The Catholic Church and Its Hospitals: A Marriage Made in Heaven?

Description

Do you know if your hospital is Catholic? Do you know what that means for your care and your community? The answers are most probably "No."

The Catholic Church and Its Hospitals: A Marriage Made in Heaven?, a new book from the American Association for Physician Leadership, will answer these questions and pose many others in an expansive examination of the Catholic healthcare system in the United States.

Written by Patricia A. Gabow, MD, MACP, with a Foreword by Donald M. Berwick, MD, MPP, this well-researched volume delves deep into the origins, evolution, and the present-day implications of the Catholic healthcare system in the United States. The book traces Catholic healthcare's lineage from its biblical foundation to the role of courageous women religious in providing care to those in need, to the modern era of bishops' control over hospitals, doctors, and their clinical practice, determining the care that will be provided to millions of Americans.

In the United States in 2021, six of the 25 largest healthcare systems were Catholic. Forty-six states have Catholic hospitals, with 14% of the hospital beds under Catholic ownership — exceeding 40% of the beds in some states.

These hospitals, their other healthcare components, and all their providers must follow 77 rules established by the bishops — the Ethical and Religious Directives for Catholic Health Care Services (ERDs). These rules cover a huge swath of healthcare for Catholic and non-Catholic patients, including almost every aspect of reproductive and end-of-life care. The ERDs take precedent over a physician's oath or judgment. A number of laws permit physicians and institutions to provide care in accordance with their beliefs, independent of a patients' own beliefs or choices.

Physicians, healthcare providers, policymakers, and patients need to understand this dynamic in the face of the reach of Catholic healthcare. Yet, there is a surprising lack of institutional transparency. Patients often do not know if their hospital is Catholic and what care is prohibited.

At its core, this book illuminates the noble origins of the Catholic healthcare system and explores how Catholic nuns, with a deep-seated commitment to service to the most vulnerable, laid the foundation of Catholic healthcare. Gabow immerses readers in inspiring tales of compassion and dedication, where care was not a financial transaction, but a selfless act of mercy.

As the narrative unfolds, it examines the shift from these humble beginnings to a system now characterized by broad reach, wealth, and power with important ramifications for hospitals, doctors, patient autonomy, and patient care.

The Catholic Church and Its Hospitals: A Marriage Made in Heaven? examines these institutions' fidelity to the Catholic Church's commitment to the poor and most vulnerable and their stated missions to care for that population. The hospitals' not-for-profit status affords them tax exemptions, but do these institutions give back the same amount to their communities?

More than just a historical overview or a critique, this is an enlightening guide that underscores Catholic healthcare's contributions and uncovers its weaknesses. It makes a compelling argument for re-examining policies and practices to ensure the Catholic health system stays true to its roots of service and charity.

Geared Towards:

• Policymakers and funders
• Politicians and legal scholars
• Healthcare leaders and physicians
• Insurers and patient advocacy groups
• Ethicists and investigative journalists
• Catholic leaders, academics, and students in health administration
• Catholics and the general public interested in the interplay of religion, power, healthcare, and society

This book will open your eyes to the history, rules, reach, and healthcare implications of Catholic healthcare in America. It will ask you to consider how transparent healthcare institutions should be with their patients. It will ask you to examine what it means to be a not-for-profit healthcare institution. Finally, it will ask you to examine the boundaries between the exercise of beliefs by hospitals and physicians and the delivery of healthcare in America's pluralistic society.

About the Author

Patricia A. Gabow, MD, MACP

Patricia A. Gabow, MD, is a national healthcare leader who has focused on the care of vulnerable populations and the institutions that serve them. She spent 40 years at Denver Health, a highly integrated healthcare system and Colorado's major safety net institution. The last 20 of those years was as CEO, retiring in 2012.

She began her career as an academic clinician and researcher in the area of renal disease. Gabow's healthcare leadership career led from head of the renal service to director of the medical services (chair) to the system's medical director to CEO. While CEO she transformed a struggling public hospital system into a model integrated, high-quality, fiscally stable system.

As healthcare and health policy leader, Gabow has served on the Commonwealth Commission on a High Performing Health System, the federal Medicaid and CHIP Payment and Access Commission (MACPAC), is currently on the Robert Wood Johnson Foundation Board (2013–2024) and chairs the Lown Institute Board.

