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Catholics run one-third of Wisconsin hospitals, putting many reproductive procedures off-limits

Ascension Columbia St. Mary’s Hospital
Coburn Dukehart / Wisconsin Watch
Under Catholic ownership, Ascension Columbia St. Mary’s Hospital in Milwaukee follows the Ethical and Religious Directives, which prohibit hospitals, except in extreme situations, from providing procedures the church deems immoral — including abortions, contraception and sterilization. In-vitro fertilization is also banned.

This story was a collaboration between Wisconsin Watch, the Cap Times and Fuller Project, a nonpartisan, nonprofit news outlet that focuses on women’s issues.

When Ascension’s St. Joseph Hospital in Milwaukee announced it would cut back services in 2018, residents of the surrounding Sherman Park area protested.

The predominantly black, low-income neighborhood already faced its share of challenges. Nearly a third of residents in the ZIP code live in poverty, and black infants born there are more than twice as likely to die as white infants.

Residents feared that reducing services would exacerbate these disparities, and even pave the way for the hospital to close. St. Joseph’s parent company, Ascension Wisconsin, eventually put the cuts on hold.

“It’s an anchor institution there,” says Reggie Newson, chief advocacy officer at Ascension Wisconsin.

But St. Joseph remains the target of a different kind of protest. The hospital is Catholic, which means it follows Ethical and Religious Directives, a set of rules written by the U.S. Conference of Catholic Bishops. The rules prohibit Catholic hospitals, except in extreme situations, from providing procedures the church deems immoral — including abortions, contraception and sterilization. In-vitro fertilization is banned.

Asma Kadri Keeler, a staff attorney at the ACLU of Wisconsin, recently met with members of the St. Joe’s Accountability Coalition, a community group formed after Ascension announced cutbacks. Although most people surveyed by the community group had positive views of St. Joseph, some residents told Keeler they were hesitant to send their pregnant loved ones there.

Keeler says the ACLU works to safeguard religious liberty, but it also has sued when patients were denied care based on religious restrictions.

“We take the position that it (religious liberty) can’t be used to harm other people,” she says.

Reproductive rights advocates say the restrictions impose religious doctrine on patients and violate medical standards of care in ways that disproportionately affect communities like Sherman Park.

Catholic health systems argue that they serve as safety nets in impoverished communities and provide the same quality of care as secular hospitals. According to the Catholic Health Association (CHA), which represents more than 600 Catholic hospitals in the United States, patients who received care at Catholic hospitals are more likely to recommend those hospitals than patients who receive care elsewhere.

That St. Joseph is both desperately needed and criticized reflects an increasingly common tension facing Wisconsin communities. An analysis by the Cap Times and the Fuller Project, a nonprofit news organization focusing on women’s issues, shows that the number of Catholic hospitals grew by 13 percent in the state, while the number of non-Catholic hospitals fell by the same percentage, between 2001 and 2018.

In most ways, these Catholic hospitals, which treat one in every seven patients in the United States, differ from secular ones in name only. Yet, critics say, in reproductive care, Catholic ethics can trump medical best practice, bishops can wield more influence than physicians, and patients can be denied care they desire or need.

Catholic hospitals common

In Wisconsin, where Catholic Germans and Irish dominated immigration in the mid- to late- 1800s, one-third of hospitals are governed by Catholic religious principles — more than twice the national average.

It is the only state where black women are more likely to deliver their babies in a Catholic institution than a non-Catholic one, Columbia Law School researchers found. And in 12 of Wisconsin’s 72 counties, the only hospitals within the borders are Catholic.

Hospitals are not always transparent about the services they will not provide, and patients often lack a choice of where they seek care, the Cap Times and the Fuller Project found.

Catholic hospitals are governed by 77 directives, which fuse theology with medicine and technology. Several directives cover reproductive care. For example, Catholic-affiliated hospitals will not provide sterilization if the sole purpose is to prevent a woman from becoming pregnant.

And abortion is not permitted, unless it is an “unavoidable” consequence of an action taken to save the mother’s life, according to Brian Reardon, vice president of communications for CHA.

Some physicians provide referrals for abortions and other restricted services or prescribe contraception for menstrual pain rather than birth control. Others adhere strictly to the directives.

SSM Health St. Mary’s Hospital in Madison refers patients seeking a common form of sterilization to undergo the procedure at a nearby eye clinic that does surgeries, according to one doctor and a nurse familiar with the arrangement.

Out of dozens of former and current medical residents, physicians, nurses and midwives in Wisconsin contacted by the Cap Times and the Fuller Project, only one currently practicing physician agreed to speak on the record for this story. Other currently practicing providers agreed to speak only anonymously because of concerns about negatively affecting their careers or because they had been instructed not to by their employer.

