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St. Francis Memorial Hospital, San Francisco. (Photo by By Simon Cobb/CC0)
October 7, 2019
Lidia Wasowicz
When San Francisco-based Dignity Health and Catholic Health Initiatives, headquartered in Englewood, Colo., combined Feb. 1 into the nation’s second largest private health care provider, they built upon foundations laid nearly 1,700 years ago by Christians who risked death to tend to plague victims in fourth-century Rome.
Before he approved the development, Archbishop Salvatore J. Cordileone mulled over its fit into that history and the local legacy of trailblazing women religious who braved the Wild West to minister to fortune hunters lured by California’s Gold Rush.
He keeps those considerations in mind in ongoing assessments of the enterprise that comprises 142 hospitals – including 30 in California and four in the Bay Area – 150,000 employees, $29 billion in revenue and more than 700 care sites in 21 states, making it second among U.S. nonprofits in the number of hospitals and first in revenue.
In a conversation with Catholic San Francisco, the archbishop clarified the complex circumstances surrounding the formation of the new entity, dubbed CommonSpirit Health and based in Chicago and its impact on those in need of medical services in his archdiocese.
Here are excerpts from the interview:
Question: Can you briefly overview the history and legacy of Catholic health care, with a focus on the San Francisco archdiocese?
Answer: In ancient Rome … plagues would break out and anyone with the means to do so would flee to the cooler hills outside the city to escape. The Christians would stay behind to take care of the sick at risk to their own health and even their own lives. So already, from early on, we showed the kind of selfless service that Christians gave to those who were ignored by everyone else.
(In the chaos that followed the fall of Rome) monasteries really became the centers of learning and preservation of culture and instigation of scientific investigation (including) health care research. (He cited the example of an Italian monastery that pioneered microsurgery in the early Middle Ages.)
In later Middle Ages, with the crusades, we had the Order of Malta – initiated as a military order to try to reclaim the Christian territory – nursing the wounded (in the religious wars), which eventually developed into the hospital system.
Then religious orders emerged with their mission to care for the sick.
(Nuns, who started arriving in the Bay Area in the 1850s to help San Francisco’s first archbishop, Joseph Alemany, attend the physically and morally ailing ‘49ers, established hospitals, orphanages and schools.)
After the 1906 earthquake, they cared for everyone injured by the earthquake and fire, so much so the city granted them the privilege (still in effect) to ride the Muni without charge.
Q: How and where does CommonSpirit fit into this history and legacy of Catholic health care?
A: Catholic health care systems are struggling to find ways to remain operating in accordance with our values and our vision within a changed world (and) economy.
Dignity, (resulting from the 2012 reorganization of Catholic Healthcare West into a technically secular network of Catholic and non-Catholic hospitals) and (the consistently Catholic) Catholic Health Initiatives … saw the need to merge not just to be viable but to flourish.
(In the new system, all its Catholic hospitals form one corporation and Dignity’s non-Catholic hospitals another. Both groups agree to abide by ethical religious directives, which forbid such procedures as abortion, physician-assisted suicide and in-vitro fertilization. In one exception, non-Catholic hospitals may perform direct sterilization, provided any related revenue be donated to charity rather than) be mixed with the funds that the two put together to put up for bonds. So there’s no financial benefit from the revenue from these direct sterilizations.
(The merger) can increase the sort of impact the Catholic division of health care can have in the overall health care debate.
Q: Did anybody (besides the Vatican) have to sign off on the deal?
A: I had to give what we call a “nihil obstat,” which basically means no objections, because Dignity has its headquarters in San Francisco. Archbishop (Samuel) Aquila in Denver (CHI’s headquarters) had to do the same. And each of us had to consult with all of the bishops who have (Dignity or CHI hospitals in their diocese).
The bishops were unanimously in favor.
Q: What benefits and what drawbacks does the new system offer that the two pre-merger entities did not?
A: The first benefit is being such a large system and a Catholic system (and) the influence it can have on the whole general world of health care.
The second advantage is keeping them financially viable so they can continue to do their good work consistent with our Catholic health care vision … Two things that have made Catholic health care distinctive from the start are its commitment to health care for the poor (and) the Catholic vision of the human person (which makes) spiritual care an integral part of the overall care for people’s health.
Disadvantages? The formation of the health care workers is critical, and I think that might be a challenge now that (the hospitals) are not run by nuns and brothers who have a very deep formation and forsook the world to give their lives completely to this.
Q: Some analysts question the wisdom of medical mergers, warning they tend to result in higher prices and lower quality of service. Are you concerned that either might ensue from this merger?
A: No, because the profit motive isn’t the bottom line in Catholic health care. I get a little nervous when health care becomes a for-profit business.
Q: What is your vision of ideal Catholic health care in the archdiocese?
A: That anyone in need of health care can receive it, no matter their income, their insurance situation, and that the health care they receive will be in accordance with their human dignity, that they’re given spiritual care, that they know they’re loved and valued and given first place.
Q: Why did you approve the merger?
A: This was one of the most important decisions I’ll probably ever make as the archbishop here. I read all of the material presented to me, all of the opinions of the ethicists and the canonists, all the explanations, and they met with me so I could discuss it and I could ask questions. (The health care leaders) created a culture of trust because of their openness with me through the whole process.
Q: During its previous transformation, Dignity – whose hospitals include St. Francis Memorial and St. Mary’s Medical Center in San Francisco, Sequoia in Redwood City and Dominican in Santa Cruz – agreed to retain the U.S. Conference of Catholic Bishops’ Ethical and Religious Directives for Catholic Health Care Services for some of its 39 hospitals and 400 care centers in California, Arizona and Nevada. Was preservation of these directives a consideration in the approval of the merger?
A: That was the sine qua non (an essential condition). Without that it wouldn’t have been possible because this is a Catholic system so there had to be no exceptions to the ERDs for the CommonSpirit system.
Q: Do you have any concerns at this point about whether the merger will do more harm than good or do any harm that is not acceptable?
A: A point that needs careful attention is what I mentioned before – the formation of the health care workers, not just that they understand what our principles are but they understand why we hold those principles.
The other one would be we don’t know what kind of brave new world we’re facing down the line with these so-called transition surgeries and now they’re talking about these chimeras, human-animal hybrids, and who knows what kind of manipulations with reproductive technology. So the brave new world is kind of scary and what does that mean for Catholic health care?
Q: On the practical side, what can patients expect, any kind of changes from the merger?
A: I don’t think on the patient end, there will be much of a difference.
Q: To what degree can you offer reassurance that the merger will not endanger either Catholic teaching and doctrine or the quality, type and cost of health care services?
A: The merger is what’s keeping Catholic health care not only viable but prominent in our country, and we need that presence in the health care world so that the dignity of the patients will come first.