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Reviewed by:
  • American Catholic Hospitals: A Century of Changing Markets and Missions
  • Bernadette McCauley
Barbra Mann Wall. American Catholic Hospitals: A Century of Changing Markets and Missions. Critical Issues in Health and Medicine. New Brunswick, N.J.: Rutgers University Press, 2011. xv + 238 pp. Ill. $45.95 (978-0-8135-4940-8).

American Catholic Hospitals challenges the assumption that without huge numbers of sisters, Catholic involvement in health care had to diminish. In this comparative study of the work of four religious communities, in Austin, Chicago, Pittsburgh, and Seattle, Barbra Mann Wall explains how the Catholic Church remains a major participant in American health care and illustrates that doing so took no small amount of adaptation. [End Page 666]

The story is one of increasing tension over how to maintain a distinctively Catholic mission and ideology, as the pressure of the marketplace became more pronounced and the markers of Catholicism (notably religious personnel) became less apparent. Members of these religious communities made deliberate decisions to maintain a presence in health care albeit altered. Moreover, most adjusted their work to a revitalized mission distinctive to their own religious community. Communities struggled to keep hospitals viable and also shifted their attention to other health-related work like nursing homes, chronic care, and outpatient clinics. They redefined their health care work beyond that of acute medical treatment, something that their founders would have understood. As a result, Catholic involvement in health care today is not identical to what it was one hundred years ago, but a significant Catholic presence remains. Wall notes that one out of six people who receive hospital care in the United States does so in a Catholic institution.

Wall’s analysis of the economic details of this history is particularly strong. Many financial issues were national, but location mattered also: fluctuation in Seattle’s timber industry, and white flight of patients and physicians from inner-city Chicago each had repercussions for the hospitals she examines. The strategies followed were not identical, but Wall emphasizes most were overwhelmingly characterized by pragmatism. Steps taken by the Sisters of Providence in Seattle illustrate the spectrum of options pursued. One hospital was merged with another voluntary hospital where they maintained control; they transferred two others to a for-profit organization. Detailing this and how they maintain seventeen acute and twenty long-term care facilities, Wall concludes that their choices reveal success and disappointment but also “the steps sisters took to maintain their religious ministry” (p. 30) that they pursued in work with the elderly. Similarly, the Alexian Brothers in Chicago merged, moved, opened new services, and supported their ministry work (HIV/AIDS and drug addiction) with their more financially successful efforts. (Her discussion of how those religious men created a Catholic identity of caretaking and masculinity offers a fresh insight on the gendered history of nursing.) One group did not land on its feet in quite the same way, and that situation illustrates a festering problem. The Sisters of Mercy in Chicago also maintained their mission by staying put in what Wall describes as a classic “safety-net hosptial” (p. 47). They abandoned plans for collaboration because of control issues but also because doing so would have meant a move out of the neighborhood where they were greatly needed. They adapted too, with programs to attract more revenue, but their patients were still overwhelmingly the same. Wall concludes that as Mercy Hospital “continues to provide care for the poor as a stand-alone facility, the probability that it will suffer financially increases” (p. 52).

These communities also grappled with another uniquely Catholic issue: the Catholic position on reproductive rights and abortion. Here too administrators were sometimes carefully pragmatic. In the partnering of the Daughters of Charity’s Seton Medical Center in Austin with the city-owned Breckenridge Hospital, the Daughters took control of Breckenridge but not ownership. This allowed Breckenridge to continue all reproductive services at odds with Catholic directives with the exception of abortion, which had always been an off-site referral [End Page 667] at Breckenridge. In the Seattle merger, however, all reproductive services ended when the Sisters of Providence took over.

The title of Wall’s chapter “S Stands for...

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