Thursday, February 17, 2011

Catholic Hospital vs Secular Hospital -- What a change!

     Below is part of the mission statement of a large local hospital that I wish to speak about below:

"At (LOCAL LARGE HOSPITAL) we value the diversity of our patients, employees, physicians and visitors. We recognize the importance of intentional activities, projects and initiatives to help make our environment one that cares for and nurtures the health and personal development of every individual. The diversity of each of these individuals, makes CSM the successful organization it is today. Our success and growth are dependent upon our:

Creating an environment of continuous learning about diversity and inclusion

Community involvement

Creating new and innovative ways to serve others

Our patients and staff deserve an inclusive environment in which they can move towards optimum health and development without unnecessary barriers to their success. We are made stronger by the diversity of knowledge, experiences and perspectives we each bring to this environment."

     Recently my hospital at which I practiced for 34 years before I retired, merged with a large Catholic Hospital in Milwaukee. For some years the two hospitals, though joined, maintained their own separate campuses. Then this combined hospital conglomer decided to build a large brand new hospital building on the site of the Catholic Campus, using some of the old buildings but adding a huge new building. They then closed the secular campus and slowly moved all operations to the new hospital.

     I had been attending Grand Rounds Medical Education meetings once a week even after I retired. There was a month or 6 week hiatus in the Grand Rounds after the move, and then the meetings were again reved up.
     There was just one major problem which continues to be an admitted problem. No space was allowed in the new hospital for medical education. That is there is no auditorium or any large room with audeo visual capabilities which will seat more than 35 people comfortably. Our old hospital had a beautiful stadium seating auditorium with an audio visual room in the back, a small stage/riser across the front and a vestibule and cloakroom at the back. This room was not only used for staff medical doctor meetings at least once or twice a week, but the nurses used it, and it was sometimes used for patient meetings as well, also sometimes opened up to the community to give educational or leadership meetings. So the idea that the brand new up to date, hottest of latest technology hospital would not allow space for larger meetings and education was inconceivable to me. I was told that space had been allowed on the top floor but in decisions to cut costs and redesign, the space was taken for some other purpose. There is now a move to put a space in the medical office building on the site, but there is no allotment for audiovisual technology so that would have to be paid for by the doctors. Incredible!
     The meeting I attended on Tuesday was one of the bimonthly medical ethics meetings. Now I have attended many of these back at the old hospital. They are led by a PhD in ethics and examine various ethical dilemmas in medicine. You can imagine that such occasions arise in the life and death business of medical care. In past ethics meetings, there was not usually any significant consideration of Catholic canon or the ethical decisions being made in a Catholic Hospital. Well, now the whole hospital is really a Catholic Hospital. The topic was "Maternal and Fetal Medical Ethical Conflicts." Our ethics PhD presented a case from Phoenex, AZ which made national newspapers. A 23 year old woman had pulmonary hypertension, a disease which can cause heart failure and has imperfect treatments. She was given birth control and told not to get pregnant, but she did get pregnant and presented at about 7 weeks. It was recommended to her in the doctor's office that she should have the pregnancy terminated. She refused. Then she returned at 11 weeks of pregnancy in heart failure and in cardiogenic shock (the heart was no longer able to pump strongly enough to maintain the blood pressure and blood flow). In other words, she was sick unto death. She was going to die probably within a day or two if the pregnancy wasn't terminated. Finally at this Catholic Hospital in AZ, after an ethics consult and much discussion, it was decided to cause the fetus to be delivered. It was felt that the mother could be returned to at least the level of function that she had before the pregnancy in a few days without the added burden of the pregnancy on her heart. The Director of Medical Care at the hospital, a nun, after much deliberation did approve the pregnancy termination to proceed. After all the baby was going to die either way: of course, if the mother died, or if the pregnancy was terminated. The baby was not large enough to survive on its own even with ventilators and all the treatments available to premature infants. This was just too premature. Everything proceeded as planned, and the mother improved and was discharged from the hospital. About a year later, apparently the local archbishop somehow got word of this and a huge bruhaha occurred within the local archdiocese. Bad things happened to that Catholic Hospital. It's Catholic status was removed, which means the hospital loses its non profict status and there are all sorts of financial and social implications. The nun who still was Director of Medical Care was excommunicated and had to resign her job so that the ramifications did not extend to her Catholic Order. This information made it to the national news media, and many obstetricians around the country began to feel that they would not be able to practice at all in Catholic Hospitals around the country. These types of issues are always possible in a busy obstetrical hospital.
     Our ethics doctor began to go into the ethics of this whole case. He then brought out the Catholic issue of abortion, even to save the mother's life and how the Holy Canon is against this. He then tried to frame the case in a different ethical way in which under these circumstances a decision not to stop the pregnancy and save the mother's life would be classed as irrational. He really had to jump through some ethical hoops to try to get around the Catholic Canon. This type of lengthy discussion would have never taken place at the secular hospital where I was on the staff. One of my retired colleagues raised his hand and commented that the problem didn't seem to be ethical, but rather was only in question because of the religion at the hospital: Catholicism and its Canon. The ethicist had nothing to offer in response to that comment. I just found the whole lengthy and convoluted discussion to be so entirely different to the types of discussions that were held at these conferences at the previous hospital campus. What a change! I have since spoken with another OB on the staff at the nice new hospital. She cites an example just in the last 9 months of her practice at this new hospital, where she was set to stop a pregnancy also to save a mother's life, though the mother's life was not as immediately threatened as the Phoenix case. This OB said that the religious director of the hospital had found out about her surgical plans and was outside the OR telling her that she could not proceed with the surgery. The mother was already anesthetized. They had to get an ethics committee to come into the hospital and lots of discussion went back and forth, but finally she was able to proceed with her operation. It sounds to me that issues like this in lesser degree are more common than we think.

     I ask you to read again the above mission statement of the hospital with its paragraph about inclusivity and diversity. Do these types of case decisions sound like inclusivity and diversity? Can current medical care of the mother and the fetus mix with Catholocism? What do you think?

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