PARIS, Texas — A major Catholic hospital system has announced its intention to sell a nearly century-old hospital — in part to be sure sterilization of women who have just given birth remains available in north Texas and southern Oklahoma, according to Dr. Thomas Royer, the hospital system's chief executive officer.

By late June, 20 companies, both profit and nonprofit, had expressed interest in buying Christus St. Joseph. A short list of candidates will be sent to the hospital system board in August, and St. Joseph's Catholic owner, Dallas-based Christus Health Systems, hopes to complete the sale by November.

The news of the spin-off came as a shock in May to the local Sisters of Charity of the Incarnate Word — whose order founded the Paris hospital — and to others in the area, where Christus St. Joseph is the largest employer.

For one, Christus St. Joseph had recently purchased the non-Catholic McCuistion Hospital, a move that would seem to point to financial strength.

But the decision was made hastily by the hospital system board days after some people expressed concerns to the bishop of Tyler, Texas, that one aspect of a plan to help save money and resources would violate Catholic teaching. That plan was approved weeks before by the local hospital board.

Since 1914, Paris had two hospitals serving what has grown to a regional population of 40,000, including many poor: St. Joseph downtown and McCuistion, just three miles to the north.

Then in 2001, Christus Health Systems purchased McCuistion. After initial financial losses, Christus St. Joseph was on a course for stability and growth, according to Monty McLaurin, chief executive officer for the hospital.

In late April, the local board approved a plan whereby the hospital could hope to save up to $2 million by moving obstetric and pediatric care from the former McCuistion (referred to as the “north campus") to the original St. Joseph “south campus” by February 2004. By consolidating all the acute services on the south campus, the hospital would reduce duplication of emergency care, X-ray services and so forth, McLaurin said.

There was one problem with the move, however, according to Royer, who is McLaurin's boss. Transferring labor and delivery to the south campus would remove those services from the Lamar Women's Health Center, a financially and legally separate sterilization center that operates in three rooms of the north campus.

Before Christus purchased McCuistion in 2001, those rooms had been “carved out” and formed into Lamar, which does two-thirds of its sterilizations postpartum and the rest as outpatient surgeries, said Lamar administrator Jinx Yoder.

Moving labor and delivery would mean patients would no longer have the option of having tubal ligations done immediately after childbirth — a common practice often considered part of “comprehensive reproductive health care.”

The Church teaches that sterilization is immoral since it is a form of self-mutilation.

A plan was then quietly floated to sell space near the new obstetrics location in the south campus to Lamar. But after learning of the plan, local Catholic family practice physician Dr. Stephen Burns objected in a letter to Bishop Alvaro Corrada del Rio of Tyler, whose approval of the sale would have been required by the U.S. bishops’ Ethical and Religious Directives for Catholic Health Care.

Those directives also state: “Catholic health care organizations are not permitted to engage in immediate material cooperation in actions that are intrinsically immoral, such as abortion, euthanasia, assisted suicide and direct sterilization. The possibility of scandal must be considered when applying the principles governing cooperation.” (See sidebar.)

Some Paris doctors insisted that the postpartum sterilization services be continued, health system chief executive officer Royer said.

“The diversity of opinion in the community regarding that transfer was certainly great enough over which the community could potentially become polarized,” he said. “It's neither right nor wrong, but because of the timing we didn't want to create an additional wedge in the community.”

Dr. Ed Clark, a Catholic pediatrician, said he and the other pediatricians and obstetricians had rallied around Christus’ original plan to move to the south campus in order to save money and grow. That hope is now in jeopardy, he said, but with the Church's restrictions against cooperating with sterilization, the sale of the entire hospital — both north and south campuses — “is probably the only choice they had.”

“Not being able to offer tubal ligations is a major problem for this community,” said Clark, who admitted he does not agree with Catholic teaching on sterilizations. He questioned whether it is ethical to make women travel 40 or 60 miles away for a second procedure, a second anesthesia, “and the risks involved with that.”

But the previously scheduled move of the obstetrics unit could have provided the Catholic hospital the perfect opportunity to avoid the possible scandal of the current arrangement, Dr. Burns said.

That option, however, was “not acceptable” to the obstetricians in Paris, said chief executive officer Royer, and neither was the elimination of obstetrical care altogether.

Father Gavin Vaverek, promoter of justice for the Diocese of Tyler, said Bishop Corrada had only just learned of the hospital unit's proposed move and then the pending sale. He said the bishop would be gathering facts on the issue.

