Questions for Merger Advocates:<\/strong><\/p>\n1.\u00a0 In 2008, the Dean of the School of Medicine, Dr. Edward Halperin, admonished his graduating class, \u201cnot to accept even the smallest of gifts\u201d that might bias your judgment.\u00a0 \u201cWhen people offer you a gift that is intended to persuade, remember that the dictionary definition of that is a bribe.\u00a0 Turn it down.\u201d \u00a0 Given that the $200 million being offered to the University Health Sciences Center is not targeted to patient care, is this gift then a bribe?\u00a0 Given that the University has refused to reveal any meaningful details of the proposed uses of the money, how is the public to decide?<\/p>\n
2.\u00a0 Dr. Taylor, you have been quoted as saying that agreeing to honor the Catholic directives was a business decision, and that this compromise was a \u201cvery small one.\u201d\u00a0 After hearing the impassioned and almost universal criticism from outside the University, do you still contend, whether public or not, that trading away the secular nature of the University’s Hospital is a small thing?\u00a0 [The audience at the Louisville Forum groaned when Dr. Taylor repeated his comment that this was a “business decision.”]<\/p>\n
3.\u00a0 Norton Hospital and the University of Kentucky have formed a partnership to attack the same priorities that you have. In fact their stated goals are nearly identical.\u00a0 They did not have to merge to do so. Why do you?<\/p>\n
4.\u00a0 The University of Louisville Board of Trustees, without public discussion, authorized President Ramsey to approve and sign \u201cany and all documents, including an academic affiliation agreement, lease, sponsorship agreement and any other agreements needed to implement the proposed merged academic teaching hospital.\u201d\u00a0 The Board of the University of Louisville Hospital is heavily loaded with individuals closely associated with the University.\u00a0 President Ramsey and the University’s spokesman have been at the forefront of public pronouncements.\u00a0 How can you in good conscience continue to assert that this is not a University of Louisville project?<\/p>\n
5.\u00a0 On June 19, a Courier-Journal editorial asked where the headquarters of the new organization would be located.\u00a0 \u201cNo merger hospital in which UofL is a partner can possibly be located anywhere other than Louisville.\u00a0 It should not even be a point for negotiation.\u201d\u00a0 Where will the headquarters of the new organization be located?\u00a0 If you promise us Louisville, how can we know you won’t pull a Rick Scott on us and move the headquarters elsewhere?<\/p>\n
6.\u00a0 Isn’t it true that this proposed business deal is more about competition with Norton Healthcare and the University of Kentucky?\u00a0 Or for that matter, about making a drug company out of the University of Louisville?\u00a0 Convince us that your platitudes about improving health care, lowering cost, and increasing access are more than that?<\/p>\n
7.\u00a0 University Hospital originally indicated it would follow the Catholic\u00a0 health system directives.\u00a0 Now you claim, out of respect, to agree by contract with some or perhaps even or all of the ethical and religious directives.\u00a0 Why is this not a distinction without a difference? \u00a0 Why did you change your position?\u00a0 The local archbishop has been clear he will approve the arrangement only if the participants agree to follow all the directives?\u00a0 How can you possibly ask the Governor, the Bishop, and the public to agree to your plans without disclosing what you have agreed to?\u00a0 [Some, but not all of the documents were released the day ot the Forum debate.]<\/p>\n
8.\u00a0 Louisville’s Archbishop Kurtz has unequivocally stated that he could not foresee a situation in which University or Jewish hospitals would operate under Catholic ownership without also following the formal ethical and religious directives for Catholic Health Care Services.\u00a0 One must admire the man for his candor.\u00a0 What part of “unequivocally” does the University of Louisville not understand?\u00a0 Should this merger advance and survive the inevitable lawsuits, the University and its hospital will have to deal with such inflexibility forever.\u00a0 President Ramsey and university leaders, how can you possibly ask us to accept this deal?<\/p>\n
9.\u00a0 Why should the University of Louisville Hospital, and ultimately the taxpayer, become liable for the $400 million of the long term debt of Jewish Hospital?\u00a0 UofL Hospital is not approaching bankruptcy but Jewish Hospital is.\u00a0 Surely UofL could have extracted a better deal from CHI.\u00a0 Why didn’t it?\u00a0 If UofL wants to buy Jewish Hospital, why not do so outright?<\/p>\n
