A proposal to merge the University of Louisville’s teaching hospital with a Roman Catholic health system -- which would prohibit the hospital from providing sterilizations, abortions and other procedures that go against Catholic beliefs -- has provoked an uproar in Kentucky, where residents and lawmakers are questioning the role of religiously affiliated health providers in public medical education and health care.
The University of Louisville Hospital, the primary teaching affiliate of the public university’s medical school, also provides most of the care for the region’s poor. The merger would combine three hospital systems, including the university’s, under the auspices of Catholic Health Initiatives, based in Denver. The merged hospitals would be required to follow Roman Catholic health directives , which prohibit abortion, sterilization, stem cell research and some other procedures.
While secular hospitals have merged with religiously affiliated hospitals in the past, with varying results, the merger of a public medical school’s teaching hospital and a Catholic institution is unusual, perhaps unprecedented. The MergerWatch Project, which tracks mergers of religious and secular hospitals (and opposes them), has no record of a similar case, although mergers have presented issues for some medical school residency programs, said Sheila Reynertson, the project’s advocacy coordinator.
More than 400 Louisville residents signed a petition against the merger, saying they fear it will limit access to vital medical procedures at a hospital that receives millions of dollars in public money. Much of the fear centered around family planning, especially sterilizations, and end-of-life care. "Both men and women will be dismayed to see their advance medical directives are not respected in a Catholic hospital," two Kentucky state representatives, Tom Burch and Mary Lou Marzian, wrote in an op-ed  in The Courier-Journal. "Women should never have to question their doctor's allegiance, and providers should not have to worry that they will be dismissed for giving comprehensive care."
The medical school says its curriculum will not change as a result of the merger. Neither the university nor its faculty is a part of the merger: the hospital, a private, nonprofit entity, pays the university to use its land and facilities, but is governed by a community board .
“All procedures that are taught through the curriculum will continue to be taught,” said Gary Mans, spokesman for the University of Louisville School of Medicine. Some will be taught at facilities that are not part of the merger, such as the medical school’s clinic, and the institution is still working out details on how those issues will be handled, he said.
But despite those assurances, the prospect of the hospital no longer providing some reproductive services -- such as a tubal ligation for sterilization after a C-section or delivery -- has raised an outcry  in Kentucky. The state attorney general said he will look into the merger, and the governor, Steve Beshear, has called for “additional discussion and transparency.”
The state must approve changes associated with the merger, including leases of public land or facilities. “Each time I have spoken with University of Louisville representatives associated with this hospital merger, I have been repeatedly assured that University Hospital’s public mission would continue in every aspect of care,” Beshear said in a written statement . “However, it is clear there are growing concerns within the community about issues related to the hospital’s future level of access to medical services.”
Mergers or partnerships between public hospitals or medical schools and religiously affiliated hospitals have often foundered when strongly held beliefs on both sides clash, most frequently over reproductive issues, said Joanne Conroy, chief health care officer for the Association of American Medical Colleges.
“That issue becomes a lightning rod in whether or not these partnerships are successful or end up never coming to fruition,” Conroy said.
For most universities, providing a thorough training in obstetrics and gynecology is paramount, including a “broad range of experience” in family planning, she said. Although medical schools are often used to dealing with conflicts between faith and medical practice with their own students and faculty, doing so with another hospital is far more difficult.
Accreditors could also present a problem, Conroy said: she said she expected there would be “some pushback” if a medical school were to stop training students for certain procedures.
“It strikes right to the core of both institutions,” she said. “Some organizations feel very strongly that it’s not something they support. Other organizations feel very strongly that that’s the essence of education -- not putting any barriers on the educational experience.”
Secular hospitals merging with religiously affiliated ones in the past have dealt with the issue in several ways, including creating a “hospital within a hospital” that provides procedures that Catholic directives forbid. Some universities send their residents to other hospitals for training in procedures that Catholic hospitals do not offer, Conroy said, although that approach presents problems with paying them.
University officials say they are examining all options.
“Our dean has worked on this for more than a year and has talked with a number of people throughout the country who have been involved in similar situations,” Mans said. “This can be accomplished and will be accomplished.”