How do we provide the best health care to the underserved?
A few days after this Policy Blog, County Attorney Mike O’Connell, the Courier-Journal and others called for an audit of the Quality & Community Care Trust (QCCT) that funds indigent care at University Hospital, President Ramsey responded in acquiescence. He had no other reasonable choice. Given increasing criticism over its habit of secrecy, any dragging of feet would have had a devastating effect on the University’s tarnishing reputation. The “Unsubstantiated C**p Defense” is no longer feasible. A better course for the University would have been to be out in front with such an offer weeks ago when it was becoming clear that the Louisville Metro Council and others were having concerns about how this particular package of public money was being used. Now we know that there was a good reason for that concern. Nonetheless, better late to the table than never.
To their credit, the University is not using its “Private Organization” defense to limit scrutiny, despite the fact that the initial results of outside scrutiny were not good. Board meetings have not been held for several years, and required records were not kept even as the University complained that it needed more money. The University of Louisville has given away its best defense against criticisms of acting secretly or even irresponsibly. The fact that this University-led Board was so careless in its management of such an important public function adds urgency to the many other calls for the University of Louisville to stop the secret internal shell game it plays with its many component foundations, corporations, institutes, and other entities.
Ramsey asked our new Kentucky Auditor, Adam Edelen, to conduct an audit “to insure that the funding for this important program is, in fact, utilized to provide the best care to the underserved in our community and state.” Yes the QCCT needs to be audited, not only to see where the state and county money went, but how it was actually put to use. This task will by necessity require more than simply listing the names on the checks that transfer money to the University of Louisville, its Hospital, back to the County, or who knows where else. Parallel audits of the receiving agencies will be necessary to show how that money was actually used by the entities that received it. For example, if all or part of QCCT money ends up in general funds, it will be impossible to determine how the money was used. That was an intrinsic problem with the Passport scandal in which money designated for the care of the disadvantaged inappropriately and even illegally ended up in the pockets of others.
I was disappointed in Metro Council President Jim King’s seemingly dismissive reaction to the QCCT Board’s failure to follow “corporate formalities” because there was not much work for them to do. The Council also has a responsibly in this matter, It is our tax dollars that they are giving to the University. It was obvious to me at the council meeting I attended, that the Metro Council was not at all happy with the accountability of the University for its QCCT program. I am told that in its early days, QCCT money was used to build the Riverfront Park. We must feel comfortable that such major (or even minor) shenanigans are not going on. That is one of the reasons it is inexcusable that the QCCT Board has not done its job. This is no time to make excuses for the University. It needs our help to get back on the right track.
President Ramsey properly appears to be calling for a broader review of the QCCT program. For example, is in fact the QCCT program the best way to provide health care to the underserved? I for one am not sure that it is, and we all should welcome President Ramsey’s call for a reevaluation of the entire program.
Peter Hasselbacher, MD
A PDF version of this post is available here.