p.s. It’s not about the neighbors or the disputed $3.1 million!
The Courier-Journal has long advocated for a downtown location for the replacement Mobley Rex VA Medical Center. The newspaper’s leadership and a variety of downtown-boosters are obviously disappointed with the result of a long-studied and reasonable determination not to place the hospital downtown, but rather on a site near the intersection of the Watterson Expressway and Brownsboro Road. A series of articles and an editorial earlier this month focused on the appraisal process used for the Brownsboro parcel purchased by the VA in July, 2012 for $12.9 million. The newspaper seems to insinuate that hanky-panky has occurred and that a cover-up is underway. Rep. Yarmouth has joined the fray asking for a governmental examination of the appraisal and purchase process. That is a fair request, especially since the reputation of some individuals has been questioned in unavoidable service to the interests of others, some of whom also wish to profit from a downtown location. Be well advised, that this controversy is no longer about the interests of the neighbors of the Brownsboro site who would have seen a major new commercial project there in any event.
Possible overpayment does not invalidate site-selection process.
I have been involved with or reporting on the site-selection process for the new VA since its inception. I believe my reports have been the most comprehensive available on the matter. Many of the public documents are available in these pages. I believe I have attended every public hearing and some non-public ones as well. The Courier-Journal and allied downtown-boosters are conflating the site-appraisal process with the site-selection process in a last ditch effort to pressure the federal government to relocate the hospital in downtown Louisville. The two processes are separate and very different things. Any inadvertent overpayment by the Federal Government for the land invalidates in no way the tediously careful process of site selection that went on. Continue reading
Hundred’s of plaintiffs and a 70% drop in angioplasties.
We have known for some time that King’s Daughters Medical Center (KDMC) in Ashland Kentucky (Boyd County) has been under investigation by the Federal Department of Justice for the spectacular number of invasive cardiac procedures performed on its premises. In fact, the rate of angioplasties in that small city was one of the very highest in the nation and the highest in Kentucky. When other hospitals in Kentucky and elsewhere with seemingly anomalous high rates were looked at more carefully, it was found that that many, if not a majority of the procedures in some hospitals were not medically necessary or were even performed on normal or near-normal people!
The extent and progress of the federal investigation at KDMC is as yet unknown but it was not a complete surprise when a civil lawsuit was filed last September in Boyd County Circuit Court. It alleged that a medically unnecessary procedure with placement of a stent was performed in the hospital by its principal cardiologist, Dr. Richard E. Paulus, whose practice reportedly had been purchased by the hospital.
New lawsuits against King’s Daughters.
Earlier this week, a pair of related lawsuits listing some 42 pages of plaintiffs was filed against the hospital, Dr. Paulus, and a variety of business entities operating under the umbrella of the Kentucky Heart Institute. Naturally, a lawsuit tells only one side of the story, but given the precedent of essentially identical scenarios at other hospitals, including St. Joseph In Maryland and St. Joseph London here in Kentucky, the story is believable. Continue reading
50 years later, still marching for voters’ rights.
Yesterday, along with thousands of others and 50 years too late, I went to Frankfort to participate in a celebration of the 1964 March on Frankfort. Ironically, and belying the opinion of some on the US Supreme Court who must willfully be wearing blinders, the principal issue of protest yesterday was of voting rights– the restoration of suffrage to felons who have paid their dues to society. Many in the huge crowd also carried signs protesting the Commonwealth’s intention to appeal last week’s Federal Court decision requiring Kentucky to recognize legal out-of-state same-sex marriages.
Innumerable signs carried by the crowd recognized heroes of Kentucky’s”s civil rights movement and identified current obstacles to full implementation of basic civil rights for all citizens. These tangible aspects of the march are symbols of the slow but inexorable progress towards the ideals that underlie American culture, but which were imperfectly implemented by the first version of our Constitution. I was even more moved however, by unexpected portents that arose along the route of the march. Continue reading
Breaking News, March 4, 2014, 11:30 a.m.
Governor Steven Beshear’s office announced this morning that Kentucky will appeal last week’s final Order by Federal Judge John G. Heyburn II that declared Kentucky’s law and constitution forbidding recognition of legal same-sex marriages performed in other states to be unconstitutional and therefore null and void. The Governor indicated that a request will be made to Judge Heyburn to further stay his Order pending that appeal. His principle justification is that the matter, currently under dispute in several states, will likely be settled by the US Supreme Court and that should the Order be overturned, confusion will occur and disadvantage accrue to those who relied on the order in the interval.
