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 Public Health Director for Louisville: Follow-up (or lack thereof).

On June 24, I sent a copy of the June 18  Blog entry below to Louisville’s Mayor Greg Fischer, and to Mr. William Altman, Chairman of Louisville’s Department of Public Health. I repeated my request to reconsider the employment structure of Dr. LaQuandra S. Nesbitt, the new Director of Public Health and Wellness. (Cover letter here.)  The letter contains the mission statements of the Louisville Board of Health emphasizing its independence.

I have not had a response, nor am I aware of any new information.  What do you know, and what do you think?  Add your two bits.

[Addendum Dec 14, 2011:  When I wrote the above letter to the Board of Health and the Mayor’s office, I somehow thought that the Louisville Metro Department of Public Health and Wellness  reported to the Louisville Board of Health– imagine that!   While the details of accountability still elude me, it seems that the LMPHW Department is a branch of Louisville Government, reports to the Mayor, and is only “advised by the Board of Health. The Board of Health is “independent,” and is appointed by the Mayor.  Its Chairman was on the search committee for the new Director, Dr. Nesbitt.  If anyone can straighten me out about this, please do so.  The details of the organizational chart do not affect the substance of my letter nor my concerns.  I still think her dual employment it is a bad idea. The absence of her counsel in the current debate over the acquisition of University Hospital is appropriate given her conflict of interest, but missed.

Peter Hasselbacher, MD

Apologies!

I am in the process of upgrading the site and its software.  Please excuse the dust and any intermittent lack of access.

As of August 6 I am still working on this. I had to repair all the links to images and documents.   I also hope to have a less generic header soon!  Managing a website has been a continual learning experience for me.  The new format and theme should allow us greater flexibility and security.

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:”

An Apology, and a Renewed Invitation.

I apologize for the hiatus in my entries which was probably a predictable consequence of my New Year’s resolution. I have a new and unbounded respect for journalists and commentators who turn out material regularly, week after week. I got sidetracked by an illness and death in my family, but so do the real journalists I admire.

It probably doesn’t make any difference anyway, because I may be the only one who reads these pages! I have no way of knowing how many people have visited the KHBI Website or Blog. To make it easier for you to contribute, I have relaxed the requirement to register in order to add comments. The anti-spam capabilities of WordPress (the software I use for this initiative) are pretty good. If things get out of hand, I can always reinstate registration. I only ask for civility. Inappropriate comments will be deleted.

Peter Hasselbacher, MD
June 13, 2011

OPTROT: A big win for Optometrists and Legislators Alike!

A few weeks after their stunning legislative maneuver that fundamentally changes the practice of optometry in Kentucky, the Kentucky Optometric Association hosted a reception to thank our legislators. Such receptions are quite common and provide legislators food, drink, and company for what otherwise might be a lonely evening in Frankfort. They are fun. They also provide further opportunities for networking (a.k.a. lobbying). According to Frankfort’s rules, as long as all legislators are invited (even the 17 who voted against) no ethical problem exists. We doctors (and presumably optometrists) have long allowed drug companies and medical device manufacturers to shower us with meals, travel, and gifts. How can we object? If everybody does it, that makes it OK– yes? The optometrists pulled off a wildly successful legislative campaign and they deserve to celebrate. I do not hold it against them.

Not to be overlooked is the fact that our legislators had a big victory to celebrate as well. The optometrists won big, but our legislators won even bigger. The bar for the amount of money it will now take to reliably pass a piece of legislation has been raised. There is an old political joke, that the top three priorities of elected officials are all to get reelected. It would be a funnier joke if there was not so much truth in it. I was immersed in federal and state legislative processes for more than 15 years. I have spoken with or interviewed hundreds of lobbyists. I have hired lobbyists. I was one once! Money counts, and that is why the job of getting reelected in Kentucky has just gotten a little easier. Yes, the optometrists did other things right, like sustained coordinated personal contacts with their representatives. However, in electoral politics, money trumps most everything, including good policy. A new blueprint has been drafted. It will be interesting to watch the cash flows next legislative season.

Peter Hasselbacher, MD

OPTROT? Business as usual? Or both?

