This is an excellent, well-researched, neatly organized and well-argued book. Fifty pages of footnotes show Barbara Mann Wall's command of a vast amount of archival materials and salient secondary sources. Early in the first chapter, Wall says: “A major thesis of this book is that Catholic hospital leaders reacted to increased societal secularization over the course of the twentieth century, they extended their religious values in the areas of universal health care, abortion and reproductive services, which led to tensions among the values of the Church, the government and society. Not only do Catholic hospitals determine the types of services they offer based on Catholic religious beliefs, but they do this while supported with large pools of public funding-more than $45 billion in 2002, according to one study. This support speaks to the private/public, religious/secular dichotomy that goes to the heart of the constitutional separation of church and state” (2–3).
The first chapter summarizes the topics that form each chapter. Wall's first chapter includes a two-page- treatment of the profound influence the Second Vatican Council. The 1950s were characterized by professional and religious renewal movements that opened traditional cloisters prevalent among congregations in health care and other ministries and Vatican II had a profound influence of the Catholic self-understanding. Conciliar documents brought changes to liturgy, issued a general call for holiness, designated the laity's mission in Church and society, and called for religious to initiate constitutions which would underscore the freedom of the sisters and brothers in health care to shift their focus to pastoral care and areas of social justice. The author concludes: “These changes were factors in congregations’ abilities to continue to staff hospitals . . . [S]ome relinquished their hospitals altogether to focus on social justice in other ways”(9).
Chapter 1 ‘“From Sisters in Habits to Men in Suits” ends in the1990s and chapter 2, “The Precarious Economic Scene,” follows into the 1990s tracing historical trends in congregations’ struggles to survive in a market health-care system while at the same time trying to maintain their commitments to quality and compassionate care despite the rising numbers of non-paying patients. Wall has a firm command of the ways in which the Catholic hospitals adapted to the steady decline in the numbers of sisters and brothers during the rise of a severely competitive market. These vowed religious served on boards of trustees and on the governance boards of their congregations’ health-care centers, some of which could not survive. The Alexian Brothers, a distinctive group of men whose origins were in the Middle Ages as ministers to “the outsider,” moved their Chicago hospital to a suburb where they offered distinctive services that guaranteed a viable census. They established hospices for men with HIV-Aids in Chicago and also in St. Louis. They are exemplary of the many hospitals that survived by maintaining their religious and social commitments.
Wall titles her third chapter “Religion, Gender, and Public Representation of Catholic Hospitals,” and engages the reader with narrative and analysis of the development of religious identities as they grew from tradition to ecumenism, aligning traditional notions of the feminine within the sisters’ movement to those of the women's movement, and noting the transition from traditional nursing as an occupation exclusively for females to one occupied by males breaking through gender barriers. Hospitals were, in a very real sense, reflections of movements within the broader culture.
Chapter 4 is entitled “Regardless of Color, Race, Creed or Financial Status,” as these stated principles and values were often, in many parts of country, observed primarily in the breach. When hospitals did admit patients of color they were housed in segregated wards. Black physicians were not tolerated even in areas outside the south. The Alexian Brothers decided to desegregate their hospitals in the mid-1960s and a year later they hired two black physicians. In general most Catholic Hospitals were responding to the poor but were not in the forefront on race relations. The social justice principle of Vatican II prepared the administrators of Catholic hospitals to desegregate and thus they were able to receive federal funds from Medicare and Medicaid.
The story of the Sisters of St. Joseph of Rochester, New York, who took charge of Good Samaritan Hospital for black patients in 1944 and worked side by side with black nursing staff, is of historical significance. The community's role is of added significance as its members were the first medical respondents to those caught in the violent resistance on Bloody Sunday. Ultimately the hospital became integrated as a matter of racial justice and of course began to receive federal funds.
“Catholic Hospitals and the Federal Government” is the topic of chapter 5. The Catholic Health Association, (CHA) plays a strong role in promoting Catholic hospitals’ solid record of responding to the poor. This convinced the government to provide funds to support the not-for-profit institution. This was also significant when other hospitals seemed to be making excess profits and should have been paying taxes. Other hospital associations joined CHA to defend the charity base of many of its activities. The emphasis on social justice during Vatican II prompted the National Conference of Catholic Bishops to pursue healthcare reform. In the process, prominent sister administrators with advanced degrees became nationally recognized advocates of reform.
Wall's chapter 6, “Harassed by Strikes or Threat of Strikes,” depicts the many struggles by administrators to free themselves from interference so that they may fulfill their vital mission to serve the poor. Self-interested unions are implicitly opposed to the principles of charity. The chapter closes by noting that many contemporary hospitals still are concerned that union demands could seriously affect the viability of this traditional mission to the poor. However there are those hospitals, influenced by pro-labor voices in the church, which willingly negotiated contracts, continued to thrive as missions and also maintain a sustained financial integrity.
In chapter 7, “Practical Solutions,” Wall's research yields the story of Seton Medical Center's merger with the city of Austin's Brackenridge Hospital allowing Seton to continue to serve the poor. Seton would take full control of the hospital and allow Brackenridge to continue to perform reproductive services, trauma, and children's services. Because there was no material cooperation with such services, Catholic morality permitted the arrangement. Though the local bishop agreed with the principle, it came under the scrutiny of conservative Catholics and a Vatican Congregation. To resolve the issue, these controversial services were conducted on the fifth floor, which became a separate hospital. The merger was with Austin's Brackenridge Hospital not with the fifth floor hospital, an arrangement that was intended to provide a viable option for the controversial merger. Still the Vatican disapproved of the arrangement resulted in the termination of the merger.
Chapter 8, “S stands for ‘Sister,’ not ‘Stupid,’” is a marvelous conclusion, exploring how the trends of the present set the challenges for the future. This book stands alone as a distinctive study of the history of Catholic Hospitals.
