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The New Hampshire Attorney General’s Office gave its blessing Monday to the takeover of Manchester’s Catholic Medical Center by for-profit HCA Healthcare, Inc.

Attorney General John Formella announced his office reached an agreement with HCA and CMC to make sure the new ownership will continue CMC’s mission to provide healthcare and serve the community. 

“This settlement represents a thoughtful approach that both addresses the insurmountable financial challenges CMC is facing and ensures that the healthcare needs of New Hampshire residents continue to be met,” Formella said.

The deal has been in the works for years as CMC sought financial salvation. The nonprofit hospital has been losing up to $3 million a year. The Attorney General’s Office review was the last step in finalizing the deal with HCA.

“CMC’s decision to sell the hospital is largely the result of financial distress that has brought CMC to the brink of bankruptcy,” Formella reported in his role as the state’s Director of Charitable Trusts. “On top of large losses over the last several years, CMC has projected losses of $41.5 million for its 2024 fiscal year, and its debt totals around $160 million. In April 2024, CMC laid off 142 employees attempting to reduce its losses, but providers and patients continue to leave the hospital, reducing revenues at a greater rate than any reduction in expenses.”

The purchase, which the report notes is “not an affiliation or partnership,” will provide financial stability the hospital has long sought.

In a statement, the Diocese of Manchester said maintaining the hospital’s Catholic identity “was essential to the CMC Board of Trustees and Bishop Peter Libasci in deciding a future course of action for the hospital. CMC was created in a close relationship with the Diocese of Manchester including that the Bishop of Manchester approves certain activities of the hospital and the assets of CMC transfer to the Diocese upon the sale of CMC. Going forward, these assets will be held and used exclusively by a foundation that will continue the legacy of CMC’s commitment to provide Catholic health care in the community.”

As part of the deal, HCA first got Vatican approval to take over CMC by signing an agreement to operate within the Catholic Church’s ethical standards for medical care.  

Formella’s agreement with HCA will see that the key funding is in place for hospital expansion and as well as continuing charity care for the Manchester community. 

“As part of HCA Healthcare, CMC and our new colleagues will have access to much-needed resources that will pave the way for financial stability and continued growth. We are committed to making significant capital investments and enhancing key service lines that will benefit not only Manchester patients but patients across New Hampshire with expanded choice and ensure they have the highest-quality care available close to home,”  said Dr. William Lunn, president of HCA Healthcare’s Capital Division.

HCA will contribute $2 million over the next three years to local community health initiatives like Healthcare for the Homeless and Poisson Dental Clinic. 

“With HCA Healthcare, CMC’s legacy of excellence will not only endure but flourish — expanding access to care, enhancing services, and remaining deeply rooted in our Catholic mission,” Alex Walker, president and CEO of CMC said.

Mayor Jay Ruais called Monday’s announcement a pivotal moment for the city.

“CMC’s partnership with HCA Healthcare ensures immediate access to the financial and operational resources necessary to sustain its more than 130-year legacy of providing high-quality Catholic healthcare to our region,” Ruais said. “I am pleased that vital and beloved community programs, such as Healthcare for the Homeless and Poisson Dental, will also continue to serve our community for years to come.”

HCA is a Tennessee-based for-profit company that operates 180 hospitals throughout the U.S., including three in New Hampshire. Critics oppose HCA’s acquisition of CMC, pointing to its actions at Frisbee Memorial Hospital, where the company shut down the labor and delivery department after promising to keep it open. 

HCA’s proposed deal with CMC was hounded last year by nurses from HCA’s North Carolina Mission Hospital in Asheville who said HCA operated in an unsafe manner that put their lives and the lives of patients at risk. The nurses came to New Hampshire to stage protests, publish newspaper ads, and talk to the media, all in an effort to stop the sale.

“The community needs to know what happened to our hospital, because the same thing will happen to their hospital,” Kelly Coward, a nurse and union representative at Mission Hospital in Asheville, told NHPR last year.

Those nurses, all members of the National Nurse United union, stopped their protest a day before the Oct. 23 attorney general’s public hearing at CMC. The union kept silent through the fall and had no statement Monday about the deal’s approval. 

