Lebanon -- Leaders of Catholic Medical Center and Dartmouth-Hitchcock Medical Center are moving forward with an agreement to align health care services in the Manchester area, although some activists oppose mixing the Catholic and secular organizations.

Dartmouth-Hitchcock Health and CMC Healthcare System, holding companies of the two institutions, have filed papers with the New Hampshire Attorney General's Office detailing their affiliation agreement.

Approval from the Charitable Trust Division of the Attorney General's Office is needed for the agreement to be enacted.

CMC and Dartmouth-Hitchcock officials stressed that the affiliation is not a merger, but provides the necessary corporate framework for the two organizations to make joint decisions and share resources in the region.

The affiliation agreement would allow CMC and Dartmouth-Hitchcock to collaborate without their divergent positions on issues such as reproductive health and end-of-life care clashing, said Alyson Pitman Giles, CMC's president and chief executive officer. “Each will maintain its own culture.”

The agreement would make Dartmouth-Hitchcock Manchester, a physician group practice, part of the CMC Healthcare System. At the same time, the CMC Healthcare System would be made a member of Dartmouth-Hitchock Health, an alliance that currently includes Mary Hitchcock Memorial Hospital and the Dartmouth-Hitchcock Clinic.

In order to become part of the Catholic medical system, Dartmouth-Hitchcock Manchester must adhere to the Ethical and Religious Directives issued by the United States Conference of Catholic Bishops. The directives prohibit abortion, contraception and some fertility treatments, and they forbid honoring some end-of-life decisions as directed by a living will.

Also, the bishop of Manchester “retains the ultimate authority to interpret non-compliance” with the Ethical and Religious Directives under the agreement. Nevertheless, Thomas Colacchio, a physician and president of Dartmouth-Hitchcock Health, said that the Manchester clinic's 120 doctors would not have to change their practices under the affiliation agreement.

“They will continue to provide services to their patients as they do today,” he said.

Practices such as prescribing birth control, sterilization procedures and artificial insemination would be exempted by the agreement, Pitman Giles said.

The Manchester clinic does not currently provide abortions, nor would it do so under the agreement, she said.

To integrate the Manchester clinic with CMC, the Dartmouth-Hitchcock Clinic would lease its services to Alliance Health Services, a subsidiary of CMC Healthcare System.

“What will be leased are the actual services that are being provided,” Colacchio said. “There is a set of services that we will be providing to Alliance Health for the care of patients, and there is a set of services that we will not be providing to Alliance Health.”

Doctors could provide the services exempted by the agreement, but CMC would not take payment or responsibility for them, he said.

Dartmouth-Hitchcock and CMC officials said that as nonprofit healthcare organizations, their common goal is to better serve the health needs of everyone in the community.

“We're focused on understanding how we can improve the health of the populations that we serve,” Colacchio said.

A tighter association between Dartmouth-Hitchcock and CMC could improve access in southern New Hampshire to the array of specialty medical services provided by Dartmouth-Hitchcock Medical Center.

“We're one of the few states that doesn't have an academic medical center in its largest city,” Pitman Giles said.

Better access to services that an academic medical center offers could benefit both parties because fewer patients might go to Boston or New York City for treatment.

Colacchio said that as part of the agreement, Dartmouth-Hitchcock would try to bring those specialty services to Manchester instead of trying to draw Manchester patients to Lebanon.

An affiliation with an academic medical center could also allow CMC to charge higher rates for certain procedures.

Leaders of the two organizations dismissed the opposition to their agreement based on conflicts between Roman Catholicism and secular medicine.

“I believe they are very vocal minorities on both sides,” said Pitman Giles.

She said that most people in the communities that would be served under the agreement, as well as medical staff, support the affiliation.

“From an internal and a local point of view, it is overwhelmingly positive,” she said.

Anti-abortion activists in the state are vehemently against the affiliation because some providers that belong to Dartmouth-Hitchcock Health perform abortions.

“I'm very sad that a Catholic, pro-life hospital is partnering with doctors that do abortions. I think it's outrageous,” said Barbara Hagan, a member of the New Hampshire Right to Life Committee, herself a Catholic.

She said that the committee would try to persuade the Attorney General's Office to deny approval of the affiliation agreement, and would also put pressure on the Bishop to withhold final approval.

Reproductive-rights activists have also raised concerns about the agreement, but Planned Parenthood of Northern New England, for one, is not taking action to block it at this time, said spokeswoman Dawn Touzin.

She said she was waiting to see if the Attorney General's Office would do a thorough legal review of the affiliation agreement.

“That to me will be the important next step,” she said.

As part of the 120-day review process, community forums are to be held in Lebanon and Manchester. Dates have not been scheduled, but Pitman Giles said they would be held sometime in the fall.

Touzin said that merely soliciting comments from the public wouldn't be enough to address her worries about access to reproductive health services under the agreement.

“We want the full level of public information that comes with a complete investigation,” she said.

Martin Downs can be reached at mdowns@vnews.com or (603) 727-3210.