Yet Another Lawsuit over Norton-Kosair Children’s Hospital.

Kosair Charities sues Norton Healthcare over alleged contractual breach.

Breaking News 7:20 p.m.

It has been a while since I’ve written anything about the painful marital difficulties between the University of Louisville and Norton Healthcare over the custody their child, Norton-Kosair Children’s Hospital. Frankly I did not have much new information and I did not want to fan the flames while the court-ordered mediation of last February played out. I was getting nervous when even a few weeks ago I learned that a mediator had not yet even been appointed.

The latest broadside in this drama comes as Kosair Charities joins the fray in a lawsuit against Norton Healthcare claiming among other things that Norton is using its Kosair name and monies in violation of earlier agreements. To add insult to supposed injury, Kosair Charities claims that despite its financial support, the performance of Kosair Children’s Hospital lags behind that of its peers in the region and elsewhere. (Of course, such a criticism would then also apply to the University of Louisville which provides much of the professional support of the hospital.) Naturally, the claims expressed by one party in a lawsuit represent only one side of the story.

Shifting Alliances? An Invisible Hand?
If it weren’t so painful, I might extend my simile of domestic discord to suggest that a home-wrecker might be involved. Can anyone confirm the whispers in my ear that UofL is seriously courting Kosair Charities this Derby season?  [It was true.]  Of course there is nothing wrong with courting potential donors to the University– UofL does that at its own sporting events all the time.[Your sports and education dollars at work for University lobbying.] I used to help arrange such things. However, at a time when there is an as yet unresolved attempt to seize control of Norton-Kosair Children’s Hospital by the University of Louisville, and with a contractual agreement to shift the University’s pediatric relationship to KentuckyOne Health in the background, the possibility of a change in allegiance of this significant third-party sponsor of the Hospital is destabilizing to say the least. My head spins at the complexity. Our community deserves to understand what is happening. After all, the monies Kosair Charities or Norton Children’s Hospital Foundation collects comes out of our pockets and is raised in support of a trusted community resource. How many families among us have not spent some of the most difficult hours of our lives in the wards and clinics of Norton-Kosair Hospital– and been grateful.

The other side of the coin.
I have seen a media statement from Norton on the matter. It tells a very different story of Kosair Charities’ not meeting its financial obligations while taking credit for supporting the Hospital in its fund-raising:

“Over the last few years, Kosair Charities has engaged in a continuing systematic pattern of raising baseless allegations in an effort to avoid its contractual obligations to the children’s hospital that carries its name. Its allegations are particularly offensive to the many dedicated caregivers serving Kosair Children’s Hospital on a daily basis.”

Is this part of a larger controversy??
I am having a sense of deja vu all over again. After almost a year, we of the community are no closer to knowing the unvarnished facts underlying the University-Norton conflict than we were. My understanding, based on what several sources on both sides have told me, is that the major stumbling blocks in the “discussions” include: that the University wants the multiple existing contracts worth many millions, and which support the salaries of its large pediatric faculty, to continue in perpetuity with relatively little accountability; that UofL wants to close the hospital to all except its own designated medical faculty and staff; and that the University is unwilling to commit to supporting changes in the hospital lease agreement that would make it less ambiguous that it can kick Norton out of its own hospital.

The University has a lot on the table to lose as well. It has one of the largest pediatric faculties in the nation but is unable to provide the salaries to support them without Norton’s help. I am told that the finances of several clinical departments at the Medical School are in bad shape, including Pediatrics. It would be one thing if KentuckyOne and its parent, Catholic Health Initiatives (CHI), were willing and able to step in and fund the whole enterprise, but KentuckyOne has been rocked back on its heels. It is said without refutation that KentuckyOne not been able to give UofL even the funds that were expected.

Is the LCME watching?
In its application in anticipation of its recent LCME accreditation review, UofL touted the financial support of both Norton and KentuckyOne to the extent that the reviewers thought that funding for the teaching programs “was sufficient.” In my opinion, the obvious subsequent uncertainty surrounding that funding and those relationships must have contributed to the Medical School being placed on probation. The stakes are very high and many other people and organizations are watching.

Who else might be interested??
By all accounts and in my opinion, important services that KentuckyOne expected from the University in its merger and partnership deals were women’’s health, pediatric services, and patient-referrals from the University’s clinical faculty. CHI is on the record elsewhere in the nation as wanting to assume more of an insurer’s role in forming comprehensive accountable care networks. It can’t do that in Lousiville (or probably in Kentucky) without control of its own pediatric services. Whether it is a formal party to any of these discussions or not, KentuckyOne and CHI must certainly have an interest in the outcome. [Recall also that UofL bound its clinical faculty to KentuckyOne at the hip by promising to make them work only at KentuckyOne facilities, restricting local academic appointments to KentuckyOne doctors, and requiring KentuckyOne’s permission to make collaborative agreements with other academic institutions.]

Why wreck a success?
I had the privilege of attending an award ceremony for the graduating class of the Medical School this week. (I was there as a supportive faculty member and not a journalist– I raised none of these issues.) I was surprised and impressed at the number of the outstanding students that were choosing careers in pediatrics. They spoke well of their experiences at the hands of the pediatric faculty, at Norton-Kosair Children’s hospital, and in community clinics. Some of the graduates are going on to the very best medical centers in the nation for further training. I was proud. The School should be. Nonetheless, I was disappointed that so few of these award-winning students in pediatrics or other specialties were staying in Louisville for their internships and residencies. Frankly it makes me both angry and sad to see this jewel of a children’s hospital– the only one in the Commonwealth– the focus of what is emerging as an increasingly ugly battle in the ongoing hospital and healthcare wars that will haunt us for years to come. Is this the environment in which we should be training our future healthcare professionals?

I will attempt to obtain the actual legal documents that emerge from this newest engagement and if successful [see below], will make them available and will comment further. As always, if I have made an error of fact or interpretation, please let me know. If you wish to comment or confirm anything publicly, please do so in the comments section below– or if privately,  use my KHPI email address provided in the sidebar.

Peter Hasselbacher, MD
President, KHPI
Emeritus Professor of Medicine, UofL
May 8, 2014

Media Statement by Norton Healthcare. May 8, 2014

Lawsuit filed May 8, 2014 by Kosair Charities against Norton Healthcare. (5 MB PDF)

2 thoughts on “Yet Another Lawsuit over Norton-Kosair Children’s Hospital.”

  1. Geri Rabalais gave the “state of the department address” at Grand Rounds Friday the 13, June:

    The presentation generously assigns blame to outside entities for UoL’s current woes but offered little substance regarding a plan for solutions other than the announcement of a new collaborative effort with Kosair Charities to build new facilities near the UoL hospital. It may be at the point where the only “partnership relationship” UoL’s Pediatric program is willing to foster is one of beneficiary to a charity.

  2. Peter
    You are a voice of reason in the midst of an awful, avoidable situation. Your analyses are right on target, and I thank you. God knows how it will end, but the mission of Norton Healthcare to provide excellent care for the children of our region will always stay the same.
    Bo Nixon, Chair Emeritus, Norton Healthcare

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