Passage of Kentucky’s Optometry Bill into Law.

Gov. Beshear signed Kentucky’s optometry practice expansion bill into law yesterday. Thus ends the remarkable passage of Senate Bill 110 that in one fell swoop transforms the practice of optometry in Kentucky from correcting vision with lenses, to the practice of treating eye disease with medicine and surgery.

Much can be said about many aspects of this episode.  For example, the erosion of the monopoly of MDs to practice medicine. However the special privilege of caring for the sick has been drifting away from us physicians for some time. Some of these sharings are not all bad: you don’t have to be a brain surgeon to manage an immunization schedule or treat a sore throat. I predict that we physicians will continue to share the responsibility of treating illness and that the pace of the sharing will increase dramatically with the inclusion of the concepts of wellness and disease prevention into our financial structure of treating illness. (There is no limit to the demand for wellness, disease prevention, or screening by the public; nor limit to the willingness of healthcare workers of all levels of competence to provide.) This optometry bill was not the only scope of practice legislation before this General Assembly. Why have not the others passed as well? Is this optometry bill a crack in the dam? Did we physicians do something to bring this on ourselves?

Changes in scope of practice are not occurring in isolation from other major shifts in the landscape of healthcare delivery. I am informed that the considerable majority of primary care physicians in Louisville are now direct employees of hospitals. A large and increasing fraction of specialists are also hospital employees. I predict this trend will do more to change the practice of medicine than the sharing of professional responsibilities with optometrists, or nurses for that matter. What is happening is that systems of medical care are largely replacing Mom and Doc operations. That’s probably for the better. Even in a given specialty, there is too much to know, too much to do, and too much efficiency required. What is most important is that the primary obligation of the physician to their patient retains its primacy. That is what we are most at risk to losing. That may not be for the good. Continue reading “OPTROT? Business as usual? Or both?”

The Best Law Money Can Buy?

Or good public policy?  How can we know?

In follow-up to an earlier posting, the wheels were greased sufficiently well that Senate Bill 110,  an Act relating to Optometry, raced through the Senate committee structure and floor in less than 4 days. In less than 4 more work days it passed through the committee and floor of the House. moving through both chambers in spectacular time and with overwhelming majority votes. Only a single other non-housekeeping bill has passed both chambers so far in this session. Talk about “inside-track!”   The bill now goes to the Governor who has promised to meet with interested parties before he makes a decision to veto or not. What facts does the Governor want to hear? Facts that might have come out of testimony in the Health and Welfare Committee that might properly have heard the bill in the first place?

Over the same days, the legislature rejected a bill protecting the public from the usurious interest rates of the Payday Loan industry (that also paid big bucks for the privilege of exercising their free speech),  and allowed a bill to review child deaths from abuse or neglect to falter.   I rather suspect the abused children did not have a PAC to counter the political influence of the anti-abortion lobby who placed their suicide belt around the bill.

SB 110 is a complete overhaul of existing law defining the lawful practice of Optometry. The traditional role of Optometrists in refraction and fitting lenses is no longer central. Instead, Optometrists are now authorized to correct and relieve optical abnormalities using surgical procedures and prescription drugs. The bill is pretty much silent on what kinds of surgery is permitted. “Optical abnormality” is not defined and I interpret it to mean disease of the eye. Instead, the bulk of the text itemizes prohibited surgery, including non-laser surgery of the cornea, sclera, lens, etc. The exclusions are so outrageously obvious that they obscure the implications of what can be done. Much is made of the distinction between laser and non-laser surgery, but this is a false dichotomy. Lasers are used to excise tissues as an alternative to “the knife” in a wide variety of traditional surgeries. In my reading, this bill appears to authorize laser surgery on almost any part of the eye! Curiously, the bill prohibits “laser or nonlaser injection into the posterior chamber of the eye…” I have no idea what “laser injection” into the eye means. This phrase appears to me to be an error in the writing of the bill reflecting its rocket-speed passage. If a nonsensical medical procedure is present in the bill, how well discussed or understood could the rest of the legislation been considered? [I will be happy, even reassured, to stand corrected.] Continue reading “The Best Law Money Can Buy?”