RELIGION IN THE NEWS Spring 2003

Connecticut provides a case study of the formidable challenges Catholic bishops face as they try to preserve doctrinal control over the provision of care in historically Catholic medical institutions. These pressures come not only from state and federal regulators, but also from structural financial pressures that are pushing more hospitals of all types toward consolidation, often in profit-driven corporate settings.

Southern New England remains an impressively Catholic place, but it’s no longer a sort of Catholic Utah. As recently as 1990, a majority of the populations of Connecticut, Rhode Island, and Massachusetts identified as Catholic and there was considerable deference in routine life to Catholic preferences. Now, only about 38 percent of Connecticut’s population identifies as Catholic.

Dwindling numbers in the pews translate into bigger difficulties supporting Catholic institutions of all kinds. But very expensive health care institutions, which already rely on massive Medicare and Medicaid funding, are particularly hard to hold on to. And when the reputational catastrophe of the clerical sexual misconduct scandal is factored in, the result has been less deference to the views of church leaders in the public realm. This is so despite the massive presence of Catholics among elected officials.

This challenge is especially daunting to the current generation of politically and theologically conservative bishops, many of whom would like to recapture some of the dogmatic ground lost in the recent past. Their concerns range from the virtually universal flouting of the church’s ban on contraception among married Catholics; to the broad failure to mobilize effective opposition to abortion; to, most recently, the legitimation of same-sex marriage in states like Connecticut.

The church’s ultimately unsuccessful struggle in 2006 and 2007 to exempt Connecticut’s Catholic hospitals from a new state mandate that all hospitals offer emergency contraception to rape victims provides a backdrop to the bishops’ 2012 mobilization against the Obama administration’s mandate that Catholic institutions serving the general public—hospitals, nursing homes, schools and universities, and social service agencies—provide employees with health insurance that covers contraceptives.

The emergency contraceptive drug called Plan B received FDA approval in 1998 and rapidly became part of the treatment protocol in American hospitals for rape victims and for those who wished to take a contraceptive after sexual intercourse. The drug was so popular that in the midst of the Connecticut controversy, it was approved for over-the-counter use by adults.

According to the manufacturers, the drug, which has higher levels of hormones than ordinary contraceptives, functions in two ways: by preventing ovulation and, secondarily, by preventing the attachment of a fertilized egg to the uterus. Plan B, however, does not disrupt already established pregnancies. It is most effective when taken soon after unprotected intercourse.

During the early 2000s, the standard protocol for rape victims in all of Connecticut’s hospitals, including the state’s four large acute-care Catholic ones, included an offer of Plan B to those being treated for rape. The hospitals were permitted to ask if a patient already had an established pregnancy.

But in January 2006, the two bishops whose dioceses include Catholic hospitals decided that they were uncomfortable with the established standard. In order to prevent the possibility of abortion, Archbishop Henry Mansell of Hartford and Bishop William Lori of Bridgeport (who as Archbishop of Baltimore would later lead the charge against the Obamacare birth control mandate) said they would require their hospitals to take an additional step and administer a separate test to determine if the patient was ovulating, in order to prevent any possibility of violating church teaching against abortion.

While both Mansell and Lori were relatively new appointees to their diocesan positions, neither was noticeably more conservative than his predecessor. But the two agreed on the importance of staking out distinctive Catholic values in their hospitals.

By March, the Hartford Courant was reporting opposition to the bishops’ position in the legislature and from Connecticut attorney general Richard Blumenthal, who told a legislative hearing on March 6 that, like other public institutions, Catholic hospitals received very large public subsidies and could be required to provide Plan B to patients without violating the religious freedom of the church.

The chair of the state’s Permanent Commission on the Status of Women also weighed in, saying it was reasonable “to expect a hospital to act like a hospital.” Leslie Gabel-Brett told the hearing it was “unfair to require victims to wait or to travel to another hospital,” especially since Plan B works most effectively within the first 72 hours after intercourse.

Gov. John W. Roland and the state’s victim’s advocate (who was also a Catholic deacon) then weighed in on the side of the bishops and no bill was reported from committee before the end of the 2006 legislative session.

The following year, proponents of the bill were better prepared. They told reporters they had majorities in both houses of the legislature committed to requiring all hospitals to offer Plan B to rape victims, but said they were open to negotiating how to do that with the bishops. One proposal, used in other states, was to authorize Catholic hospitals to contract with third parties to provide the medication.

And for a brief moment, that appeared to provide a way forward. Mansell told a rally at the state Capitol on March 22 that he wanted to reach a “mutually respectful” solution. “The current debate on Plan B and our Catholic hospitals must be resolved by a solution that respects the legitimate needs of the rape victim, yet allows the Catholic hospitals to operate according to a manner respectful of the religious beliefs and values,” he said.

