My concerns remain relevant. On May 2, 2012, UofL President Ramsey asked Dr. Nesbitt, among others, to lobby Mayor Fischer and the members of the Metro Council to increase the amount budgeted by the city for University Hospital without addressing any of the the underlying issues of whether this is the best way for the city to provide care to its most disadvantaged, or to deal with Louisville’s legacy segregated system of medical care. UofL obviously sees Dr. Nesbitt as their inside person in Government. That is probably why they wanted to hire her and exactly why Dr. Nesbitt needs to work for the city of Louisville and its Public Health Department alone.

Peter Hasselbacher, MD
May 3, 2012

There are still some who would like to see the VA change its mind about excluding a downtown location. Fair enough, but I am less swayed by the argument that a downtown site allows access to better experts. There are certainly some medical experts downtown, but there are doctors equally good and often better all over the city. They would be insulted by the contention that all that is good is downtown. What is more to the point is who would actually be in the building tending to the Vets. There is the rub. Our VA hospital has a closed medical staff: essentially a monopoly for University physicians. These faculty have historically loved the VA salaries and benefits, but resist putting in the time for which they are paid. (They can make more in their private offices and laboratories.) Additionally, since an unrestricted Kentucky medical license is not necessary to practice in the VA, the University likes to place physicians there who do not qualify for a regular medical license. Interns and residents often like the VA because the supervision is less there. Not all senior physicians attend at the VA It. Just being downtown does not automatically give a veteran better access to downtown physicians. (Physicians from Norton and Jewish do not attend at the VA.) I am told that one of the reasons that the VA Administration ruled against the downtown site as preferred was because of problems dealing with the University and its doctors. This report is as yet unconfirmed, but is in keeping with my long experience working in VA hospitals.

More to the point, would having a VA downtown increase the likelihood that Veterans would actually see experienced physicians more often? If the experience in Lexington is any guide, the answer is no. Even when the VA hospital was right next door to the medical center, the scandal of faculty physicians not putting in their time made the national news. Maybe things are better now, but at least one clinical department refused to see any VA patients at all rather than follow the rules and earning their pay. I have seen the same thing happen at University Hospital when one clinical department opted not to bill for services to Medicare patients so they would not have to follow Medicare’s guidelines to actually see the patients! This kind of stuff was in the news too.

I think the privilege of serving our veterans has to be earned. They are not fodder for economic development or guinea pigs for commercial research. If University Hospital had the highest marks for quality in Louisville instead of the lowest, perhaps a better claim could be made, but that is not the case. The downtown medical center is in a state of chaos. What I would like to see is the medical community of Louisville have to compete on quality and cost to provide services to Veterans. That is more likely to happen in the non-downtown site that veterans strongly prefer.

You wrote a very objective review of last night’s events. I wish that everyone could read this so that they can see that this is more of a problem than the general public thinks it is.

I am the woman who spoke near the very end whose husband is the “tall, bald guy.” I am a military wife of 20 years, a neighbor, and a tax payer. We have been trying to get a straight answer on this proposal from the VA, and nobody will answer us. We get platitudes and maybes and “we’ll see what we can do…” Meanwhile, they are not listening to our concerns. The Veterans are not going to get the facility that they deserve, and the taxpayers are going to be out nearly a billion dollars for a facility that we have been told “should last 50 years.”

This whole thing has been a comedy of errors. None of our politicians will touch this with a 10 foot pole because they don’t want to be seen as “not supporting the Vets.” The neighbors who try to point out the obvious are demonized as rich east end Vet haters, and the only one who will win in this situation is the developer, who shows up with an entourage of PR folks and lawyers.

It disgusts me.

Thank you again for your article.

Reply: Thank you Ms. Roles. I was up late last night! I made the corrections you noted. P.H.

That the time allotted by the University to prepare and evaluate even a single proposal was insufficient should be no surprise to anyone. I am now beginning to believe the doctor’s-lounge gossip that the RFP process collapsed without a viable response. The fact that any search has been slowed is a good thing for the community as it will allow the State Auditor and the Hospital Ad Hoc Operations committee to finish their work and place it before the public. What is good for the community is ultimately going to be good for University hospital.
Peter Hasselbacher

Of course, Humana and other healthcare and financial institutions give me permission to “opt-out” of these disclosures to non-affiliated third parties. That’s big of them. What I want to know, and would like explained to me by elected representatives who wrote the laws governing this process, is why I should have to opt-out at all. If I want my name marketed to others so someone else can make a buck, the default option should be that I should have to actively opt-in! How do we get a ground swell to change this? If Tweeters and Facebookers can get credit card companies to eliminate unfair fees, why cant we get more control over what is done with our most private information without our knowledge?

I am not sure that “rebate” is a term I associate with the QCCT structure. Perhaps the budget language refers to the $1 million that the QCCT has returned to the city in recent years. I never understood where that came from. I will try to read all the amended QCCT contracts to see if anything becomes more clear. What is clear is that the QCCT system is coming under even more scrutiny by concerned parties, and with good reason. This is the organization whose Board of Trustees that did not even meet for several years. I think they are paying attention now.

You can review the regulation that I was referred to that guides this competitive negotiation. http://www.lrc.ky.gov/krs/045a00/085.PDF

Responses to the RFP are still due Friday!

Peter H.
March 19

I was also asked to apologize to Dr. Edward Halperin, one of the course directors and organizer of the conference. I think I can do better than that. Before the conference I had not met Dr. Halperin personally. I knew and admired him largely because of two of his presentations to our medical students and Health Science Center. Shortly after his arrival he exhorted a graduating medical school class not to accept gifts from pharmaceutical companies whose intent was to influence their judgment and were therefore were bribes to be rejected. Just last month in a moving lecture on medical ethics entitled, “The Banality of Evil,” he spoke against the lingering residue of segregated medicine at the University of Louisville, which he categorized as a thing evil. I wrote about these presentations earlier. In my 30 years of association with the University of Louisville, I have never heard more bold or impassioned public statements emerge about something so fundamental to the highest standards of our profession. I could hardly believe that Dr. Halperin was part of the leadership team that planned the unsuccessful merger last Fall that so many of us felt also compromised important principles of patient autonomy and the primacy of the physician-patient relationship. No doubt he may have felt embattled.

I have observed that at the University of Louisville, being called the conscience of your unit is not always meant as a complement. Last month, Dr. Halperin resigned as Dean of the School of Medicine. I hope that he found his 6 years in Louisville to be professionally and personally satisfying. I wish him a fulfilling opportunity to make a difference at his new institution, New York Medical College. Nothing I have written in the past should be interpreted to be anything except respectful of him personally and I am sorry if he or anyone else felt otherwise.

Peter Hasselbacher, MD
March 16, 2012