September 21, 2011

Merge with caution

It’s difficult to imagine how the proposed mega-merger that would place University Hospital and others under the control of Catholic Health Initiatives can come to fruition without some concessions from the Catholic Church.

Despite an aggressive spin cycle led by University of Louisville President James Ramsey and his public relations apparatus, concerns are escalating.

Ramsey and his merger partners — Jewish Hospital & St. Mary’s HealthCare and the St. Joseph Health System — make compelling cases for the marriage to advance.

But the insistence of Archbishop Joseph Kurtz that the hospitals adhere to ethical rules and directives of the Catholic Church is a major obstacle.

At risk pending Catholic Health Initiatives’ first acquisition of a public hospital, according to progressive dissenters, is nothing less than the separation of church and state as well as the reproductive freedom and health of indigent women, future medical procedures and end-of-life decisions.

Proponents would be wise to heed their voices — which seem to be proliferating — and address their grievances.

An hour-long panel discussion organized by the Metro Louisville Women’s Political Caucus last Thursday laid bare some yet-to-be-reconciled differences. A contract with Baptist Hospital East to perform tubal ligations was the hot-button issue.

“Baptist Hospital East, while it’s a very good hospital, it does not have a Level III neonatal intensive care unit,” said Beverly Glascock, a medical attorney. “And those are for the really severely sick babies, premature babies as well as babies who are born with all kinds of congenital defects.”

With “indigent patients who come to the table with a lot more health problems,” she said, “I think you’re under-serving that population and putting their babies at risk.”

“University Hospital has traditionally and always been the safety net for Louisville indigent care,” said Derek Selznick of Kentucky’s ACLU. “Taking away a service, which they said was a very small compromise ... and putting it onto another organization we see as very, very problematic.”

Selznick referenced a scandal at a Catholic-affiliated Arizona hospital where a woman who needed an emergency abortion waited while her case crept through an ethics process. “And we think at University Hospital, that doctor should be able to make that independent judgment call,” he said.

State Sen. Kathy Stein, D-13, chimed in, “Isn’t it always strange that a ‘small compromise’ involves the majority of women’s lives?”

A packed house at the Sam Swope Center on the Masonic Homes campus erupted in applause.

Metro Public Health Director LaQuandra Nesbitt paraphrased an open letter from U of L: “Emergency contraception will continue to be provided in the clinics. That tells me that they’re gonna provide them at the Center for Women and Families but probably not at the hospital.”

She added the policy needs “not to be clarified with more fake statements but to put this stuff in writing!”

Asked by moderator Ryan Alessi to enumerate the chief concerns of the public health department, Nesbitt replied, “What expansion of services is likely to occur as a result of this merger? Our first question, however, is what happens if there is no merger? What happens if there is no safety-net facility at all for people to go to? Is that actually a reality if there is no merger?”

Alessi asked state Sen. Stein whether she was reassured by St. Joseph Health System’s reported claim that no “living will had been superseded by any doctors” there.

She replied: “These business people with medical backgrounds, with legal backgrounds, can say what they believe will happen as much as they want, but we still have to hear from the bishops themselves — and how they interpret the directives that have been published.”

The ACLU’s Selznick said he was vexed. “They said that, ‘In virtually no instances have there been problems with this,’ and I have a real problem with the word ‘virtually’ because it implies that there is occasionally” a problem.

He also was troubled by the possibility that the ethical directives could change, thus reducing services — and that an “unwind clause” in the event the merged entity is dissolved could cost taxpayers mightily.

Critics generally agree the devil is in the details, and they want specific medical contingencies guaranteed in writing. Some hope a compromise can be struck, even if faith and health policy don’t readily mix. Otherwise, the potential for a lawsuit looms large.