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D-HH, CMC plan to join forces brings abortion, end of life choice questions



Valley News Staff Writer
Friday, May 17, 2019

LEBANON — Anti-abortion activists and some Catholics have questions about what the plan for Dartmouth-Hitchcock Medical Center and Manchester-based Catholic Medical Center to join forces might mean for women’s health care and end of life choices.

As they prepare to file a proposal with state and federal regulators in July, the CEOs of two New Hampshire health systems — Dartmouth-Hitchcock Health, which includes DHMC, the state’s only academic medical center, and GraniteOne Health, which includes CMC — are hosting listening sessions, including one that took place at DHMC on Wednesday.

The CEOs have encountered pushback from some who see the plan as a threat to their values and those of CMC.

“I’ve been concerned for a long time about the amount of abortions that Dartmouth-Hitchcock performs,” Christine Caron, of Danbury, N.H., said during the question portion of the Lebanon session. Patients “need options that don’t affiliate themselves with taking life.”

Under the plan, announced in January, D-HH — which in addition to the 396-bed DHMC also includes five other hospitals — would join with GraniteOne Health, which in addition to the 330-bed CMC includes two other hospitals. Together, the new system would be known as Dartmouth-Hitchcock Health GraniteOne.

GraniteOne CEO Joseph Pepe said that coming together with D-HH will strengthen CMC and allow it to retain its identity into the future. CMC already has joined with two other secular hospitals in New Hampshire, Huggins Hospital in Wolfeboro and Monadnock Community Hospital in Peterborough, to form GraniteOne.

“We at Catholic Medical Center will never be secular,” he said.

The proposal includes safeguards to protect CMC’s Catholicity such as reviews by the bishop of Manchester and the National Catholic Bioethics Center. Under the proposal, which hospital officials are calling a combination, the member hospitals would continue to operate under their own boards of trustees.

D-HH CEO Joanne Conroy would be the CEO of the combined system and president of one region, while Pepe would be the president of the second region, they said in January. Nine of the new system’s board members would be appointed by D-H, and six would come from GraniteOne.

The Rev. Peter Libasci, bishop of Manchester, is supportive of the idea, which hospital officials say would be a “combination,” not a merger because the members would retain local boards and leadership.

“I am impressed with the deliberate discussions that have taken place thus far, and I believe that this combined system would strengthen Catholic Medical Center’s ability to care for the suffering and sick in our community, while at the same time maintaining the integrity of its Catholic identity,” Libasci said in an email on Thursday.

But difficulty melding the Catholic mission of CMC with D-H’s secular mission contributed to the failure of a previous attempt to bring the organizations together about a decade ago. A similar inability also led to the failure of a merger attempt between CMC and the Manchester-based Elliot Hospital in the 1990s.

“The inability to reconcile the Ethical and Religious Directives of the United States Conference of Catholic Bishops with non-Catholic healthcare services resulted in the end of that relationship,” Elliot spokeswoman Susanna Fier said in an email. “The charitable missions of both organizations were deemed to be incompatible.”

Opposition from Catholics does not surprise either Conroy or Pepe, but they say bringing the bishop and the Catholic bioethics center into the process early, they feel confident that this time is different.

“Their concerns are noted, but I don’t believe they understand all the work and due diligence we’ve put into this,” Pepe said in a phone interview on Thursday.

Other than explaining that the two institutions will retain their identities and that coming together will make both stronger, Conroy and Pepe declined to directly address Caron’s abortion questions during Wednesday’s meeting.

In a Thursday phone interview, Conroy said the rate of teen pregnancies and abortions are at their lowest since 1972. Of the women who seek care at DHMC, fewer than 5% elect to end their pregnancies, Conroy said.

“It’s invisible to anybody except the provider and patient,” Conroy said. “As it should be.”

Two other women at Wednesday’s meeting at DHMC also expressed concerns about the plan.

One, Susan Smith, of Newport, said she had worked as a registered nurse at DHMC for almost 11 years until six weeks ago. She said she believes she was let go because she disagreed with a patient’s treatment plan that involved removing his feeding tube. As a part of her dismissal, Smith, a Catholic, said she was told she could not be employed by any affiliates.

“What happens to employees … who stand up for their principles and then get terminated?” Smith asked during the meeting.

Conroy, in a Thursday phone interview, said she could not speak to any specific personnel matters.

But at the meeting, Conroy said that end of life care at the two organizations is not all that different and is “probably more similar than dissimilar.”

Pepe also said that while CMC may look at the end of life through the lens of Catholicism, the outcomes of patients at the end of life are actually quite similar at a Catholic and a secular institution.

“Not all feeding tubes have to stay in,” Pepe said at the meeting. “There are a lot of different things that go into it.”

The third woman who spoke at Wednesday’s meeting declined to provide her name but was interested in how the new relationship might affect a Catholic fertility treatment program available at CMC.

The program, which started about two years ago and does not offer services that conflict with the Catholic faith such as in vitro fertilization, “couldn’t have been made possible without the help from the OB/GYNs from Dartmouth,” Pepe said.

The two hospitals already share some clinical services in obstetrics, pre- and post-natal care, oncology, rheumatology, endocrinology and critical care. They have said they hope to expand that sharing as part of the creation of the new system.

New Hampshire Right to Life, in a statement on its website, urges members to oppose the merger on a variety of fronts, including concerns related to abortion, such as the requirement that DHMC providers refer women seeking abortions to providers who will perform them even if they themselves opt not to out of ethical concerns.

“For Catholics, abortion is pretty much murder,” Right to Life President Jason Hennessey said in a phone interview. “For the other side, ‘that’s just part of what we do.’ ”

Hennessey, who attended a listening session in Manchester earlier in the week, said he and other antiabortion advocates oppose the merger out of concerns that donations to CMC might be mingled with funds used for services that donors don’t support, such as abortion.

While there will be a shared bottom line, Pepe said that each hospital would be responsible for its own budget.

“Whatever’s raised in Manchester for CMC will stay in Manchester,” Pepe said.

Hennessey also said his organization is concerned that bringing two of the state’s largest hospitals together could mean higher costs for patients.

By pooling resources, Pepe said D-H and CMC would reduce costs and pass those cost reductions on to insurers. Whether those savings would be passed on to consumers, Pepe said, would be out of the health system’s control.

“We believe that the costs will actually go down,” Pepe said.

Given that most of the opposition has been related to preserving CMC’s Catholic mission and they feel that they have taken the steps necessary to do that, both Conroy and Pepe, in the interviews after Wednesday’s meeting, said they are optimistic.

“We think we’re managing this — specifically the Catholicity issue — efficiently,” Conroy said.

The fourth and final listening session on this tour will take place at 6 p.m. on June 6 at Monadnock Community Hospital in Peterborough. Additional public sessions will take place after the institutions file their proposal with regulators this summer.

More information about the plan can be found online at forahealthiernh.org.

Valley News Staff Writer Nora Doyle-Burr can be reached at ndoyleburr@vnews.com or 603-727-3213.