To clarify how Wisconsin’s Catholic hospitals use the directives, the Cap Times and the Fuller Project sent a series of questions to six such hospital systems: Ascension, SSM Health, Hospital Sisters Health System, Divine Savior Healthcare, Essentia Health and Holy Family Memorial. Questions were also sent to Aspirus and Mayo Clinic Health System-Franciscan Healthcare, two non-Catholic health systems that own hospitals that adhere to the ERDs.

None responded individually. However, Nathaniel Blanton Hibner, CHA’s director of ethics, sent a statement on behalf of the organization and Ascension, SSM and Hospital Sisters Health System, clarifying that physicians will prescribe contraceptives for “a variety of underlying medical conditions” and will offer emergency contraception to rape victims.

The full statement can be read here.

Doctor recalls potential ‘time bomb’

Dr. Kathy Hartke worked in Catholic hospitals for 27 years. She recalls a young woman pregnant with twins who arrived at the Catholic hospital in Brookfield, now known as Ascension SE Wisconsin Hospital-Elmbrook Campus. At about 21 weeks, the fetuses had virtually zero chance of survival.

The longer they waited to terminate the pregnancy, the greater the risk the woman’s uterus would become infected, Hartke said. But at Elmbrook, medical personnel were told they had to wait until the fetuses had no heartbeats.

Hartke recommended the patient be transferred to the secular Waukesha Memorial Hospital, where they could induce labor. But nurses gave the patient the opposite advice.

“Meanwhile, we’re sitting on a possible time bomb of somebody who is going to get very, very sick … and potentially die,” says Hartke, who has retired from practice.

The patient remained in Hartke’s care, growing sicker in the ensuing days. She developed sepsis, a life-threatening condition. Hartke says the patient went into spontaneous labor and was provided antibiotics, which prevented her from growing sicker. The fetuses did not survive.

Hibner says if a mother is suffering from a life-threatening condition, Catholic hospitals will provide all medically indicated care — even if it results in the death of the child.

The Rev. Charles Bouchard, senior director of theology at CHA, says he urges doctors to be “proactive” and not “wait until this infection starts.”

But in her experience, Hartke says, “They push it to the last possible second.”

“How is any physician supposed to be able to predict when it’s too late and a woman is going to die?” she says.

As a medical resident, Dr. Jessika Ralph tried to facilitate an abortion for a patient who became ill after going into premature labor with twins at St. Joseph in 2017. Ralph, who now works at University of Minnesota Health, says she was forced to wait until the woman hemorrhaged or showed signs of infection to help end the doomed pregnancy. Ralph eventually induced labor using medication, but was unable to use a particular recommended abortion drug. The ordeal lasted 24 hours, she says, and neither fetus survived.

“While overall I believe these hospitals do provide good obstetric and gynecologic care for women, this unfortunately is a really big gap, and it’s a gap that patients don’t know about,” says Ralph, who also told her story to Rewire.News.

Tubal ligations raise thorny issues

Women delivering by C-section at a secular hospital can ask physicians to tie their fallopian tubes, cut them and cauterize the ends while the abdomen is still open — a procedure that might last just a few minutes.

But at a Catholic hospital, the same woman often must schedule a second surgery at a different hospital to get a tubal ligation. Researchers have found that nearly half of women who requested to be sterilized but were denied became pregnant within a year.

Hospitals also charge nearly three times more for postpartum tubal ligations than they do for the same procedure done during a C-section, according to a list of procedure costs from Aurora hospitals in Wisconsin. The median charge for a C-section tubal is $515; a postpartum tubal is $1,390.

Doctors at Catholic hospitals face a dilemma: Risk violating hospital rules, or make the patient go through two surgeries.

Says Hartke: “When you have a moral conflict like that, it eats away at you.”

Contraception policies vary widely

Secular hospitals commonly implant long-acting reversible forms of contraception such as intrauterine devices (IUDs) after a woman gives birth. Physicians from Catholic hospitals told the Cap Times and the Fuller Project they were not allowed to implant IUDs, which provide contraception that can last for years.

Data from the Wisconsin Hospital Association suggest this is largely true. Ascension’s St. Joseph Hospital, for example, billed for an IUD just nine times for the fiscal year ending June 2019, whereas the non-Catholic Froedtert Memorial Lutheran Hospital, less than 5 miles away, did the same more than 1,500 times.

Cami Thomas is a leader of Maroon Calabash, which describes itself as a black radical reproductive justice organization. She says reproductive health care should be about “dignity and consent.”

