Month: December 2011

Analysis of Hospital Acquisition Sponsorship Agreement: Catholic Health Directives.

There are a number of reasons why many individuals and organizations have opposed or had serious concerns about the proposed acquisition of University of Louisville Hospital by Catholic Health Initiatives. The transfer of a state and public asset to a private one, the separation of church and state, the alignment of the entire medical training and clinical operations of a public medical school with a religious organization, transferring a substantial portion of Kentucky’s healthcare system to an out-of-state caretaker, or agreeing to onerous anticompetitive restrictions with other Kentucky health care providers and educational institutions are among them.  Any one of these issues provides sufficient grounds for rejecting the proposed business arrangement.

Perhaps the most emotionally controversial of these problems is the agreement by the University of Louisville to subjugate itself to some of the religious teachings and policy of the Roman Catholic Church as the basis for the provision of medical care in its teaching and clinical facilities. The University of Louisville has placed its operations at ground zero of an abortion controversy that has torn asunder the civil fabric of our community.  Because it is defined even in the Sponsorship Agreement as an instrumentality of the Commonwealth of Kentucky; the University of Louisville has put Governor Beshear, Attorney General Conway, State Auditor Luallen, Mayor Fischer, and other governmental offices and officials into the most difficult position possible.  I do not know what these officials have been told in their private briefings by the business partners, but I heard the hospital system representatives say publicly that medical treatment of women would hardly be affected at all; with the exception of certain procedures the University has contractually agreed not to do. To my and many ears, their protestations and promises changed from day to day and place to place. Requests for the specific contractual language and other relevant agreements were refused in an off-hand manner. To hear the advocates speak, the implications of their business decision on our community and on women’s health care, and the magnitude of the compromise of our institutional academic and medical ethics and independence were a “small thing.”  I cannot agree. Continue reading “Analysis of Hospital Acquisition Sponsorship Agreement: Catholic Health Directives.”

Governor Beshear Replies to KHPI Letter.

I very much appreciated that our Governor responded to our concerns.  A facsimile of the letter is available here.  Its text follows:

Dear Dr. Hasselbacher:

Thank you for your contacting me with your concerns about the proposed merger between the University of Louisville Hospital, Jewish Hospital, St. Mary’s HealthCare and the Saint Joseph Healthcare System, part of the Catholic Health Initiatives (CHI) network of hospitals. The proposed merger could have wide ranging positive impacts for improved healthcare in the Louisville region. I appreciate knowing your opinion on this important issue.

The Commonwealth of Kentucky has two roles in the review of this proposal: to review the legal issues associated with a merger and, just as importantly, to review the public policy of how University Hospital will continue to honor its mission as a public teaching hospital that provides access and care to citizens, especially those who are indigent. Continue reading “Governor Beshear Replies to KHPI Letter.”

The Empire Strikes Back!

Someone forwarded to me a reply by President Ramsey and the CEOs of the three hospital systems to last Sunday’s editorial in the Courier-Journal.  These are the hospitals that would become the “Network Entity” with the acquisition of three large Louisville hospitals by the 7 or so smaller ones of CHI. (It is hard for me to count up these latter because not all of the CHI hospitals seem to be recognized by or eligible for Medicare.)    The rebuttal acknowledges the problem of picking a fight with a party that buys ink by the barrel, but I do not think it rises above sounding arrogant, self-serving, and whiney. The three complain about being characterized as having acted in a “secretive and contorted fashion.”  It is a matter of settled fact that few of the pubic knew that anything had been going on until the announcement last summer that the entities were going to merge.  I certainly believe they are still keeping secrets about their plans and what they propose to do with their money.  It has only been in the last week that any documents were released at all.  Two or three weeks ago a caller to the WFPL radio interview told the merger representatives that he was disappointed in the way they were proceeding, and that “they were losing the public relations war.”  The University did not take that advice until forced to by a judge.

[Addendum Jan 4:  I take some affirmative consolation that the Attorney General of Kentucky in his report of Dec 29 also scolded the University and its Board of Trustees for proceeding so far without informing the Commonwealth!] Continue reading “The Empire Strikes Back!”

Is the University of Louisville a Scofflaw? Or Just Ethically Confused?

I have been unsettled by the University of Louisville’s unseemly rush to have its own takeover by Catholic Health Initiatives approved before the overriding issue of whether it is a private hospital or not works its way through the courts.  My discomfort is amplified because I have seen the University do this kind of thing before.  For example, it was reported publicly that the University plans for finance the construction of a new instructional building  for its medical school with tuition increases, especially for non-resident students.  (Most of us think that medical students already graduate with exorbitant debt that distorts their career choices.)  The University plans to increase its proportion of out-of-state medical students to leverage this unconstrained source of income.  I was surprised to see the Medical School admit that it already has 25% non-resident students despite a Kentucky state law that specifically limits such students to 15%.   If the University does not like a law, it has the right to try to change it, but not a right to ignore it.  Because I believe this pattern of behavior is relevant to the current merger-mania, I wrote to the Attorney General of Kentucky about the matter.  The text of my personal letter is below, and its supporting documents are available here. Continue reading “Is the University of Louisville a Scofflaw? Or Just Ethically Confused?”