The Rise and Fall of Faith-Based Hospitals: The Allegheny County Story

By Georgine Scarpino RSM PhD

This book is a meta-analysis of the relationship of margin and mission of faith-based hospitals in Allegheny County, Pennsylvania to their beginnings and endings. It reviews the various local, state and federal events and factors that impacted these hospitals during their growth and decline from 1847 through 2008. Most importantly, the book shares the courage, hardships, and perseverance of the founders of these institutions, many of whom were women, as they responded to one crisis after another but never gave up their commitment to serve the poor and sick of Pittsburgh and Allegheny County.

• Language: English
• Publisher: AuthorHouse
• Release date: Mar 29, 2013
• ISBN: 9781481700214

Georgine Scarpino RSM PhD

Georgine Scarpino, is a Sister of Mercy engaged in service to nonprofit organizations as a planning consultant, meeting facilitator, teacher and trainer. Her newest ministry is coordinating support groups for Grandparents Raising Grandchildren. Georgine’s leadership experience includes serving as a Trustee of Pittsburgh Mercy Health System, Holy Cross Health Ministries, Catholic Health East, Carlow University, St. Xavier University, the Auberle Home and the Portiuncula Foundation. Georgine is also past president of the Pittsburgh Regional Community of the Sisters of Mercy of the Americas. Sister Scarpino received her Ph.D. from the University of Pittsburgh Graduate School of Public and International Affairs (GSPIA), secondary principal certification from the University of Pittsburgh, a M.S. in mathematics from the University of Notre Dame and a B.A. in mathematics from Carlow University. Georgine was an adjunct professor at GSPIA teaching policy analysis and statistics. She also was the Assistant Director of the City of Pittsburgh’s Department of Personnel and Civil Service responsible for the administration of its CETA and Job Training Partnership Act (JTPA) programs. From 1958 - 1974, Georgine was a teacher and a principal at various Catholic high schools in Allegheny County.

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© 2013 by Georgine Scarpino, RSM, Ph.D. All rights reserved.

No part of this book may be reproduced, stored in a retrieval system, or transmitted by any means without the written permission of the author.

Published by AuthorHouse 03/26/2013

ISBN: 978-1-4817-0023-8 (sc)

ISBN: 978-1-4817-0022-1 (hc)

ISBN: 978-1-4817-0021-4 (e)

Library of Congress Control Number: 2012924010

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Contents

Acknowledgements

Author’s Note

Preface

Chapter One      The Rise of Faith-Based Hospitals

Chapter Two      Mission and Margin

Chapter Three      The Fall of Faith-Based Hospitals

Bibliography

Endnotes

Acknowledgements

The old African proverb asserts that it takes a village to raise a child. In the literary domain, acknowledgements attest to an analogous experience. It takes the engagement of an eclectic assortment of friends and associates to raise a collection of information to the level of a book, especially one like the Rise and Fall of Faith-Based Hospitals.

I was graced with many who participated in bringing my thoughts and experiences to publication. Two friends who guided my work during its nascent period can never be thanked sufficiently. Kathy Washy, archivist at UPMC Mercy Hospital is a first class researcher. She found every document or reference that I needed. When I came to the archives to work there were countless materials waiting for me.

I was in awe of her knowledge of Mercy before it became part of UPMC. Kathy even read, corrected and suggested changes and additions in the early versions of the manuscript. Thanks, Kathy.

Sam Friede, director of the Health Policy Institute’s Government Initiative at the University of Pittsburgh, was a special mentor in the early days of the project. He proofread the draft and let me share it with his health care management students who had interesting questions for my reflection. He also provided linkages for me with persons who had important information for this work. His support was very special. Thanks, Sam. And thanks to Ed Kelly from Carlow University who was a great cheerleader for the project.

Congregations of women religious include in their archives rich information about their hospitals. My thanks to the archivists of the Sisters of St. Francis (Millvale), Sisters of St. Joseph, Sisters of Mercy, Sisters of Divine Providence and Sisters of Charity who welcomed me into their document enclaves to gather whatever information I needed. I am also grateful to the authors of books about the history of local hospitals. They provided invaluable resource material.

