Tell Me It Isn’t True!
On yesterday’s Courier-Journal Website was a report of a presentation made by officials of University Hospital to the Metro Council urging them to increase the amount of money that the Mayor’s budget targeted to the QCCT fund for indigent care by $2.8 million more that the University actually received last year. I have written before about this longstanding and less-than-forthwright deal between the City and the University. Now it is coming back to bite them! This is one of the consequences of transparency and accountability. Sometimes when the bright light gets shined on you, you get caught, and sometimes even have to give money back, as in the Passport scandal in which the University had also played fast-and-loose with public finds. I am quite confident that we have not yet heard all the stories out there.
I have heard enough threats from the University about what they will or won’t do unless it gets its way again. Patients are to be served, not held as hostages. The University of Louisville and the Hospital it controls have put themselves in a position where the appropriate community posture is “trust, but verify.” If the University says it does not have enough money to do the job we have asked of it, then it must open up its books and prove it to us. Neither the recent Kentucky State Auditor’s Examination, nor the just-released blockbuster state review of Passport, nor even the University’s own Ad Hoc Internal Review were true financial audits designed to “follow the money.” I have read them all. On their face they do not justify the University’s claims. The public which provides this money deserves full disclosure before we and our elected officials drink the Cool-Aid again.
There is no doubt that the University is digging itself in deeper and deeper. One added complication relevant to this posting is that some state legislators (in what seemed to me to be either mean-spirited, or else designed to flush away the subterfuge) want to decrease the amount of any state contributions to the QCCT by any amount the University might give back. Some legislators thought they had been tricked into appropriating more than their fair share of money. However the state legislature has its own little $5 million side-deal with the QCCT going on. That Mayor Fischer, to his great credit, has finally given us an honest accounting on behalf of the City should not trigger retaliation by the legislature. Let’s have instead the same degree of transparency and accountability from Frankfort. What should be triggered are unconditional demands on the University of Louisville and its Hospital, at long last, and in the name of all that is decent, to earn back the trust they have lost. Fund the QCCT month-to-month until or unless a better and more honest system of serving the medically underserved is devised. I think we need one badly. The two-tiered segregated system that evolved from the old Louisville General was not appropriate then, nor is it now.
PH
Open Letter to the Courier-Journal: May 31, 2012
A Cut That is Not a Cut.
Dear C-J.
There is a cynical warning shared among doctors that you can inappropriately scare patients into letting you do whatever you want to them. Such an approach is also unworthy in public policy. In my opinion, testimony given before the Louisville Metro Council yesterday as reported by the Courier-Journal appears to tilt in that direction. It is claimed that University Hospital’s indigent care fund is being cut in the city budget by $2.7 million and that “some will die.” My reading of the Mayor’s budget says differently. In fact, the University will end up with exactly the same amount of money as last year. What Mayor Fischer has appropriately presented us with, perhaps for the first time, is an honest, and certainly a more accurate accounting of how the city contributes this important fund. Although last year, the City passively took credit for contributing $9.6 million to the QCCT fund for indigent care, for reasons that have always remained murky, the University gave $2.7 million back. (In earlier years, the University gave it all back!) There was apparently never a commitment for a net $9.6 million dollar transfer. Any “cut” is only the illusionary result of an elaborate accounting shell game. If the University and its Hospital are concerned that they do not have enough money to support their principal responsibility to provide clinical care, I suggest they decrease the many millions the Hospital contributes annually to the University’s commercial research enterprise.Because the amount of money actually given for University Hospital’s use from the City of Louisville has not changed, there is no justification for some Frankfort legislators to press for a decrease in the Commonwealth’s own contribution to the QCCT. Indeed, the Commonwealth has been playing its own $5 million shell game with the University. The financial manipulations above were described in State Auditor Edelen’s recent examination of the QCCT. What the Louisville community deserves is an open, honest, and understandable accounting of how public funds are used to fulfill our joint responsibility to provide medical care to the disadvantaged. This cannot occur until there is a transparency and accountability from the University of Louisville and its Hospital that has been curiously and even perversely denied to us. How many more disappointing critical audits are necessary before we as a public demand more of a voice in how this essential public responsibility is conducted?
[The above letter was not printed by the Courier-Journal.]
Peter Hasselbacher, MD
President, Kentucky Health Policy Institute.
Emeritus Professor of Medicine, UofL