10.\u00a0 The interpretations of the bishops that guides implementing the Ethical and Religious Directives require that the Bishop or his delegate sit on the hospital’s ethics committee and that regardless of the decision of the committee, the Bishop’s opinion is final.\u00a0 Will University of Louisville Hospital follow these requirements or ignore them?\u00a0 Will it be mandated that that a priest or nun sit on its ethics committee?\u00a0 Will a Catholic Priest chair any interdenominational chaplains committee as is required by Catholic Health Systems?<\/p>\n
11.\u00a0 Freedman and colleagues studied miscarriage management in Catholic -Owned Hospitals. The study concluded that in “some Catholic-owned hospitals, the private patient\u2013physician relationship, patient safety, and patient comfort are compromised by religious mandates that require physicians to act contrary to the current standard of care in miscarriage management.”\u00a0 Given the lack of clarity and consistency in your responses on this matter, how can you possibly continue to withhold from the public, or the church for that matter, the specific agreements you are willing to make in allowing this takeover of our most critical community hospital?<\/p>\n
12.\u00a0 The City of Louisville Website and its Department of Public Health and Safety direct individuals wanting help with family planning and contraceptives to go to the University Ob\/GYN Foundation in the Ambulatory Care Building of the University of Louisville Hospital.\u00a0 Are you going to ask the city to take down that webpage?<\/p>\n
13.\u00a0 Last July, Mayor Fischer said regarding the lack of details in a proposed merger plan, \u201cthis issue will not go away from the city’s perspective until these issues are addressed with some concrete action plans and the citizens are happy that the service level is there.\u201d\u00a0 \u201cIf we’re having this same conversation a month from now, that’ll be a problem.\u201d\u00a0 Why are we having this same conversation in December?<\/p>\n
14.\u00a0 Merger talking points stressed that out of respect, the religious identities of two of the hospitals will remain intact.\u00a0 Why does not the secular identity of University of Louisville Hospital remain intact?\u00a0 Why does not respect go both ways?\u00a0 [I asked this question myself at the Forum.\u00a0 It was not answered.]<\/p>\n
15.\u00a0 How can the University of Louisville School of Medicine affiliate with an institution in such a major way that prohibits the use of condoms to prevent the spread of HIV infection and AIDS, and uses pseudo-science and disinformation to discredit the effectiveness of this fundamental public health principle.\u00a0 Are not magical thinking, inerrancy, and discrimination antithetical to the clinical and scientific practice of medicine?\u00a0 How do you justify this to your students and trainees, indeed to yourselves?<\/p>\n
16.\u00a0 Much has been made about the University’s plans to ship women to Baptist Hospital for procedures you will refuse to do at University Hospital, and then as a magnanimous gesture, pay for those services.\u00a0 Will you do the same for all the women in the rural counties served by the small hospitals with which you will be merging that deny these vulnerable women these essential and basic services?\u00a0 Those women have no such face-saving workaround available to them?\u00a0 If not, how can you possibly justify this merger with the claim that you are increasing access to health care?\u00a0 Indeed, as a partner, you facilitate a deliberate strategy of limiting basic health care for women for religious reasons that may not be their own.<\/p>\n
17.\u00a0 Baptist Hospital provides very little indigent care.\u00a0 Why should not Baptist provide medical care to the transported patients for free?\u00a0 Let University Hospital keep its $15 million for other uses.\u00a0 In fact, Baptist should be pleased to provide reproductive and family planning care for free to all the women living in the catchment ares of the partner hospitals who request\u00a0 this essential but denied care.\u00a0 Would you support such a proposal?<\/p>\n
18.\u00a0 According to Federal statistics, St. Joseph Hospital provides less than half the average amount of indigent care provided by other hospitals in Kentucky. University of Louisville Hospital and Jewish & St. Mary’s (mostly St. Mary’s)\u00a0 provide among the highest amounts of indigent care.\u00a0 Why should not University and Jewish Hospital acquire St. Joseph’s Hospital on their own terms, and show St. Joseph’s Health Care System how providing indigent care is really done?\u00a0 [I provided this data at the Forum.\u00a0 The proponents were not pleased.]<\/p>\n
