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Last month’s departure of Rabbi Jeffery Silberman, who held the job for five years, has forced the issue. His position won’t be filled permanently until the matter is resolved.

If the agencies eliminate the custom that a rabbi hold the chaplaincy job, the hospital would begin a search among clergy of all faiths. Spiritual counseling specifically for Jews — who make up 20 percent of patients admitted to the hospital — would continue to be provided through visits from rabbis at Ruach Ami: Bay Area Jewish Healing Center.

However, one of the few tangible remnants of San Francisco’s former Jewish hospital would be lost.

Ann Lazarus, chief executive officer of the nonprofit Mount Zion Health Systems, asserts that the hospital itself should begin paying for the chaplaincy position, as occurs at UCSF Medical Center.

MZHS, which is separate from the hospital, was created in 1990 when UCSF bought the institution from the Jewish community. MZHS’s responsibilities include handling the millions of dollars donated to the hospital when it was still a Jewish entity. MZHS also oversees Ruach Ami.

Martin Diamond, the hospital’s director, contends that MZHS is the entity charged with maintaining the hospital’s Jewish character. “They are obligated by the integration agreement,” Diamond said.

That agreement, signed when Mount Zion and UCSF merged a decade ago, included a section called “Jewish tradition.” The section specified that MZHS would maintain the “Jewish tradition historically observed” at the hospital, which included arranging for a rabbi to counsel hospital patients.

Thus, Diamond sees the final decision as resting with MZHS and the S.F.-based Jewish Community Federation, which also subsidizes the chaplaincy position.

From 1887 to 1990, the Jewish community owned and operated the hospital. So the concept of filling a chaplaincy position with a rabbi was a natural. When UCSF bought the nearly bankrupt hospital in 1990, keeping a rabbi on staff was still considered essential.

Karen Wener, president of the UCSF-Mount Zion Auxiliary, said she believes the Jewish community should maintain its financial support of the chaplaincy position.

“It’s taking care of your own family,” said Wener, who is Jewish. But, she added, “it probably boils down to dollars and cents.”