With red pens in hand a wonderful group of friends provided rich editing of the final draft. These special people include my dear high school classmate and friend Arlene Busse Grubbs and Ray Smith, a friend and mentor since the days when he was responsible for the Long-Term Care component of Pittsburgh Mercy Health System. Thanks to Sister Susan Welsh who did final editing. Undoubtedly, Sister Bonnie Heh is always there as friend, supporter, critic and proof reader whenever I write anything and especially in this case. Thanks Arlene, Ray, Bonnie and Susan for editing help. Thanks also to Ed Stankowski who read and offered a different viewpoint about this manuscript. Ed, I haven’t given up on your suggestion and will follow-up on it after I take a deep breath.

It was always encouraging to hear from friends who asked about and encouraged my completing this manuscript. Most especially, I thank all the Sisters of Mercy who showed support for me and were interested in this work.

Lastly, I have deep respect for all those who founded and sustained these faith-based hospitals. They leave a considerable contribution to the health and well being of Western Pennsylvania and beyond.

Author’s Note

Why explore the rise and fall of faith-based hospitals? Why those in Allegheny County? The rationale for focusing on faith-based hospitals in Allegheny County revolves around three factors. First, they made significant contributions to health care in Western Pennsylvania. Second, they no longer exist due to closures or mergers into secular health care systems. Third, I journeyed with some of them for over a quarter of a century.

As a member of the Board of Trustees of Pittsburgh Mercy Health System and the Mercy Hospital of Pittsburgh at various points between 1984 and 2007, I participated in decisions that led to the purchases of St. John’s (1985), Divine Providence (1993), and Jeanette (2003) hospitals by Pittsburgh Mercy Health System. I also participated in their closure or sale. I was involved in the failed attempts to merge St. Francis and Mercy (1996-2002). I voted to include Mercy in the Eastern Mercy Health System (1986) and was a founding member of its successor, Catholic Health East (1998). I served on the board of Mercy Hospital in Johnstown when it was sold. I was president of the Pittsburgh Sisters of Mercy who were the canonical sponsor of Holy Cross Hospital in Fort Lauderdale (1996) when the sisters were in jeopardy of losing control of its mission and future. Lastly, I served on the Mercy Hospital board when it was sold to UPMC (2008).

Many of these experiences were painful, personally and corporately. The sale of Mercy stands out as the most painful because Mercy was the first hospital founded by the Sisters of Mercy in the world, the first permanent hospital in Pittsburgh, and the last faith-based hospital in Allegheny County. Its 160-year continuous service to Western Pennsylvania is a considerable amount of history to hand over to UPMC, an international for-profit and not-for-profit conglomerate of hospitals and health services.

The Allegheny County Story parallels experiences of other faith-based hospitals throughout the country. Many will recognize them. Hopefully these parallels will stimulate reflections on the stories of other faith-based hospitals in other geographic areas. I welcome and encourage sharing these stories in order to build a more comprehensive portrait of the rise and fall of faith-based hospitals throughout the country. All of these hospitals deserve to be remembered for their successes and struggles. It is important to know why they began and why they ended if for no other reason than to profile for other faith-based non-profits the price of discipleship.

Preface

The rise of faith-based hospitals in Allegheny County was mission driven. Their fall was margin driven. This statement is true and false, simple and complex. Analysis of the internal and external factors affecting the shift from mission to margin as the driving force in the history of these institutions is an attempt to explore what is true, false, simple and complex about this transition.

This book is not about the history of each faith-based hospital founded in Allegheny County. It is an analysis of their collective history or meta-history, that is, commonalities associated with why they began, how they fared, and what happened to them and their religious orientation as a whole. It takes the perspective of question asking rather than hypothesis testing. Therefore, this is not a scientific research study. However, it explores why and how these hospitals appeared and disappeared.

Hospitals included in this analysis are those founded as voluntary, community and non-profit hospitals in Allegheny County, Pennsylvania. Long-term care facilities, personal care homes, tuberculosis, rehabilitation and government hospitals or other freestanding service centers of recent development are excluded.

Maternity hospitals are included because health services offered for mother and child by these institutions were essential and comprehensive. Tuberculosis and rehabilitation hospitals are excluded primarily because they are not included in the Pennsylvania Health Care Cost Containment Council Reports (PHC4). Government hospitals are omitted because local citizen boards do not control them. In Allegheny County, the government hospitals were/are the VA Hospital (federal); Dixmont Hospital (state); the Kane Hospitals for the aging (county); and, the City’s Municipal Hospital that isolated those with contagious diseases.

