Mergers threaten CATHOLIC ETHICS St. Michael's - WELLESLEY IN TORONTO.

Mergers involving Catholic and public health services have created ethical conflicts everywhere. The most recent cases involve the Mineral Springs (Catholic) hospital in Banff, AB, where the Alberta Department of Health insisted that abortionists be allowed to ply their deathly ministrations or else acute services would be moved elsewhere (Western Report, November 1998); and the merging of two hospitals in Sault Ste. Marie, ON, with the surviving Catholic hospital being asked, or ordered, to provide "a full range of hospital-based services, including women's reproductive services" (The Sault Star, Jan. 21, 1999). For those who don't know, "reproductive services" is another name for use of contraceptive instruments, sterilization, or abortion.

In Toronto, the downtown Wellesley Street Hospital has been merged with St. Michael's Hospital. After a futile campaign by aggressive "gays"--abetted by free publicity from the Toronto Star--to overthrow the Catholic Code of Ethics at St. Michael's, the "solution" now calls for a separate unit at Wellesley-Sherbourne-Street, where the assault on human life (i.e., "reproductive services") may be carried out freely. Our medical contributor, Dr. John Shea, MD, has some thoughts about the technical aspects of the new arrangement.

Editor

The Toronto Star, December 27, 1998, under the title "St. Mike's clinic set to offer sex health services," quoted Stephen Squibb, head of the Sherbourne Hospital Corporation, as saying,

"We don't expect to be restricted in any way by St. Mike's Health-Care Ethics Guide....If they (abortions and vasectomies) are not readily available in the South Toronto area, I would say, maybe we would go beyond counselling and referral."

He said that his institution would be in a position "to provide abortion referral and other sexual and reproductive health services."

Sherbourne Board

The Sherbourne Health Centre Board, proposed by the Health Services Restructuring Committee, consists of fifteen persons, five from St. Michael's board, five from the Wellesley Central board, and five from the local community. The Sherbourne Board awaits incorporation approval from the Ontario government.

On January 26, 1999, Jeffrey C. Lozon, president and CEO of St. Michael's Hospital, Toronto, said in a letter to the Toronto Star headed "Sex health clinic independent of St. Mike's", that the paper's December 27, 1998, report was misleading in the statement, "St. Mike's health clinics set to offer sex health services." Lozon stated,

"It implies that the Sherbourne Hospital Corporation is a Catholic institution and that it is affiliated with St. Michael's Hospital. [But] the Sherbourne Health Corporation is an independent legal entity, that operates under its own fifteen-member board of directors.... Only five of these are representatives of St. Michael's Hospital" (Emphasis mine).

Is not the last part of the sentence an admission that St. Michael's Hospital is represented on the board of that Centre?

Mr. Lozon, appointed Deputy Minister of Health by Ontario Premier Michael Harris in late February, went on to explain that the Health Services Restructuring Committee had directed St. Michael's Hospital to

"provide specific agreed-upon services under a management contract.... These services will not include programs and services not currently offered by St. Michael's Hospital. The contract will be negotiated with the Sherbourne Hospital Corporation and finalized with the Ministry of Health.... St. Michael's Hospital will not provide services that would contradict its mission as a Catholic institution, but presumably the Sherbourne Hospital Corporation could contract with another institution to provide such services, or it could provide such services itself.... The Sherbourne Hospital Corporation is independent and autonomous and therefore has no affiliation with St. Michael's Hospital."

In the light of these statements, one must ask the following questions:

1) What exactly are the terms and conditions of the management contract between St. Michael's Hospital and the Sherbourne Health Centre?

2) What role does St. Michael's Hospital fulfil in this contract; that of manager, supplier of services, or both?

3) The Health Services Restructuring Commission directed St. Michael's Hospital, in conjunction with the Wellesley Central Hospital, to incorporate a new corporation by November 30, 1997, the "Sherbourne Hospital Corporation" to establish ownership and governance of an ambulatory care centre (No.4). They were also directed to enter into an agreement with the Sherbourne Hospital Corporation to manage its operations (No.6). Was not St. Michael's therefore clearly directed to be involved in the incorporation and management of the new ambulatory care centre?

