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The Rise of the Corporate-Catholic “Zombie Hospital”

A labor fight at Saint Vincent Hospital in Massachusetts reveals how massive health systems use weak religious affiliations as cover for toxic practices, from unions to reproductive health.

Nurses wear protest signs and hold candles during a strike vigil at Saint Vincent Hospital in Worcester, Massachusetts.
Courtesy of Amy Littlefield

Rain dots the sidewalk outside Saint Vincent Hospital in Worcester, Massachusetts, as Pastor Moses Makor of Christ Vision Ministries ascends a plywood podium. Makor, dressed to preach, in black with a mustard-yellow collar, works at the hospital as a nurse. He and hundreds of co-workers have been out on strike since March 8 over nurse-to-patient ratios they say have led to unsafe conditions and an increase in patient bedsores and falls. It’s a Wednesday in late April, and the nurses surround the podium at the interfaith vigil, cupping battery-powered candles in the gray evening light as Makor quotes from the Epistle of James. 

“Now listen, you rich people, weep and wail, because of the misery that is coming on you,” he reads in a steady baritone. “Your wealth has rotted, and moths have eaten your clothes. Your gold and silver are corroded. Their corrosion will testify against you and eat your flesh like fire.” 

Makor looks out over the nurses and their supporters as he declares, “It’s the word of God, and I believe it with all of my soul.” The crowd claps and calls “Amen!” 

The rich people in question are the executives of Tenet Healthcare, a Dallas-based for-profit corporation that runs this beloved community hospital founded by the Sisters in Providence in 1893 and named for a saint revered for his service to the poor. Tenet posted $97 million in first-quarter profits this year, boasting that its earnings “exceeded our expectations,” even as it spends millions to fend off a strike the singular stated mission of which is to improve patient safety. “When you don’t have enough nurses at the bedside, you have nurses who punch out at the end of a shift, and they’re crying on the way home because they’re despondent,” Marlena Pellegrino, co-chair of the bargaining unit and a Saint Vincent nurse for 34 years, said. “Despondent about the care they’ve been forced to give.”

When Pellegrino graduated from the nursing school that was attached to Saint Vincent in 1986, her nursing pin read, “God is Charity.” The name Saint Vincent carries a long and revered history in this postindustrial city in central Massachusetts, where some 40 percent of the population is Catholic. Three Catholic officials, including Bishop Robert McManus, sit on the board of Saint Vincent. The website makes sparse mention of Tenet, which first acquired the hospital in the 1990s, before selling it to another for-profit and then buying it again. Tenet presided over Saint Vincent the last time the nurses went on strike, in 2000, to win their first contract. That strike lasted 49 days. This strike has lasted more than 50 so far.   

The nurses find themselves facing a bizarre and formidable foe: a multibillion-dollar corporation running a hospital where business executives sit beside Catholic leaders on the board of directors and where, despite more than two decades of for-profit ownership, reproductive health care is restricted by Catholic doctrine. Such corporate religious hybrids are far from unusual, and the courts in recent years have granted them broader and broader leeway to use their religious ties to exploit workers. Nationwide, one in six hospital beds is subject to Catholic restrictions that have been invoked to deny birth control, tubal ligations, and gender-affirming surgeries, and to deny or delay care to patients who are bleeding and in pain from miscarriages if their fetuses still have a heartbeat. Many of these Catholic hospitals are owned by the country’s largest hospital systems. As a result, what many patients and communities have been left with is massive health care systems that can wield their religious affiliations to limit access to care and skirt laws intended to protect workers, while conveniently overlooking the more than century-long Catholic tradition of support for workers and unions.

Tenet, one of the nation’s largest health care systems, has expanded its reach in part by marketing its willingness to keep the Catholic rules in place. “Tenet was an early for-profit health care system that moved to acquire Catholic hospitals, and it basically established that it was willing to comply with Catholic doctrine following the purchase of these hospitals,” Elizabeth Sepper, professor at the University of Texas Austin School of Law, said. “It was a tool that Tenet used to break into markets and to acquire Catholic hospitals that were up for sale that otherwise probably would have gone to a Catholic health care system or another nonprofit.” 

Sepper coined the term “zombie hospitals” to describe the creations resulting from these mergers. Such hospitals have little to no remaining connection to a church but are bound to follow religious restrictions on health care, sometimes through agreements attached to the land itself that purport to prohibit forever the use of the property for sterilization, abortion, or aid-in-dying. When the private equity firm Cerberus Capital Management announced it would acquire the six-hospital Caritas Christi Health Care system in Boston in 2010, The Wall Street Journal quipped, “Catholic nuns, meet your new owners: A three-headed dog from hell.” The sale, Sepper notes, included a $25 million penalty if the archbishop determined that the for-profit owners were not upholding the Church’s principles.

The typical origin story for these hospitals goes like this: The hospitals were founded in the 1800s as charitable institutions by benevolent nuns who were then forced by competition and consolidation in the health care system to sell their struggling hospitals. Sepper admits she had been among those to promote this narrative. But in subsequent research, she has uncovered evidence of the hospitals using their church affiliation to exploit workers for financial advantage as far back as a century ago. In the 1920s, for example, proponents of a new Catholic hospital in Buffalo pointed out that the unpaid labor of the Sisters of Mercy would allow the hospital to charge about half of what other hospitals charged: $2.50 a day instead of $4.60. 

