Does all Kentucky business happen at basketball games?
I made an interesting field trip to New York City last Friday. By accident, I discovered that the University of Louisville’s Department of continuing medical education was offering a seminar in the Big Apple entitled, “What We Can Learn about Hospital Mergers, Capital Investment and Construction in a Landlocked Urban Environment.” This topic sounded familiar! Given all the excitement about religious intermarriages of hospitals, I thought it would be interesting to hear what some of the players would have to say off the battlefield. It took a few phone calls, but eventually I got my name on the list. As I learned later, this meeting was part of an annual affair for University officials and faculty going to the Big East basketball tournament. Physician members can get some of continuing medical education credits necessary for licensure. The trip also gives University representatives a chance to visit other medical schools and teaching hospitals and to talk about things like technology transfer and mergers. This year’s field trip included a visit to Mount Sinai Hospital and Medical School which had recently gone through a high-profile marriage with New York University, and an even higher profile divorce.
There were some 20 people in attendance at the conference– a pretty high-powered team. President Ramsey, Provost Willihnganz, Vice President Inman (development, governmental relations, and marketing), and the Deans of the Schools of Medicine and Education made up the starting five. On the bench were the director of the University’s Residency Programs, and various division chiefs and program directors including neurosurgery, neurology, and anesthesia. I was actually shocked to find in attendance two very senior officials from Jewish Hospital who were leaders in last year’s failed merger attempt. This was not a party to which I would have been invited had I not crashed it myself. A few of the group were obviously not happy I was there and I suspect their conversations following the scholarly presentations of the conference were guarded in my presence.
Medical School Dean Halperin, who is a historian at heart, gave a very interesting presentation about the rise and fall of the American Jewish Hospital. As the more blatant versions of anti-Semitism have diminished in most of America, the driving force behind the creation of Jewish hospitals has faded away. Things were different when hospital staffs were restricted, and quotas for Jews, African-Americans, and women in medical schools were posted right on the doors.
I was beginning to think I was attending a purely academic session after all, but it became clear to me that I was in the middle of an active fact-finding and planning session of the once and future merger partners.
The next major presentation was a lecture by a visiting guest, Dr. David Sulmasy, a Catholic friar/physician/ethicist who served as a consultant to Dean Halperin during the previous (and ?ongoing) merger attempt. It was entitled, “Ethical issues and practical solutions when hospital mergers involve Roman Catholic and secular hospitals.” In any setting, the presentation would have been interesting and informative. Dr. Sulmasy took us through the highly specific definitions attached to the words and concepts contained in the ethical and religious directives (ERDs) that that were the focus of so much discussion last December. He presented to the group organizational structures of hypothetical religious/secular mergers that he believed would be acceptable under the ERDs including carve-outs with firewalls, and joint ventures. He admitted that many bishops would not agree with his interpretations, especially in the rising conservative political tide of institutional Catholicism. I may have more to say about his discussion at another time.
I was not the only member of the audience who paid close attention. I was frankly surprised, given the prohibition of communication under the terms of the University’s Request for Proposals for a new partner, that this group would be discussing such things where someone like me could hear them. The handouts provided to the other attendees before the meeting included the recent New York Times article and editorial about the rise and fall of the hospital merger in Louisville and the failed mergers in New York. Mergers were very much on the agenda of the New York retreat. Dr. Sulmasy was going to be available later for further questions at lunch.
I was even more surprised at the nature of the discussion when we visited Mount Sinai Medical Center later in the morning. There we met with the President of the combined medical center and the Dean of its medical school, together with program directors of rehabilitation medicine and autism. It became even more clear to me that this was an active fact-finding and organizational mission. Officials from the University and Jewish Hospital were exploring future activities together. UofL people asked about how they could create a higher-powered academic rehabilitation program at Frazier Rehab Center, how they could augment their spinal cord injury program and other neuroscience initiatives, and how they could augment the new autism program presently on Eastern Parkway being pushed by President Ramsey. There was much discussion about how to organize and finance network facilities out in the community and how to compete with other healthcare organizations. One UofL person asked how Mt. Sinai felt about competing with the major cancer center down the street. (Mt. Sinai loved the competition.) There was discussion about how to organize and compensate faculty and office physicians. I was particularly attracted to Mt. Sinai’s unified hospital and medical school structure, and their policy of taking care of all their patients, rich and poor, in exactly the same facilities.
The only references I heard related to “Our Merger” were at the end of Dr. Sulmasy’s presentation. I was thanking him for his lecture when Provost Willihnganz came up to us and blamed the merger failure mainly on anti-Catholicism. (My German-Irish Catholic family was not there to protect me!) I heard President Ramsey blame the defeat on “politics.” There is no doubt that Dr. Sulmasy already knew a great deal about what had happened in Louisville.
I am no lawyer, but it seems to me that the substance and conduct of this off-site meeting constitutes an improper sharing of planning information between the University and a likely responder to its RFP. Of course I may have it all wrong and KentuckyOne Health is not interested in the more comprehensive partnership. But if they were, I believe I saw impermissible collusion between the two parties. If I were another potential applicant (and there is at least one other highly ranked team on the court) I would be very unhappy at the apparent favoritism and ongoing active planning behind the scenes.
In its recent release of answers to questions about the RFP, the University again stressed that all communication between the University and potential responders must be funneled through the University’s designated purchasing agent or else risk disqualification. It seems to me that KentuckyOne health has either already decided that they are not going to submit a proposal, or that they have disqualified themselves. I expect that we will hear some additional discussion about this matter.
Peter Hasselbacher, MD
March 12, 2012
Criticism of My Article:
I was beginning to think that no one ever read these musings. Now I know that I am not the only one. I received a communication that was critical about several points of my reporting and opinions concerning a UofL-sponsored meeting held in New York City about hospital mergers involving religious institutions. In preparing the Policy Blog entry, I had worked from extensive notes and a recording of the event. However, I want to be both accurate and fair and have made some minor changes in the original text.
I was also asked to apologize to Dr. Edward Halperin, one of the course directors and organizer of the conference. I think I can do better than that. Before the conference I had not met Dr. Halperin personally. I knew and admired him largely because of two of his presentations to our medical students and Health Science Center. Shortly after his arrival he exhorted a graduating medical school class not to accept gifts from pharmaceutical companies whose intent was to influence their judgment and were therefore were bribes to be rejected. Just last month in a moving lecture on medical ethics entitled, “The Banality of Evil,” he spoke against the lingering residue of segregated medicine at the University of Louisville, which he categorized as a thing evil. I wrote about these presentations earlier. In my 30 years of association with the University of Louisville, I have never heard more bold or impassioned public statements emerge about something so fundamental to the highest standards of our profession. I could hardly believe that Dr. Halperin was part of the leadership team that planned the unsuccessful merger last Fall that so many of us felt also compromised important principles of patient autonomy and the primacy of the physician-patient relationship. No doubt he may have felt embattled.
I have observed that at the University of Louisville, being called the conscience of your unit is not always meant as a complement. Last month, Dr. Halperin resigned as Dean of the School of Medicine. I hope that he found his 6 years in Louisville to be professionally and personally satisfying. I wish him a fulfilling opportunity to make a difference at his new institution, New York Medical College. Nothing I have written in the past should be interpreted to be anything except respectful of him personally and I am sorry if he or anyone else felt otherwise.
Peter Hasselbacher, MD
March 16, 2012