Hospital emergency

NEW YORK-When Nel Shelby and Christopher Duggan carried their baby out of St. Vincent's Hospital for the first time, a nurse mentioned to a Catholic priest that the couple was taking their baby home after a premature birth and 84 days in the neonatal intensive care unit. The priest offered to bless the baby. Shelby, who had just cried while saying goodbye to the nurses and doctors who had nurtured Gracie, no longer remembers the priest's prayer, but she recalls the peace that stayed with her as she cared for her baby alone for the first time.

Shelby had earlier vowed to avoid all hospitals and hired a midwife to assist in a home birth. But at 27 weeks of pregnancy her unborn baby stopped moving, and the midwife advised them to rush to St. Vincent's Hospital since it welcomed home-birth transfers. The staff found that the baby's umbilical cord was wrapped around her neck and feet, and they would need to induce labor. When Gracie was born on Sept. 29, 2008, she weighed 2 pounds, 2 ounces.

The St. Vincent's stay surprised Shelby-particularly when a prominent obstetrician stayed and chatted for 45 minutes while Shelby pumped breast milk, letting the parents know how Gracie was doing, what they could expect next, "and also comforting us and making us feel as though everything's going to be OK." Shelby and Duggan felt comfortable speaking of their faith since others at the Catholic hospital prayed, too: "We knew that she was being taken care of, not only by them but by a bigger source."

So they are distressed to learn that St. Vincent's Hospital Manhattan, the last Roman Catholic general hospital in New York City, is facing $700 million in debt and only limped through February after slashing salaries and getting a $6 million transfusion of state funds to meet its payroll costs. The hospital's struggles match the struggles of other religious healthcare providers whose charitable mission makes it difficult to compete in the healthcare economy. Healthcare reform may help them survive, but will it compromise their cause?

St. Vincent's Hospital, founded by four Sisters of Charity in 1849, says it is "committed to reflecting God's love by advancing Christ's healing ministry" and to serving "all who come to us in need, especially the poor." It was the first hospital in New York City to welcome HIV/AIDS patients for treatment, even before healthcare providers were sure how the virus spread. It refuses to provide abortions or referrals for them and just opened a new center that promotes natural family planning. When a mother learns of a potentially fatal birth defect and decides against the late-term abortion most doctors recommend, St. Vincent's provides a perinatal hospice center where families can say goodbye to their newborns.

On 9/11, responders rushed the wounded to St. Vincent's, the only emergency room below 59th Street in Manhattan. Elan McAllister, president of Choices in Childbirth, remembers walking past the hospital on 9/11 and seeing the avenue closed off to make a path for emergency vehicles, medical personnel buzzing everywhere, and gurneys holding the wounded: "It's one of those scenes that you don't forget. I was incredibly proud of the hospital and the community in that moment." Now McAllister is part of a broad coalition-from gay groups to nuns-who have rallied to save the hospital.

One in six U.S. patients

receives care from the nation's 600 Catholic hospitals each year, but they are only a part of the nonprofit picture. The country's 2,900 nonprofit hospitals comprised the majority of acute care general hospitals in 2006. Leonard J. Nelson, law professor at Samford University and author of Diagnosis Critical: The Urgent Threats Confronting Catholic Health Care, said the hospitals serve a high proportion of uninsured populations or Medicaid and Medicare patients. But often Medicaid reimbursement rates don't cover all of the costs and other patients pay nothing at all. To attract wealthier patients with private insurance to offset the cost, hospitals need the newest technology and brand-new facilities; but that's expensive, and the hospitals' real mission is to serve the poor. This makes it hard to sustain the mission and the hospital itself, said Nelson: "The temptation is to go out to the suburbs-out to a lot of people with private insurance-and build a new facility out there, but that's not really serving the mission. At least the mission that's a motivating factor in the first place."

Some hospitals seem to have lost sight of the mission already. A 2005 report by the Government Accountability Office found that on average, charity hospitals devoted only slightly more of their patient operating expenses to uncompensated care than did for-profit hospitals. Yet the hospitals still bear a share of a load that's growing heavier. The number of uninsured Americans under the age of 64 reached 43.6 million in 2008, according to the Centers for Disease Control and Prevention. In New York City, the number of uninsured patients treated by New York City hospitals rose 14 percent in four years. The New York City Health and Hospitals Corporation says it is watching the fate of St. Vincent's, knowing that its possible collapse will strain an already burdened healthcare system.

The Catholic Health Association has urged healthcare reform, since it would mean previously uninsured patients could pay for their care. But the CHA has also said that it does not support the federal funding of abortion that is in prominent proposals, leaving it in a quandary: mission or money? Bob Moffit, director of the Center for Health Policy Studies at the Heritage Foundation, said as long as the bill makes abortion a federally mandated benefit, it will be "a direct threat" to the hospitals' mission: "This would directly compromise their ethical responsibilities and put them in a very, very difficult position." He advocates restructuring Medicare and Medicaid to look more like private insurance, saying that charitable hospitals would actually survive better in a more competitive environment: "A lot of people like these hospitals. They're well-established, they've got a good reputation. They've got a caring staff. They're well-known."

Before its troubles, St. Vincent's was trying to attract more business with an ill-timed $1.63 billion reconstruction proposal. But by this February, it had laid off 300 people, negotiated with the unions for 10 percent temporary pay cuts, and slashed non-union salaries by up to 25 percent. New York Giants quarterback Eli Manning took perhaps the largest pay cut. He'd received $600,000 for doing publicity for the hospital but declined future payments when he heard about the hospital's woes.

After the priest's prayer and the goodbyes to St. Vincent's staff, Duggan-usually a speedy driver-inched down Sixth Avenue toward home. Shelby looked down at her baby and thought, "OK, here we go. She is now completely under our care." Since then, she has written letters to public officials and raised funds to try to save St. Vincent's Hospital so that the doctors and nurses who nurtured her first baby-"a miracle"-can, if need be, care for her baby again.