Someone forwarded to me a reply by President Ramsey and the CEOs of the three hospital systems to last Sunday’s editorial in the Courier-Journal. These are the hospitals that would become the “Network Entity” with the acquisition of three large Louisville hospitals by the 7 or so smaller ones of CHI. (It is hard for me to count up these latter because not all of the CHI hospitals seem to be recognized by or eligible for Medicare.) The rebuttal acknowledges the problem of picking a fight with a party that buys ink by the barrel, but I do not think it rises above sounding arrogant, self-serving, and whiney. The three complain about being characterized as having acted in a “secretive and contorted fashion.” It is a matter of settled fact that few of the pubic knew that anything had been going on until the announcement last summer that the entities were going to merge. I certainly believe they are still keeping secrets about their plans and what they propose to do with their money. It has only been in the last week that any documents were released at all. Two or three weeks ago a caller to the WFPL radio interview told the merger representatives that he was disappointed in the way they were proceeding, and that “they were losing the public relations war.” The University did not take that advice until forced to by a judge.
[Addendum Jan 4: I take some affirmative consolation that the Attorney General of Kentucky in his report of Dec 29 also scolded the University and its Board of Trustees for proceeding so far without informing the Commonwealth!]
I heard three or four of their later presentations. They had been carefully scripted, and until the Louisville Forum session, presented in formats that allowed them to avoid meaningful rebuttal. Troublesome to me and others were changes in answers over time allowing one to believe that the details of the arrangement were still evolving or changing in response to criticism. Examples were changes in the degree and mechanisms in which the University would follow or honor the ethical and religious directives of the Catholic Bishops. The outright refusal to back up their promises with documents on which the public could depend further devalued the dependability of their comments. I would not argue with a characterization of “contorted.”
Additional statements were made that certainly lead this observer to believe that the partners either failed to grasp, or refused to admit how upsetting their plans would be to large segments of the community. We were told this was a “business decision” and a “small thing”, and that only a “few patients” would be affected. For some of us, that even a single patient would be discriminated against, or that even a single service would be eliminated at the request of a religious organization would have been sufficient grounds to reject the whole proposed enterprise. No wonder things were kept under wraps as long as possible.
President Ramsey and the CEOs further complained about the charge that University of Louisville Hospital would be “bartered away to a religious group.” I have not yet been able to read through the documents that have been released. (I do not even know if all the relevant documents have been released.) It may well be true that the University of Louisville Hospital is contractually not being called a Catholic Hospital. However it certainly has contracted and agreed to in some ways act like a Catholic hospital. Perhaps this is a distinction without a meaningful difference. The simple fact is the University of Louisville and its hospital have agreed to take both the moral instruction and administrative direction of a Catholic Hospital System. It only takes about 30 seconds on the Internet, or even the pages of the Courier-Journal to learn that trying to “respect” the tradition of the Catholic hospital system ties Catholics and non-Catholics alike into knots. Relatively predictable things like tubal ligations are minor compared to the intensely emotional and overwhelmingly personal trials that emerge from the whirlwind of everyday hospital and emergency room practice. Perhaps Dr. Taylor still believes this is a “small thing,” but as a physician and an educator, I find it to be a rather big thing. The University of Louisville Hospital holds itself out to the community as a full-service hospital for all. It has no obligation, indeed no right to assume an institutional conscience exception to decrease the services it already provides.
The institutional leaders also complain about the Courier-Journal’s characterization of their deal with Baptist Hospital. They resort to blaming the state and its 24-hour notice law as somehow a justification for their plan but I do not follow their logic. They further wax eloquently over the the principle that patients and their physicians should make all decisions about treatment, but reserve for themselves the decision of where that treatment can occur. This is another distinction without a difference. The mailing repeats the claim that University Physicians are not part of the merger, but neglects to mention that UofL has promised to do all that it can to prevent its faculty from competing with CHI anywhere in the state. That does not sound like an independent faculty of physicians to me. The University frequently claims that it is not one of the merging parties, but the minute one begins to read the released documents it is clear that the University and CHI are the major parties of this new business deal. (I felt mislead.) The Commonwealth is by extension being sucked in with them. Just imagine the new round of open-record conflicts alone.
The rest of the letter is self-serving blather and platitudes about common missions where none presently exist except for being in the hospital business in the first place. The CHI hospitals are not teaching hospitals. St Joseph Hospital does only half of even the state average of indigent care. Baptist Hospital does virtually none. Some of the St. Joseph hospitals are little more than cottage hospitals that are not suitable to sponsor residency training programs or field research programs. “You know us,” proclaims the letter. Yes we do, that’s why we don’t trust you. “Review the [released at the last second] merger documents yourself.” I am– and I am stunned about just how much the University is willing to give away for money.
Peter Hasselbacher, MD