On Oct. 22, National Nurse United announced it had reached a contract deal with HCA for 17 hospitals in 6 states, including the Mission Hospital in Asheville. 

Former state Sen. Lou D’Allesandro, who represented Manchester for decades, backs the HCA deal.

“CMC must be saved, and we must make sure that all contingencies are met,” D’Allesandro told NHJournal Monday. “I am a strong supporter and will continue to work on behalf of all the citizens of Manchester to have quality medical care continue to be provided.”

Bishop Libasci says he’s pleased with the result.

“We may look forward now to a strong, vigorous, Catholic hospital on Manchester’s West Side and Catholic healthcare throughout the state of New Hampshire,” Libasci said.

EDITOR’S NOTE: An earlier version of this article erroneously reported that the Diocese of Manchester owns CMC. NHJournal regrets the error.

New Hampshire’s Roman Catholic Diocese is not taking part in the annual March for Life, the largest pro-life demonstration in the country, citing concerns over the COVID-19 pandemic.

“The Diocese of Manchester recently decided to not organize a large, diocesan-wide contingent to attend the March for Life in Washington, D.C., primarily due to the difficulty of monitoring and mitigating the COVID-19 risk with a group of over 100 participants,” said Bevin Kennedy, the diocesan cabinet secretary for communications. 

The decision means that individual parishes that once booked seats on buses the dioceses chartered for the trip to Washington D.C., and secured hotel rooms through diocesan reservations, were left to scramble to make their own accommodations for this year’s trip.

The March is scheduled for Jan. 21, to be close to the Jan. 22 anniversary of the Roe v Wade United States Supreme Court decision being handed down. Claire Pullan, with the March for Life national organization based in Washington D.C., said she’s heard from some groups that normally take part that they are worried about the pandemic.

“People are concerned about what COVID is doing, and what role that’s going to play this year,” she said.

The March organizers are telling people to take the pandemic seriously and take sensible precautions to keep themselves and others safe. The larger problem connected to the pandemic is the costs for the trip. Many groups that relied on charter buses to get down to Washington D.C. are finding the trip costs have effectively doubled.

Because of the COVID-19 restrictions, many bus companies are requiring social distancing in the bus, leaving half the seats empty. Pullan said a group like a school or a church that could charter three buses in past years now has to charter six because of the restrictions.

“There are more costs because of COVID restrictions, and a lot of people are calling,” she said.

The march usually draws hundreds of thousands of activists to participate, but it is hard to guess how many might take part this year, Pullan said. Last year’s march was converted to a virtual event because of the pandemic, and it is not clear if the continued COVID-19 surge will continue to keep people away. Pullan thinks people might want to show up this year especially after dealing with the pandemic for so long.

“People are recognizing the need to stand up,” she said.

Kennedy said the Diocese is encouraging people to attend smaller, local events to mark the occasion and is encouraging individual parishes to hold their own events.

This year’s event comes as many in the pro-life movement believe the controversial Supreme Court decision creating a nationwide right to abortion, Roe v. Wade, may be overturned or significantly curtailed by the Court sometime next year.

New Hampshire Democrats, many of whom support an even more extreme pro-abortion position than the trimester system laid out in Roe, are hoping a backlash on the abortion issue will help them avoid a 2010-style wipeout in next year’s midterms.

However, a new NHJournal poll found that abortion was named as the top issue by just four percent of Granite State voters.

The St. Anne-St. Augustin Parish, a Manchester Catholic church, is defying the wishes of the state’s Roman Catholic bishop by declaring itself a sanctuary church for undocumented immigrants, following the lead of hundreds of other congregations in the United States that are looking to protect people from President Donald Trump’s beefed up immigration policies.

Bishop Peter Libasci of the Diocese of Manchester sent a letter to clergy earlier this month stating that congregations should not allow undocumented immigrants to be housed within their churches to avoid being deported. The letter came in response to a meeting with several priests who expressed concerns about increased immigration enforcement.

“We have not designated our churches as ‘sanctuary’ churches in this sense of the word because it creates a false hope to tell individuals living in fear that we can protect them from law enforcement actions,” Libasci wrote.

