Why the operation failed

On June 27, with enormous pride, optimism, and a sense of history, the CEOs of Abington Health and Holy Redeemer Health System faced reporters and announced their plans to form a partnership.

The leaders knew this was a bold move, even shocking, to partner a secular hospital with a Catholic one, but they felt it was so beneficial and important they were sure the community would come to see it as they did.

The community did not.Within three weeks, the proposed partnership - a year in planning - was dead.

In deference to its Catholic partner, Abington's leaders had agreed to stop doing abortions at the hospital. They knew this would be unpopular, but they believed an acceptable alternative could be found outside the hospital.

The community felt the partnership was presented as a done deal, and rose in swift, vocal, and organized opposition. Many in the community, and even hundreds of Abington's own doctors, saw this partnership as an attack on women's rights, an encroachment by the Catholic Church, and a secretive and arrogant act by leadership.

Abington was a highly regarded hospital, with excellent reputation and community support. How did its leaders misjudge so badly?Laurence Merlis, Abington's CEO, first approached his counterpart at Holy Redeemer, Michael Laign, about a year ago. They talked about ways they could cooperate, and the talks quickly escalated. The two leaders saw the immense potential.

Abington's strengths were its acute care, inpatient care, great specialists. The hospital delivered more than 5,000 babies a year, always second or third most in the state.

Holy Redeemer excelled in areas where Abington did not. Its motto is "health care, home care, life care," and it had well-formed and well-respected outpatient services, home health and retirement and life care communities, a hospice with 450 patients.

The two hospitals were in Abington Township, less than two miles apart.

Merlis had been hired 21/2 years ago to think outside the box, develop partnerships, do exactly what he was doing. He also understood the risk of not going forward. If Abington didn't partner with Holy Redeemer, surely somebody else would. Thomas Jefferson University Hospital might do so, snagging a toehold in affluent Montgomery County.

Merlis in late fall said he approached his board chair, Robert Infarinato, who gave his blessing to continue partnership discussions, and Laign did the same with his board chair.

Laign told Merlis from the very beginning that Holy Redeemer couldn't move forward unless Abington agreed to stop doing abortions.

"It became clear this was an unmoveable requirement," said Infarinato. "We decided to try and adjust our side."

Holy Redeemer would accept letting Abington continue every other form of reproductive health services, including procedures that violated Catholic doctrine - just not abortion.

Holy Redeemer made one other condition, and Abington agreed: If physican-assisted suicide, legal now only in Oregon and Washington, were ever lawful in Pennsylvania, Abington would not do them.

Since passage of such a law in Pennsylvania is inconceivable, and most assisted suicides take place in the home, Abington consented.

Both Infarinato and Merlis insist that even at these earliest stages of discussion, there was never any doubt that Abington would find a way to fulfill its mission to women and provide a full range of reproductive services.

Holy Redeemer spokeswoman Barbara L'Amoreaux explained the church's flexibility this way, in an e-mail earlier this month:

"Catholic bioethicists have been recognizing that collaborative relationships between Catholic and non-Catholic health systems are a reality" today.

"In Catholic health care," she noted, "there is a long-held principle of 'material cooperation' which provides that it is sometimes acceptable to cooperate with others even when you do not agree with their actions."

Talks moved forward, but the circle of involvement at Abington was extremely small. Initially only a three-member steering committee of the board worked with Merlis, then the eight-member executive committee. Merlis said there is a balance in such negotiations between "confidentiality and engagement."

Merlis did not engage his medical staff or the community. Carolyn Scanlan, CEO of the Hospital & Healthsystem Association of Pennsylvania, said this is standard procedure. Confidentiality is maintained until the parties announce a letter of intent.

But Abington has long prided itself on a free and open dialogue between the medical staff and the administration.

Infarinato and Merlis did sit down with Joel Polin, chair of obstetrics and gynecology for 31 years and the hospital's biggest defender of its abortion policy. He passionately conveyed his concerns.

Abington may do only 50 or 60 abortions a year, Polin told them, but these are often the most challenging cases, in which a mother's life is endangered, or a hospital setting is necessary.

Polin also stressed that there is a climate of fear in the country, and abortion doctors in clinics become targets of assassination. Moving abortion outside the hospital puts Abington physicians and patients at risk.

