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?”

Faculty Letter to UofL President Ramsey & Provost Willihnganz About Hospital Merger

I have not heard much public criticism of the proposed acquisition of University of Louisville Hospital by Catholic Health Initiatives from UofL faculty members.  Not surprisingly there has been support by the University-dominated boards of the hospital, the Cancer Center, and the like.  The individual response of the retired faculty member of the Brandeis School of Law and widely respected constitutional law scholar, Professor Robert Stenger, could not have been more critical of the proposal.  I asked an old friend on the Medical School Faculty how his colleagues felt about the acquisition.  I was told that they were unsettled.

There are legitimate reasons of self-protection why individual current faculty members might hesitate to express their honest opinions.  Such a move could be a career-limiting event.  I confess to being a little surprised but immensely proud when I was given the following letter sent by the most senior faculty of the School of Arts and Sciences to President James Ramsey and Provost Shirley Willihnganz.  Their letter is in the finest tradition of higher education and citizenship.  I do not believe it has been published before, or a least I have not seen it referenced in the current debate.  There is little I can add to it.  Here it is. Continue reading “Faculty Letter to UofL President Ramsey & Provost Willihnganz About Hospital Merger”

Questions Unasked at Recent Louisville Forum on Hospital Mergers

Last Wednesday, Dec 14, I appeared on a Louisville Forum panel with two other individuals with serious concerns about the proposed acquisition: Ms. Beverly Glascock, a nurse and attorney; and Dr. Ken Zegart, a prominent Ob/Gyn physician.  It turned out to be a spirited affair.  The house was packed with UofL supporters.  There was not much time for many of the questions submitted in writing from the audience.  I was disappointed in the spectrum of questions asked.  I had prepared a list of questions that I hoped would be asked of the supporters, and in fairness, a list of questions I half-expected would be asked of us.

How would you answer these questions?  I will take a stab at them one-by-one in subsequent entries in this Policy Blog.  If you indicate a favorite, I will tackle that one first.  I numbered the questions in each section for that purpose although they are not in any particular order.  Look also at the many questions I posed in the first major entry in this Hospital Acquisition Series.  What questions would you have asked?  Ask them here!  Perhaps the acquisition proponents will respond respond as well.  Read on to see the questions.

Continue reading “Questions Unasked at Recent Louisville Forum on Hospital Mergers”

Dust-Up Over Disbursement of QCCT Funding to University Hospital

There was a little excitement this week in the Louisville Metro Council over whether or not to continue the next installment of the $7 million indigent care payments to University of Louisville Hospital from the QCCT funds. The City of Louisville and Kentucky provide many millions of dollars annually against which University Hospital can bill for eligible indigent patients.

There were a number of issues that caused the Budget Committee to put the brakes on the city’s payments as of January 1. One was that that in the post-Passport scandal era the Hospital had not provided the requested and expected accountability. It is puzzling to me that the Council expressed the same transparency concerns last July but had still not been satisfied. Is the council giving too much deference to the university?  The procedural move also signaled that there are deep concerns about the proposed acquisition of University of Louisville Hospital by the hospital chain Catholic Health Initiatives out of Denver. Would the same services be provided, and would it even be legal to give public funds to a private religious organization.

Two days later the Council as a whole voted to release additional installments of the remaining $4.8 million funding until March, pending the apparently delinquent reports by the Hospital. Councilman Downard said that, “the hammer is still there” concerning their demands for information, but I thought the hammer had already been cocked! So much for transparency from this self-declared private institution. Amendments were offered to make the continuation dependent on providing the same range of services after as before any take-over but they were defeated. The protest of the committee hold was overridden, but its point was made. The University of Louisville made some of its documents available publicly the very next day. The University seems to realize that it has lost its public relations war against the citizens of Louisville. I sent the Council an open letter the day of their main meeting. It gives additional details and outlines my thoughts about whether the QCCT mechanism is still an appropriate way to fund indigent care in our city, or whether it has had unexpected and undesirable consequences. What do you think?

Continue reading “Dust-Up Over Disbursement of QCCT Funding to University Hospital”

Open Letter to Governor Steve Beshear Concerning Acquisition of University of Louisville Hospital

Last week I submitted the following letter to the Governor’s Office.

