The Bottom Line: Managed Care's Unhealthy Preoccupation

Catholics from a wide variety of professional backgrounds are expressing serious concern with the “corporatization” of medical care that has occurred in the United States during the last 20 years. Many now believe that so-called managed health care not only jeopardizes patient medical treatment but also undermines core Catholic ethical principles. Taking Christ's words “Whatsoever you do to the least of my brothers, you do unto me” as its slogan, the Minnesota-based Moscati Institute was founded in 1991 to counteract such treatment and return the practice of medicine to its ethical roots.

“Managed care has to do with population, not with individuals,” explains 30-year nursing veteran and Institute founder, Marianne Fightlin. “In a managed care plan you don't get treated, you get managed. Managed care has nothing to do with care. It has to do with profit and who gets it.

“I don't think most of the hierarchy understands that managed care is about rationing,” Fightlin continues, “and rationing is the link between genuine medical treatment of the individual [regardless of gender or age] and euthanasia.”

Fightlin named the organization for Giuseppe Maria Alfonso Moscati, a distinguished Italian lay physician and devout Catholic, who taught and practiced medicine earlier this century and was canonized by Pope John Paul II in 1987. He lived in an era when his country was saturated with liberal socialism and Catholic ideals were not popular. Although Moscati was only 45 when he died, Pope John Paul II proclaimed him a role model for physicians and others in the medical profession.

“His greatness came in his recognition that all of his work was as an instrument of Christ,” explains Fightlin. “He saw that medicine is first of all a gift, a vocation, a calling, and that we are there to help our brothers. He saw Christ in each person he treated and took care of the sick the way Mother Teresa took care of the poorest of the poor. As a professor, he would tell his students that their patients were created in the image of God and therefore very special. Because he aspired to the core beliefs of a Catholic physician, he is the image of what we're trying to restore.”

To date, the Moscati Institute advisory board includes three prelates: Bishop Raymond Burke of LaCrosse, Wis.; Bishop Roger Schweitz OMI of Duluth, Minn.; and Bishop Fabian Bruskewitz of Lincoln, Neb. Additional board members include William Bentley Ball, a nationally known constitutional lawyer; Dr. Jane Orient, executive director of the American Association of Physicians and Surgeons; Msgr. William Smith of St. Joseph Seminary (Dunwoodie) in Yonkers, N.Y.; and a hand-selected group of canon lawyers, journalists, theologians, physicians, and nurses.

“There's no question about the need [for this organization],” says Donna Steichen, a Catholic journalist and author of the book Ungodly Rage. “Everybody in the medical field is aware that HMOs have reduced the level of medical care, just as things like abortion and euthanasia have reduced, if not destroyed, the respect for the sacredness of the human individual. We can all see that the recovery has to start somewhere. The Moscati Institute is a beginning.”

For Catholic medical professionals in each diocese around the country, the Institute plans to offer retreats, days of recollection, White Masses (liturgies for medical professionals) and seminars to promote genuine Catholic teachings and ethics, especially as such teaching relates to current medical practices. Additional conferences on viable alternatives to managed care are also planned for the public at large, as well as encouragement for Catholic insurance providers and actuaries to further develop such options.

In addition, the Institute plans to set up a toll-free telephone number for anyone seeking a Catholic perspective on various medical issues, such as the definition of ordinary and extraordinary means of preserving life, what to do in a case of medical negligence or maltreatment, and referral information to set up a medical savings account.

“This organization is more important than ever for today because of the way life is trifled with so easily,” says Father Alfred Kunz, a canon lawyer and former head of the matrimonial tribunal for the Diocese of Madison, Wis.

“We need a clearing house for questions that have to do with the protection of life and the ethical means to protect [it],” adds the priest, who is now pastor of St. Michael's Parish in Dane, Wis. He believes the toll-free number will help protect people from unknowingly making decisions that are opposed to the sanctity of life. Many times, people who seek professional advice are being told that something is a routine procedure, when it could in fact be unethical, he said.

Father Kunz says the toll-free phone lines would be staffed by people versed in moral theology and up-to-date on the latest medical procedures. The Moscati Institute plans to be an outside source by which people can investigate or confirm such information.

Adding a further cause for concern, Father Kunz warns: “Just because a hospital goes under the name Catholic, certainly does not necessarily mean that all of the medical procedures are moral.”

Dr. John Brennan, a Milwaukeebased ob-gyn, who has been practicing medicine for more than 27 years, and a former president of the Catholic Medical Association, agrees: “I'm afraid that there are disadvantages to managed medical care, both for the patient and for the doctor. [It's] called the best medicine for the least cost, and that's a fault because you don't get the best medicine for the least cost. With the loss of nuns [in Catholic hospitals], we lost charitable hospitals.

“Now it's hospitals for profit. That's a step in the wrong direction—lay people making profits out of medical care when the nuns were giving their lives for charity in medical care. The nuns certainly wanted to break even, but they weren't looking for profits [at the expense of inappropriate or inadequate medical treatment].”

In addition, Brennan notes that many Catholic hospitals are merging with non-Catholic hospitals and, in the process, often abandon their adherence to Catholic ethical principles, such as refusing to perform abortions, offer contraceptives, sterilizations, in vitro fertilization, or euthanasia procedures.

Adds Fightlin: “Catholic hospitals feel that they can't survive without government money, but the government money is what produces onerous regulations.”

In sum, The Moscati Institute offers a resource to train health care professionals to incorporate genuine Catholic medical ethics in their practice, to regain focus on the individual patient rather than the bottom line corporate dollar in assessing medical treatment, and to continue to develop viable alternatives to managed medical care.

Karen Walker writes from Corona del Mar, Calif.

Work of a Catholic Hospital?

“I haven't recovered from the shock of St. John's Catholic Hospital here in Oxnard, [Calif.] starving a patient to death a few years ago,” says Catholic journalist Donna Steichen, citing an incident that was widely publicized in local newspapers in Southern California. “He was a young patient who had been severely injured in an accident and had been in a coma for a long time. At the request of his mother, they removed his food and water.… But that's not what a Catholic hospital is supposed to be doing.”

Robert Helmueller, whose wife and daughter are both registered nurses and on the Moscati advisory board, found himself caught in a similar situation. With his wife and daughter out of town, he was left to be the decision-maker when his 93-year-old mother-in-law sought unexpected treatment at a Catholic hospital in the Midwest. Although she went in to treat a broken leg, she was kept overnight and by the following afternoon became unresponsive.

The treating physician informed Helmueller that she had suffered a stroke and asked if he wanted the hospital to use “extraordinary means” to keep her alive. Helmueller refused, unaware at the time that a subsequent examination of the medical charts would reveal that she had been over-medicated.

Two days later, Helmueller requested her transfer to a hospice, where she would receive appropriate care for her continued unresponsive condition. But before the transfer, the medical staff injected her with a massive dose of Delantin. She died before the transfer could even take place.

“What happened to my mother-in-law five years ago alarmed [my wife and daughter] that there are other people who are being killed the same way. If you happen to be over 65 years of age—look out when you go to the hospital [even a so-called Catholic hospital],” warns Helmueller.

—Karen Walker