On the day Phoenix Bishop Thomas J. Olmsted declared St. Joseph's Hospital and Medical Center can no longer call itself Catholic, hospital officials vowed to provide patient care the way they always have, saying they could not ethically and legally comply with the bishop's demands.

Both sides on Tuesday insisted their interpretation of a case that involved a pregnancy terminated at the hospital was correct.

Decree revoking "Catholic" name | Response from St. Joseph's Hospital Catholic bishop warns hospital on practices | Bishop Olmsted's letter Olmsted declared the procedure an abortion barred by Catholic teaching, while hospital officials insisted the surgery was appropriate under church guidelines that allow certain exceptions for saving a mother's life.

St. Joseph's and its parent company, Catholic Healthcare West, considered an appeal of Olmsted's decision to the Vatican but plans none for now, a hospital representative said. In response to concerns raised by some that Catholic guidelines could compromise women's health, Dr. Charles Alfano, St. Joseph's medical director, said pregnant women are and always will be safe at the Phoenix hospital.

The dispute between the hospital and the bishop came to a head in late November, when Olmsted declared an end to discussions that had gone on since he heard about a surgery he considered an abortion that took place more than a year earlier.

The case involved a terminally ill woman suffering from pulmonary hypertension.

Her condition was worsened by her pregnancy, to the point where her death was imminent, doctors said. St. Joseph's officials insisted Tuesday that they tried to save both the mother and fetus and that the decision to terminate the pregnancy in November 2009 was a last resort.

Alfano said there was no safe way to transfer the woman to a facility that wasn't guided by Catholic health-care directives.

"She essentially was moribund," he said.

Alfano confirmed the hospital did not believe it was in violation of Catholic directives, which prohibit abortion, because the purpose of the surgery was not to kill the baby but to save the life of the mother. He said the hospital has terminated pregnancies before in similar situations and couldn't affirm it never would do so again.

"What he wanted us to do was impossible, considering the level of care we provide," he said, referring to the bishop's demands.

Alfano, an obstetrician, said similar cases have arisen before but added, "Pregnant women have always been and will always be safe at St. Joseph's."

Three demands were contained in a Nov. 22 letter Olmsted sent to Lloyd Dean, president of Catholic Healthcare West.

The bishop wanted the hospital to give him more oversight of its practices to ensure it complies with Catholic health-care rules; provide education on those rules to medical staff; and acknowledge the bishop was correct in the dispute over what he deemed an abortion.

Asked whether saving one life was better than losing two, Olmsted said, "There is no way to rationalize this. It would have been best to try to save them both."

The hospital insisted it did so.

"Our first priority is to save both patients," said Linda Hunt, the hospital's chief executive . "If this is not possible, we will always save the life we can save.

"Morally, ethically and legally, we simply cannot stand by and let someone die whose life we might be able to save."

Olmsted also said St. Joseph's has not been communicative, allowing him to have input into such decisions, although Hunt said Tuesday that the diocese appointed one member of the hospital's ethics committee.

Hunt said the level of care provided at St. Joseph's exposed it to the bishop's demands. She said another hospital in the CHW system, Mercy Gilbert Medical Center, would not have faced the same dilemma.

"Mercy Gilbert does not have the high-risk obstetrics cases that we do," she said.

Hunt said her hospital will not alter its mission, change its name or remove the statue of St. Joseph, father of Jesus, which sits in front of the building.

"Nothing is really changing at St. Joseph's," she said. "We will be steadfast in fulfilling our mission of care."

Clashing views



At his news conference, the bishop said CHW made a conscious choice not to comply with Catholic ethical and religious directives governing health care.

The decision, he said, confirms his belief that patients at the hospital will not receive the kind of health care he can endorse.

Olmsted said ongoing discussions with hospital executives "have only eroded my confidence about their commitment" to the church's Ethical and Religious Directives for Catholic Healthcare. "They have not addressed in an adequate manner the scandal caused by the abortion."

The issue became public last spring, when the bishop said Sister Margaret McBride, a vice president of the hospital, had excommunicated herself because she approved the procedure.

Since then, Olmsted said, he has discovered numerous other violations of the Catholic directives, which prohibit abortion in all circumstances, as well as sterilization, prescription of contraceptives and in vitro fertilization.

The other violations, he said, are taking place at Chandler Regional Hospital, a CHW hospital that never has followed the church guidelines, and under the Mercy Care Plan, a non-profit health-insurance plan for poor patients who qualify under the Arizona Health Care Cost Containment System.

Hunt, the hospital executive, said that the Mercy Care program is government-provided insurance for the poor and that any required procedures that do not comply with Catholic teaching are farmed out to a third party, not done at St. Joseph's.

The arrangement had been in place since 1986, more than a decade before Olmsted became bishop.

The Rev. John Ehrich, Olmsted's key adviser on medical ethics, said the problem existed because the hospital facilitated the procedures, which he described as "formal cooperation in evil."

Impact questionable



The bishop said he is worried his decision will lead to division in the church, "but it would be unfaithful to pretend the (St. Joseph's) institution is Catholic."

The declaration has no practical effects on health care at the hospital, although the bishop will not allow Mass to be said there anymore. Priests and church ministers still will be able to care for patients at their request.

Olmsted said donors might want to consider St. Joseph's status before giving to the hospital.

Hunt had no concerns about donations or other financial support.

"Our donors have been very supportive," she said. "We do not expect a financial impact."

Hunt said the hospital will make a continued effort to comply with the Catholic directives. No abortions or sterilizations will take place there.

"We are the same hospital as we were yesterday and will be tomorrow," she said. "The Sisters of Mercy are still here, and we will still follow the directives as well as we can."

St. Joseph's was founded by the Sisters of Mercy, a Catholic religious order.

It is the oldest hospital in the Valley and, for more than 100 years, was the only Catholic hospital in the Phoenix area until CHW built and opened Mercy Gilbert in 2006.