ATTORNEY GENERAL Martha Coakley proposed yesterday that the Archdiocese of Boston limit its control of the Caritas Christi hospital system - an idea that overlaps with the six-hospital chain's internal recommendations. But there is an important exception: In the system's own plan, Cardinal Sean O'Malley, archbishop of Boston, and his successors would still have veto power over new members of the governing board and the chief executive, and would have to approve property transfers. That extra layer of control adds sluggishness that Caritas cannot afford.
Four of its hospitals, in Fall River, Methuen, Brockton, and Norwood, are healthy. But Caritas needs to avoid being dragged down by its two Boston affiliates, St. Elizabeth's Medical Center in Brighton and Carney Hospital in Dorchester. Chairman James Karam and the rest of the board are trying to improve the management structure and hire a new CEO. Yet they are still stuck with a hospital system whose chief rationale is not medical or economic, but its Catholic affiliation.
Karam said yesterday that the board is already following some of the recommendations in Coakley's report. Under its plan, St. Elizabeth's would no longer compete across the board with the major teaching hospitals. Carney would seek to find its niche in mental health and the other fields where it does well.
These changes may suffice to turn the two around. But if they fail, board members need to consider all options, including affiliation with another hospital, and the cardinal's veto could hold them back.
Coakley's report, written by the consultants Health Strategies & Solutions, acknowledges that the archdiocese has a responsibility to focus on "moral and ethical issues" involving Caritas. The cardinal had no problem with Caritas Good Samaritan in Brockton linking up with Beth Israel Deaconess in Boston to provide hospital services for patients of a physicians group in the southern suburbs. Other collaborations with secular hospitals are best done by the board in consultation with the archdiocese, but without a veto.
Karam has another worry. He believes that insurance payment schedules favor wealthy hospital chains over Caritas and lower-cost providers. The state is beginning a conversation on healthcare costs that will yield information about these differences. In the meantime, St. Elizabeth's and Carney need to keep showing that their lower costs do not result in lower quality.
Deregulation of hospital rates has put a premium on nimbleness and creativity. The attorney general has a statutory duty to make sure nonprofit institutions fulfill their charitable intentions. She'll need to keep pushing so that Caritas improves its awkward governance structure to sustain these important healthcare institutions.
