By Ann Carey

Texas hospital challenges bishop on sterilizations

Investigation finds evidence of 'serious misinterpretation' of U.S. bishops' code governing Catholic health facilities

A Catholic hospital in Tyler, Texas, is bucking the diocesan bishop's attempt to bring it in line with official Church teaching on sterilizations. The hospital, Trinity Mother Frances, disputes Bishop Alvaro Corrada's position that tubal ligations for contraceptive purposes violate the Ethical and Medical Directives for Catholic Health Care Services (ERD), the U.S. bishops' code governing Catholic health care facilities.

According to an investigative report by Our Sunday Visitor (OSV) in July, the hospital provided 1,619 female sterilizations out of a total of about 10,000 performed by Texas Catholic hospitals between 2000 and 2003.

After his own investigation into the report, Bishop Corrada released a statement in late November that he was "deeply saddened and upset" to discover "serious misinterpretation" of the ERD, resulting in "many direct sterilizations" being done in the two hospitals in his diocese.

Bishops in other dioceses with hospitals named in the report are still collecting and evaluating information, and meeting with health care officials, Andrew Rivas, executive director of the Texas Catholic Conference, and Brenda Trolin, executive director of the Catholic Health Association of Texas, separately told OSV.

"Until these are concluded we will not have all the information we need to respond to your request" for information on the content of the talks, Trolin said.

Medical necessity

Catholic teaching prohibits "direct sterilization," such as tubal ligations, that are performed to prevent future pregnancy, even if the sterilization is done in anticipation of a medical problem that may arise in a future pregnancy. Medically necessary procedures to treat "a present and serious pathology" like cancer of the uterus are permitted, and are considered "indirect sterilization" if the needed procedure causes sterility.

This distinction between direct and indirect sterilization has been a contentious point for years, in spite of repeated revision of the ERD by the bishops, as well as Vatican efforts to clarify the teaching. Complicating the picture are some ethicists and theologians who do not understand the ERD themselves and pass this misinformation along to bishops and hospitals.

In his statements, Bishop Corrada reported that one of his two hospitals, CHRISTUS St. Michael's Hospital in Texarkana, contacted him immediately when the allegations surfaced, conducted their own investigation and discontinued the prohibited procedure when the misinterpretation was pointed out. The bishop also urged in his statements that the other hospital in the diocese, Trinity Mother Frances in Tyler, take the same action.

But in a brief statement sent to OSV by Trinity Mother Frances spokesman John Moore and later posted on the hospital's website, the hospital denies performing "direct sterilizations." The statement said the ERD permit "medically necessary" indirect sterilizations and that "medical necessity" is determined by doctors in consultation with the hospital ethics committee. Also, the statement said that Sister Sally Marie Kiepura, provincial superior of the Sisters of the Holy Family of Nazareth, the hospital's sponsoring religious order, had requested a personal meeting with Bishop Corrada.

Asked for comment, Sister Kiepura said through a spokeswoman that she endorsed the hospital's statement.

Hospital 'equivocates'

But the diocese criticized the hospital's statement as insufficiently clear. The diocesan promoter of justice, Father Gavin Vaverek, said, "The hospital equivocates and does not clearly state whether they perform tubal ligations or not."

Father Vaverek, a canon lawyer, added that the hospital's statement tries to "obscure" by using language other than the ERD. The ERD make no mention of "medically necessary" procedures or "indirect sterilizations," the priest said. Rather, the ERD make clear that procedures that induce sterility are permitted only when their direct effect is to cure or alleviate a present serious pathology and a simpler treatment is not available.

The diocese's concern that the hospital is misinterpreting the ERD finds confirmation in an interview Moore gave to OSV for the July article. In it, he incorrectly cited conditions like cancer, heart disease and obesity as justifying sterilization under the ERD.

When the allegations about the Texas hospitals surfaced, Father Vaverek said the diocese was completely surprised. Diocesan authorities then spoke with the hospitals and determined that the protocols of both hospitals erroneously did allow for sterilization if a woman had health problems that might be complicated by a future pregnancy, he said. The hospitals were directed to bring their protocols in line with a correct interpretation of the ERD, and St. Michael's Hospital did this immediately, he said.

According to Father Vaverek, subsequent communication with Trinity Mother Frances has been through a hospital vice president who is legal counsel, not with the president or any provincial level people involved with the hospital's mission. Bishop Corrada has requested information from the president of the hospital, Father Vaverek said, but as of Dec. 12, the president of the hospital had not responded.

Father Vaverek also said that, contrary to Moore's statement, Bishop Corrada was "very sad to say" that, as of Dec. 11, Sister Kiepura had not requested a personal meeting with him. She had recently sent the bishop one letter, he said, "attempting to legitimate their practices of tubal ligations in exceedingly high numbers."

Inherited protocols

Misinterpretation of the ERD was widespread in Tyler, and apparently extended even to the previous bishop. Sister Damian Murphy, a Sister of Charity of the Incarnate Word who is vice president of mission integration at St. Michael's Hospital in Texarkana, said that when her hospital opened its ob-gyn department in 1994, the sisters consulted with Trinity Mother Frances Hospital and Msgr. William Broussard, then-president of the Catholic Health Association of Texas. She said that then-Tyler Bishop Edmond Carmody approved their protocols, and the sisters did not realize they had received bad information until they spoke with Bishop Corrada this summer.

Both Sister Murphy and St. Michael's CEO Chris Karam told OSV that the new protocol on sterilization had been well received by the medical community and its patient base because they appreciate the Catholic hospital. It was an opportunity to teach the values of the Catholic tradition regarding the dignity of the human person, Karam added.

The community has reacted well, Karam said, because the people appreciate what the sisters have done for them: "It's a great tribute to the sisters' service here."

What the Church teaches

Direct sterilization of either men or women, whether permanent or temporary, is not permitted in a Catholic health care institution. Procedures that induce sterility are permitted when their direct effect is the cure or alleviation of a present and serious pathology and a simpler treatment is not available.

-- Ethical and Religious Directives for Catholic Health Care Services, No. 53

Ann Carey writes from Indiana.