The Quest for Neonatal Intensive Care Beds. A Statewide Phenomena.

As the controversy between Norton Healthcare and the University of Louisville over control of Norton Kosair Children’s Hospital continues to unfold, our colleagues at Insider Louisville have emphasized a central role that control of neonatal intensive care unit (NICU) beds is playing. Every hospital that delivers babies will have a nursery, but not all are qualified to run the NICUs that take care of the very sickest and most vulnerable infants. Aside from providing necessary care, it is no state secret that NICUs are one of the very most profitable services in a children’s hospital.

The number of NICU beds in individual acute care hospitals is regulated by Kentucky’s certificate of need (CON) process. There are four possible levels of NICU beds ranging from Level I for routine infant care, to level IV for institutions capable of caring for virtually any sophisticated need, including surgery. Kentucky’s continuingly updated State Health Plan addresses the criteria and requirements for each level. On May 31, 2013, the Plan was revised to bring it more into line with the most recent “Guidelines for Perinatal Care” of the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists. The Plan now includes specific requirements for a new state designation of Level IV. You can download the NICU-related pages of the 2013 State Health Plan here.

The new regulations make it possible for a level II facility to care for sicker babies if it has a written affiliation agreement with a Level IV facility. Similarly, a Level III facility must now also have a formal collaborative relationship with a Level IV facility for consultation and transfers. This puts hospitals with Level IV NICUs at the top of networks of care and referrals. In medical terms, this is also referred to as guaranteed income streams. You can see where this might be going. Continue reading “The Quest for Neonatal Intensive Care Beds. A Statewide Phenomena.”

UofL-Norton Dispute over Norton Kosair Children’s Hospital: Documents and Statements

The prominent dispute between Norton Healthcare and the University of Louisville over who controls what at Louisville’s Norton Kosair Children’s Hospital broke into public view the day I was leaving for a two week cruise around the British islands. I have been scrambling to catch up ever since. Due to the magic of technology, I was able to post two initial articles from the Amsterdam Airport and the middle of the Irish Sea.

There has also been much local media attention ably reported by Terry Boyd of Insider Louisville, Laura Ungar of the Courier-Journal, David A. Mann of Business First, Devin Katayama of WFPL, and others. Our local television outlets also covered the story. The matter spilled over to the national media. It is a great story for journalists!

Show Us the Documents.
Many statements have been attributed to the various players at Norton and UofL. Naturally, each wants to advance their particular viewpoints and each claims to be acting in the public interest. Some of the statements reported seem contradictory to me.

My instinct throughout this policy blog has been to go to primary documents and data wherever possible. In that spirit, I intend to use this post to assemble all primary documents and official press releases to make them available to the pubic. Therefore, I begin a list below of material I have available now. I will add to it as more become available.

Invitation to UofL and Norton.
I have seen emails and been shown other information intended for your internal use, but I am unsure of my right to make these public. I invite both parties to allow me to post the documents and internal communications to employees underlying their dispute so that the public can make reasoned judgments of their own. Because this matter is so important to Louisville and the Commonwealth, I do not think your argument should be conducted behind closed doors. We have a valid right to know the facts. In particular, I invite both Norton and UofL to send me their Affiliation Agreements, past and present, as well as the “Term Sheet” so frequently referred to in their legal letters. What is it you are really arguing about?

In the background.
There are another players mentioned in these documents whose relationship with UofL unavoidably and inextricably involves them in this matter: Catholic Health Initiatives and KentuckyOne Health. In fact, because KentuckyOne Health is now managing the Certificate of Need process for expanding the number and type of NICU beds at University of Louisville Hospital, I would say it is right in the middle!  Clinical and academic agreements exist between UofL and KentuckyOne that are highly relevant and of legitimate concern to Norton and the medical community. I have written about these before. Therefore, I also invite UofL and CHI/KentuckyOne to make their current affiliation and partnership agreements and other relevant documents available to us. In the meantime, I will summarize again in another article what I was able to extract from earlier public merger and partnership documents.

Continue for list of documents and statements. Continue reading “UofL-Norton Dispute over Norton Kosair Children’s Hospital: Documents and Statements”

Norton Responds to UofL’s Lawyers

It is early in the morning but my internet connection is intermittent and I wanted to post these documents for public use while I am able. Attached is Norton’s formal response to UofL’s Notice of Breach and Demand letter of 8-27-13. Much commentary is possible and I will add some later. UofL’s legal letter to Norton is available for your comparison.  You can judge for yourselves who has made the better argument. It was easy for me.

Also attached here is a letter of Aug 23, 2013 from Norton’s President Steve Williams to UofL’s Senior Vice President for Medical Affairs, Dr. Dunn.  I had seen a copy of this letter earlier which was useful to me in sorting out the various claims going back and forth from UofL.  It is clear that there are alternate versions of these early events. In my opinion, some are more believable than others and one need not be a lawyer to make your own judgements.

I discuss the original agreement to enter into a longterm lease in my last article.

To my knowledge, I was the first to point out publicly that the merger/partnership documents between UofL and Catholic Health Initiatives included language that UofL was willing to offer control of its pediatric services to its new best friends.  In the present reply letter from Norton, it is clear that I am not the only one to believe that UofL was the partner in breach!

More to come.  Please offer your own thoughts.

Peter Hasselbacher, MD
President, KHPI
Emeritus Professor of Medicine, UofL
September 5, 2013

Available Documents:

Announcement Partnership with UK 8/22/13
Letter from Steve Williams to David Dunn 8/23/12
Notice of Breach & Demand from UofL 8/27/13
Press release from Norton 8/28/13
Reply to Notice of Breach from Norton 9/4/13
Agreement to seek lease 8/12/81

UofL and Norton Healthcare go to the Mattresses.

The Battle for Ownership of Norton Kosair Children’s Hospital.

I do not have a feeling for how this is going to turn out, but the University of Louisville has loosed its dogs of war and nothing will be as it was. Perhaps that is for the good, because the existing structure of the downtown medical center was becoming more and more dysfunctional. Much of what is being aired now in terms of accusation and response is targeted to the media and public opinion. Ultimately a solution will be based on previous agreements to the extent that they are still valid and rational, and, if there is any reason and justice in the world, what our state government leadership judges is best for the citizens of Louisville and the Commonwealth.

After approving and even endorsing the partnership between the University of Louisville and Catholic Health Initiatives/KentuckyOne Health in which the University gave up significant pieces of its academic, clinical, and research independence, Kentucky’s Governor and Attorney General promised us they would monitor how the University of Louisville handled its subsequent affairs. Now is a good time to do so! I have already called for an unwinding of the current partnership structure for other reasons.

While the initial legal and political maneuvering in the background goes on, and in the absence of any inside information at all (Hint, hint!), I begin here to analyze available documents that are said to control our community’s future. In this with additional documents, I will pose questions for which I think the pubic deserves answers in order that it will be able to express it own reasoned opinions to the parties involved, including to our public officials.

In the first (and earliest) document available to me, I find no requirement that Norton Healthcare operate a children’s hospital to the exclusive benefit of any entity within the University of Louisville. Indeed, any benefit is assigned equally to all citizens of Kentucky. Neither do I find in this initial primary document that the lack of an affiliation agreement voids the lease held by Norton. Circumstances that may have made sense 30 years ago have changed dramatically. No party in the current confrontation deserves to be held hostage by the other. Continue reading “UofL and Norton Healthcare go to the Mattresses.”