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.
At the last possible minute, under court order, and indeed on the very day the proponents hoped their business papers would be signed, the University and its partners released a number of documents. These are heavy going for me as a non-lawyer, but now I can see why they wished to keep the documents and their plans secret. I invite any of you to help me review these. On the philosophy that we need first to deal with the elephant in the room, I analyze here the issue of to what extent the University of Louisville has agreed to abide by Ethical and Religious Directives for Catholic Health Care Services, Fifth Edition, of the United States Conference of Catholic Bishops (the ERDs). I have only had time to analyze the Sponsorship Agreement and its supporting exhibits. I do not yet know what lies in the other recently released documents, but I am afraid to look!
I believe the Commonwealth and its Courts cannot permit this acquisition to proceed. Current services expected by the community will be reduced; non-Catholic patients and physicians will be forced to abide by Catholic religious doctrine; a state institution and its faculty will be impermissibly restricted from interacting with other health care providers or academic institutions; the University surrenders control of its medical practices, and more. The University of Louisville is a full partner in this enterprise and cannot use as an excuse that it is not merging and therefore will not be affected. Such statements undermine its credibility further.
The ten page analysis is available as a Word Document or a PDF. A supporting Appendix containing relevant parts ot the Catholic Directives is also available here as Word or PDF. A copy of the Sponsorship Agreement itself (3.2 MB) can be downloaded here.
Peter Hasselbacher, MD