Secret War Against Birth Control in Louisville Now Out of the Closet.

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.

Representatives of KOH responded to Ms. Ungar, including Dr. Dan Varga, Chief Clinical Officer for KOH and one of the major public figures advocating for the once-and-future failed acquisition of University hospital by CHI. Their comments left me just as unclear as I was last Fall when the same issues were raised. For example, “Legacy” Jewish Hospital and its physician groups are free to operate under a different set of restrictions than the historic Catholic hospitals, but those differences still remain obscure to me. For Medicare business purposes, Jewish Hospital and St. Mary’s are a single hospital. Are they subject to different religious directives? Dr. Varga, asserts that, “the doctor-patient relationship is sacred,” but not apparently as sacred as the Catholic Church which takes it upon itself to decide what the doctor and their patient can actually do about anything they may talk about.

If it were an insurance company or government prohibiting the full practice of contemporary medicine, doctors would be going nuts, writing to the paper, having their professional societies protest, and otherwise raising the roof just as they are doing now about restrictions on prescribing controlled substances.  Where have doctor’s voices been up to now? Is there a justified fear about keeping their jobs? I hold in highest admiration the physicians of Highlands Family Medicine for their principled, demonstrably ethical, and perhaps even courageous action. I would not be surprised if their contract with Jewish Hospital did not include a do-not-compete clause that would have prohibited them from practicing at all in Louisville if they left! If so, it must have been waived: any other action would have been recognized as outrageous in my opinion.

Officials at Norton hope that the patients of the practice will follow their physicians to its new location and I encourage them to do so. If usual business practices are operative, the patients’ charts may still belong to Jewish. Getting control over groups of patients for referrals has been the major driving force behind the purchasing of doctor’s practices by all of Louisville’s hospitals. I confess that a concept that patients are assets to be captured for the benefit of individual hospitals is uncomfortable to me. We as patients and potential patients should be free to see whatever doctor is willing to take us on, and free to go to whatever facility has demonstrated that it provides the best care. That choice has largely already been taken away from us based on things that should be irrelevant such as who our employer is or indeed whether we currently even have a job, or whether we receive public health insurance, or whether someone else judges us to be medically indigent. The last thing we need is to have somebody else’s religious dogma further limiting our choices. I encourage other physicians to follow the patient-centered lead of Drs Busse, Roszell, and Nurse-Practitioner Ward of Highlands Primary Care, or at least to offer some reasonable defense for not doing so. The patients who trust us deserve at least that, but not our silence.

Peter Hasselbacher, MD
President, KHPI
Emeritus Professor of Medicine, UofL
August 24, 2012