A most interesting wrinkle in the Governor’s announcement is that Attorney General Jack Conway advised the Governor that he will not represent the Commonwealth further in this matter, and that the appeal and additional request for further stay will be conducted by other council. I have not yet seen a statement from the Attorney General on this matter. One might speculate that Attorney General Conway felt that he found no longer morally defend an unconstitutional law, but that the Governor felt compelled to do so. Some skeptics will likely suggest that this path of action takes the Attorney General (who has state-wide political ambitions) off the hook from making the no-win political decision described by several political editorialists this past week. I would like to believe the former possibility is more accurate. [Addendum: In fact, Tom Loftus reports in the Courier Journal that Attorney General Conway announced earlier this morning that "Judge Heyburn got it right" and that by appealing he would be defending discrimination, something "that I will not do." I applaud General Conway for his ethical position.]
Judge Heyburn speculated at last week’s hearing that such an appeal from the Commonwealth might happen. From his comments, and from the confidence I perceive in his belief in the justness of his Opinion, I predict that Judge Heyburn will not grant a further stay of enforcement.
More information is likely to become available, and I will comment further as indicated.
Below are the full statements of both the Attorney General and the Governor.
Peter Hasselbacher, MD
March 4, 2014 Continue reading
What will KentuckyOne Health and other employers do?
For a single day following Judge G. Heyburn’s historic court order requiring Kentucky to recognize legal same-sex marriages from out-of-state, such couples were legally able to do things that many of us take for granted such as changing names on drivers licenses. Sadly, there are reports that despite having two weeks to prepare, some clerks turned people away yet again. Confusion about what to do seemed the socially acceptable and perhaps even understandable excuse. This was the justification offered by the Attorney General’s office in requesting a 90-day stay of the Judge’s order so that the Commonwealth could prepare for an orderly implementation of the new law, and to minimize confusion.
The Judge balanced the lack of any strong argument that the Commonwealth would be harmed by moving forward, against the further injustice of enforcing unconstitutional policy. He may also have been influenced by information presented at Friday’s hearing that some married couples would in fact be harmed by a further 90-day interval. In the end, Judge Heyburn stayed his order of February 27 for 20 days until March 20 to allow the state “proper time to administratively prepare for compliance with the Order.”
Will or won’t the Commonwealth appeal?
A decision of whether or not the Commonwealth will appeal the underlying Order within the allowable 30 days will apparently be made soon. The basis for such an appeal would likely be that the Attorney General has a responsibility to enforce state laws and policy. Of course that is a justification used in the past to suppress the civil rights of minorities. I believe that our Governor and Attorney General will not appeal, even without the cover provided by the United States Attorney General advising that states’ Attorneys General need not defend unconstitutional laws, or last June’s US Supreme Court’s United States v. Windsor decision that turned gay-rights marriage law on its head. This high-drama matter will play out in Kentucky and several other states as it will. In the meanwhile, it is not only the Commonwealth of Kentucky that must prepare for compliance with the new law, but other public and private institutions that have used Defense of Marriage- type laws to support their choice not to recognize legal same-sex marriages. I predict much squawking and maneuvering to avoid doing the right thing as occurred following other civil rights actions in the past.
Here in Kentucky, one of the most prominent actors who will have to change their spots is KentuckyOne Health, the hospital corporation that manages several facilities around the state including in Louisville: Jewish, Sts’ Mary and Elisabeth, Our Lady of Peace, and the University of Louisville Hospitals. Currently in these hospitals, the legal marriages of same-sex families are not recognized for the purposes of employee healthcare and other benefits. In the case of University Hospital, and following the directives of its Catholic parent company, benefits that same-sex partners earned from the previous manager of the hospital were taken away by KentuckyOne Health.
What will KentuckyOne Health do? What should it do? Continue reading
Kentucky must recognize all legal out-of-state marriages regardless of the mix of the sexes involved by March 20, 2014.
On February 27, 2014, Federal Judge John G. Heyburn, II issued a historic final order declaring null and void, Kentucky’s statutes and Constitution forbiding the state to recognize legal out-of-state marriages of same-sex couples. In an earlier Memorandum & Opinion on February 12, the Judge found that no state purpose was served by such discrimination. The carefully reasoned and sensitively written memorandum is destined for the history books.
Immediately following the final order, the Office of Kentucky’s Attorney General filed a request for a 90-day stay in order to give the Commonwealth time to consider whether or not to appeal the judgment and to allow time to prepare for implementation of that order. In a hearing today at the Federal Courthouse in Louisville, Judge Heyburn granted a short stay. For all the happily married same-sex couples, the doors are opening wide to all of the rewards, civic, financial, and emotional, of their commitment. The order granting stay can be viewed here. Continue reading
University Presidents speak about cooperation.
A month ago, I wrote about issues concerning the pediatric cardiac surgery program at Kentucky Children’s Hospital in Lexington. That institution, part of the University of Kentucky’s University Hospital programs, was receiving much adverse publicity about allegedly poor mortality rates for cardiac surgery for pediatric congenital heart disorders. The institution temporarily suspended that surgery program and conducted an intensive in-house review emphasizing plans for the future.
