Physician-assisted suicide and abortion dominated audience questions during forums held Thursday and Friday on a possible partnership between Ashland Community Hospital and Dignity Health.
Several of the nearly 100 people who attended voiced their concerns over Dignity Health's stance against the Oregon Death with Dignity Act and banning direct abortions unless the mother's life is at risk.
A patient's right to choose whether to have an abortion or receive aid in dying are "important" issues to Ashland residents, Mayor John Stromberg said during Friday's morning forum.
Afterward, Stromberg said he thought Dignity Health's presentation was well done.
"I thought they made a serious effort to be forthright with us "… and not dodge any of the tricky issues," Stromberg said.
"It's a very important, big decision for us," he said. "We also have to consider that we're in the position with a hospital (ACH) that is not stable, and something has to be done."
Unreimbursed costs associated with treating Medicare and Medicaid patients, other unpaid medical bills and charity care contributed to a $2.5 million loss last fiscal year for ACH. The hospital also posted a $1.5 million loss on operations during the 2008-2009 fiscal year.
ACH Chief Executive Officer Mark Marchetti said a partnership would strengthen the hospital's ability to compete with larger hospitals in Medford and increase revenue and patient services.
"We can help Ashland get back on its feet — not only survive, but thrive," said Peggy Sanborn, Dignity Health's vice president of partnership integration.
Sanborn said Dignity Health has identified ways to bring ACH into the black and increase its services.
Dignity Health and ACH have signed a memorandum of understanding to the potential merger, but a definitive agreement will have to be signed before anything is official.
Because the hospital operates under a long-term lease with the city of Ashland, the City Council will have a say in approving the partnership.
"The decision is going to be made by the council, and we're all going to take part in diligent conversation before it's made," Stromberg said. "I am going to be prepared to vote, but I try not to express opinions ahead of time."
The mayor only votes to break a tie.
"I heard it loud and clear," said City Council member Carol Voisin. "Death with dignity and abortion are serious issues that the community thinks our hospital should be able to address and perform."
Stromberg and Voisin were the only council members at either meeting, and Voisin attended both.
If a merger is formed between Dignity Health and ACH, its working physicians would not be able to prescribe patients who qualify under the Oregon Death with Dignity Act medication that induces death upon ingesting, said Carol Bayley, Dignity Health's vice president for ethics and justice education.
Currently, ACH has "no policies that dictate the issue one way or another," said Marchetti.
On Wednesday, Marchetti had insisted that the end-of-life care ACH patients receive will not change if a partnership is formed with Dignity Health.
"If the comments I made concerning the issue were not clear, I apologize," Marchetti said Friday. "From a practical perspective, nothing is going to change."
If a merger is formed, the hospital's physicians still will be able to discuss the option of aid in dying with patients, Bayley said.
"I do not want my community's hospital to partner with someone who does not support Death with Dignity," said Sharry Teague, 70, of Ashland, during Friday's forum.
Pauline Black of Ashland said she struggled to find independent doctors in Ashland to treat her parents, who are Medicare patients, so they receive care from the ACH clinic, which is required to accept them.
Black said her father chose to stop taking his diabetes medication as the disease worsened, which led to his death, and it is "very possible" her mother might ask for an aid-in-dying prescription.
"I think we should have the option," she said during the meeting.
Unlike Dignity Health's Catholic hospitals, its non-Catholic institutions allow surrogacy and surrogate decision makers for patients. They also will not prolong life against a patient's wishes.
"If ACH merges with Dignity Health, we foresee less access to the law, and that's a loss for Ashland," said Jason Renaud, a representative from Compassion & Choices of Oregon, an advocacy group for patients seeking aid in dying.
Renaud said the organization plans to hold an open forum in Ashland surrounding the potential merger between ACH and Dignity Health. No date has been determined.
During the meeting, Stromberg asked whether Dignity Health's Statement of Common Values could be modified.
Dignity's non-Catholic hospitals are required to follow the Statement of Common Values.
"As far as loosening it, don't hold out hope," Bayley answered. "We have our feet in Catholic mud, there is no denying it."
Concerning direct abortion, Bayley said, "Abortion, unless it's to save the life of a mother, is not done in any of Dignity Health's hospitals."
She said, like aid in dying, patients still will be able to discuss the option of having an abortion with physicians, but Dignity Health's doctors will not advocate either option before the patient brings it up.
Currently, ACH doesn't perform direct abortions, said Marchetti, but it has done so in the past, and had never been barred from doing so.
Dignity Health's policy concerns Planned Parenthood of Southwest Oregon CEO Cynthia Pappas.
Planned Parenthood submitted a letter to ACH when it learned the hospital was considering Dignity Health as a partner, and warned that women's right to choose could be at risk, Pappas said.
"Our position is that religion should not get in the way of providing health care," Pappas said. "A decision to have an abortion should be between a woman and her physician only."
The other organizations that presented proposals to partner with ACH are Asante Health System, which runs Rogue Regional Medical Center in Medford; Providence Health & Services of Seattle, which operates Providence Medford Medical Center; and Capella Healthcare of Franklin, Tenn.
During the forum, one woman asked whether Asante stops its physicians from prescribing aid-in-dying medication.
"The answer is no," Renaud said.
Dignity Health operates 40 hospitals and 150 care centers in California, Arizona and Nevada, employing about 65,000 people. If a partnership is formed with ACH, it will be the health care system's first affiliate in Oregon.
"I'm very, very concerned that we're getting ourselves into a situation that may eventually really hurt the hospital," said Voisin. "Dignity is not going to change, and that's sad, to me."
Reach reporter Sam Wheeler at 541-499-1470 or email firstname.lastname@example.org.