“Don’t Ask, Don’t Tell” Medicine.

It has taken a while, but finally the traditional press (Courier-Journal and Leo) has picked up on the fact that the merger of Jewish and St. Mary’s Hospital with the St. Joseph Hospital system of Catholic Health Initiatives (to form KentuckyOne Health) has resulted in substantial restrictions on the ability to provide the modern standard of healthcare in Louisville. On June 9, and August 24 I reported in these pages the results of my own investigation. Jewish Hospital and the physician offices owned by KentuckyOne Health were now following the Ethical and Religious Directives Of the Catholic Church (ERD)– this despite the fact that Jewish Hospital had been designated a “legacy” hospital and promises that nothing would change. These were the changes that the University of Louisville Hospital would also have had to follow had the full intended merger been successful. I was writing about about these matters of reproductive health, surgical emergencies, end-of-life care, and falsification in the medical record as early as last December. There should be no surprises here. We know better now. Continue reading “Louisville Finally Recognizing Religious Restrictions on Healthcare.”

KentuckyOne Health physicians are now on the record about medical practice restrictions.

On June 9, I reported in these pages that agents for KentuckyOne Health (KOH) were enforcing certain new restrictions on their employed physicians, and in particular, on Obstetricians and Gynecologists. I used these prohibitions to demonstrate how in my opinion University of Louisville physicians and trainees would have had to ignore contemporary standards of the practice of medicine had Catholic Health Initiatives (CHI) been able to acquire the clinical operations of the University. I had, in my opinion, reliable evidence that KOH physicians were being prohibited from offering birth control and other standard reproductive or women’s health services, limited in their treatment of ectopic pregnancy, restricted in end-of-life care, and subject to other of the Ethical and Religious Directives of the Catholic Church. Hypocritical “work-arounds” were suggested that in my opinion opened wide the door to medical falsehood by patients and physicians alike. I could not get a single physician to go on the record to confirm what I was being told privately. Neither could I get a reply from Jewish Hospital or their major women’s health program.

As of today we have a different story. Laura Ungar reported on the front page of Louisville’s Courier-Journal that the physicians of Highlands Family Physicians, a major primary care practice employed by the Jewish Hospital Physicians Group, have severed their association with KOH and joined the physicians of Norton Healthcare where they will be allowed to practice to the full standards of modern scientific, evidence-based medicine and their medical license. The major stumbling block reported was a prohibition against birth control and a required documented emphasis on “natural” family planning (a.k.a. the make-love-and-worry-for-a-month rhythm method, or presumably abstinence). At this time, we do not know the full spectrum of related prohibitions. When the physicians of Highlands Family Medicine requested written direction to dispel confusion about rules that “could change,” none were made available. As a matter of courtesy to those concerned, I again offer to publish any such clarification in these pages. I think the public has a right to know, don’t you? You can download a copy here of the “contractual” restrictions that the University of Louisville would have been only too happy to adopt last January 1. From all that I can see, it appears to me that these are the rules that Jewish Hospital and its physicians are now following. I would be happy to publish a clarification that no physician was ever shown such a list. Continue reading “Secret War Against Birth Control in Louisville Now Out of the Closet.”

Implications for possible future UofL Hospital partnership.

The University of Louisville offered a target date of the end of June to announce their newest life-partner-intended for clinical and academic activities. Despite my musings in the last post, most observers believe the University will try to follow through on its original plans to merge with, or be acquired by some combination of Catholic Health Initiatives (CHI) or KentuckyOne Health (KOH). If anyone wishes to wager on a different outcome below, I am willing to bet a martini in the favorite Louisville bar of the correct predictor. My bet is on CHI/KOH.   [So far, no one has been willing to bet against me!]

Background.
Any new proposal from the former would-be partners, or any other for that matter, will have to grapple with a number of existing thorny issues and probably some new ones. It will be interesting and probably entertaining to see how it all plays out. It would be less entertaining to write about if the outcome was not so determinative of the style and quality of medical care that will be offered on the public’s behalf to the disadvantaged of Louisville. This article will deal with the issue of how a potential new partnership with CHI/KOH might effect the way end-of-life, reproductive health, or woman’s healthcare would be delivered under UofL auspices. As the best available indicator, I base this discussion on how Jewish Hospital & St. Mary’s (JHSM) and their associated medical practices provide these medical services following the creation of KentuckyOne Health. Recall that the University of Louisville fully expected to be a part of this new entity, and even while trying to downplay (some would say obscure) the changes in medical practice it was willing to make, it was clear that the University and its Hospital were prepared to follow religious doctrines of the Catholic Church in exchange for money for University programs. It was a “business decision.” Although this article deals mostly with reproductive and women’s heath, and with end-of-life care, the Religious and Ethical Directives of the Catholic Church (ERDs) cover much more ground than that. Continue reading “Changes in Reproductive and Women’s Healthcare in Louisville.”