Apr 22, 2023

Hospital Gets to Keep Chapel Candle Burning

by Sophie Putka, Enterprise & Investigative Writer, MedPage Today May 9, 2023

The Centers for Medicare & Medicaid Services (CMS) and Saint Francis Health System in Oklahoma ended a dispute late last week sparked by a continuously lit chapel candle that threatened their hospital's re-accreditation.

CMS agreed to grant a waiver to Saint Francis, a Catholic not-for-profit health system based in Tulsa, that will allow it to keep the candle burning in the chapel, after the Joint Commission (TJC) initially cited the hospital for fire safety concerns, leading to a protracted battle between the hospital and CMS. TJC is an independent accrediting organization whose findings are used to determine Medicare and Medicaid certification.

"Today, the government was able to see the light, allowing Saint Francis' flame to continue to live on as it has for years without issue," Becket Law, a religious liberties law firm representing Saint Francis, said in a statement.

Becket Law -- the same law firm that won a Supreme Court case for Hobby Lobby, which allowed the retail company to deny its employees insurance coverage for contraceptives -- argued in a May 2 letter that the candle was safe, and that TJC's objections to the lit candle represented an infringement on religious liberties protected under federal law.

"If we go to court, you will lose," the law firm wrote.

According to the letter, on February 21, a surveyor for TJC cited the "living flame" -- which the letter described as "a perpetually burning candle [that] symbolizes the eternal, everlasting and undying Presence of Jesus Christ" -- in Saint Francis Hospital South's chapel as a violation of CMS rules. Specifically, an April 20 letter from CMS said the candle went against a previous memorandum that stated candles must be "placed in a substantial candle holder and supervised at all times they are lighted."

According to survey findings, "there was a lit candle with open flame burning unattended 24/7."

The TJC, which follows the National Fire Protection Association (NFPA) rules for healthcare facilities, forbids open flames within 1 foot of a nasal cannula and 15 feet from any oxygen delivery equipment. The letter from Becket Law noted that Saint Francis' sanctuary candle is not in a patient room, and would never be within 1 foot of a nasal cannula.

The law firm further noted that the NFPA "expressly permits sanctuary candles" that are separate from anything flammable, and added that the flame had been lit for 15 years, had passed numerous fire marshal reviews, was protected by sprinkler heads and exhaust ducts above the sanctuary, and sits in a double-enclosed lamp "mounted and elevated far from any prying nasal cannulas or other oxygen enriching devices." It also has a bronze top enclosing the flame, and is mounted 6 feet off the ground.

"This is not Mrs. O'Leary's barn," the letter stated, referencing the owner of a storied cow that is alleged to have caused the Great Chicago Fire of 1871.

St. Francis said it had requested a waiver from CMS four separate times, offering to add tile on the wall and floor around the candle.

"Saint Francis believes that the laws governing the liturgy and chapel suitability have been divinely instituted by Jesus Christ Himself and that derogating from these laws is an affront to God," Becket wrote. The corrective action dictated by TJC would cost Saint Francis their Medicare and Medicaid eligibility and "its ability to serve elderly, disabled, and low-income patients in Tulsa."

A CMS spokesperson told MedPage Today in an email that on May 4, "CMS hosted a meeting with the hospital and the independent accreditation organization that made the safety finding. The parties agreed on mitigation steps so the hospital can maintain the sanctuary candle."

The hospital agreed to post a sign outside the chapel warning about the flame and restricting patients, visitors, or staff with oxygen equipment from getting too close to it, if possible, with a rail or rope, according to a follow-up letter from Saint Francis to Scott Cooper, MMSc, PA-C, of CMS.

Lori Windham, vice president and senior counsel at Becket Law, said in an online statement, "The game was simply not worth the candle for HHS. It realized that it would be playing with fire in court if it stood by its absurd demand, so it chose wisely. We are glad Saint Francis can continue to serve those most in need while keeping the faith."

Sophie Putka is an enterprise and investigative writer for MedPage Today. Her work has appeared in the Wall Street Journal, Discover, Business Insider, Inverse, Cannabis Wire, and more. She joined MedPage Today in August of 2021. Follow