Column: Providence Health denies claim that it’s punishing a respected California hospital

Providence Health, the giant Catholic healthcare chain fighting an effort by a leading California hospital to end their partnership, is quietly trying to marshal support for its position that it’s better for the two entities to remain together.

We say “quietly,” because the effort thus far has taken the form of a statement defending the partnership and emailed to a limited number of Southern California “caregivers and physicians,” attacking a column I wrote about the issue last week.

Providence hasn’t distributed the statement more broadly as yet, say by publishing it on its websites. (I asked Providence to describe the recipient community for the statement, but as of this writing haven’t gotten an answer.)

The statement, which went out over the signature of Erik G. Wexler, president of operations and strategy for the Providence region covering California, Texas and New Mexico, makes a number of misleading and demonstrably inaccurate assertions about the Providence-Hoag partnership.

So it’s proper to take a close look. (A copy of the statement can be found here.)

First, a quick recap. Hoag Memorial Hospital, a revered institution headquartered in Newport Beach, has been trying since last May to dissolve its affiliation with Providence.

Among the reasons are what Hoag says are increasingly stringent religion-based restrictions on its services to patients.

These include a ban on abortions at Hoag and what doctors say are refusals by a Providence-affiliated health plan to pay for contraceptives they’ve prescribed for patients. Some of these assertions have been made in a lawsuit Hoag filed in May to force the dissolution, and some in a complaint lodged by Hoag providers with Atty. Gen. Xavier Becerra, as I reported in November.

Hoag’s leadership also contends that Providence, which is based in Renton, Wash., has all but abandoned the goal of enhancing local decision-making by its local-area hospitals.

That was a goal of the original partnership, which was launched in 2012 through an alliance of Hoag with St. Joseph Health, then a small Catholic hospital network. When St. Joseph merged with Providence in 2016, Hoag was part of the deal.

Hoag’s leaders, including several members of the Hoag family, sued last May to dissolve the partnership. Since then, according to Hoag administrators and doctors, Providence has taken several retaliatory actions.

Providence dropped Hoag doctors and its 13 urgent care clinics from the provider group it offers to health plans and their members. That obviously created problems for patients who suddenly, at the end of the year, had to hustle to find new providers.

Providence also stripped any mention of Hoag’s three facilities from its website listing “our locations,” even while Wexler is declaring that Hoag’s facilities are crucial to Providence’s services and “we remain better TOGETHER.” (Caps in the original statement.)

Now back to Wexler’s statement. He writes, “From the very start of our affiliation, Hoag has always been allowed to make its own choices and has never been prevented from taking any action or decision that it wished to take.”

This is patently false. Hoag has made the choice to disaffiliate from Providence. But its management is being prevented from taking that action by Providence, which is fighting Hoag’s lawsuit in court.

If Wexler is saying that actions or decisions by Hoag physicians haven’t been blocked, that’s also false. From the beginning of the affiliation — that is, when it was between Hoag and St. Joseph — Hoag doctors have been prevented from providing their patients with abortion services.

Indeed, Richard Afable, who negotiated the 2012 pact as Hoag’s then-CEO and immediately jumped into a top executive slot at St. Joseph, told me at the time of the deal that ending abortions at Hoag was a fundamental condition of the affiliation — “sacrosanct … required of ourselves and anyone that we [St. Joseph] would work with.” The ban is still in place.

Providence’s position, as I reported in my latest column, is that all the actions Hoag attributes to Providence are Hoag’s fault. Wexler repeats this theme. He said Hoag’s decision to seek its own contracts with local HMOs prompted Providence to drop Hoag from its provider network, and that Hoag’s refusal to participate in a Catholic-themed advertising “rebranding” of Providence led to its exclusion from the Providence website.

Hoag disputes this version. Its administrators say nothing stopped Providence from making a separate deal with Hoag physicians to keep them in its provider network, as Providence has done with other unaffiliated doctors. They say the list of locations on Providence’s website isn’t an advertisement, but an informational statement to which they have no objection.

Wexler also ascribes criticism of Providence’s actions to anti-Catholic animus.

I’ve reported at length about the encroachment of religious and ideological influences on medical practices, which should be based strictly on science. Unfortunately, it’s a fact that the leading source of these restrictions is the Catholic Church.

This is hardly a secret. As a University of California committee examining its healthcare affiliations observed in 2019, “non-evidence-based policy restrictions on care that disproportionately impact women and LGBTQ+ people” have arisen from many sources. But in UC’s experience, the institutions imposing such restrictions “have mostly been affiliated with the Catholic Church.”

Some other denominations have standards for medical care that may not be strictly science-based. But the Catholic Church both imposes the most stringent limitations on medical practice, and casts the largest shadow over American healthcare through the scale of its hospital ownership — four of the 10 largest healthcare systems in the country are Catholic-affiliated. (Hoag was founded by Presbyterians, a denomination that imposes no major restrictions on care.)

The Catholic Church exercises its authority through the Ethical and Religious Directives for Catholic Health Care Services (ERDs), a product not of doctors but the U.S. Conference of Catholic Bishops.

The ERDs vest ultimate authority over medical practice in Catholic facilities in local bishops. Some Catholic-affiliated hospitals are subject not to the ERDs but a slimmed-down version known as the Statement of Common Values. Both versions bar abortions.

Wexler’s statement doesn’t mention the ERDs or defend Catholic restrictions on medical care, which after all are among the reasons for Hoag’s desire to dissolve the partnership.

But by blaming Hoag for the discord, he’s doing a disservice to Hoag and to the entire Orange County community. The community deserves a full picture of why Hoag wants to disaffiliate from Providence and how Providence continues to interfere in its services.

Instead, what the community just received from Providence is more evidence for why these two organizations will be stronger apart, not together.