“We're going to be looking at this because, No. 1, the sale may not go through; and 2, if there [are] immoral things going on there, that has to be stood against,” he said. “If they announce they are closing in six months, the evil should not be going on, if there is evil. The sale could take a long time.”

Father Vaverek said he was particularly sorry a Catholic hospital might no longer be providing services to the many poor in the area, who he said need to hear the Gospel of life preached to them.

“At the end of the day it's not about the directives ... it's about what's wrong or right,” he said. “[Catholic hospital officials] have allowed the [sterilization] issue to be confused and conflicted. There is no doubt from the Church's perspective that sterilization is a crime against the dignity of the human person.” It is “not an appropriate part of health care,” he added. “It is a procedure that takes a healthy organ and renders it unhealthy.”

He agreed with Burns that the earlier plan to sell space to a sterilization center would have been “a problematic cooperation.”

Father Bob Lampert, director of ethics for Christus Health Systems, said that in the 2001 acquisition the Catholic hospital “had no part” in Lamar Women's Health Center.

“It's clearly signed; it's not our property; we did not buy that part of the building. You can have two organizations in the same building. That happens all the time,” he said.

Oscar Omperon, chairman of the board for Lamar, indicated there was more to the arrangement than purchasing a hospital minus three rooms. He said Father Lampert met with him prior to the transfer of assets, and that the ethicist “was very much involved in that process.”

Father Lampert would not return calls asking for further comment on those meetings.

Lamar administrator Yoder said that after an initial awkwardness, collaboration between St. Joseph and Lamar “has been working beautifully.”

A woman who is delivering normally and wants to be sterilized goes to Christus for labor and delivery, then is taken by Lamar staff to the sterilization center for her surgery. A woman delivering by Caesarean section goes to the Lamar center rooms for the birth and the tubal ligation, then she and the baby are discharged to Christus, where her baby is cared for in the nursery and she continues her recovery.

Some staff work at both the hospital and center “but not at the same time,” Yoder said. They wear badges that can be flipped over, depending on whose “clock” they are on. The center pays the hospital a monthly fee for utilities, she said.

Dominican Father Albert Moraczewski, an ethicist with the National Catholic Bioethics Center in Boston, said if one thing can be said about Catholic health care collaborations, it is that no two are alike.

“It's a complex issue, and each alliance is unique and distinct,” he said. “So it's hard to make any judgment on the case without knowing the whole thing. The devil is in the details.”

What many people, Catholics included, fail to understand in these situations is the important moral principles involved regarding the nature of human reproduction, Father Moraczewski said.

“The whole business of sterilization and contraception the Church sees as a violation of basic human dignity regarding human procreation,” he said. “A lot of people say contraception and sterilization are not as bad as abortion. That is a true statement; nonetheless, they are morally evil.”

Lawrence Welch, professor of systematic theology at KenrickGlennon Seminary in St. Louis, said the “immediate material cooperation” forbidden by the bishops’ health care directives means that which contributes something essential to the wrongdoers’ evil action, in this case, direct sterilization.

However, he said, a hospital selling space to a sterilization center could actually constitute an even greater degree of cooperation known as “implicit formal cooperation,” which intends the evil of the wrongdoer not for its own sake but as a means to another end — in this case, to offer postpartum sterilizations so that obstetricians stay at the hospital or so the hospital can remain open.

“You can't implicitly intend something that's immoral. You can't say,’ We're going to provide you space,’” he said. “Frankly, it's [Lamar's] problem [if the obstetrics unit moves away]. That's not the Catholic hospital's problem.”

Also addressed by the health care directives is the issue of scandal, defined in the Catechism of the Catholic Church (No. 2284) as “an attitude or behavior that leads another to evil.”

“Simply because you don't have implicit formal or immediate material cooperation [in a given situation] doesn't mean that it's licit,” Welch said. “There's always the possibility of scandal. Is that avoided here? I think that's a serious question.”

Glenmary Father Bob Poandl serves at a parish in Hugo, Okla., about 25 miles from Paris. He said he worried that a sterilization center operating within a Catholic hospital would confuse people about what the Church taught and how the Church acted on the question of sterilization.

“One Protestant told me he was very glad the Church would compromise and allow sterilizations,” he said. “He's a minister. He's getting the message.”

Ellen Rossini writes from Richardson, Texas.