She has authored over 130 articles, 36 book chapters, and two books, including The Lean Prescription: Powerful Medicine for Our Ailing Healthcare System and TIME'S NOW for Women Healthcare Leaders: A Guide for the Journey.

Gabow's numerous awards include the American Medical Association Nathan Davis Award for Outstanding Public Service, the Association of Medical College's David E. Rogers Award, the Health Quality Leader Award from the National Committee for Quality Assurance, The National Healthcare Leadership Award, the Gustav O. Lienhard Award from the National Academy of Medicine, and the Ohtli Award from the Mexican government.

She was elected to the Association for Manufacturing Hall of Fame and the National Academy for Social Insurance. Gabow has received honorary degrees from the University of Colorado School of Medicine and the University of Denver. She graduated from Seton Hill University and the Perlman School of Medicine of the University of Pennsylvania. She is Professor Emerita of the University of Colorado School of Medicine and a Master of the American College of Physicians.

Table of Contents

Dedication

Acknowledgments

Foreword by Donald M. Berwick, MD, MPP, President Emeritus and Senior Fellow, Institute for Healthcare Improvement

Introduction

1. The Foundations of Healing
2. The Beginnings of Catholic Healthcare in America
3. Exemplary Mothers
4. The Hierarchy and the Rules
5. The Impact of the Rules on Patient Care
6. Fulfilling Oaths and Following Conscience
7. The Landscape of Catholic Healthcare
8. Mission Fidelity
9. Walking the Old Path and Building New Roads

References

Testimonials

• "Like the nuns who trained her, Dr. Gabow has never taken no for an answer. She always seeks the yes that will lead to better medical care for those in need. When other cities shut down their safety-net hospitals, Dr. Gabow built hers up. After decades of leading the way in developing sustainable systems for caring for the indigent ill, she delivers an urgent plea that all policymakers, administrators, and clinicians should heed. All should attend to her trenchant call for an equitable version of Catholic healthcare." — Abraham Nussbaum, MD, Chief Education Officer, Denver Health; Professor of Psychiatry, University of Colorado School of Medicine; Author of Progress Notes: One Year In the Future of Medicine
• "I couldn't put this book down. In her latest blockbuster, Dr. Gabow diligently traces the path that Catholic healthcare in America has followed, from its altruistic roots to its current role as a major player in the healthcare landscape. Her clarion call for transparency could not be more timely, as medical practice has achieved a level of sophistication that puts it more and more at theological and philosophical odds with basic tenets of Catholicism. It is an important conflict in need of resolution, and Dr. Gabow not only lays out the issues but proposes a path forward in this courageous work." — Nanette Santoro, MD, Professor and E. Stewart Taylor Chair of Obstetrics and Gynecology, University of Colorado School of Medicine
• "In one of the largest Catholic health systems where I served as vice president, we often said 'no margin no mission' to justify our choices. She may be the only person qualified to do so. She is a physician, a former CEO of the largest safety net healthcare systems in Colorado, a national leader in delivery system innovation and care for vulnerable populations, and a practicing Catholic. Dr. Gabow takes us on a journey from the very beginning of Catholic healthcare, through the many facets of care delivery today. She thoughtfully questions current practices and offers ideas for moving forward. May her work provide grounding for future discussions and actions that improve care for every American, especially the most vulnerable." — Evon Halladay, MBA, Former Vice President, Catholic Health Initiatives
• "This is a passionate dissent against the financialization of Catholic healthcare institutions and the extension of church doctrine into realms where it does not belong. Gabow's voice, grounded in church teachings, needs to be heard — in statehouses, in Congress, in the Vatican, in C-suites, and by everyone who cares about the future of American healthcare." — Merrill Goozner, Former Editor and Columnist for Modern Healthcare; Editor and Publisher of GoozNews
• "Dr. Gabow closes by charting a pathway for revitalizing the Catholic commitment to caring for the sick, especially the poor, thus rekindling the vision of the Church and its hospitals as the fruit of a marriage made in heaven." — Michael J. Baxter, PhD, Department of Religious/Catholic Studies, Regis University, Denver, Colorado
• "With careful referencing and inclusion of scripture, Dr. Gabow delineates the history, mission, and foundational role Catholic healthcare institutions played in caring for poor, vulnerable, and marginalized Americans. As financial and secular forces changed Catholic healthcare, Gabow examines the ways it strayed from its noble past and offers a framework for getting back on track. Gabow doesn't pull any punches. Students of US healthcare, especially those concerned with health equity, will find this a must read." — Risa Lavizzo-Mourey, President and CEO Emerita, Robert Wood Johnson Foundation
• "Her book helps readers of all faiths more fully understand the healthcare and equity challenges we face today, especially when it comes to reproductive health. Dr. Gabow's stature as one of the nation's leading figures in healthcare, and her deep commitment to the Church's original healing mission, give her recommendations for greater health equity even more power." — Sara Rosenbaum, JD, Professor Emerita, Health Law and Policy, Milken Institute School of Public Health, George Washington University
• "Affirming its historical roots, grounded in Jesus' compassion and healing ministry and incarnated through the unwavering commitment of nuns and religious orders, she provides critical insight into the current organizational and operational structures of Catholic healthcare. She proposes ways to move forward by returning to the original mandate of Catholic healthcare grounded in the Gospel and more fully committed to Catholic social teaching." — Todd Salzman, PhD, Amelia and Emil Graff Professor of Catholic Theology, Department of Theology, Creighton University
• "Dr. Patricia A. Gabow is asking all the right questions in this penetrating examination of how Catholic hospitals in the United States have transformed from humble facilities founded by orders of sisters with a mission to serve the poor into giant multi-state healthcare corporations with billions of dollars in assets that are governed by religious doctrine handed down by the US Conference of Catholic Bishops." — Lois J. Uttley, MPP, Health Policy and Advocacy Consultant; Faculty Member, Master's in Health Advocacy Program, Sarah Lawrence College
• "An inspiring critique of Catholic healthcare today, made even more powerful by the author's obvious love and respect for her church, its belief systems, and its remarkable history in healthcare. When Dr. Gabow asks why Catholic social teachings about care for the poor have become mere recommendations, while its restrictions around sex and reproductive care have become iron-clad rules, the reader feels her visceral frustration." — Matthew Wynia, MD, MPH, Director, Center for Bioethics and Humanities; Professor, School of Medicine and Colorado School of Public Health, University of Colorado, Anschutz Medical Campus