Thomas recounts going to a Catholic hospital about a decade ago when she was on the brink of death, having lost two-thirds of her blood after her menstrual cycle went on for six months. Her doctor recommended Depo-Provera, an injectable contraceptive, but the hospital’s rules on contraception prohibited it. Furious, he found a loophole.

“Not all doctors are like that,” she says. “Thank goodness I had that doctor.”

The nonprofit Wisconsin Watch collaborates with Wisconsin Public Radio, Wisconsin Public Television, other news media and the University of Wisconsin-Madison School of Journalism and Mass Communication. All works created, published, posted or disseminated by Wisconsin Watch do not necessarily reflect the views or opinions of UW-Madison or any of its affiliates.

Comments (25)

  1. Submitted by Ray Schoch on 01/10/2020 - 09:24 am.

    This is little more than a sad example of theocracy in the guise of “religious freedom.” Or, for Margaret Atwood readers, Gilead brought to communities in Wisconsin and around the country.Very few of those who claim to be “pro-life” support genuinely “pro-life” policies. Mostly, their focus is limited to control of women’s bodies. It’s 2,000-year-old patriarchy with a patina of equally-patriarchal religious thought.

  2. Submitted by Craig Nelson on 01/10/2020 - 11:40 am.

    Thank God for the Catholics, and other Protestants who took the lead in health care as this country grew and prospered. They based their care on teachings of their Creator. Show me evidence of this outpouring of human care anywhere else in the world, outside of Christianity!

    • Submitted by Patrick Tice on 01/10/2020 - 03:48 pm.

      I’m more impressed with people who are good because it’s the right thing to do rather than those who are afraid a god is looking over their shoulder, ready to smite them if they step out of line. Thankfully there is no need to believe in that stuff to be a good person – or to run a hospital in the interest of patients instead of dogma.

      • Submitted by Connor OKeefe on 01/13/2020 - 07:46 am.

        “Thankfully there is no need to believe in that stuff to be a good person – or to run a hospital in the interest of patients instead of dogma.”

        Agree completely, sir. I would serve them right if you built your own hospital and ran it dogma free.

    • Submitted by Eric Snyder on 01/10/2020 - 05:56 pm.

      Presumably you’ve done a ton of sociological and anthropological research to support your belief.

    • Submitted by Raj Maddali on 01/13/2020 - 07:47 am.

      On a per capita basis, i believe jewish communities have done far, far more than Catholics. Also, christian missionaries were able to set up shop in these countries cause the colonial master made sure natives could not.

      Indians and all other colonies could not even cultivate salt under British rule. So cry me river about the overwhelming care by one religion.

    • Submitted by Pat Terry on 01/13/2020 - 02:39 pm.

      Christian is about the last thing I would use to describe the terrible health care system in this country.

  3. Submitted by Scot Kindschi on 01/10/2020 - 12:02 pm.

    100 % of health care in Marshall, MN is from a Catholic organization. It didn’t use to be that way. We actually use to have a decent provider. The Avera (dis)organization is the absolute worst system that I have ever experienced.

  4. Submitted by Eric Snyder on 01/10/2020 - 01:59 pm.

    “As a medical resident, Dr. Jessika Ralph tried to facilitate an abortion for a patient who became ill after going into premature labor with twins at St. Joseph in 2017. Ralph, who now works at University of Minnesota Health, says she was forced to wait until the woman hemorrhaged or showed signs of infection to help end the doomed pregnancy.”

    This is outrageous and should be criminally prosecutable. What would a public investigation reveal as to the risks these hospitals are taking with the lives of patients? Is legislation needed? At which point does religious liberty become a license for abuse?

    If “least harm” is not a principle in the Catholic Church’s ethical standards for hospitals, they need to rethink or get out of the way.

  5. Submitted by M Olson on 01/10/2020 - 02:57 pm.

    The hypocrisy is never ending. I know. I struggled with twelve years in catholic schools. You are indoctrinated as probably your parents and their parents were. Once I hit the age of reason graduation seemed an impossible task but I made it. Let’s talk about the Doctrine of Discovery shall we? Claiming religious freedom equals a lack of Liberty for the non Kool Aid drinkers.

    • Submitted by Frank Phelan on 01/10/2020 - 08:00 pm.

      Describing Catholics as Kool Aid drinkers is highly offensive and inflammatory.

      Do the mods really allow this? Because if a commenter describe Muslims or Jews this way, it would never fly in the first place, and the mods would not need to be called out.

      • Submitted by Paul Yochim on 01/11/2020 - 05:01 pm.

        Frank, thank you for emphasizing this selective outrage that exists here.

        • Submitted by Frank Phelan on 01/12/2020 - 06:40 pm.