Hospitals built and operated on the grounds of asylums are also not included. The Orphan’s Home of the United Presbyterian Church and St. Paul’s Orphanage were about primary, long-term, residential services and were not founded as hospitals. They functioned more like an infirmary to meet the health needs of the children in residence.

This story begins in 1847 with the founding of the first permanent hospital in Allegheny County, Mercy Hospital. However, it has dual end points. The first is 1955 when the last faith-based hospital opened. The second is 2008 when Mercy Hospital, the last county faith-based hospital, was sold to UPMC with the agreement that it would remain Catholic and adhere to the Ethical and Religious Directives for Catholic Health Care Services. Whether this model of a faith-based hospital embedded in a secular system will survive is a complex yet-to-be answered question.

There are two criteria for classifying a hospital as faith-based at its founding. First, hospitals needed to be affiliated with a religious denomination. Hospitals in this category, though founded by individuals or groups, initially received financial support and/or recognition as sponsored works of their various churches – Catholic, Lutheran, Presbyterian, Episcopalian – or their Jewish community and synagogues. When these hospitals were incorporated all of their trustees were members of the sponsoring or associated religion. They may have had religious stipulations in their founding documents. Hospitals such as Presbyterian and Montefiore met this criterion.

Second, hospitals needed to be founded by women or men’s religious Congregations. The Sisters of Mercy (Pittsburgh), the Franciscans (Millvale), Sisters of Charity (Greensburg), Divine Providence Sisters (Allison Park) and the Sisters of St. Joseph (Baden) are the specific congregations responsible for founding hospitals in Allegheny County. These are the names of the congregations when the hospitals began.

Applying these two criteria led to the identification of thirteen faith-based hospitals founded in Allegheny County from 1847-1955. None was founded since then. The story of these faith-based hospitals from the day they began until they became part of a different reality is a story of courage, commitment, continuous care of the poor, sacrifice and great achievements.

Another important classification for faith-based hospitals came from government. The State of Pennsylvania categorized them as sectarian. This classification was significant and costly. Sectarian hospitals could not receive any financial assistance from the legislature according to the state’s constitution. However, the majority of the faith-based hospitals in Allegheny County fought being classified as sectarian because they served everyone. For example, Mercy Hospital, during the early 1920’s served patients representative of thirty-two different nationalities that were members of 15 different churches/religions. Some of the early hospitals like Shadyside were classified as non-sectarian by the state but organized religious services and practices in their facilities. Other hospitals did not provide any religious services for their patients. To put aside the debate about sectarian and non-sectarian nature of a hospital, all the hospitals that were not faith-based will be called nondenominational. Health systems that emerged more recently and have no religious identity are classified as secular institutions.

There are three stages related the shift from mission driven to margin driven faith-based hospitals. Each is covered in one of the following chapters. Chapter one scopes out a profile of the foundations of the thirteen faith-based hospitals including their founder(s), religious affiliation, geography, challenges, sacrifices and the role of mission in the period from 1847 to 1955. This chapter explores the early history or rise of Pittsburgh and Allegheny County hospitals from the perspective of the driving forces that compelled their founders, with little money for the most part, to begin such awesome endeavors.

Chapter two addresses margin and related driving forces that influenced both the rise and fall of the faith-based hospitals in the county. Some of the external causes of this shift include competitive market forces, new health care methods, shifting societal values, increased government intervention, powerful insurance monoliths and the loss of financial and other support from their churches and synagogues. Internally, the mission versus margin debate, the size of the institution, its location, occupancy, governance, collaborative partnerships and financial reserves influenced the gradual shape-shift of these faith-based hospitals to larger systems or extinction. These factors set the scene for examining the nature of this shape-shift through the lens of Etizioni’s organizational compliance structures and illustrates the relationship between mission/margin behavior and normative/utilitarian systems.

Chapter three examines other driving forces contributing to the fall of faith-based hospitals as independent, stand-alone institutions. These factors include the ways to continue their health-care mission, the decline in the membership of the founding groups, the implications of their governance models, and the development of attitudes that questioned the need for faith-based hospitals at all. Continuity and Spiritual Care Models as well as Chaos Theory serve to provide insights into the rise and fall of faith-based hospitals.

By 2008, ten of the faith-based hospitals merged into secular systems. Two closed because the need was no longer there. Another went into receivership. But that is not the end of the story. Throughout their tenure, faith-based hospitals gave testimony to the role of their