Governor Steve Beshear
700 Capitol Avenue, Suite 100
Frankfort, Kentucky 40601

Re: Premature approval of hospital acquisition in Louisville.

Dear Governor Beshear,

You have been asked to consider approving a merger/acquisition involving the University of Louisville and University Hospital, Jewish Hospital & St. Mary’s, and the St. Joseph’s Hospital System under the auspices of Catholic Health Initiatives.   Individuals and Organizations (including women’s organizations) in the Louisville Community who have written or spoken about this matter are overwhelmingly against this merger, save for employees of the University, or its business partners.   The opposition continues unabated despite several public and private briefings.  This is in great measure because of the puzzling refusal of the proposal advocates to disclose relevant details supporting the real public or indigent-care need for the merger, or the implementation of its most controversial elements– especially those revolving around church and state issues. Continue reading “Open Letter to Governor Steve Beshear Concerning Acquisition of University of Louisville Hospital”

Let Them Eat Cake! (In somebody else’s hospital.)

I have been reviewing all of the letters sent to the Courier-Journal by members of the community.  So far, without exception, all have been employees, faculty, or associated with one of one of the proposed partner institutions, or capital venture company that benefits from the University’s commercial research program.  One of these letters is particularly painful to me.

It was written by a medical student who has not yet even begun his clinical training.  It begins by parroting an assortment of the arguments that have been made by the University and Jewish Hospital & St. Mary’s almost as if the letter were from a University official.    Nonetheless, even a medical student deserves to have their voice heard, and perhaps especially a medical student, whose training will be very much affected by the proposed change in business structure.  The last sentence however broke my heart.  When speaking about the women’s health policy regarding tubal ligations, the writer concludes, “patients who don’t want to deal with it can always choose to go elsewhere.”  This is one of the most unfeeling  comments I have seen with respect to this proposed merger/acquisition.  I hope someone has taken the student aside and counseled them. Alas, perhaps not the two faculty leaders who also wrote regarding end-of life care, “When the stipulations of the Catholic Church make it difficult to follow the patients’s and families wishes, the patient can be transferred to another facility where the desires of the patient and family can be met.”

I hope the student above can bring more sympathy to the patients he may have the privilege of attending to in the future.  Perhaps as he learns to take a medical and social history from those patients he will learn that in fact these patients do not have a choice of going elsewhere.  That is the whole point!  Shame on the University of Louisville School of Medicine, its leadership, and its faculty for creating an environment where such a statement is thought justifiable by your student.  The privilege of caring for the indigent must be earned.  In past months, the University of Louisville has in my opinion abused that privilege.  The majority of the patients, students, trainees, and employees of the proposed merged entity are not Roman Catholic, yet their most intimate personal decisions are now subject to review by somebody else’s bishop.   How can that stand?

Peter Hasselbacher, MD
Dec 5, 2011

Why Is A Bishop Even In The Room?

I was plowing through my unread pile of newspapers and came to the report by Patrick Howington of October 17; “Hospital Merger- Altered Catholic rules pose problems.”  A subtitle asserted that “Hospital officials say fears of church interference are overblown.”  Really!   In point of fact, they are not overblown at all.  A number of  examples of church and secular hospital mergers were listed for which the winks and nods and work-a-rounds that were approved by a local bishop were overturned later by higher authorities or changes in rules.  We are not talking about a theoretical problem.

By coincidence (or perhaps as a sign) as I read this article today, the leadoff report on the CBS Sunday Morning Show focused on a Catholic hospital in Phoenix.  A woman who was 11 weeks pregnant developed severe pulmonary hypertension as a complication of her pregnancy.  The result for both her and her fetus would have been fatal.  The local hospital Ethics Committee considered her case and gave its approval for an emergency abortion to save the life of the mother.  That decision was shared by the nun who sat on the committee.  The woman’s life was saved but her pregnancy was sadly but predictably lost. Continue reading “Why Is A Bishop Even In The Room?”

Still Another Hospital “Merger” in Louisville Kentucky

Potential Questions and Issues Related to the Proposed  Acquisition or Merger of University of Louisville Hospital with Catholic Health Initiatives.

I am very troubled with the way this vaguely defined proposal has been revealed to the public.  I cannot avoid the impression that important elements of the deal have been intentionally hidden.  There is a lot to cover and these initial thoughts just scratch the surface.  If I had an opportunity to ask clarifying questions, I would start with these.  I ask them from my perspective as a life-long medical educator, physician to both the rich and poor, and a lobbyist for higher education.  What do you think?

