The Connecticut Office of Health Strategy is raising questions about a proposed deal between Massachusetts-based Catholic health system Covenant Health and Day Kimball Hospital in rural Putnam. If the deal is approved, the new owners would eliminate some reproductive health services at the hospital.
Under the terms of the deal, Covenant Health would acquire Day Kimball, bringing the struggling rural health care system into its larger network and absorbing tens of millions of dollars of its debt. Day Kimball is one of the few remaining independent hospitals in the state, and it has performed poorly financially relative to other Connecticut hospitals in recent years.
But the acquisition by a Catholic health system would mean Day Kimball has to adhere to the Ethical and Religious Directives for Catholic Health Care Services, or ERDs, which limit services related to reproductive health, emergency contraception, fertility, gender-affirming, end-of-life and other care. A similar proposal by Waterbury Hospital a decade ago fell apart after opposition from women’s reproductive rights advocates.
Covenant and Day Kimball announced their agreement late last year. This April, Day Kimball filed a 726-page application with the state — known as a “certificate of need” — seeking the Office of Health Strategy’s approval for the transfer of ownership.
On May 27, OHS responded, asking for additional information from the two hospitals on several aspects of the application — among them, the ERDs.
OHS asked how Day Kimball will ensure access to services that are terminated as a result of adopting the ERDs; whether Day Kimball would provide referrals and transportation for patients seeking those services; and which other Day Kimball entities — the system includes home and hospice care operations, a medical group and four health centers — will be subject to changes in policies and procedures under Covenant.
The letter also inquired about cost and quality, limits to women’s health services at another Covenant medical center and further details on Day Kimball’s financial challenges. The hospital has 60 days to respond.
Kyle Kramer, chief executive of Day Kimball, said in an emailed statement that the planned affiliation with Covenant Health would actually allow Day Kimball to expand patient care, “serving people of all faiths, backgrounds and incomes.” While earlier discussions with other hospital systems were unsuccessful, Kramer said the agreement with Covenant would ensure Day Kimball retains many of its services, including labor and delivery, intensive care units and other inpatient care.
Noting that Day Kimball is the region’s largest employer, Kramer said, “Our affiliation with Covenant Healthcare will provide a strong and stable financial position and accelerate the funding of future clinical and infrastructural capital needs.”
In an emailed statement, a spokeswoman for Covenant Health said the two hospitals were reviewing OHS’ request and planned to “provide a thoughtful written response” within the requisite timeframe.
“Based on our due diligence to date, it is clear that the proposed affiliation will preserve a wide array of high-quality health care services and jobs for community members in Northeast Connecticut,” spokeswoman Karen Sullivan wrote.
Options for patients
The proposal comes amid heightened debate nationwide over access to abortion, contraception and other reproductive health services. As many states — including Connecticut — seek to expand access and provide a safe haven for patients seeking abortions, the ethical and religious directives could restrict Catholic health systems in those same states from providing some of the services legislators are working to protect.
Top Catholic health systems, like many large health systems, are becoming dominant providers in their regions, growing through acquisition of smaller, struggling hospitals. Four of the country’s 10 largest health care systems are Catholic, and they control hundreds of acute care hospitals, urgent care clinics, physician practice groups and other facilities.
In Connecticut, Trinity Health — the nation’s sixth-largest system, according to a recent report — operates Saint Francis Hospital in Hartford, Johnson Memorial Hospital in Stafford and Saint Mary’s Hospital in Waterbury, among other facilities.
As Catholic health care providers grow, advocates and researchers are raising concerns over the expanding influence of ERDs in patient care.
Lori Freedman, a professor with the University of California San Francisco’s Bixby Center for Global Reproductive Health, said patients often don’t know the difference between Catholic and secular hospitals and which services are available at one as opposed to the other.
If a woman is losing a pregnancy, Freedman said, a secular hospital may offer her a choice between waiting to see whether she might naturally deliver the pregnancy, taking medication to induce delivery or undergoing an abortion procedure.
“Catholic hospitals differ,” Freedman said, “because they might only offer her the ‘watch and wait’ [option] until she becomes sick. Once she becomes sick, they’re allowed to intervene.”
Freedman said most people don’t understand those nuances. And in rural locations like Putnam, patients in emergency situations might not be able to make a longer trip, even if they have a preference in care.
Meghan Holden, a spokeswoman for the American Civil Liberties Union of Connecticut who grew up near Putnam, said, “On the whole, what these ethical and religious directives mean for people seeking care is fewer options. And when you’re talking about a rural hospital like Day Kimball, that can have some pretty dire consequences for folks in the community.”
One of those options is no longer available. In 2020, Planned Parenthood of Southern New England closed its health center in Danielson, the nearest location to Day Kimball, citing economic hardship caused by the pandemic.
“We’re not an exclusively Catholic community. There’s Jewish people and Muslim people and people of other faiths, as well as no faith here,” said Rev. Jane Newall, the pastor at Federated Church of Christ in Brooklyn, CT, who occasionally fills in as chaplain at Day Kimball. “To be beholden to some other directive, and to have that also be your only choice in a rural area is very troublesome,” Newall said.
According to its certificate of need application, Day Kimball “has not performed any voluntary interruptions of pregnancy for many years.” Indeed, the vast majority of abortion procedures — 95%, according to Freedman — are done at clinics, not hospitals.
But the application lays out several procedures that Day Kimball would no longer offer if it becomes part of Covenant Health, including vasectomies, IUD insertion and tubal ligations, known colloquially as having one’s “tubes tied.”
In reviewing Day Kimball’s application, as with any certificate of need application, state officials focus on questions of cost, quality and access, said Steven Lazarus, an analyst with OHS.
“Looking at the applicant, we look at the financials to make sure there’s financial stability. We also want to make sure that we have access to services and continue to make sure that quality is maintained,” he said.
Once Day Kimball responds, OHS will review the application again and may request additional information. That could go back and forth a few times, Lazarus said.
Members of the public are welcome to submit comments, and there’s likely to be a public hearing within the next several months once the review is complete. Residents can keep track of the process on the Office of Health Strategy’s CON portal (docket No. 32538).