Provena Hospitals owns and operates six hospitals, including Provena Covenant Medical Center (PCMC), a full-service hospital located in the City of Urbana. PCMC was created through the merger of Burnham City Hospital and Mercy Hospital. It is one of two general acute care hospitals in Champaign/Urbana and serves a 13-county area in east central Illinois. The services it provides include a 24-hour emergency department; a birthing center; intensive care, neonatal intensive care, and pediatrics units; surgical, cardiac care, cancer treatment, rehabilitation and behavioral health services; and home health care, including hospice. It offers case management services to assist older persons to remain in their homes and runs various support groups and health-related classes. It also provides smoking cessation clinics and screening programs for high cholesterol and blood pressure as well as pastoral care. PCMC maintains between 260 and 268 licensed beds. Each year it admits approximately “10,000 inpatients and 100,000 outpatients.” Some 60% of its inpatient admissions originate through the hospital’s emergency room, which treats some 27,000 visitors annually.

PCMC provides an emergency department because it is required to do so by the [Illinois] Hospital Emergency Service Act. Where emergency room services are offered, a certain level of health care is required to be provided to every person who seeks treatment there.

That is so as a matter of both state and federal law. [Citations omitted here and throughout.] Staffing PCMC are approximately 1,000 employees, 400 volunteers and 200 physicians.

The physicians are not employed or paid by the hospital. . . . Provena Hospitals’ employees do not work gratuitously. Everyone employed by the corporation, including those with religious affiliations, are paid for their services.* Compensation rates for senior executives are reviewed annually and compared against national surveys. Provena Health “has targeted the 75th percentile of the market for senior executive total cash compensation.”

Discussion Questions 

1. As this Provena excerpt (about one-fourth of the total) shows, the case decision is long and complicated. It reflects the public policy struggles inherent in these issues. From what you have read, which of the two opinions (majority or partial dissent) do you feel is better reasoned, and why?

2. The court relies on—and quotes with approval—cases that are many decades (even more than a century) old. Why might those old cases not be relevant today?

3. Should the idea of charity be redefined to meet today’s realities? Is it still a valid concept in the context of healthcare? If not, what would you recommend be changed?

4. Given what you know about other hospitals, to what extent do you think the Illinois court’s rationale will serve as a blueprint for other states to revoke hospitals’ tax exemptions?

5. How, if at all, can hospitals position themselves better to deal with property tax issues?