Nature of the Proposed Arrangement:
Is a true merger of hospitals planned, or simply an acquisition by another hospital chain?  For example, will the new entity have a single Medicare Provider number?  If a true full merger is not planned, why not?  Which, if any, hospitals will be truly merged, or is University Hospital just being put in play once again by another hospital chain?  What will be new?  For what is the University of Louisville, its Hospital, and the Commonwealth of Kentucky giving up precious independence and control?

University Hospital has been managed by at least 5 outside corporate chains or partnerships of hospitals in the last 25 years.  All failed.  Other existing or contemplated partnerships, programs, or mergers with Louisville Hospitals have also failed.   What were the reasons for those failures?  What plans have been made to ensure a better outcome?  Where can we see those plans?  Why not? Continue reading “Still Another Hospital “Merger” in Louisville Kentucky”

Lots of Health Policy Still in Play!

I had the good fortune to be able to travel abroad and at home for most of the fall.  I confess I still have a foot-high pile of newspapers to look through.  It is immediately clear that a number of things have happened related to items I have been commenting upon in these pages.  Among these items:

  • The state legislature, not surprisingly, followed through with its support for a new concept of optometry by approving new regulations.
  •  The Veterans Administration listened to the overwhelming resistance by veterans and others to placing a new Veterans Hospital in downtown Louisville but also, reasonably in my opinion, felt that remaining on the existing Zorn Avenue site was impractical.   This decision has not disarmed the proponents of another downtown hospital who will no doubt continue to bring political pressure to bear against the remaining suburban locations.
  •  Drug companies continue to behave like tobacco companies.
  •  Everyone agrees our healthcare system is in big trouble but almost no one agrees with what to do about it.   My prediction: it will get worse before it gets better.)
  •  For sheer volume of public concern however, nothing comes close to the resistance against a vaguely revealed merger or acquisition of University of Louisville Hospital by the religious organization, Catholic Healthcare Initiatives.  In some as yet undisclosed way, University of Louisville Hospital will combine with Jewish Hospital & St. Mary’s Healthcare.

I will try to comment on these and other issues.  Please join me.

Peter Hasselbacher

New Director for Public Health in Louisville:

Who should she serve?

Compared to the tumultuous search for a new school system superintendent, the announcement of the appointment of a new Director of the Louisville Metro Department of Public Health and Wellness seemed to come out of nowhere. Since the departure of the previous Director, Dr. Adewale Troutman, the announcement in the Courier Journal on June 14 was the first indication of progress of which I was aware. Did I miss something– like a public hearing? Was there any public input into the process? Perhaps the search became invisible in the shadow of the school superintendent search. Yet both searches are equally critical for our future. As our failing private health system continues to eject middle income Americans (employed or otherwise), a new form of systemic health disparity is growing rapidly. The widening income gap in America is causing a pernicious denial of access to affordable health care within a system that is tailored for the well-employed and the wealthy. In a health system where even the “haves have not,” I predict that our public health departments will become increasingly important. They will likely be incubators for whatever our future system of health care looks like. As a society, we are only as healthy as the sickest among us.

Dr. LaQuandra S. Nesbitt, MD, our new Director, looks like a great catch. She has impeccable credentials of training and experience. She most recently held a senior public health role in the cauldron of Washington, DC. The challenges she faced there provide relevant experience for our needs. I wish her well. I hope I can help.

As far as I know, Dr. Nesbitt’s successful candidacy was without controversy. Therefore, let me introduce some! One sentence in the C-Js reporting positively gave me the shivers. It was reported that half her salary of $180,000 and half her benefits will be paid by the University of Louisville. I think this is a bad idea: a very bad idea. No doubt the fiscally-strained city was glad to have someone else pick up part of the tab, but I think this is bad public policy. This is not simply the customary gratis faculty appointment that honors Dr. Nesbitt, allows her to teach, and otherwise participate in the academic life of the University. Hundreds of other physicians in Louisville have such privileges. The current arrangement makes her an employee of the University of Louisville. By placing her in a position of having two very different employers, she will start on day one with conflicts of interest. Continue reading “New Director for Public Health in Louisville:”