STATE DIIMER Catholics run one-third of Wisconsin hospitals, putting many reproductive procedures off-limits A retired obstetrician says Catholic restrictions kept her from providing the best care to patients: "When you have a moral conflict like that, it eats away at you: BY PARKER SOHORR (THE CAP TIMES) AND RIKHA SHARMA RAN FULLER ROeCT) is one of 15 states that does not have a process for con- trolling hospital expansions or mergers, often calleda Certificate of Need. In most ways, these Catholic hospitals, which trest one in every seven patients in the United States, differ from secular cnes in name only, Yet, crities say, in a small but imporetant ccener of reproductive care, Catholic ethics can trump medical best practice, bish ops can wield more infuence than physicians, and patients can be denied care they desire or need. of the most heavily retiant states Wisconsin is one uben it comes to health care from Catholic hospitals, with about one-third of the facilities governed by a set of directives from US. Catholic behops. These V ens dtesve ncoee and rural areas sometimes require doctors to deny or delay certain Imedical services. But the directives types of tive erph Hoptal in in Mihwaukee announced it would eut back services in 2018, resi dents of the surounding Sherman Park area balked. e predominantly black, lowincome neighborhood already faced its share of challenges. Nearly a third of residents in the ZIPcode live in poverty, and black infants born there are more than twioe as likeby to die as white infants. Residents feared that reducing CATHOLK HOSPITALS COMMON In Wisconsin, where Catholie Germans and Irish dominated immigration in the mid to li o thirdof hospitals are governed by principles-more than twice the national averagn Hospitals are not always transparent about the services they willand often lack a cholce of where they seek caree what Or. Kathy Hartke, aretired obstetrician and gynecologist and former chalirwoman of the Wisconsin section of the Amer- will not provide, and patients thee disparities, and even care they will receive, the Cap Times and the Puller kan College of Obstetricians and Gynecologists, recalls an o be shuttered complete Project found. Wisconsin is more heavily reliant on Catholie Incident she described as a "possible time bomb" in which Catholic directives required her to delay care to a woman who went into premature labor with twins. Sheis seen at her home in Brookfield, Wis ly. They protested tiercely to keep servioes in place, and St Joseph's parent company. Ascension Wis consin, eventual put the cuts on hold. St. Joseph Hospital works to maintain the community's trust and fulfill the unmet social needs of patients, through programs such as Blanket of Love, which educates families about "san ancho there." says Reggie New son health care than almost any other state in the coun try. It is the only state where black women are more ikety to deliver their bables in a Catholle institution than a non-Catholie one, Columbla Law School re searchers found. And in 12of Wisconsin's 2- the only hospitals These hospitals are governed by 77 directives. borders are Catholle. prenatal health, natrition and exercise rinstitutiont which fuse Catholic theology with medicine and lay out the Catholie Charch's vision a times, incladinga commit- on the margins of society and v Catholic hospitals should mergewith chief advocacy But St. of protest. Th he target ofadiffere bechnology. They of heakth care in modernr omoer M Ancensikn Wisconstn tkind Iis Catholie, which means t ca etof rules t0o serve those rules fr boe pon Catholie ones raldieties cover reproductive care that the h says can undermine the "biological, psycho- logieal and moral bonds" undergirding marriage and family. For example, Catholicaffliated hospitals rinen bethe ES Cenfneefcatholie Bishop The rules prohibit Cathedic hound extreme situations, from providing procedures the church deems immoral-including abortions, con traception and sterilization. In vitro fertilization is banned, as is physician assisted suicide which is legal innine chospitals, except in will not provide sterilization if the sole purpose is to Wisconsin is one of the states that relles most heavily on Catholic hospitals in the United States. Those hospitals e states and the Distriet of Columbia, although not in W Asma Kadri Keeler.a prevent a woman from becoming pregnant. And abortion is not permitted, unless t is an "un- avoidable" consequenoe of an action taken to save the mother's life, according to Brian Reardon, vice p dent of conmmunications and marketing fr CHA. ron what Include the Mayo Clinic Health System-Franciscan Healthcare hospital in La Crosse, Wis. It is one of 40 Catholic-affliated hespitals in Wisconsin. ca staffattorney at the ACLUof sin, recently met with members of the St. Joe's Accountatility Coalition, a community group formed ater Ascension announced its cutbacks. Afber