Louisville Finally Recognizing Religious Restrictions on Healthcare.

“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.

No more secrets please!
Since my initial report, I have had only additional reliable first-hand confirmation from both doctors and patients of how the religious rules have profoundly interfered with providing the standard of medical care. We are talking life-and-death stuff here! Please free to add your own stories below. There is no room for secrets any more– as if there ever were. Despite several opportunities provided by me and others, KentuckyOne Health has not denied any of this. Most of the public attention has been on matters of family planning and childbirth. This is quite curious, as KentuckyOne Health does not provide a hospital maternity service in the city! They must be assuming that the all the other maternity services in Louisville are willing to provide something other than the standard of care for the patients of KentuckyOne Health doctors. Although the obsession of the Catholic Church with women’s health is well known, let it also be very clear that your legal end-of-life directives will not be followed in KentuckyOne Health facilities. I can only hope that KentuckyOne Health physicians will give you more respect than that no matter where they take care of you. Time will tell.

And the search goes on-
The University of Louisville is apparently still looking for a new partner and no one is admitting that KentuckyOne Health is out of the running. The survival of Jewish and St. Mary’s Hospital itself remains to be seen. (Those of the historical medical staff who have remained at Jewish Hospital through both its decline and the religious changes are very unhappy about the prospect of University department heads coming in to take over. More are threatening to leave.)  In the hopes of consummating their earlier merger deal, I understand that all sorts of “work-arounds” may be offered to allow the Church and University to save face and yet still be allowed by the Commonwealth. (For example, keeping the condoms, birth control pills, and IUDs in a closet “rented” by someone else.) Of course, there is no reason why KentuckyOne Health and the University cannot cooperate taking care of patients and advancing medical education without having to merge financially. That is to say, no reason except that they would be living in Catholic sin together.

The insoluble dilemma.
I have been critical of the University of Louisville and its leadership for being willing to sacrifice their academic, administrative, and medical independence upon the altar of a “business decision.” Even though I do not agree with its infallible dogma, I am equally critical of the Catholic Church for what in my opinion is the hypocrisy of a willingness to overlook its own standards in the name of financial gain, especially when they leave the resulting ethical debris upon on the shoulders of others. Why should a doctor or insurance worker have to feel they are lying in the medical record in order to do business with KentuckyOne Health? Another Louisville physician put it better than I can.

… the central problem is that the most basic question CANNOT be answered. Either:
a) the ERD is a sincere document, to be taken at face-value as the Church’s enumeration of absolute prohibited and recommended guidelines for medical care;
b) or the ERD is a document meant to give moral cover to the church as it enters into corporate health care, with the expectation that providers pay lip-service to it, while carrying on with 21st century medical care in direct opposition to the ERD.

If the ERD is sincere, most enlightened providers could not in good faith agree to abide by it.

Another delay.
I am informed that any day now, the University of Louisville will again postpone a public announcement, this time from September to later in the winter, about its search for a new exclusive business partner. I assume that several reports to me that all is not going well in this search are true. Next week will also see a scheduled court hearing about whether the University can continue to refuse to provide information to the public about the University of Louisville Hospital it claims is its private entity. Perhaps the delay and the hearing are related. UofL is inventing its own dogma concerning its role in our community. Unlike the Catholic Church, it has no claim of infallibility. We of the public have no obligation to worship either institution, but we do have a reasonable expectation of openness, accountability, forthrightness, and most certainly, honesty.

Peter Hasselbacher. MD
President, KHPI
Emeritus Professor of Medicine, UofL
16 September 2012

One thought on “Louisville Finally Recognizing Religious Restrictions on Healthcare.”

  1. My prediciton that UofL would again delay its announcement regarding its search for a new partner of some sort came true. No surprises there. Laura Ungar extracted a few additional tidbits of information including verification that Uofl has been talking with more than one party.

    What is a surprise to me is that one very well connected individual tells us that the latest rumor for a merger partner is United Healthcare, the big insurer. Having United for a partner would solve some big problems for UofL. United now provides healthcare for UofL employees and for retirees who choose to allow the University to subsidize their Medicare coverage. Unfortunately this means that UfoL retirees do not get the drug coverage supplement to Medicare they were promised when they were hired. Humana has a drug plan as part of its Medicare Advantage plan, but UofL refuses to subsidize Humana for its retirees. United does not currently offer an Advantage plan in Louisville.

    We already know that UofL and its faculty private practices have not always played well with Humana and Anthem. A UofL retirement administrator told me that the reason that UofL dropped Humana as its insurer a few years ago was that UofL faculty no longer participated with Humana. You will recall the very public fight of UofL surgeons with Humana. Perhaps Humana still does not include UofL Hospital in its networks. As I recall, similar problems have come up with Anthem and physicians over the years. Having University Hospital and perhaps Jewish as partners means that United might be able to float an Advantage plan and that UofL would be able to force its employees and retirees to use its own medical provider networks. That possibility does not sit well with me as a UofL retiree.

    I predict that UofL will make another “business and fund-raising decision” that may or not be in the interest of its employees, retirees, or even its patients. We will see.

    Peter H.

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