Abington Hospital Commits To Less Care, More Malpractice

[UPDATE, July 18, 2012: Abington and Holy Redeemer have called it off.]

Two weeks ago, out of the blue, two of the major health systems in Montgomery County, Pennsylvania (where I live) announced they had signed a letter of intent to merge (they call it a joint venture, but they’re merging their executive officers and their boards). They even had a long but light on details press release to mark the occasion:

Abington Health and Holy Redeemer Health System today are announcing their intention to create a new regional health system. The announcement is being made after the boards of both organizations, led by Robert M. Infarinato, chair of Abington Health, and William R. Sasso, chair of Holy Redeemer Health System, authorized the signing of a letter of intent at their respective meetings of the boards of trustees.

“We are very excited to pursue our shared vision to come together in a new healthcare organization to better serve the community,” said Infarinato. “Under healthcare reform, many quality improvements depend on enhanced coordination of care, which in turn relies upon closer alignment between health systems, physicians and other providers. We believe this partnership will facilitate the collaboration that will help both organizations move toward shared goals.”

The merger was dubious to begin with, at least from Abington’s standpoint, considering that Abington Memorial Hospital generates twice the revenue of Holy Redeemer Hospital and is well-managed and profitable, while Holy Redeemer Hospital is financially struggling. And then the other shoe dropped:

Said [William R. Sasso, chair of Holy Redeemer Health System], “… By aligning these two reputable health systems, we will form a new parent company that will provide oversight and direction to enable both organizations to fulfill their mission and goals while respecting each other’s values and preserving Abington’s long-standing heritage and Holy Redeemer’s Catholic identity.”

It turned out that “respecting each other’s values” meant ‘Abington’s physicians will have to follow Catholic Church directives on healthcare,’ so that “the Catholic medical facility appears to triumph in dictating reproductive health care policy to secular Abington, eliminating abortion services, while securing chairmanship of the board.”

There’s no need for me to wade into the politics of abortion, because the reality of interference in patient care — and the risk of medical malpractice liability to Abington — is staring us in the face:

In 2011, Abington performed 64 abortions, primarily for women with high risk pregnancies that compromised their health. For women with such high risk pregnancies, abortion can be a life-saving procedure. For other women, abortion terminates non-viable pregnancies, possibly due to fetal abnormalities or placental problems.

Truth is, surgical abortion is rarely a lifestyle choice, and it’s often a treatment for seriously compromised pregnancies.

How seriously compromised? Ask Sister Margaret McBride, a longtime administrator of St. Joseph’s Hospital and Medical Center in Phoenix, and the on-call member of the Hospital Ethics committee. Sister McBridge got the call for an ethics decision when an 11-week pregnant woman presented with severe pulmonary hypertension resulting in right heart failure, and a prognosis from her doctors of “close to 100 percent” mortality. The woman was going to die, right there, right then, taking the fetus with her.

Sister McBridge did what any moral, sensible person would do, and approved an abortion; she was excommunicated by the Bishop of Phoenix.

Need I mention that, in addition to saving the woman’s life, Sister McBride saved the hospital from millions of dollars in malpractice liability? “To have a child is to give fate a hostage,” John F. Kennedy supposedly said, and pregnancy is similarly both fragile and fraught with inherent dangers. For example, consider ectopic pregnancies, in which a fertilized egg implants outside the uterus, usually in the fallopian tubes: 1% of pregnancies are ectopic so that, if left untreated, they will rupture and kill the mother. Even with treatment options available, 1 in every 2000 pregnancies ends with the mother’s death from a rupture ectopic pregnancy, yet the Catholic Church is firm that physicians in their hospitals simply cannot treat ectopic pregnancies. (Here’s a 2011 article from the National Catholic Bioethics Center that notes how some Catholic “ethicists” have just begun defending some treatments, which means we’re at least a couple decades from any actual treatment.)

Ectopic pregnancy, like severe pulmonary hypertension, is fatal to the mother and fetus yet is treatable by termination of the pregnancy. Sometimes infections take the same course, resulting in certain death to mother and fetus unless an abortion is performed; Physician News discusses a case in which Holy Redeemer had to transfer such a patient to Abington. Congential birth defects like Zellweger Syndrome, Trisomy 18, Trisomy 13, and Tay-Sachs produce children who almost invariably die at a very young age. Abington’s decision to abdicate its responsibility to its patients will not only deny those pregnant women their care, but will imperil patients elsewhere, too, because residents training at Abington will be deprived of training in how to perform those procedures.

It is, in my opinion, simple malpractice for a hospital to prohibit a doctor from performing these procedures, and it is offensive to see even training in them denied. It’s thus no surprise that the physicians at Abington Memorial Hospital are fighting tooth and nail to terminate the merger. Said the 20 OB/GYN residents at Abington in a letter, “There is strong opposition to having our medical practice dictated by Catholic doctrine rather than our patients’ best interests and standard of care.” Indeed, they have reason to worry; read some of the examples discussed last fall when a secular Kentucky hospital was contemplating a similar merger in which the Catholic hospital put the doctor–patient relationship at the secular hospital second to their religious beliefs.

It bears repeating that the “Ethical and Religious Directives for Catholic Health Care Services” go far beyond surgical abortions, far beyond abortifacients, and far beyond even reproductive services. For example, do you or someone you know have advanced care directives for what should happen if you are struck with a painful, terminal disease? Per Directive 24, Catholic health care institutions “will not honor an advance directive that is contrary to Catholic teaching.” Thus, patients will have to follow, for example, Directive 61, whether they want to or not: “Patients experiencing suffering that cannot be alleviated should be helped to appreciate the Christian understanding of redemptive suffering.” I suppose it’s easy to talk about the redemptive power of suffering when someone else is doing the suffering.

Abington has given no assurances that it will not be operated under all of the same limitations as a fully Catholic hospital, and thus we can assume it will order its physicians to deny their patients the same care they would be denied at Holy Redeemer. The question is why Abington’s administrators are abandoning their community, their patients, and their physicians for this deal. If you’re in the area, join the Facebook page in opposition to the Abington merger.


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  • Emhpack

    These two hospitals have served their communities for most of the last century, each providing and adapting services to their respective patients. My family and friends have been born, treated and died at these two institutions. We could write a familial historical novel set at either. Our respect and gratitude far outweigh the disappointments and concerns we have had, and continue to have with decisions and policies we have disagreed with.

    Given the long-term service, successes and survival of these “dinosaurs of independence,” it would be prudent to allow them some time and space to complete their deliberations and due-diligence in consummating this agreement. Their solution may offer us a roadmap for religious/secular coexistence going forward.

    Meanwhile, we owe it to them and ourselves to offer constructive, respectful feedback on their endeavor, and the decision makers owe us, their patients and employees, attention to our input.

    Mike Hoffmann
    emhpack@mindspring.com

  • Guest

    I’m also from the area, and it’s obvious that this is a public relations nightmare for Abington. My family will not receive care from Abington in the future if the merger happens. If any med mal cases materialize from the substandard care patients are more likely to receive at religious hospitals (when religion interferes in the care, such as with reproductive health. Otherwise, I imagine the care is similar to other hospitals), it’s probably not in Abington’s best interest to poison the jury pool by ignoring community concerns. Didn’t Abington learn anything from Susan G. Komen’s public relations nightmare earlier this year?

  • MB

    I don’t understand how a hospital that serves the public–a public accommodation that receives federal money–can impose religious doctrine on patients of all faiths. I fully respect a patient’s right to choose not to have an abortion, but I am appalled that a hospital administrator can take away my right to choose, a decision that is between me and my doctor.