she Wisconsin. e cn what the directives mear workarounds nhas a Madisen kinga theut Carhelie with some Wwensin, poticy, "Light rsays Informed them abouts bulhs went of in the r Although the community group had positive vlews of St. Joseph eresidents bold Keler they were worlied and hes Itant to sersd their pregnant loved ones to the hospital. Keeler says while the ACLU works to sadoruand religious ibert, it alenhas uedubun denjed care based on religkous restrictions Wet Questions were also sent to Aspirus and Mayo Clinic Health System-Franciscan Heakhcare, two non Cath- olie health systems that own hospitals that adhere to the ERD None responded individually. However, Nathaniel Blanton Hibner, CHAS director of ethies, sent a state hospital that refers patients common form of sterilization to undengo the proce dure at a nearby eye clinie that does surgeries. In oth er instances, adherence to Catholie directives bas led to denials and delays that physieians say put women's e mak by the health How Catholie law is interpreted varies by hospital and which doctor you have. Some physicians provide referrals for abortions and other rostricted services or ment on behalfof the organization and Ascension. SSM and Hospital Sisters Health System: Phosielans do preseribe contraceptives to ta derlying medical conditions" Hibner wrote, "Catholie I when patlents were working in Catholk facilities canand position that it treticions liberty) can't etake the be used to harm oeher people." sbe sanyk Reproductive rights advocates say the restrictions Impose religious doctrine on patients and violate medical standards treat a variety of un find workarounds to the Catholie rules, suchas pre seribing contraception for menstrual pain rather than birth control Others adbere strietly to the directives Out of donens of former and current medical resi dents, physicians, nurses and midwives in Wisconsin contacted by the Cap Times and the Fuller I only one currently practicing physiclan agreed to speak on the record for this story. Other currently practicing providers agreed to speak only anony mously because of concerns about negatively affect ing their careers or because they had been instructed not to by their employer. Commenting on the the Catholie peinciples, onse Milwaukne obstetrician bospitals also prowide emergency contraception to victims of rape or seal assault.Catholic hospitals also do not provide elective procedures where the sole intention is to cause the sterilization of the patient. Is of care in ways t communities like Sherman Park. that disproportion ately affecte Catholic health systems argue that they serve as safety nets in impoverished communities and pro- vide the same Accceding to the Cathole Health Association (CHA). which represents and advocates Sor the more than 600 Catholic hospitals in the United States, patients who recelved care at Catholichospitals are more likely to recommend those hospitals than patients who recelve care elubere That St. Joseph is both desperately needed and criticined reflects an increasingly common tension facing communities. An analysis by the Cap Times and the Fulker Project, a nonprotit news organization focusing on women's issues, shous that in Wisconsin. the mumber the mumber of non Catholie hospitals fell by the rProject. DOCTOR RECALLS POTENTIAL TIME BOM quality of care as secular hospitals Dr. Kathy Hartke worked in Catholie hospitals for 27 years. She recalls one patient from several years ago whom she says was negativey affected by the directives A young woman pregnant with twins arrived at the Catholic hospital in Brookfield, now known as Ascension SE Wiseonsin Hospital-Elmbrook Campus. Her water broke, and she began having labor contrae tions. At about 21 weeks, the fetuses had virtually zero chance of survival. e variation in implementation of who asked not to be named says: "t's very difficulr becaase you don't know what you're dealing with at different hospitals with diferent policles. Asridicu loas as it sounds, it'salmost like they have different religious valaes" Toclarity pret, apply and communicate the directives. the Cap Times and the Fuler Project sent a series of questions to six such hospital systems: Ascension. SSM Health, Hospital Sisters Health System, Divine Savior Health care, Essentia Health and Holy Family Memorial, y waited The longer they and her cervix remained dilated, the greater the risk the woman's uterus would become indected, Hartke said. But at Elmbrook, medical personnel were told they could not terminate the pregnaney as long as the d to terminate the pregnancy Wisconsin's Catholic hospitals inter rof Catholic hospitals grew by 13 percent, while same percentage, between 2001 and 2018 Wisconsin hospitals can make these moves with lit tle oversight-or regard for how business decisions might limit access to health care services, Wisconsin fetuses had heartbeats SEECATHOLC HOSPITALS, FACG