4) St. Michael's has agreed to provide five board members from their board to act as members of the board of the Sherbourne Hospital Corporation. Have they not agreed to help manage the centre by their participation in the Sherbourne Hospital Corporation Board? They have agreed to provide (as yet unspecified) programs and services for that centre. How can they validly claim to carry no responsibility for the operation of the Sherbourne Health Centre? Only board members have the authority to set policy and manage an institution. How can Mr. Lozon claim that there is no affiliation between the two institutions?

5) What will the insurance policy of St. Michael's Hospital cover? Will it, for example, cover the cost of lawsuits brought against the Sherbourne Health Centre, such as might arise as a result of a botched abortion?

The answer to this question should reveal, at least, the legal responsibility of St. Michael's for its management of the Centre.

6) A final question must be answered. Do not the five members of the St. Michael's Hospital Board who were appointed to the Sherbourne Health Centre Board act as agents of St. Michael's Hospital Board inasmuch as they act within the parameters of their appointment by the St. Michael's Board. Do they not also act as agents of the Sherbourne Health Centre? They do not act in a private capacity. In the event that the Sherbourne Hospital Corporation were to be sued, what is the legal responsibility of the Board of Governors of St. Michael's, and of the owners of St. Michael's Hospital, the Sisters of St. Joseph, or the new Catholic Health Care Corporation?

Mr. Lozon's explanation of the Directions given by the Health Services Restructuring Commission to the St. Michael's Board of Directors may be misleading because it is incomplete. The commission had instructed St. Michael's, he said, to "provide specific agreed-upon services under a management contract...." These "services" are as yet unknown.

More importantly, has not Mr. Lozon, according to the press report, ignored the fact that St. Michael's was directed in no uncertain terms to provide five of their board members to act as members of the board of governors of the new ambulatory care clinic owned and governed by the new Sherbourne Corporation?

American equivalent rejected by Rome

Not only that, but St. Michael's was also instructed that, after an initial period of three years during which the Wellesley Central Hospital would provide five members of the Sherbourne Hospital board, St. Michael's would continue to provide five members of their hospital board to function as members of the Sherbourne Hospital Board. These five members would constitute one-third of the membership of the board. In other words, these St. Michael's directors were not limited to just the provision of certain specified services and the management thereof; were they not also directed to be responsible for the general conduct of the Sherbourne unit covering everything, including abortions?

In August, 1997, a merger was proposed between a Catholic hospital (St. Peter's Medical Center) in New Brunswick, New Jersey, and the Robert Wood Johnson University Hospital. The affiliation between the two institutions was essentially focused on "women's reproductive programs". An arrangement was made whereby there was an allegedly separate board for the shared facility which dealt with those programs. The local bishop referred the matter to the Vatican Congregation for the Clergy, which forbade the proposed affiliation. It alluded to "a sense of risk ... that the Christian perspective was not adequately addressed". The rejection was dated June 16, 1997.

Msgr. Wm. B. Smith, a well-known American moral theologian, has pointed out (Homiletic and Pastoral Review, Jan. 1997) that there is a danger of scandal where a Catholic institution ends up owning, sponsoring, or otherwise merging its Catholic mission with the delivery or sponsorship of what the Catholic Church forbids. Does not the fact that St. Michael's has agreed to provide five board members to the Sherbourne Health Centre board constitute at least a sponsorship of the Centre? It should be noted that to undertake to provide a third of the membership of the Sherbourne Health Centre hospital board all but guarantees that St. Michael's Hospital will be unable to have any real influence on that board's decisions. The fact that St. Michael's has let itself be put in such a parlous moral position is incomprehensible.

If there are any valid answers to these questions, they should be provided in order to prevent the appearance of scandal. If there are no valid answers, then St. Michael's Hospital should withdraw its members from the Sherbourne Hospital Corporation Board.

John Shea is a retired diagnostic radiologist and a Fellow of the Royal College of Physicians of Canada. He is past president of the Catholic Doctors' Guild of Toronto, a co-founder of the Canadian Fellowship of Catholic Scholars, and an associate editor of Catholic Insight.