Faith and Medicare Funding

Payments to Christian Science Nursing Centers Under Attack

Washington Post/March 22, 1999
By Avram Goldstein

Medicare has paid about $50 million over the past seven years to Christian Science facilities that treat sick people with prayer instead of traditional medicine, and critics now are challenging those payments in federal court as an unconstitutional government endorsement of religion.

Nursing facilities affiliated with the Boston-based First Church of Christ, Scientist have been receiving Medicare money since the program of government-paid health care for the elderly began in 1965. Last year alone, Medicare spent $8 million for services for 851 patients at 22 Christian Science facilities nationwide, including one in Alexandria.

The treatment they received is considerably different from care given to other Medicare patients. Instead of the drugs, surgery and therapy that Medicare typically provides in hospitals and nursing homes, sick church members receive care that includes praying, Bible reading and hymn singing.

The issue of government financial support for what Christian Scientists call "spiritual healing" is the subject of a suit in the 8th U.S. Circuit Court of Appeals in Minneapolis. Civil libertarians and medical groups have filed briefs opposing the payments, while church groups and U.S. Sen. Edward M. Kennedy (D-Mass.), who represents the home state of Christian Science, have registered support.

"What the framers really intended to do was separate church and state power," said Marci A. Hamilton, a Yeshiva University law professor who has studied the question of payments to the church's facilities.

"You have to twist yourself into a pretzel to say it's constitutional."

The church's leader, board Chairman Virginia S. Harris, declined last week to be interviewed about the Medicare payments. In a written statement, she praised the care given to sick church members.

"Christian Science nursing facilities offer a loving and supportive atmosphere to patients requiring physical nursing care, who wish to experience transformation and healing," the statement said. "These facilities provide a great service to society."

An attorney for the church said the Medicare payments provide a reasonable way for Christian Scientists to get a return on the Medicare taxes they have paid. He argues that the federal funds pay for the physical care of the patients, and not for prayers or other religious practices.

"It's awfully difficult to say in the context of Medicare or Medicaid that the federal government is endorsing Christian Science," said church attorney Michael W. McConnell, who also is a constitutional law professor at the University of Utah. "That seems absurd on its face. This is carving out a very small corner of the program that enables people of this religious persuasion to get some benefit from the programs without violating the religion."

But the payments are an important component of the facilities' budgets. Administrators at Lynn House, a 22-bed facility on West Braddock Road in Alexandria, say the $300-a-day payments for each elderly patient from Medicare account for half its revenue.

"Our patients have paid into Medicare for years, and they should have some benefit from it," said Lynn House administrator Lois E. Herr.

Mainstream medical groups blame Christian Science beliefs for the much-publicized deaths of sick children who were not given traditional medical care, and they strongly oppose the federal payments. They also point out that church facilities are exempt from many of the government regulations that apply to hospitals and nursing homes.

Although Medicare mostly covers the elderly, an Iowa-based child protection group said it launched the constitutional challenge four years ago because the church regularly cites the federal payments as proof of spiritual healing's legitimacy when it lobbies state lawmakers. The church has persuaded 45 states to give immunity from child-abuse laws to parents who withhold medical care from children.

Church spokesman Gary Jones contends that the issues surrounding Medicare payments should not be linked to children's care because Christian Science facilities rarely treat children. He does not dispute figures from the federal Health Care Financing Administration showing that Medicare has paid church facilities about $50 million since 1992, but he said the figure is only a tiny part of Medicare spending.

"This number is essentially minuscule compared to the total Medicare outlays . . . over the same period," he said.

Christian Science began in the 1860s with the theories of Mary Baker Eddy, a Boston woman whose experiences with spontaneous healing launched her on a spiritual journey that led to a church with outposts in 74 countries. Church members believe that sickness, pain, injustice and evil are illusions that can be wiped away through self-reliance, prayer and insight into the divine reality of God.

The religion, strongly rooted in Protestantism, began at a time when doctors had little to offer the sick and often made illnesses worse through their treatments. At the time, many people preferred to take their chances on prayer. The first Christian Scientist facility, which the church calls a sanatorium, opened in 1920.

The church will not release membership figures; estimates range from 100,000 to 170,000 followers in the United States at about 1,500 churches today.

Dale A. Matthews, a Georgetown University associate professor of medicine who wrote a book last year endorsing the positive effects of spirituality on health, said that religious beliefs are an important part of a patient's medical history. He said he prays with patients who request it. But he opposes government support for spiritual healing unless researchers prove it works.

"I have a lot of respect for faith healers," Matthews said, "but . . . I don't think it's biblical to neglect medicine. For the government to pay, I think that does require that the scientific model be applied to demonstrate some benefit."

The scientific method is not a part of Christian Science beliefs, however. The nurses in church facilities have no medical training and are forbidden to make diagnoses. They don't take blood pressure, administer medications, test blood or check for fevers. They bathe and feed patients and change diapers and dressings.

If a patient has a heart attack or any other emergency, a nurse would not perform cardiopulmonary resuscitation or call 911 but would call a Christian Science practitioner and then try to make the patient comfortable. The practitioners, who are paid by patients to pray for their recovery, are the closest thing to doctors in Christian Science. They generally stay in touch with clients by phone from their homes or offices.

If a patient dies, the nurse's final task is to read Christian Science texts to the body until the practitioner telephones to say that she has released the patient from her prayers.

The federal lawsuit questioning Medicare payments for such treatment was filed in 1996 by Children's Healthcare Is a Legal Duty (CHILD), an Iowa-based advocacy group headed by a former Christian Scientist, Rita Swan, whose infant son died of untreated meningitis. In August of that year, a judge agreed with CHILD and overturned the original Medicare law because it gave the Christian Science church a role in designating whether a facility was eligible for the benefits.

After that decision, Attorney General Janet Reno withdrew Justice Department lawyers from defending the Christian Science payments because she said it was improper for Medicare to pay for nonmedical services. Legal experts say the attorney general rarely withdraws from a case defending a law passed by Congress.

The following spring, Sens. Kennedy and Orrin G. Hatch (R-Utah) collaborated on an amendment to the Balanced Budget Act of 1997 that restored the payments.

The new wording dropped any mention of the Christian Science church and instead created a new category of health care provider: the "religious nonmedical health care institution." References to Christian Science were stripped so the law would not be limited to that group, but so far, no other religious group has set up such a facility.

CHILD filed another lawsuit contending that the new category is a sham, but this time Reno allowed Justice lawyers to defend it in court. Department officials declined last week to discuss why Reno changed her position.

In 1998, a federal district judge dismissed the case, and CHILD appealed to the 8th Circuit, which is expected to schedule oral arguments this spring. Kennedy filed a friend of the court brief last month arguing that the law allowing the payments is needed to protect religious freedom.

Kennedy and his staff declined to be interviewed on the issue last week, but he said in a written statement that the need for the amendment was obvious to Congress.

"The Christian Science church was founded in Massachusetts over a century ago, and its members deserve the same basic fairness in federal aid that all other Americans receive," Kennedy said. "It would be fundamentally unfair for Medicare . . . to discriminate against Christian Scientists, and I welcomed the opportunity to work with Sen. Hatch to protect them."

Hatch declined to comment.

McConnell, the church attorney, who said he is not a Christian Scientist, said the suit is a politically motivated attack that will only harm elderly church members. He said there are dozens of examples of federal laws being modified to accommodate religious groups.

"It's hard to see how anyone is made better off by denying them nursing care, given that they aren't going to be accepting medicine anyway," McConnell said. "It's an act of ideologically motivated cruelty. "If the court were to strike it down, it would be a rather extraordinary blow to religious accommodation in this country."