STATE DIIMER Catholics run one-third of Wisconsin hospitals, putting many reproductive procedures off-limits A retired obstetrician says Catholic restrictions kept her from providing the best care to patients: "When you have a moral conflict like that, it eats away at you: BY PARKER SOHORR (THE CAP TIMES) AND RIKHA SHARMA RAN FULLER ROeCT) is one of 15 states that does not have a process for con- trolling hospital expansions or mergers, often calleda Certificate of Need. In most ways, these Catholic hospitals, which trest one in every seven patients in the United States, differ from secular cnes in name only, Yet, crities say, in a small but imporetant ccener of reproductive care, Catholic ethics can trump medical best practice, bish ops can wield more infuence than physicians, and patients can be denied care they desire or need. of the most heavily retiant states Wisconsin is one uben it comes to health care from Catholic hospitals, with about one-third of the facilities governed by a set of directives from US. Catholic behops. These V ens dtesve ncoee and rural areas sometimes require doctors to deny or delay certain Imedical services. But the directives types of tive erph Hoptal in in Mihwaukee announced it would eut back services in 2018, resi dents of the surounding Sherman Park area balked. e predominantly black, lowincome neighborhood already faced its share of challenges. Nearly a third of residents in the ZIPcode live in poverty, and black infants born there are more than twioe as likeby to die as white infants. Residents feared that reducing CATHOLK HOSPITALS COMMON In Wisconsin, where Catholie Germans and Irish dominated immigration in the mid to li o thirdof hospitals are governed by principles-more than twice the national averagn Hospitals are not always transparent about the services they willand often lack a cholce of where they seek caree what Or. Kathy Hartke, aretired obstetrician and gynecologist and former chalirwoman of the Wisconsin section of the Amer- will not provide, and patients thee disparities, and even care they will receive, the Cap Times and the Puller kan College of Obstetricians and Gynecologists, recalls an o be shuttered complete Project found. Wisconsin is more heavily reliant on Catholie Incident she described as a "possible time bomb" in which Catholic directives required her to delay care to a woman who went into premature labor with twins. Sheis seen at her home in Brookfield, Wis ly. They protested tiercely to keep servioes in place, and St Joseph's parent company. Ascension Wis consin, eventual put the cuts on hold. St. Joseph Hospital works to maintain the community's trust and fulfill the unmet social needs of patients, through programs such as Blanket of Love, which educates families about "san ancho there." says Reggie New son health care than almost any other state in the coun try. It is the only state where black women are more ikety to deliver their bables in a Catholle institution than a non-Catholie one, Columbla Law School re searchers found. And in 12of Wisconsin's 2- the only hospitals These hospitals are governed by 77 directives. borders are Catholle. prenatal health, natrition and exercise rinstitutiont which fuse Catholic theology with medicine and lay out the Catholie Charch's vision a times, incladinga commit- on the margins of society and v Catholic hospitals should mergewith chief advocacy But St. of protest. Th he target ofadiffere bechnology. They of heakth care in modernr omoer M Ancensikn Wisconstn tkind Iis Catholie, which means t ca etof rules t0o serve those rules fr boe pon Catholie ones raldieties cover reproductive care that the h says can undermine the "biological, psycho- logieal and moral bonds" undergirding marriage and family. For example, Catholicaffliated hospitals rinen bethe ES Cenfneefcatholie Bishop The rules prohibit Cathedic hound extreme situations, from providing procedures the church deems immoral-including abortions, con traception and sterilization. In vitro fertilization is banned, as is physician assisted suicide which is legal innine chospitals, except in will not provide sterilization if the sole purpose is to Wisconsin is one of the states that relles most heavily on Catholic hospitals in the United States. Those hospitals e states and the Distriet of Columbia, although not in W Asma Kadri Keeler.a prevent a woman from becoming pregnant. And abortion is not permitted, unless t is an "un- avoidable" consequenoe of an action taken to save the mother's life, according to Brian Reardon, vice p dent of conmmunications and marketing fr CHA. ron what Include the Mayo Clinic Health System-Franciscan Healthcare hospital in La Crosse, Wis. It is one of 40 Catholic-affliated hespitals in Wisconsin. ca staffattorney at the ACLUof sin, recently met with members of the St. Joe's Accountatility Coalition, a community group formed ater Ascension announced its cutbacks. Afber