          Selective indeed. Just a couple days ago, on the article Study links increase in minimum wage to decrease in suicide rates”, I submitted a simple non-controversial comment that this made increasing the minimum wage a pro-life issue. That was somehow not permitted, but anti-Catholic hater speech is. The permissible outrage here is both arbitrary & capricious.

        • Submitted by Tom Anderson on 01/15/2020 - 10:11 pm.

          I recently suggested that high schoolers could protest on weekends and take the bus to school instead of driving and was “moderated” out.

        • Submitted by Pat Berg since 2011 on 01/17/2020 - 10:27 am.

          I agree there seems to be inconsistency in the nature of what gets through and what doesn’t. I’m not sure the moderators are paid (I seem to recall seeing somewhere that they volunteer to do this, but I could be wrong). But the fact that there are more than one of them (and perhaps MANY more than one) could certainly lead to inconsistencies based on individual differences in judgement as to what is appropriate.

          Additionally, I suspect they have a LOT of comments to wade through, and it would not surprise me in the least to find that some of them simply get lost. Especially if moderators are unpaid or low paid.

          I don’t like the inconsistency, but over time, I’ve pretty much resigned myself to it given the setup here.

  6. Submitted by Alan Nilsson on 01/11/2020 - 07:53 pm.

    “According to the latest numbers from the Guttmacher Institute, 24 percent of women who procure abortions identify as Catholic, almost the same as 22 percent of all U.S. women who called themselves Catholic in a 2014 survey by Pew Research Center. “

  7. Submitted by Kris Yesame on 01/13/2020 - 04:51 am.

    Sad to say but the Church should get back to its mission and take care of the poor, needy, and faithful. In other words it should be selling it’s hospitals schools ect.. and basically getting out of business. If they can keep some that would be good. They should be accepting no government funding all the way down to building the roads to them if necessary.

  8. Submitted by Connor OKeefe on 01/13/2020 - 07:42 am.

    Those darned theocrats; building their own hospitals, then running them the way they want.

    • Submitted by Dennis Wagner on 01/13/2020 - 02:15 pm.

      Sorry, as you know they are non-profits, meaning they don’t pay any taxes meaning yes they are taxpayer subsidized, (no, income, sales or property taxes). Suspect they also accept Medicare, Medicaid etc. to help pay the bills as well, not so free of the city, county, state, federal, etc. government teats as it looks.

      • Submitted by Connor OKeefe on 01/13/2020 - 04:53 pm.

        Ah. “You didn’t build that” has not lost it’s cachet in some circles.

        And yet, despite the long list of free stuff available, no other bunch of theocrats are (not) building anything to compete with them…I wonder why?

        • Submitted by Dennis Wagner on 01/14/2020 - 10:55 am.

          The message was simple, as a religious institution they receive government support, but want to do things 100% their way, and use that governemnt support to further their personal religious beliefs, indoctrination, and deny folks their rights under existing law. Shouldn’t they be non-religious partisan? “all men are created equal” So the first amendment does not like “establishment” apparently you are all for the establishment of religion stuff, and using government funds to do it. So much for that constitution/BoR stuff.

  9. Submitted by Dennis Wagner on 01/13/2020 - 11:30 am.

    Churh-state/church-state: Decisions, decisions. The answer from this perspective is those (C) folks, forcing their religious will on other folks, in short denying them their right to their religion or freedom from it. Are you in the hospital business to help people or to shove religious beliefs down other folks thoughts when they are in need of care?

  10. Submitted by Robert Gauthier on 01/14/2020 - 11:45 am.

    Having worked at Elmbrook and Saint Joe’s, I was surprised to hear about what happened to those patients. I know personally that there were several “ missed abortions” that resulted in D&C’s which is the procedure technically used for elective AB’s. In other words, they got an abortion electively.

    Sometimes There is something going on behind the scenes that is not apparent to a non-medical personnel. If there is a conflict between the OB doc and nurses, they can make life difficult in the specific conflicted interactions.
    In other words, the patient suffers because someone’s upset who is not pregnant. It’s a sad fact of life. Elmbrook is in Waukesha, which is an extremely conservative suburban, whereScott walker came from.

    It’s funny how people like to claim that such actions are pro-life and that the hospitals should be commended. In the same hospitals, I would get calls asking for me to standby while the respiratory therapist “practiced” an intubation on an already ventilated and intubated patient. Because they needed the practice. I would refuse and then catch hell from hospital because I did not believe non consented procedures that were unnecessary should be performed on sick patients for non medical reasons. Doesn’t sound very prolife to me. Or ethical.

  11. Submitted by Tom Anderson on 01/15/2020 - 10:15 pm.

    “Catholics run one-third of Wisconsin hospitals”

    Insert any other group you wish for Catholics. With the money and people to do it. Any takers? It is a free country and you are all, all eligible.

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