The State of Catholic Health Care in Washington, DC
The Catholic health care institutions in the District of Columbia largely reflect national realities about Catholic health care: the facilities pay their top officials well and could do substantially more to help the poor and meet their expected public obligation.
Seven Catholic health facilities in the city, including hospitals, long-term housing and long-term nursing centers, treated more than 12,000 people on Medicaid and Medicare in 2003. Included in the seven facilities are Georgetown University Hospital, affiliated with the Jesuit university and owned by non-Catholic MedStar Health, and Providence Hospital, a part of the Catholic nonprofit network Ascension Health; Georgetown University Hospital claimed gross charity care charges of $6.1 million from July 2005 through April 2006 (two months short of a complete fiscal year report), while Providence Hospital posted $17 million in charity care for the same period. The city’s Catholic universities offer some reproductive health care but often appear not to provide sufficient information to students about such care.
In May 2006, Pope Benedict XVI appointed bishop Donald W. Wuerl of Pittsburgh to succeed Cardinal Theodore McCarrick as Washington’s archbishop. The archdiocese counts more than half a million Catholics and has more than 80,000 students under its instruction.
The Catholic hierarchy in the District supports an advocacy office, the District of Columbia Catholic Conference (DCCC), that promotes public policy positions articulated by the leadership of the archdiocese to all branches of the District’s government. In addition to the DCCC, the archdiocese operates Catholic Community Services, composed of Anchor Mental Health, Catholic Charities, the Lt. Joseph P. Kennedy Institute and the Spanish Catholic Center.
The archdiocese is also represented by the Maryland Catholic Conference, as the Archdiocese of Washington contains the Maryland counties of Calvert, Charles, Montgomery, Prince George’s and St. Mary’s. Figures for the District of Columbia and the larger Archdiocese of Washington may be different.
District of Columbia at a Glance:
Catholic population in the Archdiocese of Washington: 578,796 (1)
Total population of the Archdiocese of Washington: 2,630,894 (2)
Catholic hospitals in the Archdiocese of Washington: 3 (3)
Catholic hospitals in the District of Columbia: 2
Total charity care for Catholic hospitals in the District of Columbia: $23.1 million
Total hospitals in the District of Columbia: 17 (4)
Annual number of patients served at Catholic hospitals in the Archdiocese of Washington: 387,130 (5)
Catholic-non-Catholic hospital mergers and acquisitions in the District of Columbia since 1994: 1
Catholic institutions serve a small percentage of the District health system’s patients but are important to many low-income Washington residents. In 2003, the Catholic system treated 8,838 persons on Medicare and more than 3,600 persons on Medicaid. (6) According to the US Census Bureau, nearly 77,000 citizens of the District of Columbia lack health insurance, making them potential clients of Catholic health care, which purports above all to serve the poor and marginalized.
The system employs nearly 7,500 people. As in other parts of the country, the top salaries of corporate officers in the District’s two Catholic hospitals are high. Figures from 2003 IRS forms indicate 31 corporate officers in District Catholic health institutions earned total salary and benefits of over $100,000 and eight earned packages exceeding $300,000. Some salaries were paid directly by the hospital entities, while others were paid by parent organizations.
District of Columbia Catholic Health Care
|Hospice, home health, assisted living and
senior housing facilities
[Catholic Health Association, “Catholic Health Care in the District of Columbia: Commitment to Serve” and “Catholic Health Care in the United States,” 2005.]
Church Ethics and Catholic Hospitals
Catholic health institutions operate under the Ethical and Religious Directives for Catholic Health Care Services, produced by the US Conference of Catholic Bishops Committee on Doctrine. The Directives lay out specific requirements and restrictions for Catholic-provided care, which differ in important ways from generally accepted non-Catholic health care norms. The guidelines forbid sterilization, most assisted reproduction, provision of contraception—including emergency contraception—and provision of abortion under all circumstances.
These restrictions are regularly imposed on non-Catholic patients, when the latter have access only to a Catholic hospital or are uninformed about theDirectives and their implementation.
Georgetown University Hospital: MedStar Health
Frequently, mergers or purchases involving both Catholic and non-Catholic health institutions lead to the Catholic guidelines’ being observed in the new entities created. These issues came into play in the District of Columbia in 2000, when MedStar Health, based in Columbia, Maryland, purchased Georgetown University Hospital from the Jesuit-run university. The hospital had accumulated more than $80 million in debt. After the purchase by a non-Catholic entity, the hospital, while claiming to be Catholic, can in fact only claim a “Catholic identity” and is not a traditional Catholic hospital as it lacks an official Catholic sponsor.
