For more than a decade, the Vashon Health Center has been managed by Highline Medical Center, a nonprofit health organization based in Burien. Now, however, Highline — and with it, Vashon’s largest health clinic — are part of the Catholic-owned Franciscan Health System, and some islanders are voicing concerns.

Those involved with the change say it is a welcome turn of events, a chance to bring  greater financial stability to the clinic at a time when Highline was facing a difficult financial picture. But others fear this new partnership could limit medical choices in significant ways.

The merger comes at a time of increasing attention to the growth of Catholic health systems throughout the country and in Washington in particular. The American Civil Liberties Union estimates that by the end of this year, 47 percent of hospital beds in the state will be in Catholic-operated facilities. Now, health care activists and others are taking note and raising questions, particularly those concerned about reproductive health, end-of-life issues and the influence of the Catholic church over health care practices.

A community meeting, spearheaded by islanders with questions about the recent transaction, will take place on Thursday, April 25. Mark Benedum, the CEO of Highline, and Dianna Kielian, the senior vice president of mission for the Franciscan Health System, will speak and answer questions.

Those involved with the new affiliation, including Vashon Health Center manager Rita Cannell, say that care on Vashon will not be curtailed in any way.

“We have been assured time and time again that it will be business as usual,” she said. “Women can still get their birth control prescriptions here; men can still get their vasectomies here if they want them, and to terminate a pregnancy, we will still refer out. Making sure that patients get the care they need will continue regardless of the religious affiliation.”

Dr. Gary Koch, a longtime health center physician and the clinic’s medical director, also expressed his support for the merger in a statement released through the Franciscan public relations office. He said the change could be the best thing that has happened to the clinic and, like Cannell, stated that patients could expect the same range of services the facility has always provided.

“The Franciscan Health System has assured me that the doctor-patient relationship is paramount and that they’ll support my medical judgment when it comes to caring for my patients; it says so right in my employment contract,” he said in the statement.

Other islanders, however, have concerns about the ramifications of a faith-based system providing health care, including Kate Hunter and May Gerstle. The two women organized Thursday’s community meeting and, with a small number of others, have established a group they call Vashon HealthWatch.

Hunter and Gerstle said they began collaborating last fall on how to improve the Vashon Health Center facility, an aging structure many consider inadequate. When they learned of the upcoming affiliation, however, their focus changed. They encourage all interested islanders to attend next week’s meeting.

“We hope people will come and get their questions answered and be able to make choices on how they’re going to deal with their health care based on what they’ve heard,” Gerstle said.

At the heart of the matter, they say, are concerns about just how closely Vashon Health Center physicians will be required to follow a set of guidelines called the “Ethical and Religious Directives for Catholic Health Care Services.” These directives, which Catholic health care systems are mandated to follow, are written by the U.S. Catholic Conference of Bishops and contain 72 guidelines that span six categories, including the professional-patient relationship and beginning-of-life and end-of-life issues. The directives state explicitly that Catholic health care services must adopt the directives as policy and adhere to them.

Regarding reproductive health, the directives allow only natural family planning and forbid contraceptives. They also prohibit sterilization procedures unless deemed medically necessary and forbid abortion, including for ectopic pregnancies, which can be life-threatening for women.

Advocates for end-of-life choice say they’re concerned that Catholic health systems interfere with the Death with Dignity Act, which Washington voters passed in 2008. The law allows patients with a terminal diagnosis and a life expectancy of six months or less to obtain a life-ending prescription from a physician. The directives, however, strictly prohibit physician-assisted death. The Catholic Church strongly opposed the law and lobbied against it, said islander Kay Longhi, the president of Compassion & Choices of Washington, a nonprofit that helps people with end-of-life decision-making and assists people in overcoming obstacles in using the law.

To those outside a Catholic health care system, it is not clear how faithfully employees are expected to follow the directives. Critics, though, point to what they say are worrisome examples of religious doctrine dictating care, including a nun in Arizona in 2009 who authorized a life-saving abortion for a mother of four. The bishop excommunicated her for the decision, and the diocese severed its connection with the hospital.

