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Nurses wary as SF’s Dignity Health moves toward merger

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Members of the California Nurses Association on Thursday turned out to voice concerns about a merger between San Francisco-based Dignity Health and Colorado’s Catholic Health Initiatives. (Laura Waxmann/S.F Examiner)

Nurses and healthcare advocates on Thursday questioned the impacts that a pending merger between San Francisco-based Dignity Health and Colorado’s Catholic Health Initiatives could have on their pensions and on patients’ access to care.

Dignity operates 31 hospitals across the state, including St. Mary’s Medical Center and St. Francis Memorial hospital in San Francisco. The proposed merger, announced in 2016, would combine the two ministries, placing all but one of Dignity’s non-Catholic hospitals in a separate, single Catholic non-profit healthcare system called Integrity Healthcare Operations.

The merger still requires regulatory approval from federal, state and church officials. On Thursday, at the first of a series of hearings led by Deputy General Attorney Wendi Horwitz in San Francisco, many affected by the deal expressed concerns about potential hospital closures, changing contracts, and how religious rules would shape access to women’s and LGBTQ healthcare.

“This is a merger between two Catholic hospital systems, which generally follow the Ethical Religious Directives (ERDs) that prohibit many crucial reproductive health services including contraception, abortion and fertility treatments,” said Karen Camacho, organizing coordinator with the ACLU. “Transgender patients have had gender affirming surgeries denied on religious grounds.”

Civil rights advocates said that it is not clear how reproductive health care services currently offered at Dignity’s non-Catholic hospitals would be preserved — the merger proposed a minimum five-year commitment to maintaining all services and keeping all hospitals open.

Members of the California Nurses Association called for the proposed minimum to be extended to 15 years, and demanded that their collective bargaining agreements, which include RN pensions and patient care protection, remain intact after the merger.

“We are extremely concerned about the future and unknown impact that his proposed merger will have on our pension,” said Vivian Cherion, a nurse based in Redwood City. “Especially due to the structural changes that will take place in Dignity Health as it splits into two separate companies, Catholic and non-Catholic.”

Horwitz assured participants that Integrated Healthcare Systems “will not be Catholic,” and non-Catholic hospitals transferred will “remain non-Catholic.”

“They are not subject to the ERDs and will retain or adopt a statement of common values that does allow tubal ligation but prohibits direct abortions, in vitro-fertilizations and provider or physician assisted suicide or aid in dying,” said Horwitz.

But the nurses also pointed out that charity care benefits and community benefit obligations, required of nonprofit hospitals, could also be at risk.

Dignity Health currently provides on average $71 million annually in total charity care and $135 million annually in community benefit programing for all of its hospitals, said Yasmin Peled of Health Access California.

“After five years, should this merger be approved without strict and clear charity care and community benefits conditions, this new hospital corporation will skirt and avoid any future …obligations,” she said.

Todd Strumwasser, senior vice president of operations for Dignity Health Bay Area, said that a changing healthcare landscape has presented new challenges for providers.

“[Patients] want care that is affordable and convenient, that helps them stay healthy, uses smart technology and the highest clinical standards and most of all they want to make sure that access to health services in their community is protected ,” said Strumwasser, adding that the merger “will allow us to continue caring for communities in California for years to come.”

He said that the alignment, which is expected to create an entity with $28.4 billion in estimated annual revenue, would help make “clinical expertise and technology from both organizations available to all our communities,” advocate for health care policies, and invest in new technology that would “help patients do things like schedule appointments more easily, access test results on your phone and computer and talk to your provider anytime.”

An additional 16 public hearings on the merger are scheduled.


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