The University of Louisville seems desperate to find a new “partner” for its fundamental academic responsibilities. It claims its principal teaching hospital is failing and in some well-defined ways it is. Here is my best shot at what such a contract should look like and to be in the best interests of the University and the public is wishes to serve. What would you add or delete from this list? Use the “Leave a Reply” link at the end of this article to contribute. Your name will not be revealed unless you choose to do so, and your email address will never be shared.
Peter’s Vision for a New University Partnership.
• No agreement should be signed until the legal issues related to the University’ claims of private status for its various internal divisions is settled comprehensively once and for all. Is the Hospital private or public? Can the other various University foundations, corporations, institutes, and other entities continue to operate in secret, or are they accountable to the public, including through open record laws? The University’s stubborn and dubious adherence to claims of private status and the myriad ways it hides its internal activities and those of its faculty caused it to lose the confidence of the public and was a major factor in the failure of its last merger attempt. This issue will plague all further efforts by the University to further its missions of education, research, patient care, and community service.
• No agreement should be signed until the audits by the State Auditor and the University’s own Internal Ad Hoc Operations Review are completed and have had a chance to be examined and validated by the public. The University has been involved in a series of major scandals from diversion and inappropriate use of public money that was intended for indigent care, teaching, and research. People at the highest administrative levels of the University have gone to jail or lost their jobs. The University must make a good faith attempt to regain the trust of the community before it can expect the community to continue to support it, or to allow the University to manage public funds for the public good. As a professional educator, I give the University an ‘F’ in its efforts so far. [Addendum: The State Auditor also gave the University an 'F' in its use of public money. The Operations Review was very disappointing in terms of quality and efficiency. An unexpected State audit of Passport gave an initial 'F' which was changed to a 'D' or perhaps 'C' on retest. None of these reviews revealed meaningful financial information and none was a financial audit.]
• The University of Louisville and its component entities must not agree to restrict in any way their ability to work or interact with any other individuals or entities. “Do not compete” clauses that limit either business, clinical, or academic cooperation are completely inappropriate. The University of Louisville and any of its healthcare professionals should be able to act in the best interests of their patients, their students, or their public. In my mind, selling away this fundamental academic principal was one of the greatest betrayals of the earlier failed merger.
• This partnership is being justified in the interests of providing indigent care. Therefore any new money accepted should be used for indigent and other patient care. This should not be a contract in which money flows into the general coffers of the University. The University must tell us first where current money is going, and exactly where any new money will be focused. University Hospital has the lowest quality rating locally and is among the lowest nationally. Fix this first, before even more money is diverted to building and staffing another research castle. Excellent medical education cannot be provided in a place where the clinical care is not also excellent. An agreement in which new money flows into the general shush fund of the academic or research departments is unacceptable.
• The activity of any partnership should not result in the further marginalization of University of Louisville Hospital nor worsen the already segregated nature of its clinical services. All patients that walk into a University of Louisville program seeking medical care or advice must enter through the same door and be treated in the same place and manner and by the same staff and trainees regardless of their financial or ethnic status. If the University wishes to expand its teaching services into other hospitals or floors of other hospitals, they must be open to all and staffed in the same way regardless of diagnosis, race, or socioeconomic status. No more second-class status as teaching material or fodder for commercial research activities. Trading University patients for research space and dollars is what has kept us in our present place.
• The transfer of money from the Hospital to the University will be subject to rigorous scrutiny and verifiable justification. It is unconscionable that the University cry poor and then bleed the hospital dry in the name of research or research recruitment. University income from clinical activities should first support clinical needs, and not provide a cash cow to run the rest of the University.
• The University of Louisville faculty are full-time employees of the University of Louisville, and therefor the Commonwealth of Kentucky. Their activities in clinical medicine, teaching, or research are not subject to control or restriction by any entity other than the University of Louisville. That includes any other internal or external private practice entity that is not fully owned and controlled by the University of Louisville. University of Louisville faculty does not comprise a private practice that can be sold or rented to another hospital or healthcare system. Neither is it a faculty that can choose when or where to support University Hospital at its own option of self-interest. We have had enough of that already. The University and its faculty have wanted to be both private and public since the University entered the state system. That dual allegiance has brought University Hospital to its knees.
• Finally, but not least for this iteration, as a public institution there can be no obedience or obligation to any specific religious entity. No aspect of the practice of medicine or the education of the University’s students at any location will be restricted or institutionally influenced by any religious entity or representative. Religious institutions are free to influence their believers in their own churches and from their own pulpits. They cannot direct or limit University of Louisville Hospital, nor any University of Louisville health professional or teacher with respect to what can or cannot be done in the practice of medicine or education. The University of Louisville cannot trade away this fundamental separation of the church and the public worlds. Agreeing to follow religious doctrine by contract or under the vague cloak of “respect” was not an acceptable workaround for an earlier University business deal, and it cannot be acceptable for any future one.
I am going to continue to think about what else should be added to or changed in this list. I urge you to do the same. Read some of the background of this issue that has been explored on these pages over the last 5 months. I do not believe the citizens or governments of Kentucky and Louisville will allow University of Louisville Hospital itself to fail, or to fail to provide adequately for the medically disadvantaged among us. However, this will require the University of Louisville to behave less like a Kingdom, and more like the community trust is is. Unless the community gets involved in a more active way, pouring more public money into a failed system will be the likely result. We have a historic opportunity to get things right. We must seize it.
Peter Hasselbacher, MD
April 14, 2012