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A hospital's trust

The BayCare network was created for good reasons, but its evasiveness and secrecy, as well as the recently revealed abortion restrictions, could jeopardize the hospital alliance.

Two years ago, St. Petersburg's Bayfront Medical Center and other non-profit Tampa Bay hospitals forged a regional alliance with two vital goals: ensuring financial survival and shielding their communities from proprietary behemoth chains such as Columbia/HCA Healthcare Corp.

Bayfront leaders promised the public that each member of the BayCare network would maintain its unique qualities in continuing to serve its community. Sadly, as we now learn that the network is allowing some medical decisions to be compromised out of deference to its two Catholic hospitals, that ideal is at risk.

Worse, BayCare is exhibiting some of the very characteristics of the Columbia culture that the alliance was supposed to prevent _ evasiveness, secrecy and medical decisions driven by a central corporate office.

When Bayfront sought approval for the alliance, hospital officials never mentioned that they had agreed to limit their abortion services in the trade-off. In the process, they misled the community. (St. Petersburg City Council members, who approved Bayfront's partnership in 1997 out of what they believed to be financial necessity, are understandably irritated.) When reporters asked BayCare Health System president Frank Murphy recently to shed light on the types of "elective" abortions that are now banned in his secular hospitals, he mused: "I can't; a theologian might."

When Bayfront-St. Anthony's Health Care president Sue Brody was first sought for an explanation, she wouldn't return phone calls. Even on Thursday, the same day that public questions were being raised about the BayCare alliance and whether Bayfront had violated its lease agreement with St. Petersburg, BayCare officers declined to release their operating agreement and the names of their board directors.

Bayfront officials insist that all eight alliance hospitals compromised a bit for the sake of the network. While Bayfront sacrificed its patients' access to certain procedures, the Catholic hospitals agreed to tolerate teaching programs in the system, Brody says. But the two are hardly comparable. Bayfront and the other secular hospitals agreed to submit a medical procedure to a religious test. Just as BayCare would have been wrong to attempt to force the Catholic hospitals to forsake their own religious identities and offer full abortion services, it was misguided to force religious doctrine on the secular institutions. In the case of Bayfront, which leases its land from the city, the ban may also violate the lease and raise constitutional questions.

Brody is correct that the abortion limits will, as a practical matter, affect only a small number of patients. But the hospitals have now flatly banned all elective abortions, and they are allowing a committee led by a Catholic nun to review even the abortions sought by women who have seriously deformed fetuses. What other dictates of the Catholic Church is BayCare prepared to accept? Banning tubal ligations and vasectomies? Refusing to honor end-of-life requests made by families?

The BayCare network was created for the right reasons and financially it has paid off so far. The hospitals have been able to cut costs through joint purchasing power and by trimming administrative and medical service duplication. Bayfront itself continues to lose money, but the chances of success without the entry of a profit-hungry national chain are far greater with BayCare in place.

But BayCare now faces much more than a financial dilemma. Patients of Bayfront and the other non-religious hospitals in the network deserve to know that they can continue to rely on their providers for the full range of care they historically have received. The communities that surround and support the BayCare institutions need also to know that their hospitals continue to be worthy of their good faith and charity. Given the recent BayCare conduct, people may now have reason to question their community hospitals. And, in the long run, a loss of trust would be as pernicious as any loss of money.