Such hospitals have deployed religious arguments to oppose unions dating back to at least the 1970s. “In Buffalo, the right to strike was viewed by the Sisters of Mercy as abolishing an individual’s power to select his own relationship with an employer,” medical historian Guenter Risse wrote in Mending Bodies, Saving Souls: A History of Hospitals. 

Saint Vincent, meanwhile, has denied the claims about patient safety made by the nurses and praised the more than 100 out of 800 nurses who, it claims, have crossed the picket line. “They embody the true mission of Saint Vincent Hospital, which is to provide safe, quality care to our community in a patient-focused manner,” Saint Vincent CEO Carolyn Jackson said in a statement. 

The legal system has been increasingly receptive to religious arguments when they are brought by corporations seeking to undermine the rights of workers. Religious affiliations have become a kind of calling card that allows corporations and institutions to do everything from underfunding employee pension plans to firing disabled workers and busting unions. Last June, the National Labor Relations Board said it did not have jurisdiction over faculty members at religious colleges and universities, ruling that its oversight would threaten the First Amendment rights of the religious institutions. Religious schools have used a legal loophole intended for churches to argue, successfully, that they should be able to fire teachers with disabilities without facing discrimination claims because the teachers are “ministers.” Centura Health, a Catholic and Seventh-day Adventist health care system, even attempted to use the ministerial exemption against a doctor in Colorado who wanted to help a cancer patient die. 

As the legal rights of these corporations to exploit their workers widen, the criteria for what makes the institutions religious have grown murkier. 

“This has been a discussion that has been ongoing basically since the 1950s, at least: What is it that makes a hospital Catholic?” Sepper said. “And one thing you used to be able to say, for sure, is it’s a nonprofit with nuns at the helm. And then you stop being able to say that nuns are at the helm, and now you can’t say that it’s nonprofit. So it comes down, in some sense, to abortion, to a saint’s name, maybe, and to some religious iconography.”

In the case of Saint Vincent, records on the Diocese of Worcester’s website show the diocese bankrolled construction of a hospital chapel. “Such a chapel, with God ever-present, makes the Catholic hospital substantially different—the underlying reason for both the chapel and hospital is Christ, whose example determines what should be done and how care in that facility must be provided,” the website states. 

Reached by The New Republic, Reverend Richard Reidy, vicar general for the Diocese, and a board member of Saint Vincent Hospital, declined to comment on the strike or the Diocese’s relationship with the hospital. “Tenet operates it as a Catholic hospital,” Reidy said. “I think they can give you the particular details on that.”

“We have a Catholic chapel on site that is part of the Diocese,” a spokesperson for the hospital wrote in response to the question, adding that the hospital has a “Catholicity Covenant” with the Diocese. “The daily masses are broadcast on closed-circuit in all patient rooms.”

For many Catholics, their religious tradition is about more than closed-circuit broadcasts of daily mass. Scott Schaeffer-Duffy, founder of the local chapter of the Catholic Worker, is perhaps the most steadfast representative of the Catholic faith at the Saint Vincent picket line. Wearing a black knit cap and hooded sweatshirt on the podium at the vigil, he offers a prayer for the nurses’ victory, invoking the long history of papal support for organized labor, beginning with Pope Leo XIII’s praise of “workingmen’s unions” in Rerum Novarum in 1891. Part of a rich tradition of Catholic activism against war and in support of the poor, Scott and his wife, Claire, have opened their house to homeless people and been routinely arrested at peace vigils. “The way I figure it, in the Second Vatican Council, the Church said the Church is the people of God, so when everybody complains about the Church, I just say, OK, then I guess I have to do something, because I’m the Church,” Schaeffer-Duffy told me after the vigil, gripping a waist-high placard depicting Lisa Simpson, peace sign emblazoned on her chest, holding a sign that reads “Honk for Nurses.” 

The nurses, many of whom are Catholic, have been disappointed by the lack of support from the Diocese, even as more than a dozen faith leaders from Christian, Muslim, and Jewish traditions have come to praise the workers, along with many of the state’s leading politicians. 

“I think that the Bishop should have weighed in and said that this is an issue of social justice. Is that not his place?” Marie Ritacco, vice president of the Massachusetts Nurses Association, and a lifelong Catholic who has worked at Saint Vincent for 38 years, said. “I think there probably are certain procedures that they don’t want performed here, that would be out of line with the Catholic teachings, so I think that’s primarily their reason for wanting to be on the board of directors.… It’s clearly not to influence the hospital to make better decisions with regard to how they treat the staff and the patients in the building.”

Typically, the duty to enforce the Catholic directives does indeed rest with the bishop. When Catholic hospitals have violated the directives by performing forbidden reproductive health services, bishops have stepped in to demand compliance. In Iowa in 2018, the Archbishop of Dubuque intervened to stop what he called a “serious moral problem” when he discovered a Catholic hospital in Waterloo was using a decades-old workaround brokered by nuns to offer tubal ligations in an area one provider had nicknamed “the sin room.” The same directives that ban sterilization require Catholic hospitals to maintain “a work environment that ensures employee safety and well-being; just compensation and benefits; and recognition of the rights of employees to organize and bargain collectively without prejudice to the common good.”

Yet the only statement the nurses have received from the Diocese came in the form of a denial. On the eve of the strike, a union organizer reached out to ask if they could use the parking lot at the demolished Our Lady of Mount Carmel Church for a rally. The Diocese said no.