In negotiations on the deal, MedStar agreed to “preserve Georgetown’s strict adherence to the Ethical and Religious Directives for Catholic Health Care Services.” (7) , (8) A Georgetown University Hospital spokesperson told Catholics for a Free Choice—when asked whether the hospital offered certain reproductive health services—that the hospital “follows the religious directives of the Catholic church.” Accordingly, the hospital does not provide in vitro fertilization, abortions or sterilizations. It did not reply to a 2002 survey question about whether it provided emergency contraception to women who had been raped.
The hospital, founded in 1898, has 609 beds and employs 1,100 physicians. According to a hospital spokesperson, the facility had revenue of $515.2 million in 2005. The hospital reported $6.1 million in charity care from July 2005 through April 2006, two months short of the fiscal year. In that same period, the hospital had 16,478 admissions and 27,721 emergency room visits.(9) The three most frequent zip codes of inpatient origin at the hospital are 20007, 20016 and 20011, all of which are in the District. (10)
The facility was bleeding from debts in 2000 and was sold to MedStar on June 30 of that year. The hospital had lost over $200 million between 1997 and 1999. MedStar covered the hospital’s $80 million in outstanding debt and arranged for the university to earn up to $70 million more over the life of the sale agreement if the hospital met certain targets. (11) It was not the first time the secular MedStar had purchased a Catholic hospital. The $2.7 billion nonprofit corporation also owns Good Samaritan Hospital in Baltimore.
The Georgetown University School of Medicine Department of Obstetrics and Gynecology is home to the Institute for Reproductive Health, which researches, and promotes internationally, natural family planning. The institute receives grant funding from the U.S. Agency for International Development.
Providence Hospital: Ascension Health
Chartered by US president Abraham Lincoln in 1861, Providence Hospital is Washington’s only Catholic-owned and -operated hospital. Providence is the oldest continuously operating hospital in the District and was led for 15 years by Sister Carol Keehan, who subsequently became president of the national Catholic Health Association.
Providence Hospital is affiliated with Ascension Health, the nation’s largest Catholic health system, and operated by the Daughters of Charity of St. Vincent de Paul. The hospital has a 382-bed medical facility and a 240-bed rehabilitation center. According to its annual report, Providence Hospital had 15,157 admissions in 2004, along with 46,630 visits to its emergency room facilities. (12) Annual revenue for 2005 was $214 million, with $17 million allocated for charity care. (13) The top three zip codes of inpatient origin at Providence Hospital are 20011, 20019 and 20002, all of which are in the District. (14)
A spokesperson for the hospital confirmed in an e-mail that Providence does not perform the reproductive health care services that are banned by theEthical and Religious Directives. These services include abortion, sterilization and in vitro fertilization. (15) In a December 2002 survey of Catholic hospitals, Providence Hospital said it did provide emergency contraception in cases of rape to women who were not already pregnant. (16) That policy appears to be unchanged. (17)
All of the physicians on staff are bound by their contracts to the Ethical and Religious Directives. The hospital spokesperson said, however, that concerning observance of the Directives by doctors with offices in the Providence complex, hospital officials “understand where to draw the line and back off.” The spokesperson said the hospital cannot regulate or take responsibility for what is said “in the privacy of a physician/patient encounter.” (18)
“We won’t seek out confrontation with this issue. There is no upside to going that route,” the spokesperson said.
The hospital claims to be a major provider of charity care for the District. The spokesperson said the facility never turns away patients and that charity care is its “strong suit.” The spokesperson wrote in an e-mail, “We really do walk the walk on this…we did $17M of free care last year in DC.” (19)
Providence Hospital offers HIV/AIDS prevention and counseling services. It does not offer condoms but, according to the spokesperson’s e-mail, “It is common knowledge…that these are available within the same building, and Providence does nothing whatsoever to deter a woman (or man) from going that route. We provide information, we tell folks where we stand, but in no way will we pass judgment—that would be entirely inappropriate. To us, personal dignity and discretion trump dogma.” (20)
Charity Care in Catholic Hospitals in Washington, DC
Hospital Revenue Charity care Percentage of revenue
Georgetown University Hospital $515 million $6.1 million 1.2%
Providence Hospital $214 million $17 million 7.9%
Reproductive Health Care at Catholic Universities
In a 2003 survey of Catholic universities, Catholics for a Free Choice found that many did not provide students with basic reproductive health care or information about such care. Washington’s Catholic universities did not appear exceptional in this regard. The Catholic University of America, for example, said it did not offer sexuality education or pregnancy counseling but did refer students elsewhere for the latter. Catholic offered pap smears, annual gynecological exams, screening for and education about HIV and other sexually transmitted diseases and contraception for medical purposes.
