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The Catholic bishop of Phoenix will strip St. Joseph's Hospital and Medical Center of its Catholic status on Friday if the hospital's parent company, Catholic Healthcare West, does not meet his demands to guarantee compliance with church teachings.

Three demands were contained in a Nov. 22 letter Bishop Thomas J. Olmsted sent to Lloyd Dean, president of Catholic Healthcare West. The bishop wants the hospital to give him more oversight of its practices to ensure it complies with Catholic health-care rules, provide education on those rules to medical staff and acknowledge that the bishop is correct in a dispute over a procedure the diocese says was an abortion.

"There cannot be a tie in this debate," Olmsted wrote. "Until this point in time, you have not acknowledged my authority to settle this question."

St. Joseph's and San Francisco-based CHW did not immediately comment on the letter.

If the bishop were to revoke the hospital's Catholic status, Olmsted said, he would prohibit Mass and some religious items at the building. How the loss of Catholic identity would affect the facility's mission, funding and perception by patients and the public remains unclear.

The letter is the culmination of a debate that began in November 2009.

A pregnant woman at the hospital suffered from pulmonary hypertension, a condition that limits the ability of the heart and lungs to function and is made worse, possibly fatal, by pregnancy. After consulting with Sister Margaret McBride, a member of the hospital's ethics committee, doctors terminated the pregnancy.

Olmsted condemned the surgery as an abortion, which is prohibited by church doctrine, and at the time said the decision effectively meant the excommunication of McBride, a St. Joseph's vice president.

St. Joseph's has since argued that the case was more akin to removing a pregnant woman's cancerous uterus, which is permissible under church doctrine, than to a standard abortion. McBride remains a nun on the hospital staff.

Two months of discussions followed but, according to Olmsted, did not resolve the question of whether the procedure was allowable. In the November letter, Olmsted said that he did not believe CHW intended to change its policies.

"Because of this, I must act now," he wrote, to ensure "no further such violations" take place at the hospital and to "repair the grave scandal to the Christian faithful that has resulted from the procedure."

In order to retain his support, he said, Catholic Healthcare West must:

• Acknowledge he was right and the hospital was wrong in its interpretation of a church health-care directive regarding so-called indirect abortions.

• Submit itself to a diocesan review and certification "to ensure full compliance" with Catholic moral teachings. Olmsted wrote that the certification would be similar to other accreditations that hospitals seek.

• Agree to give its medical staff ongoing training on the Ethical and Religious Directives, a document from the national bishops council that explains Catholic moral teachings for health-care providers.

"Failure to fulfill these requirements will lead me to decree the suspension of my endorsement of St. Joseph's Hospital, forcing me to notify the Catholic faithful that St. Joseph's Hospital no longer qualifies as a 'Catholic' hospital," the bishop wrote.

CHW is based in San Francisco, where Archbishop George Niederauer is the diocesan leader. He was copied on the letter. The effect of the letter on CHW as a whole was unclear.

St. Joseph's would not be required to stop calling itself Catholic or remove Catholic items at the hospital unless they belonged to someone who requested their return.

The initial effects of losing Catholic affiliation would include a ban on Mass being said at St. Joseph's, removal of the Communion wafers that Catholics believe are the body of Christ and a public advisory on the diocesan website that the hospital no longer had Catholic status with the diocese.

The bishop said ministry to the sick by priests and church ministers would continue as requested by patients, as it does at other hospitals.

Unknown is whether the move would affect contracts, donations, relationships with doctors, patient use of the hospital or other factors.

Rob DeFrancesco, communications director for the Diocese of Phoenix, confirmed the authenticity of the letter, a copy of which was obtained by The Republic. He said letters between the bishop and others are confidential and declined to comment further.

Numerous Catholic institutions, from universities to hospitals to publications, call themselves Catholic without being affiliated directly with the church.

St. Joseph's has no official connection with the bishop, but it was founded by the Sisters of Mercy, a Catholic religious order.

It is the oldest hospital in the Valley and, for more than 100 years, was the only Catholic hospital in the Phoenix area until CHW built and opened Mercy Gilbert Medical Center in 2006.

Chandler Regional Medical Center joined the group in 1999 but purposely remained a non-Catholic hospital that is not bound by Catholic health-care directives.

Catholic Healthcare West was formed in 1986 to merge control of hospitals, including St. Joseph's, run by several religious orders. The eighth-largest hospital provider in the nation, it makes nearly all its money from patient payments for treatment and does not rely on local dioceses to fund its hospitals.

But the bishop, under church law, enjoys wide discretion in overseeing local institutions that identify themselves as Catholic. In his letter, he refers numerous times to his authority as bishop.

He writes, "Your actions communicate to me that you do not respect my authority to authentically teach and interpret moral law in this diocese."

The bishop also restated concerns he has raised in the past about Chandler Regional Hospital, which joined CHW in 1999 but never adopted the Catholic directives. He pushed CHW to move to put those rules in place in Chandler.

"The irony of our present state of affairs is that an organization that identifies itself as 'Catholic' (CHW) is operating a hospital in my diocese that does not abide" by the directives, the bishop wrote.

Suzanne Pfister, vice president of external affairs at St. Joseph's and spokeswoman for CHW, said she could not comment. She said she would address questions later.

Other parties involved, including the Sisters of Mercy and Chandler Regional Hospital, also referred inquiries to Pfister.

At least one other bishop has removed a hospital from the Catholic rolls. Early this year, Bishop Robert Vasa of Baker, Ore., removed church support from St. Charles Hospital in Bend, Ore.

The church was performing tubal ligations at the request of patients, which the church does not permit. Hospital officials said that they will continue to follow church directives when possible but added that their primary responsibility is to provide comprehensive care to the community.