"He made it very clear to us that we needed to stay the course," said Infarinato. "We said 'Joel, we're going to challenge you and see if you can do this alternatively.' "

A day before Merlis and Laign announced the partnership, the boards at Abington and Holy Redeemer met to give consent. Both voted unanimously to do so.

Jack Kelly is the chief of medicine at Abington, the top doctor, a voting member of the board, and a defender of Abington's commitment to provide abortion services.

"We had a duty to look at this if it would make our hospital and our community better going forward," Kelly said. "But I had reached no conclusions whether this was doable or not."

Initially, he had hoped an alternative could be found. Perhaps even set up a hospital within a hospital, or turn the Levy pavilion - a building across Old York Road, connected by an underground tunnel to the main hospital - into a reproductive rights center."I wasn't going to turn away anybody who currently counts on us for care."

Ivy Silver, another Abington board member, was a Planned Parenthood volunteer as a young woman.

"When I was voting," she said, "it was with the understanding that the letter of intent is a beginning point, not an ending point. Also with the understanding that the issue of reproductive rights must be resolved. . . . I truly envisioned a way of resolving this."

Then came the news conference. The elimination of abortions at Abington was announced in a matter-of-fact way, as if the decision was irreversible.

Merlis said the hospitals would now move into the next phase, 90 days of "due diligence" when the two hospitals would "develop strategic and operational plans."

There was no mention of public input, or suggestion that the community should have a say in any of this. There was no acknowledgment that the decision to halt abortions at Abington, at least in the minds of many Abington board members, was predicated entirely on finding an acceptable alternative outside the hospital.

And immediately the community revolted. "During the year of negotiations behind closed doors, no staff or community members were involved in the decision-making process," wrote 20 residents in Abington's ob-gyn program. "There is strong opposition to having our medical practice dictated by Catholic doctrine rather than the best interests of our patients."

Merlis tried to clarify. He promised that Abington would always perform abortions if the life of the mother were endangered. But critics were not reassured. They noted incidents in which women in distress and needing an emergency abortion were sent from Catholic hospitals to other facilities despite the risks.

Merlis also promised that if an acceptable way to provide abortion services outside the hospital could not be found, there was no way he or the board would ever push this partnership through.

Many didn't believe him.

His assurance came in an environment of suspicion about the Catholic Church's willingness to tolerate medical partnerships with secular institutions. Earlier this year, the Catholic Church had spent months attacking the federal law requiring many health plans to cover contraceptives. While purely religious institutions like churches were exempt, church-run hospitals were not.

Critics of Abington's proposal pointed out that church teachings oppose common non-abortion services including tubal ligation, vasectomies, infertility services, and emergency contraception for rape victims. They worried that Abington's written promises to continue such services would not be enforceable, since they contradict Catholic doctrine.

Merlis was getting a barrage of vitriolic e-mails, letters, and Facebook posts from clergy, women's groups, professional groups, and residents. Rita Poley of Elkins Park created the Stop the Abington Hospital Merger page, which became the virtual center of the opposition.

When Abington doctors spoke up, social media reinforced the messages. Nobody in Abington's leadership anticipated the assault or knew how to respond.

By July 18, Kelly told a board meeting he couldn't go forward.

He knew abortion outside the hospital was untenable - hence, so was any possibility of partnership.

Boards of both Abington and Holy Redeemer voted that day to stop.

A few days before the final vote, in an interview, Merlis said, "Did we make some mistakes in the process? Yes. Moving forward, would we do it differently? Yes. Is input from the physicians and others important and critical? Yes. We anticipated doing that as we are now. But we accept it wasn't done well."

Merlis supported his board's decision to stop. The public clearly had spoken. He had mismanaged the message and the engagement with the community, and took responsibility for it.

Board member Ivy Silver felt regret that the partnership plan never got the full 90 days of consideration.

"That's the part that saddens me," she said. "The public never perceived it as a viable idea."

Many at Holy Redeemer felt stung by the public's attacks and accusations listed on the Facebook page.

"There is a level of disappointment and I would say hurt by some comments and statements being made," said Holy Redeemer's Laign just days before the final vote. Abington leaders call it a "learning experience," and say the positive side is that the community has shown just how deeply it cares about the hospital.

Source: Philly.com Health News , By Michael Vitez "Inquirer Staff Writer"