That encouraged the legislature to move forward with a state mandate allowing third-party contractors to get involved, but when the bishops abruptly declined to support the new bill the state senate overwhelmingly approved it.

The Courant’s Mark Pazniokas reported that Mansell and Lori, “after consulting with bio-ethicists said that they could not agree to the compromise because the hospitals would have to contact the third parties who would administer the drug.” This came despite the news that Catholic bishops in New York and New Jersey had accepted similar policies.

Most of the bishops’ supporters in the legislature then moved behind the Plan B mandate. “What I struggle with is this,” State Sen. David Capiello, a Republican from Danbury, told Pazniokas. “If I was a Catholic in New York, this would be OK. But as a Catholic from Connecticut, this is not OK. I could not get my arms around that.”

The bill was adopted 32-3 in the Senate and moved to the General Assembly, where Speaker James Amand received a phone call from the archbishop while standing at the podium to announce the final 113-36 vote for passage.

The Courant strongly supported the new law. Catholic hospitals, it editorialized, “receive public money and they treat patients of all religious affiliations. Women, especially after a trauma, should not have to shop around in the dead of night for help.”

The struggle ended oddly several months later, when the state’s bishops announced that Catholic hospitals would conform to the law without the use of third party contractors.

“The administration of Plan B pills in this instance cannot be judged to be the commission of an abortion because of such doubt about the way that Plan B and similar drugs work and because of the current impossibility of knowing from the ovulation test whether a new life is present,” their statement read. “To administer Plan B without an ovulation test is not an intrinsically evil act.”

Behind the skirmishing over the role of Catholic doctrine in the administration of the dioceses’ hospitals lay their increasingly shaky futures as Catholic institutions.

With financial pressure growing on all hospitals to hold down costs, Catholic hospitals are among those most vulnerable to consolidation, as a national analysis published on November 30 in the New York Times reported. Many hospitals are now competing to buy doctors’ practices to capture the business of their patients, and by and large the Catholic hospitals don’t have the money to compete.

In Connecticut, two of the four hospitals involved in the Plan B controversy are already in deep financial crisis. St. Raphael’s Hospital in New Haven is moving rapidly toward consolidation with Yale New Haven Hospital. St. Mary’s Hospital in Waterbury recently abandoned efforts to merge with Waterbury Hospital and jointly sell their business to a for-profit chain, which had offered to construct a new hospital for the consolidated operation.

Once again Mansell played the key role in blocking the merger because of concerns about how to handle contraceptive services in the new hospital.

In 2011, the two Waterbury hospitals announced that they wanted to merge and strike an agreement with LHP Hospital Group of Plano, Texas. LHP would then have constructed a new $400 million for-profit institution, with 80 percent of the venture owned by LHP and 10 percent each by the two hospitals.

The Courant reported on October 14 that, after a year of negotiations, Waterbury Hospital had decided it would be “impossible to comply with Catholic directives on birth control.”

“We confronted numerous challenges and obstacles that made it difficult for both of the hospitals in Waterbury to remain true to their respective missions,” said Darlene Stromstadt, Waterbury Hospital’s chief executive officer.

The hospitals and LHP attempted to agree on the development of a separately incorporated “hospital within a hospital” that would provide reproductive health services not condoned by Catholic doctrine, but Mansell would not agree to allow that under a single roof. No abortions would have been allowed at the merged hospital.

Proponents of the merger argued that the “hospital within a hospital” model was working and had received the approval of local Catholic bishops in Troy, New York, where a group of Catholic and non-Catholic hospitals had consolidated in 2009. But Mansell did not agree.

“If you’ve seen one merger, you’ve seen one merger,” said St. Mary’s chief operating officer Chad Wable in a June 24 story in the Courant. “Every city’s a little different and has different characteristics.”

The particular sticking point was tubal ligation surgery, which prevents all possibility of future pregnancy in patients. The surgery is often performed after Caesarian sections, because that is the safest and most convenient time to do so. Waterbury Hospital currently performs about 250 tubal ligations a year.

The construction of a satellite surgical facility off the new hospital campus was also considered, but it proved impossible to imagine how surgical patients could be safely moved. The failed merger triggered concern from state officials that both hospitals might fail financially, leaving Waterbury with no acute-care hospital at all.

Two weeks after publically abandoning the merger talks, Waterbury Hospital announced its merger with the Tennessee-based for-profit chain Advantage Health Care systems, which now also includes St. Vincent’s Hospital in nearby Worcester, Massachusetts.

So Mansell chose to risk losing one of his three Catholic hospitals rather than accepting a compromise that other Catholic bishops had agreed to.

The choice was less stark in New Haven, where Yale-New Haven will continue to operate St. Raphael’s as a free-standing institution that follows all Catholic healthcare directives. Yale-New Haven’s officials noted, however, that all employees of the consolidated hospitals will receive health insurance that covers the full range of reproductive healthcare services, from birth control through abortion.

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