By Ann Carey

Health Systems involved in the report

Ascension Health System, headquartered in St. Louis, Mo., has 65 acute care hospitals and operates facilities in 20 states and the District of Columbia. It is the largest Catholic health system in the country and the third largest of all healthcare systems. Ascension is sponsored by the Congregation of St. Joseph (Cleveland); the Sisters of St. Joseph of Carondelet (St. Louis); and four provinces of the Daughters of Charity (Albany, N.Y.; Emmitsburg, Md.; Evansville, Ind.; and St. Louis).

CHRISTUS Health System, with corporate headquarters in Irving, Texas, is the result of the 1999 merger of Sisters of Charity Health Care System and Incarnate Word Health System. CHRISTUS has 40 hospitals in six states and is the fifth largest Catholic health system in the country. CHRISTUS is sponsored by the Sisters of Charity of the Incarnate Word, based in Houston. The sisters also co-sponsor the Catholic Healthcare West system, headquartered in San Francisco, along with five other orders of sisters. Catholic Healthcare West has 41 hospitals and medical centers in California, Arizona and Nevada. It is the eighth largest hospital system in the nation and the fourth largest Catholic system.

Franciscan Services Corporation of Sylvania, Ohio, has six hospitals in Texas and Ohio and is sponsored by the Sisters of St. Francis of Our Lady of Lourdes of Sylvania. Members of Franciscan Services Corporation are St. Joseph Health System and Trinity Health Services Corporation, both in Texas, and Trinity Health System of Steubenville, Ohio.

Sisters of Mercy Health System, headquartered in St. Louis, has 18 acute care hospitals in four states and is the 10th largest Catholic system in the country. Its hospital in Laredo was included in the report but was sold in 2003 and now is named Laredo Medical Center. Mercy Health System is sponsored by the Sisters of Mercy of the Americas, whose institute office is in Silver Spring, Md. They also sponsor or cosponsor six other national health systems.

St. Joseph Health System of Orange, Calif., sponsored by the Sisters of St. Joseph of Orange, has 14 acute care hospitals in California and Texas. In Texas, the Covenant Health System is a member of St. Joseph Health System.

Trinity Mother Frances Health System, with two hospitals, both in Texas, is sponsored by the Sisters of the Holy Family of Nazareth, Holy Family Province, whose provincialate is in Des Plaines, Ill.

(Note: Hospital rankings were obtained from the 2008 "Hospital Systems Survey," published in the June 16 issue of Modern Healthcare magazine. The national rankings are based on net patient revenue.)

An OB-GYN blames excessive focus on the bottom line

"I would estimate from speaking with my colleagues around the country, that at least a majority of Catholic hospitals allow sterilizations done in conjunction with, or at the same time as, a repeat Caesarean section," says Dr. Lorna Cvetkovich (SET-ko-vitch), an obstetrician/gynecologist since 1983 who practices medicine at the Tepeyac Family Center in Fairfax, Va., and also serves as regional director for the Catholic Medical Association.

This is happening, she said, partly because of "the deep and wide acceptance of, and desire for, sterilization in our society, including among Catholics." Also, many Catholic hospitals now have non-Catholic boards and administrators focused on the "bottom line" and on keeping the hospital financially solvent in a financially tenuous arena. The ERDs, she said, are seen as stumbling blocks to provision of services that are offered by their competitors.

"They rationalize that if they don't offer the full smorgasbord of contraception, abortion, sterilization, and Assisted Reproductive Technologies, patients will go elsewhere for those services, as well as for delivery of their babies, and thus they will lose the small financial margin which allows them to care for the underserved."

Dr. Cvetkovich believes because authority over Catholic hospitals traditionally came from religious orders, when they changed their policies to allow some of these procedures, some bishops may have believed they did not have the authority to intervene, based on inaccurate advice from ethicists and canon lawyers.

"I believe it likely that in some cases, such policies and procedures were obscured or even outright denied when questioned by diocesan authorities," she said. "In general, it has been the great confusion over Catholic teaching on contraception and sterilization over the past 40 years which led to pressures on many fronts and thus paved the way for the blatant disregard for the ERDs we see in Catholic health care today."

Indirect? Direct?

Sometimes a serious medical condition requires treatment that will leave a person infertile. This could happen in treatment for ovarian, uterine or testicular cancer. And sometimes a woman's uterus must be removed because of a complication of childbirth, like placenta previa, which may cause severe hemorrhaging. In such cases, a serious condition is present, and the sterility is an indirect effect of a necessary treatment.

Direct sterilization, on the other hand, is intended to prevent a future pregnancy. The severing or clamping of the female fallopian tubes or male vas deferens is not a treatment for any pathology, because this surgery kills the tubes. And future pregnancy, even if it brings potential health risks for the mother, is not a "serious pathology."

In their book, "Life Issues, Medical Choices" (Servant Books, 2007), moralists Janet Smith and Christopher Kaczor explain there are cases in which a woman's uterus is not a threat to her health while not pregnant, but may become a threat if she were to become pregnant.

The Church does not permit tubal ligation or hysterectomy even in these cases, they write: "The Church teaches that acts that directly cause sexual acts to be infertile are intrinsically wrong."

"Couples facing serious medical situations of this type would want to learn a very reliable method of natural family planning and follow it with due diligence," they said.

Ongoing confusion

Even now, the spokesmen for some Catholic hospitals appear confused about the immorality of sterilization in some cases.

Months ago, Our Sunday Visitor asked a number of spokesmen for Catholic health systems operating in Texas about data available from a trade group, Texas PricePoint, that provided hospital statistics based on state data on its website, www.txpricepoint.org.

The latest PricePoint report available -- 2005 -- shows data for "vaginal delivery with sterilization" at most of the Catholic hospitals that also appear in the WikiLeaks report. While the PricePoint data is less precise because it includes procedures that are morally acceptable, it suggested that sterilizations were being performed.

Our Sunday Visitor contacted each health system involved for comment, and their responses revealed some of the misinterpretations of the Ethical and Religious Directives.

Trinity Mother Frances spokesman John Moore said their hospital observes the ERD and provides only "medically necessary sterilization procedures" (PricePoint reported 174 out of 1,717 deliveries in 2005 at their Tyler hospital), which he said are necessitated by conditions such as cancer, heart disease and obesity. But Moore's exceptions would not be permitted under the directives.

Covenant Health System spokeswoman Gwen Stafford said its hospitals honor the ERD, and that the PricePoint data in that category could mean a "dilation and curettage" (D&C) rather than a sterilization. Covenant's three hospitals reported 249 procedures in that category out of 1,615 vaginal deliveries -- a 15 percent rate. That's higher than normal, according to Dr. Thomas Hilgers, founder and director of the Pope Paul VI Institute and a clinical professor of obstetrics at Creighton University Medical School. He said that in his experience the incidence of D&C following vaginal delivery is only about 1 percent.

CHRISTUS spokeswoman Abby Lowe said that in all CHRISTUS hospitals, a committee reviews each sterilization request and determines whether or not the request falls in line with ERD 53, which she said "allows indirect sterilization." PricePoint reported 84 sterilizations at CHRISTUS Spohn Hospital Corpus Christi -- Memorial, and 48 at the Beeville hospital. Lowe said that the hospital in Beeville is leased from the city and does not do sterilizations itself, but licenses its operating room space to a separate corporation that does the procedures. Because the sterilization provider is a separate corporation, it is not subject to the ERDs, she claimed. But the Vatican and ethicists have disputed such claims in the past.