Regarding the directives, Franciscan’s Kielian said they often incite more fear than warranted. She noted that they are wide ranging and include a mandate to serve the poor and pay staff a living wage. They also mandate that the relationship between a physician and patient is sacred. Physicians that are part of the Franciscan system are educated about the directives, she said, and at times values will conflict with one another.

“Primary to this is the patient-doctor relationship,” she said.

When Highline sought to merge with another health care system, CEO Benedum said it approached eight health care entities and looked for a good match on mission, quality of care, financial stability, local governance and culture.

“As we lined up the criteria, our board was unanimous that the Franciscan Health System was the best choice,” he said.

Highline and Franciscans call their new relationship an affiliation, but Highline is now owned by the Franciscan system, Benedum said. The Franciscan system is one of the largest health care systems in the state. It, in turn, is owned by the Colorado-based Catholic Health Initiatives, one of the largest faith-based health care systems in the country.

The deal, announced last June, became effective April 1.

Supporters of this change include Cannell, who has worked at the health center for 35 years and has seen it through some challenging times. She described genuine enthusiasm for what lies ahead.

“I look at it as very positive,” she said.

She cautioned that because the deal has been finalized so recently, many details have yet to be worked out. But, she noted, the affiliation will mean islanders will have access to more hospitals and specialists. It will also mean the clinic will move to a state-of-the-art electronic medical records system by 2014 — something they have been trying to get at the clinic for four years.

Highline has lost money in recent years, and the health center had to make painful cuts, Cannell said. Patients felt the effects, as did the doctors, whose administrative workload increased. She had grown concerned about the future of the clinic.

“The Franciscans have brought stability to us,” she said.

Others, however, worry about what price that financial stability will carry.

When islander Kelly Reese, the former legal director of Planned Parenthood of Western Washington, read a news story in The Beachcomber last fall reporting that the affiliation was not expected to result in any changes in health care, she felt dubious.

“My first response was, ‘Yes, it will,’” she said. “That’s just what happens when these types of deals take place.”

Reese, now out of the workplace to care for her young son, decided to reach out to her former colleagues about the new partnership. In March she wrote a letter to Benedum on behalf of six organizations, including the American Civil Liberties Union of Washington and the National Women’s Law Center, expressing their concern and requesting a meeting. That meeting has not happened yet because of scheduling conflicts, she said, but she hopes it will take place soon.

“I am concerned that patients will not have access to a range of health care options, and providers will have to adhere to a set of directives that may not be in the best interest of the patient,” she said.

Of particular worry, she said, is whether providers will have latitude or be forced to follow the church’s directives.

“I feel wary of arrangements like this because we don’t know,” she said.

Robb Miller, the director of Compassion & Choices of Washington, also voiced concern, particularly about patients who may want to use the Death with Dignity Act.

By law, individual physicians and entire heath care systems are allowed to opt out of participating, Miller noted, and every Catholic health care system in the state has done so.

The law does not authorize health care providers to withhold information and referrals, he said, but he has seen Catholic providers’ policies on the act that call for doing so, and Franciscan social workers and nurses have told him that they are forbidden from sharing information about the law with patients or to refer them to Compassion & Choices.

“They actively try to prevent people from using the law. … I could go on and on about the quality of care they provide, but their religious dogma trumps patients’ rights,” he said.

Compassion & Choices board president Longhi holds similar views regarding the Death with Dignity Act and said she knows the frustrations of patients who have thought deeply about the decision but cannot find a doctor to participate.

“The frustrations will be only be more common if these Catholic mergers continue and the Ethical and Religious Directives are enforced,” she said.

Like Reese, she does not believe care will remain unchanged.

“Everything changes,” she said. “Lots of unintended repercussions happen. Times change, personnel changes. I’m not saying I distrust an individual. I do distrust the system to follow through on the statement that nothing will change.”

At the health center, Cannell also encourages islanders to attend the upcoming meeting. She said she and other staff will be there and will take it as an opportunity to listen and learn as well.

“Coming to the forum will be a great opportunity,” she said.

A meeting to discuss the merger between the Franciscan Health System and Highline will be at 7 p.m. Thursday, April 25, at McMurray Middle School. Jim Hauser will moderate.