Centura-High Country merger restricts some reproductive options
December 27, 2015
It doesn't take long to recognize the religious affiliation of St. Anthony Summit Medical Center in Frisco.
In the main waiting room, there's the usual holiday decorations: a group of figures making up the traditional nativity scene, red and white poinsettia plants and a brightly lit and ornamented Christmas tree. There's also gold-framed pictures of Pope Francis and Samuel Aquila, archbishop of the Roman Catholic Archdiocese of Denver, hanging on the wall outside of the hospital's chapel. And at the north entrance of the emergency room, a bronze statue of the facility's namesake, St. Anthony, greets visitors while cradling baby Jesus on his right, a rosary and arm extended on his left.
Deeply-rooted Catholicism is not a trait St. Anthony tries to conceal. That's why some pondered what would happen to High Country Healthcare when it was announced in August that the private, nonreligious provider just next door in Frisco would join forces with Centura, which operates the hospital.
A broader national health-care shift toward consolidation for business purposes kicked a merger into gear between the two organizations on Nov. 1 of this year. That meant Centura acquired High Country's 16 primary- and specialty-care physicians, a nurse midwife and two physician assistants in four county locations, including urgent-care centers in Breckenridge and Silverthorne for an undisclosed amount. And the group's staff transitioned over to the much larger outfit's payroll and became part of Centura's network of 500 medical providers in more than 100 locations in Colorado and western Kansas.
Still, questions loomed over how the religious-focused system might affect the services High Country provides its patients.
"High Country Health providers, I suspect, will not be changing a great deal in how they interact with their patients, the services they provide to patients," said Dr. David Watson, chief medical officer for Centura Health. "The relationship between patient and doctor is sacred. That is an intimate, valued relationship that no organization is going to step in the middle of. The way physicians are going to deliver care is essentially unchanged."
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What that means exactly has been somewhat unclear, however. The accord highlights a potential collision of the secular with the sacred, the conflict of modern sensibilities and faith-based directives when it comes to one's health-care choices — what many argue is the most personal aspect of life as we know it.
Bill Wallace, county commissioner from 1997-2006, was instrumental in solidifying the deal for the creation of St. Anthony here in Frisco. He remembers a trip down to the former St. Anthony Central on West Colfax in Denver, along with fellow commissioners Tom Long and Gary Lindstrom, to explore the potential relationship.
"We recognized they were a Catholic charity," said Wallace, "but, at the same time, we wanted people of any faith to feel comfortable. St. Anthony (Central) had quite a bit of religious symbols throughout the hospital. There were crucifixes on the wastebaskets, and, at the turn of every hall, there was a statue of one of the saints. We did ask that they tone it down a bit."
St. Anthony, which at that time also managed the old Summit Medical Center on School Road in Frisco, was receptive to the request, and, not long after, in January 2004, an agreement was consummated with the county to move forward with St. Anthony Summit Medical Center. The hospital opened Wednesday, Dec. 7, 2005 and recently celebrated its 10th anniversary.
As of November, with the push toward coordinated care and electronic medical records, High Country Healthcare, providing care for the population of Summit County since 1993, accepted a buyout. A new system that will compile all of those patient histories will go live May 1 of next year, and, by most accounts, the overall transition has gone smoothly — even if some have already questioned the suggested reductions in patient costs from the new partnership.
"The doctors just want to be doctors," Paul Chodkowski, president and CEO of St. Anthony Summit Medical Center said around the time of the merger announcement. "Our health system will worry about the business side of things."
It's in the language
The major piece that's remained a little murky to this point is how St. Anthony's religious and ethical guidelines might impact service lines. To the best of Chodkowski's knowledge, SASMC has never offered condoms, and the hospital's Catholic emphasis prevents its care providers from offering patients birth-control products. However, High Country's ability to continue providing this specific request will be not necessarily change in theory — although the way in which they are written into the system has changed in practice.
"We are allowed to give contraception, as long as it's used for another reason, a menstrual cramp or irregular period," said Dr. Craig Louis Perrinjaquet, formerly the president of High Country Healthcare and better known locally as Doc PJ. "It really has not interrupted our ability on birth control at all. I'll still hand out condoms at the Ullr Parade — I have 4,000 of them — because condoms are also indicated for disease prevention.
"No one is scrutinizing what we're doing," he added, "they've just asked us to be thorough and also to document it. We're still within the ERDs — the ethical and religious directives — we follow, and it hasn't been a burden to us. We can still counsel women and discuss what choices are out there and not discourage them from making their own choices."
Certain types of intrauterine devices, also known as IUDs, are still obtainable through these means as well because some of the most popular ones are used to help control menstrual cramps or heavy periods.
"There are lots of different reasons to receive lots of different medications," noted Dr. Watson, explaining Centura's diagnosis code process. "A doctor is going to drop their code according to the care they are delivering. They can serve the patient population with little change. Nothing is different there than it was prior."
What is different as of the start of the November relationship, however, is High Country's ability to provide sterilizations. Before the merger, a male patient could ask for a vasectomy or a female an Essure, a type of tubal ligation — often referred to as a woman "having her tubes tied" — and receive the procedure. Those must now be referred outside of the Centura system.
Swan Mountain Women's Center in Breckenridge, which begins a new partnership with Kaiser Permanente the first week of January, has been one of the direct benefactors. The office offering contraception for birth control purposes, in addition to Essures, has seen an increase in appointments for contraceptive management since the start of November.
"Our understanding is High Country Healthcare is not allowed to do it there anymore just for the sake of birth control," Corrie Catron, office manager at Swam Mountain, said of contraception. "The religious and ethical directives are very strict about natural family planning and counseling. It has to be for a medical reason. We want to make sure women of Summit County know there's another option for contraceptives without going to Denver."
None of these medical facilities has ever offered abortions, so this most hotly-contested reproductive choice should raise no additional issue within the county.
Additional reporting by Elise Reuter.