Parents fearing possible deportation have provided notarized instructions to St. Anne-St. Augustin staff, spelling out family finances and who would care for their children in case they are picked up by U.S. Department of Homeland Security Immigration and Customs Enforcement (ICE) officers.

Eva Castillo, executive director of the New Hampshire Alliance for Immigrants and Refugees, said she was not surprised by the Bishop’s letter, but was “disappointed” the Bishop was “quick to dismiss” the idea of sanctuary churches.

“I find it frustrating because I went to the same Catholic school from kindergarten to high school and I always noticed that they were quick throw money, but their equal treatment and welcoming part was not there,” she told NH Journal. “I felt that from way back then. I always say we need to put faith into action and bring it out of the pew.”

Castillo noted that besides St. Anne-St. Augustin, she’s had difficulty working with other Catholic churches in New Hampshire, but there has been interest from other Quaker and Unitarian Universalist congregations about how they could help the cause. On the Seacoast, she’s spoken with members of the United Church of Christ and other Indonesian churches.

“It’s not only giving residence to somebody, she said. “You can just give support to places where people are staying. You could have a rapid response team if ICE is in ‘X, Y’ place and have a group of people there to witness the activity. Not to stop it, but to bear witness of what’s going on.”

The balance between helping those in need and breaking the law has some churches unsure about which action to take. Yet, for Bishop Libasci, he said there are two definitions to the term “sanctuary churches” and parishes should not be letting undocumented immigrants live in their church.

“Some use this term and mean what I have described above — a welcoming community ready to offer immediate aid to anyone in need. In these works, of course, we will always be involved,” he wrote in the letter. “But others use this term ‘sanctuary’ to refer to churches that will allow individuals in fear of deportation to live in the church. ‘Sanctuary’ is not a designation recognized by law and provides no such legal protection.”

By law, places of worship are not allowed to harbor undocumented immigrants, yet more than 800 churches and faith groups nationwide have protested recent actions taken by Trump to curtail illegal immigration to the United States and declared themselves sanctuary churches.

Soon after his inauguration Trump, signed two executive orders temporarily suspending immigration from multiple predominately Muslim countries, but both orders are being held up by federal judges as unconstitutional.

In Denver, Jeanette Vizguerra resides in a makeshift bedroom at the First Unitarian Church because she’s concerned that immigration enforcement agents would arrest her elsewhere. Churches in Chicago and Phoenix have also offered shelter to other undocumented immigrants who are fearful of being deported.

ICE officials with a warrant can arrest undocumented immigrants regardless of whether they’re at a church, synagogue, mosque, or other house of worship. The Immigration and Nationality Act prohibits anyone from knowingly harboring an undocumented immigrant “in any place, including any building,” and those convicted could spend years in prison.

However, ICE generally avoids arrests at “sensitive locations,” like churches, because prosecuting pastors could create unfavorable headlines and result in long legal battles.

While several cities and towns in the United States, including many in New Hampshire, are debating whether or not to become “sanctuary cities” — or places where local law enforcement limit their cooperation with federal officials on immigration enforcement — Castillo said the best chance to help undocumented immigrants is at the church level. She isn’t expecting too many cities or towns to publicly declare themselves as sanctuary cities, due to New Hampshire’s small Latino population.

According to the Pew Research Center’s Hispanic Trends, the Latino community comprised 3 percent of the state’s population in 2014, although that number is growing in size.

Three small Granite State towns — Harrisville, Dublin, and Lyme — voted at town meetings last month to declare themselves as “sanctuary towns.” However, bigger areas like Durham, home to the University of New Hampshire, and Portsmouth failed to pass similar measures. Students at Dartmouth College in Hanover passed around a petition after the November election seeking for the university to declare itself a “sanctuary school.”

Castillo remains hopeful that the Bishop changes his mind and allows Catholic churches to become safe havens for undocumented immigrants. She said she is in the process of scheduling a meeting with him soon.

“We realize that this is a big commitment on the immigrants and the people to house them,” she said. “It is really civil disobedience. That’s what we tell them. We aren’t disguising the whole notion. We aren’t advocating for one thing over another. They can all do their own part in what they are most comfortable doing.”

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