It’s been a month since Harrison Medical Center officials submitted a 70-page “Affiliation Agreement” to the Washington Department of Health. But state health department officials said Friday it may be another month before any decisions are made about the proposed affiliation.

Harrison Medical Center is proposing to affiliate with the Franciscan Health System which would mean the two medical providers would work together, something hospital officials have said is necessary because of economic needs.

Timothy Church, spokesman for the Department of Health said the application was received June 20, and the review is a two-step process.

“First, we must confirm that we have a complete application and (that) no other information is needed,” Church said. “We did that earlier this week. Now the 30-day review starts.”

The Department of Health is the chief regulatory agency that oversees hospital affiliations, mergers and partnerships. Under state regulations, it can  rule that this affiliation is “non-reviewable” which means it can go forward and not have to undergo a lengthy and expensive review from the department and the public.

Or it can rule that the proposal go through a “certificate of need” process which potentially could cost millions and would involve public hearings during which citizens could offer their opinion about the affilation.

What’s at stake is whether Harrison, a secular medical center, would affiliate with Franciscan, which is a religious hospital system and part of the Catholic Health Initiatives throughout the U.S.

At a meeting in early June in Silverdale, some residents said they were concerned about whether Harrison would operate with the Ethical and Religious Directives that are a part of the Franciscan system.

Those directives limit abortions, end-of-life counseling, and can affect the sterilization and birth control procedures that are performed.Scott Bosch, CEO at Harrison, has consistently said that Harrison will remain a secular hospital, offering the same range of services that it does now.

But Sheila Reynertson, advocacy coordinator for MergerWatch Project, a New York based nonprofit that studies hospital mergers and affiliations, said she is concerned.

In the document that Harrison filed with the state Department of Health, the section on Ethical and Religious Directives has been redacted.

“That’s where I’d want to have a better understanding of what’s really going to happen,” Reynertson said. “They’re saying they will remain secular, but because we aren’t able to read the entire document that has been submitted, we’re taking a chance. It’s problematic.”

A review of the document obtained by The Reporter and The Patriot under the Public Records Act, shows that section 13.10 reads “Ethical and Religious Directives: HMC (Harrison Medical Center) will remain a secular organization that is not subject to the ERDs (Redacted.) State Health Department officials said the document was submitted with the redaction.

Reynertson said throughout the process, Bosch has said that the affiliation is just that, “a hand-holding, we’re just friends thing, but the fact is that Franciscan has the upper hand.”

“It’s especially the case because as it stands now, Franciscan has the ability to decide who can be on the Harrison board,” she said.Besides MergerWatch, the American Civil Liberties Union has issued concerns about the affiliation.

This week, the Seattle ACLU office sent the Department of Health a letter asking that the affiliation go through a certificate of need process.Kathleen Taylor, executive director of the ACLU of Washington, stated in the letter that “the department should reject Franciscan and Harrison’s thinly veiled effort to disguise the true nature for this transaction of assets – it is in reality a sale or purchase of a hospital and should be subject to a (certificate of need) review.”

Throughout Washington, a number of affiliations have actually included the eventual transfer of assets which is what Taylor refers to in her letter.In fact, Gov. Jay Insee recently issued a directive that the state needs to overhaul its certificate of need process.

“It should be applied based on the effect that these transactions have on the accessibility of health services, cost containment and quality, rather than on terminology used in describing the transaction or the representations made in the preliminary documents,” Inslee wrote.

Nine medically-related organizations signed their names to the letter from the ACLU, including directors from Planned Parenthood, Compassion & Choices, PFLAG Washington State Council, People for Healthcare Freedom and NARAL Pro-Choice Washington.

The letter also states that a recent affiliation between Franciscan and Highline Medical Center (including clinics on Vashon) has meant that doctors no longer can give patients full end-of-life counseling, especially where death with dignity measures are concerned.

The ACLU also states that the new Franciscan Health Ventures that would oversee the Harrison board of directors is “a mere shell corporation through which Franciscan and ultimately Catholic Health Initiatives, as its corporate parent, will control and operate Harrison.”

Officials at Harrison and Franciscan issued no comments on the letter from the ACLU.