she Wisconsin. e cn what the directives mear workarounds nhas a Madisen kinga theut Carhelie with some Wwensin, poticy, "Light rsays Informed them abouts bulhs went of in the r Although the community group had positive vlews of St. Joseph eresidents bold Keler they were worlied and hes Itant to sersd their pregnant loved ones to the hospital. Keeler says while the ACLU works to sadoruand religious ibert, it alenhas uedubun denjed care based on religkous restrictions Wet Questions were also sent to Aspirus and Mayo Clinic Health System-Franciscan Heakhcare, two non Cath- olie health systems that own hospitals that adhere to the ERD None responded individually. However, Nathaniel Blanton Hibner, CHAS director of ethies, sent a state hospital that refers patients common form of sterilization to undengo the proce dure at a nearby eye clinie that does surgeries. In oth er instances, adherence to Catholie directives bas led to denials and delays that physieians say put women's e mak by the health How Catholie law is interpreted varies by hospital and which doctor you have. Some physicians provide referrals for abortions and other rostricted services or ment on behalfof the organization and Ascension. SSM and Hospital Sisters Health System: Phosielans do preseribe contraceptives to ta derlying medical conditions" Hibner wrote, "Catholie I when patlents were working in Catholk facilities canand position that it treticions liberty) can't etake the be used to harm oeher people." sbe sanyk Reproductive rights advocates say the restrictions Impose religious doctrine on patients and violate medical standards treat a variety of un find workarounds to the Catholie rules, suchas pre seribing contraception for menstrual pain rather than birth control Others adbere strietly to the directives Out of donens of former and current medical resi dents, physicians, nurses and midwives in Wisconsin contacted by the Cap Times and the Fuller I only one currently practicing physiclan agreed to speak on the record for this story. Other currently practicing providers agreed to speak only anony mously because of concerns about negatively affect ing their careers or because they had been instructed not to by their employer. Commenting on the the Catholie peinciples, onse Milwaukne obstetrician bospitals also prowide emergency contraception to victims of rape or seal assault.Catholic hospitals also do not provide elective procedures where the sole intention is to cause the sterilization of the patient. Is of care in ways t communities like Sherman Park. that disproportion ately affecte Catholic health systems argue that they serve as safety nets in impoverished communities and pro- vide the same Accceding to the Cathole Health Association (CHA). which represents and advocates Sor the more than 600 Catholic hospitals in the United States, patients who recelved care at Catholichospitals are more likely to recommend those hospitals than patients who recelve care elubere That St. Joseph is both desperately needed and criticined reflects an increasingly common tension facing communities. An analysis by the Cap Times and the Fulker Project, a nonprotit news organization focusing on women's issues, shous that in Wisconsin. the mumber the mumber of non Catholie hospitals fell by the rProject. DOCTOR RECALLS POTENTIAL TIME BOM quality of care as secular hospitals Dr. Kathy Hartke worked in Catholie hospitals for 27 years. She recalls one patient from several years ago whom she says was negativey affected by the directives A young woman pregnant with twins arrived at the Catholic hospital in Brookfield, now known as Ascension SE Wiseonsin Hospital-Elmbrook Campus. Her water broke, and she began having labor contrae tions. At about 21 weeks, the fetuses had virtually zero chance of survival. e variation in implementation of who asked not to be named says: "t's very difficulr becaase you don't know what you're dealing with at different hospitals with diferent policles. Asridicu loas as it sounds, it'salmost like they have different religious valaes" Toclarity pret, apply and communicate the directives. the Cap Times and the Fuler Project sent a series of questions to six such hospital systems: Ascension. SSM Health, Hospital Sisters Health System, Divine Savior Health care, Essentia Health and Holy Family Memorial, y waited The longer they and her cervix remained dilated, the greater the risk the woman's uterus would become indected, Hartke said. But at Elmbrook, medical personnel were told they could not terminate the pregnaney as long as the d to terminate the pregnancy Wisconsin's Catholic hospitals inter rof Catholic hospitals grew by 13 percent, while same percentage, between 2001 and 2018 Wisconsin hospitals can make these moves with lit tle oversight-or regard for how business decisions might limit access to health care services, Wisconsin fetuses had heartbeats SEECATHOLC HOSPITALS, FACG