My article was seen by Elizabeth Cohen, Senior Medical Correspondent for CNN who had been following the story. She asked me to respond to several questions. Because I believe the matter is relevant to health policy in Kentucky, I present here the responses I offered with some minor edits. Continue reading
Massive Cut Proposed in State’s Biennial Budget for Indigent Care in Jefferson County. Time for a new game-plan?
I knew I was going to have to write something more about the Quality and Charity Care Trust (QCCT) when I saw that the Governor’s budget was slated to decrease the annual appropriation substantially from $21 million to $9.5 and $6.15 million in fiscal years 2015 and 2016 respectively. That represents a 70% reduction and would surely be a body blow to University of Louisville Hospital.
I am unaware of the rationale behind the proposed reduction, but together with the decreasing contributions from the city of Louisville, it is clear that our state and local legislators are rethinking the appropriateness of the QCCT funding mechanism as the principal means to support the care of medically indigent of our community. I have argued that they are correct to do so.
The QCCT fund to support inpatient care at a public University of Louisville Hospital may have made sense in the early 1980’s, but I do not think it does any more. Much has changed, including the amount of funding and the rules regarding its use. Our healthcare providers and our community itself have also changed. This was never a funding system that should have been considered to operate in perpetuity. Perhaps the Governor’s Office knows something that we do not. Continue reading
Judge rules that Kentucky must recognize legal same-sex marriages.
Last week the Commonwealth of Kentucky made headlines all around the country when Federal Judge John G. Heyburn II ruled that Kentucky’s laws and constitutional amendment prohibiting the recognition of legal same-sex marriages performed in other states were unconstitutional. (Bourke v. Beshear) We are not the last state to recognize the wrongs of the past, but sadly we were not the first. In its recent Windsor decision, the US Supreme Court recently came to the same conclusion. Those institutions who currently discriminate against such marriages no longer can use the lame excuse that they are only following the law to cover what for at least some is simple institutional intolerance.
I find it both ironic yet predictable that some folks locally and nationally rail against Judge Heyburn’s decision concerning same-sex marriage as judicial activism and an attack on the Constitution even as they admit to not having read it! I found in the language of the opinion the most logical, eloquent, and powerful arguments in support of our Constitutions in recent memory. It will be instructive to see how local institutions change their existing policies. I asked KentuckyOne Health how they plan to modify their exclusionary policies for their Kentucky employees, but received no response yet. Perhaps KentuckyOne is waiting for the decision to become final at which time they they will have no choice but to change? Continue reading
Waiting on KentuckyOne Downsizing Day.
By all accounts, today is the day KentuckyOne Health will begin to reveal the first steps of its plan to decrease expenditures by $217 million before the end of Fiscal Year 2015. Specific details were not offered at the time the cuts were announced, but nothing was taken off the table. It seems likely that some hospitals or outpatient facilities will be closed or sold. We should expect to see clinical programs eliminated or consolidated rather than trying to offer everything everywhere. We will surely see terminations and reassignment of staff members.
None of this is in intrinsically inappropriate. KentuckyOne has to balance its books. There is much duplication of clinical services in Kentucky, but unfortunately also many areas with limited resources. The challenge for KentuckyOne is to achieve a balance of downsizing, consolidation, and redistribution of services in a way that does not give the appearance of compromising their goal of providing excellent care to Kentuckians at prices they can afford. I wish KentuckyOne well. One of my principle objections to KentuckyOne’s operations is that it is using its publicly funded healthcare system in public facilities as a vehicle to promote the religious objectives of its owners. It may even be possible that some of KentuckyOne’s financial problems stem from its position on religion-based healthcare. That may be a problem KentuckyOne cannot fix on its own. Continue reading
Breaking News 11:30 a.m.
At a hearing this morning in Frankfort, Franklin County Circuit Court Judge Thomas Wingate ordered the University of Louisville and Norton Healthcare to enter mediation to settle their dispute over control of Norton Kosair Children’s Hospital in Louisville. It is my understanding that neither party was adverse to that happening. The Judge appeared influenced by the admissions of both sides that they have been very close to a long-term agreement several times in the past, including at a breakfast meeting yesterday at Dairy Queen! Continue reading
Much Distress Among the Home Team.
KentuckyOne Health’s announcement of major cuts in expenditures, layoffs of employees, and possible hospital closure(s) is bad news to lots of people. The organization’s facilities and employees in Louisville are in the bullseye too. It is no surprise that nervous employees are reaching out to the media, hoping perhaps for some external recognition or oversight of their plight. KentuckyOne seems to be making a genuine attempt– perhaps too late and too little– to show some openness. In my opinion, the University of Louisville and KentuckyOne have developed a reputation for secrecy but they have not yet earned a reputation for transparency or accountability. Hiding plans from the public also hides them from their employees. The pain felt by these latter is both financial and emotional. Continue reading