By Rebecca Harshbarger
Sunday, March 1, 2009
For more than a decade, a hospital merger in New York state was held up by abortion politics. Last week, community activists gathered for a ribbon-cutting ceremony marking their hard-fought compromise.
(WOMENSENEWS)--It could be any other medical building in a parking lot, flanking a hospital.
But the outpatient surgery center that had its ribbon-cutting ceremony on Feb. 26 in Kingston, N.Y., six feet from Kingston Hospital, is far more than that.
By providing a place where Kingston Hospital could relocate some of its reproductive services the facility has moved abortion politics literally out of the way--a conflict that held up a hospital merger for more than a decade.
It also offers a possible model for other mergers that are being driven by the same state budgetary constraints and raising similar political hackles.
"Hospital mergers are a trend nationwide," said Cynthia Rozenberg, chief planning officer for Health Alliance Planning, an interim name for the consortium now forming to merge two secular hospitals with a religious hospital. "We are only one of many."
Rozenberg said the Foxhall Ambulatory Surgery Center is dedicated to guaranteeing access to reproductive health services. "We are moving abortions and sterilizations to a new center, and offering other services like gynecology and ophthalmology. It is one part of the new relationship between Kingston and Benedictine Hospital."
In 2006 the Berger Commission, a state panel created to review health care in New York state, ruled that Benedictine and Kingston hospitals had to merge to cut costs or one of them would be required to shut down.
"The perfect solution would be to have let Kingston Hospital keep delivering all the services it has over the years," said Lois Uttley, director of the Merger Watch Project, a group that formed when a merger between religious and secular hospitals in Troy, N.Y., resulted in a loss of contraceptive services.
"But this solution preserves key reproductive services within Kingston Hospital. It transfers the rest of them to an ambulatory surgery center immediately adjacent to the hospital."
Uttley says that community groups in Michigan, New Mexico, Colorado and Kentucky have been watching the merger in Kingston, a town of 23,000 on the western shore of the Hudson River, 91 miles north of New York City.
Between 1990 and 2001, 170 mergers united Catholic and non-Catholic hospitals, according to Catholics for a Free Choice, a Washington, D.C., advocacy organization. According to the group, reproductive health care was either reduced or eliminated in 50 percent resulting facilities.
The Foxhall center will operate as an independent, separately funded entity. That means Kingston Hospital will not violate Benedictine's religious codes against performing abortions and sterilizations.
Family planning services will continue to be provided at a separate clinic inside Kingston Hospital. Both Kingston and Benedictine distribute emergency contraception within their facilities. Benedictine offers emergency contraception to rape victims, despite Catholic policy that opposes all forms of birth control.
Uttley said Merger Watch's greatest concern now is the financial viability of the Foxhall Center, since it relies on a state grant to survive.
When construction on Foxhall began in August 2008, anti-choice activists picketed Kingston Hospital's parking lot and sidewalks. On Feb. 26, two anti-choice activists picketed the ribbon-cutting ceremony.
To defuse protest, planners diversified the center's services by including urology and podiatry. That way, protesters would not know which patients are coming and going for which services, making it more difficult to attack and intimidate women seeking abortions.
Jo Shuman is a nurse at a local men's prison and organizer for Health Care STAT, a Kingston-based community organization founded to protect women's health in light of the hospital mergers.
The group began almost 12 years ago, when a hospital merger was first being proposed among Benedictine and two smaller secular facilities, Kingston and Northern Dutchess.
"There were so many implications of the merger," Shuman said. "Many of us got involved because we realized during the women's movement that to really have power, we had to be in control of our bodies. And we were scared that we would lose reproductive health services in our community."
One thing Shuman said she worried about was that a merger would prohibit nurses and doctors at Kingston from counseling patients about safe sex and family planning. That, she said, could have posed a deadly problem if nurses could not talk about condoms to an HIV-positive patient. But in the merger agreement, Kingston Hospital will continue to provide family planning services through its Family Medical Institute clinic.
The compromise is a far cry from 1997, when Kingston, as well as the local Northern Dutchess, agreed to eliminate a range of reproductive services--such as tubal ligation, vasectomy and abortion--in order to merge with Benedictine.
That's when Health Care STAT started getting involved, Shuman said. Merger Watch has provided Health Care STAT with legal resources during the merger negotiations and its staff shared its story with other U.S. communities keeping an eye on similar mergers that put reproductive services at risk.
Had the merger gone through along the lines initially accepted by all the hospitals, community members would have had to travel miles to a small city across the widest portion of the Hudson River for reproductive health programs.
The coalition proposed alternatives, gathered thousands of signatures for a petition to save reproductive services, staged rallies, took out five billboards against the merger and mailed hundreds of letters to newspaper editors.
By September 1998 the Kingston Hospital board announced it would not support any future merger plans that forced the secular hospital to comply with the Catholic ethical and religious directives.
In 2006, the Commission on Healthcare Facilities, a group charged with lowering health costs throughout New York state, ordered Kingston and Benedictine to either merge to cut costs or face the shutdown of one or the other.
The hospitals resumed merger negotiations and at that point Uttley said she was seriously worried. "We were fearful that the hospital that could be left was the Benedictine Hospital. If that were the case, then all reproductive services would have been lost in Kingston."
Benedictine, Kingston and Margaretville Memorial Hospital, a 15-bed, secular hospital, are forming a health-care consortium to be called the Health Alliance of the Hudson Valley. It cannot be completed until Foxhall Ambulatory Surgery Center is up and running, due to requirements negotiated during the merger.
Together, the three hospitals receive about 15,000 admissions a year, according to Merger Watch. In the new consortium, each will promote the programs in which they have the most expertise, and will try to cut costs by avoiding service duplication.
Rebecca Harshbarger is a reporter for Women's eNews, based in New York City.