In a 2002 article in the Georgetown University newspaper The Hoya, the university’s assistant vice president for communications said, “Consistent with our Catholic identity, Georgetown’s student health plan does not cover any reproductive or fertility services including contraceptives.… In fact, these have never been covered in any health insurance plan designed for Georgetown students.” (21) The university does provide “comprehensive pregnancy services such as free pregnancy testing kits” (22) and, according to one right-wing activist, employs adjunct faculty who hold senior positions at Planned Parenthood. (23)
|Day care centers||8|
|Special centers for social services||71|
|Students under Catholic instruction||82,022|
|Diocesan and parish high schools||1|
|Students served by diocesan and parish high schools||631|
|Private Catholic high schools||16|
|Students served by private Catholic high schools||9,121|
|Diocesan and parish elementary schools||88|
|Students served by diocesan and parish elementary schools||20,717|
|Catholic colleges and universities||3|
|Students served by Catholic colleges and universities||20,645|
[P.J. Kenedy & Sons, The Official Catholic Directory, 2005]
Restrictions on reproductive health care at Washington Catholic health institutions are substantially similar to those imposed in other parts of the country. Catholics and non-Catholics in the District are prevented by theDirectives from obtaining abortion or contraception at Catholic health facilities.
The impact of the restrictions is potentially enormous, since almost 77,000 District residents lack health insurance, and two of the major District hospitals are Catholic-operated. In addition, Catholic universities in the District often fail to provide basic reproductive health information and care to students.
Despite the fact that Washington’s local political leaders are almost all prochoice, several District laws restrict reproductive health care. Nothing in District law requires hospitals to provide emergency contraception to women who have been raped, and medical workers may refuse on grounds of conscience to participate in reproductive health procedures.
Washington’s role as the cosmopolitan federal capital appears neither to insulate the city from the obstacles Catholic institutions pose to reproductive health care nor to invite a special focus of the church’s antichoice efforts in the health sphere. In a city with an abundance of hospitals and health care providers, Washingtonians have ample choice about health care services and about whether they want the health care guidelines of the Catholic church imposed on them.
Local organizations that can provide information on access to reproductive health care in hospitals.
ACLU National Capital Area
1400 20th Street, NW, Suite 119
Washington, DC 20036
T: (202) 457-0800
La Clinica del Pueblo
2831 15th Street, NW
Washington, DC 20009-4607
T: (202) 462-4788
DC Abortion Fund
P.O. Box 33722
Washington, DC 20033
T: (202) 452-7464
DC Rape Crisis Center
PO Box 34125,
Washington, DC 20043
Phone: (202) 232-0789
Hotline: (202) 333-7273
NARAL Pro-Choice America
1156 15th Street, NW Suite 700
Washington, DC 20005
T: (202) 973-3000
National Women’s Law Center
11 Dupont Circle, NW, #800
Washington, DC 20036
T: (202) 588-5180
Planned Parenthood of Metropolitan Washington, DC
1108 16th Street, NW
Washington, DC 20036
T: (202) 347-8512
The Religious Coalition for Reproductive Choice
1025 Vermont Ave. NW
Washington, DC 20005
T: (202) 628-7700
Washington DC Department of Health
825 North Capitol Street, NE
Washington DC 20002
T: (202) 442-5925
1407 S Street, NW
Washington, DC 20009
T: (202) 797-3500
The Women’s Collective
1436 U Street, NW, Suite 200
Washington, DC 20009
T: (202) 483-7003
National Organization for Women – DC Chapter
1100 H Street NW, Third Floor
Washington, DC 20005
T: (202) 248-0928
(1) P.J. Kenedy & Sons, The Official Catholic Directory Anno Domini 2005, Papal Succession Edition.