19.\u00a0 Will CHI pay any malpractice defense and judgements against physicians who are sued for failure to apply the standard of medical care in their institutions that was refused?<\/p>\n
20.\u00a0 Isn’t it true that virtually none of the money that CHI says it will give to Kentucky hospitals, the University of Louisville, or our Community Jewish Foundation is given as charity by their parent religious institution?\u00a0 Is the funding not skimmed off the profits of the other hospitals they own or manage.\u00a0 Why will not the same thing happen in Louisville? \u00a0 Is this a acquisition bubble waiting to burst?\u00a0 Given that public taxpayer dollars and insurance premiums are financing these Catholic hospitals, how can you justify refusing to provide services needed and expected by the public?<\/p>\n
21.\u00a0 Why abandon the Computerized medical record that University Hospital already payed for and obtained federal incentives to do so?\u00a0 Why give CHI the ability to scrutinize what we are doing here, or use Louisville patient data for other purposes?\u00a0 Is it because the electronic physician ordering module does not have a slot for birth control pills?<\/p>\n
22.\u00a0 Will you agree today to put off the merger until an independent task force can study the merger agreements to determine what are the financial repercussions to the Commonwealth and the ramifications to health care services?<\/p>\n
23.\u00a0 Dr. James Taylor has said that University of Louisville Hospital is \u201cdoing fine, thank you.\u201d On the other hand, Jewish Hospital and St. Mary’s is struggling, and the word bankruptcy is being heard in the community.\u00a0 Why then is University of Louisville Hospital being given the same paltry 15% control in the new proposed system as is Jewish & St. Mary’s, compared to the 70% by CHI.\u00a0 Is this not the definition of acquisition?<\/p>\n
24.\u00a0 What is the percentage or the amount of money that will be going into the CHI Mission and Ministry Fund?<\/p>\n
25.\u00a0 If your grandchild had a life threatening disease, and the best, if not the only treatment was embryonic stem cell, would you deny her that treatment since it is forbidden by ERDs?\u00a0 Why is UofL giving back its hard fought right to do fetal stem-cell research and use its results in its hospitals?<\/p>\n
26.\u00a0 Exactly how is the infused money form CHI to be spent, what profits do they expect, why is CHI so interested in failing institutions, what is their ROI, how much do they expect from local and state government after merger, how much more money will they be paid after the Affordable Care Act is enacted and more indigent will have insurance.<\/p>\n
27.\u00a0 How does the faculty of the University of Louisville feel about this acquisition?\u00a0 [See the subsequent Policy Blog posting for the answer to this question.]<\/p>\n
Questions that might have been asked of the “Concerned” side:<\/strong><\/p>\n1.\u00a0 Why are you so against this merger?\u00a0 Only a very few patients and treatments will be affected.<\/p>\n
2.\u00a0 If this merger does not go through, University of Louisville Hospital and Jewish Hospital may go bankrupt and have to close.\u00a0 Have you no heart?<\/p>\n
3.\u00a0 The new accountable care act is forcing hospitals to change the way they do business.\u00a0 Why are you standing in their way?\u00a0 The information technology changes alone are going to make it harder for them to provide indigent care.<\/p>\n
4.\u00a0 The Atty. Gen. has ruled most recently that University of Louisville Hospital is private.\u00a0 What right do you have to interfere?<\/p>\n
5.\u00a0 Jewish Hospital is too big to fail.\u00a0 The Louisville business community has pegged its future to the healthcare related businesses.\u00a0 We will lose jobs if this merger does not go through. Are you against jobs?<\/p>\n
6.\u00a0 Kentucky needs more doctors.\u00a0 The merger partners have promised to place more doctors throughout the state.\u00a0 Isn’t this important enough to allow this merger to go forward?<\/p>\n
7.\u00a0 If no one at University Hospital can have their tubes tied, it is not discrimination to send someone somewhere else to get that procedure. Don’t’ you agree?<\/p>\n
8.\u00a0 Why are you bashing religion?<\/p>\n
9.\u00a0 Is this merger going to affect your patients?<\/p>\n
10.\u00a0 Has does this merger affect recruiting doctors for your practice.<\/p>\n
11.\u00a0 What are the changes that you as a physician will have to make in order to accommodate the ERD restrictions?\u00a0 And what are your colleagues worried about?<\/p>\n
Peter Hasselbacher, MD<\/p>\n