satisfied that Catholic health care in the Diocese of Toledo complies with the ERDs. From time to time questions arise, especially given the complex relationships that can exist between a Catholic hospital and clinics or medical facilities in which the hospital has some role or ownership.”

It said Bishop Blair “is aware of a situation involving St. Rita’s Medical Center in Lima and a surgery center at which certain medical procedures are performed contrary to the ERDs.”

The diocese said St. Rita’s entered into the relationship “in the belief that they were sufficiently separated from moral cooperation in these procedures. However, this is becoming a moot point, inasmuch as St. Rita’s is in the process of evaluating alternative ownership models for the surgery center in light of today’s market conditions.”

Mr. Reber said ownership of the clinic is being reviewed because government reimbursement rates for outpatient surgeries have declined, making the business model less financially viable. He said the review is unrelated to tubal ligation surgeries.

“We’re working with the board and with investors to look at our other options,” Mr. Reber said.

Bishop Blair is satisfied that Catholic health care in the Toledo diocese complies with ethical directives. Bishop Blair is satisfied that Catholic health care in the Toledo diocese complies with ethical directives.
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According to the bishops’ ethical directives, a bishop “ensures the moral and religious identity of the health- care ministry in whatever setting it is carried out in the diocese.”

The Rev. Tadeusz Pacholczyk, director of education for the National Catholic Bioethics Center in Philadelphia, said that while he could not comment on the specifics of the St. Rita situation, the ERDs emphasize that “Catholic health-care organizations are not permitted to engage in immediate material cooperation in actions that are intrinsically immoral, such as abortion, euthanasia, assisted suicide, and direct sterilization.”

He explained that “material cooperation occurs when the cooperator does not share the intentions of the principal agent but participates in circumstances that are essential to the commission of an act. … Immediate material cooperation in intrinsically evil actions is morally illicit.”

Father Pacholczyk said, again speaking on general principles and not about St. Rita’s specifically, that donating funds generated by an immoral act to charity “would not lessen the evil being done, nor the immorality of the cooperation in that evil.

“The only effect such donations might have would be to ‘cover some tracks’ and perhaps mislead those who learned about the donations into thinking that the evil actions were somehow not as bad as they actually were,” he said.

John Brehany, executive director and ethicist for the Catholic Medical Association, based in Bala Cynwyd, Pa., said the CMA could not offer a complete ethical analysis on the St. Rita case without all the details, but that “this much is clear: Unethical cooperation in evil [that is, in something like direct sterilization which the Catholic Church teaches is a serious sin] is wrong in principle. It is even worse to profit from cooperation in evil, but eschewing the profit does not excuse, or make restitution for, the unethical action.”

Several U.S. bishops have exerted their authority over Catholic hospitals for what they considered violations of the church’s ethical and religious directives.

In December, for example, Bishop Thomas Olmsted of Phoenix stripped St. Joseph’s Hospital of its Catholic affiliation because of a surgery performed at the facility in 2009.

The bishop said the procedure, which ended a pregnancy to save a woman’s life, was an abortion and violated the USCCB’s ethical and religious directives.

As a result of the bishop’s decision, St. Joseph’s no longer can call itself a Catholic hospital.

In February, 2010, Bishop Robert Vasa of the Baker, Ore., diocese ended the church’s sponsorship of St. Charles Medical Center in Bend, Ore., because tubal ligation surgeries were performed in the hospital.

“As a bishop, I am responsible for attesting to the full Catholicity of the hospitals in my diocese, a responsibility which I take very seriously, and I have reached the conclusion that I can no longer attest to the Catholicity of St. Charles,” Bishop Vasa wrote in the diocese’s newspaper.

“It would be misleading for me to allow St. Charles Bend to be acknowledged as Catholic in name while I am certain that some important tenets of the ethical and religious directives are no longer being observed,” Bishop Vasa said in a joint statement released by the diocese and hospital officials.

As a result, Mass no longer can be celebrated in the hospital’s chapel and all Catholic items have been removed and returned to the church.

Earlier this month, Bishop Blair cited Catholic teaching on bioethics in issuing a statement directing all parishes and schools in the Toledo diocese to not raise money or donate funds to the Susan G. Komen Foundation. The bishop said the national anti-cancer charity has not excluded the possibility of someday funding embryonic stem cell research, which Catholic teaching deems “not morally acceptable.”

The diocese later said in a statement that individual Catholics in the 19-county diocese may contribute to the Komen Foundation.

St. Rita’s traces its roots to 1918, when the Sisters of Mercy opened the unfinished hospital to care for victims of the influenza epidemic that year. Now the medical center’s campus stretches along six blocks with covered walkways, water fountains, gardens, and a track for running and walking.

Like Toledo-based Mercy, St. Rita’s is part of Catholic Health Partners of Cincinnati, Ohio’s largest health system with hospitals, nursing homes, and other operations in three states. Five Catholic organizations co-sponsor Catholic Health Partners, including the two Sisters of Mercy communities, Sisters of the Humility of Mary, and Franciscan Sisters of the Poor.

No tubal ligation surgeries are performed at any Mercy hospitals or joint-venture facilities, a spokesman said.

Contact David Yonke at: dyonke@theblade.com or 419-724-6154.



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