Reviews

• "Dr. Gabow's book on the Catholic Church and its Hospitals is, as with all of her publications, extremely well written, easy to understand, logical and meticulously researched. I have served in healthcare administration for over 30 years, most of that time as a Chief Financial Officer, and I learned a lot of new information from this book. Highly recommended for reading and for action on Dr. Gabow's requirements for 'walking the talk' found in the last chapter."
• "Throughout her long and distinguished career, Dr. Gabow has not held back. She has called out shortcomings in the American healthcare system, e.g., related to costs and insurance, and then worked and advocated for fixes. Now she has focused in on the growing Catholic healthcare system in the United States. Dr. Gabow does not merely raise these important issues, she also channels her clear love of the Church into suggestions for dialogue and transformation."
• "Dr. Gabow is uniquely qualified to write about the history of the Catholic Church in healthcare. She is an academic clinician, and researcher, former CEO of a nationally respected safety net hospital, health policy leader, and a practicing Catholic. She is also a great writer. Thus, this book, which is full of thoroughly researched information, gives us history of the influence of the Catholic Church from the earliest times when deeply religious nuns ran hospitals to the current multibillion dollar corporate healthcare organizations."
• "In this book she calls out the Catholic Healthcare System for the problems that are caused for patients who would like access to services that are not provided (abortion, IVF, birth control), the fact that this information is often hidden from patients, and for commercial practices which mimic non-Catholic systems in reduced commitments to serving the poor and the uninsured. This is a must read book if you want to understand how powerful the Catholic Healthcare System has become and how this is impacting the delivery of all healthcare in the US."
• "I learned so much from this thoroughly researched, absorbing account of the forces driving and constraining care in Catholic hospitals. Dr. Gabow takes us through the origins of Catholic health care, provides compelling vignettes and ends with a detailed call to action. This is a brave and important book."
• "In her latest book she has taken on the Catholic Church and Its hospitals — and it is an unflinching and penetrating portrait of a system in desperate need of reform. In this highly readable account Patty exposes the extensive set of rules, the 'Ethical and Religious Directives,' which are set by the Church, but which then apply to all those who receive care in the Catholic hospital system, most of whom are not Catholic. This book is both a history, and a loud call for change."