Critics Release Questions Ahead of Hospital Merger Forum

The Louisville Metro Board of Health's public forum with the partners of a pending hospital merger is Wednesday, and the panelists already have plenty of questions to answer.The merger between University of Louisville Hospital, Jewish Hospital and Catholic Health Initiatives has raised a number of questions since it was announced. The merged entity will follow Catholic care directives, and most of the questions about the deal have concerned reproductive health, end-of-life care and healthcare access.The Board of Health is planning to release a statement on the merger, but has first invited the partners to take questions from the public. The board also sent its own questionnaire to the partners and released the answers last week.A group that's been critical of the merger says the questions don't go deep enough. They've released a statement that asks about the merger's management structure and poses specific care scenarios (see below for the questions). Group members are planning to attend the forum as well.The forum is Wednesday from 5:45 to 8:00 pm at Memorial Auditorium, 970 S. 4th St. Attendees can ask questions at the event, or submit them in advance.You can read the answers to the Board of Health's questions here.General

Why is this a one time only forum, and not part of a Mayor's Night Out, or other forums going into different neighborhoods? Merger Agreement

1. What is the structure of the merger between CHI, UMC and Jewish-St. Mary’s?  Is CHI purchasing U of L Hospital as part of the merger deal, or is University Medical Center, Inc. (“UMC”) assigning its interest in its lease with the Commonwealth to operate U of L Hospital?  What is the price that CHI has agreed to pay for purchasing the Hospital (or assuming the lease)?  Is the amount CHI is paying for the purchase or lease of U of L Hospital separate from the $320 million that CHI has stated it will be investing in the university academic medical center and in community and state-wide programs?
2. How will the $200 million that CHI says it will invest in the university academic medical center be used?  Why was/is the university medical faculty already being asked to compile their own wish lists of how to spend the money?
3. What is the purchase price and where is the money coming from?  CHI reserves, a loan, and/or a bond?
4. When will you produce the documents (including powerpoints, etc.) that CHI is providing to investment banks and other financing sources to obtain financing of this merger?

  Financial and Legal issues

1. This merger is reported to be the first public teaching hospital acquired by Catholic Health Initiatives (CHI) in the country.  In the merger agreement/stipulations, how much money (dollars or percentage) will be paid yearly to CHI for administrative fees and/or franchise fees.
2. Where is the money coming from?  CHI reserves, investment banker or broker, a private equity firm, and/or a loan or bond.  If a loan, what are the terms of the loan and who is responsible for the loan.
3. Because UofL is a public entity per the recent Attorney General's ruling, in this situation do the procurement procedures apply, i.e. requiring RFPs (request for proposals) and bids?  When will the Hospital also release its financial data showing that it is not financially viable?

Medical and Clinical Issues

1. How is it possible to reconcile the ERDs with the AMA Code of Medical Ethics Opinion 9.11 for Ethics Committees, Opinion 10.02 for Patient Responsibilities and Rights, Opinion 8.08 for Informed Consent, Opinion 10.015 for Patient-Physician Relationship, Principles of Medical Ethics Preamble, Opinion 8.021 for Ethical Obligations of Medical Directors?

  Employee Issues

1. Will all employees, and the medical staff that are not employees, be given a form to read and sign informing them that their continued employment is contingent upon their agreeing to abide by the ERDs?  If so, when and under what circumstances?  SEE: ERDs #5, #8, #9 for example.  Will an employee actually have to sign something or pledge in some way to "respect and uphold" the Catholic doctrine as stated in the ERDs?  If not, what is the standard by which an employee will be judged on respecting and upholding the Catholic doctrine?
2. What impact will the merger have on health insurance for Hospital employees, particularly employee health insurance benefits for contraception and sterilizations? What impact will the merger have on employee health insurance and other benefits for its employees who are in same sex marriages/domestic relationships?

  Patient Issues

1. Will the Brown Cancer Center be allowed to provide any stem cell based treatments?  If embryonic stem cell treatment is determined to provide the best treatment for a patient, how will you provide this treatment?
2. If a living will mandates no feeding tube or respirator, how will the patient's wishes be honored and be consistent with the ERDs?

 Reproductive and Women's Health Issues

1. How will rape victims who are taken to ULH Emergency Room because of their injuries, be given emergency contraceptives within the prescribed window and without further traumatizing the patient.  Mr. Laird and Dr. Temes, in an Open Letter to the Jewish Community, stated that emergency contraception can be provided “consistent with ERDs”.  Even though the ERDs state that a rape victim should be able to defend against a pregnancy as a result of rape, many Catholic hospitals still do not dispense emergency contraception pills to rape victims and some Catholic hospitals only dispense emergency contraception pills once medical tests have shown that the victim is not ovulating.  How will you guarantee the Louisville community that, after the merger, emergency contraception pills will continue to be prescribed and dispensed to rape victims at the University of Louisville Hospital and Jewish Hospital?  Can you also guaranteed that the Hospitals will not use an ovulation test before determining whether to prescribe emergency contraception, and that these rape victims will not be referred to another hospital or clinic for emergency contraception services?
2. If the ERDs prevent using, dispensing and prescribing contraceptives, how will those patients be treated who are in the hospital and need a refilled of their birth control pills prescriptions?
3. How is sending women to Baptist Hospital East consistent with HIPPA, and federal and state patient privacy laws, as everyone will know what procedures these women were have just by virtue of being diverted from University to Baptist?
4. UL hospital has a Level III neonatal intensive care nursery and a team of maternal-fetal med specialists for high-risk pregnancies, which Baptist Hospital East (BHE) does not have.  How will these high-risk patients be cared for?  Will UofL School of Medicine going to have an OB team readily available for delivery and tubal ligations, even on an emergency basis at BHE?  What happens when the pregnant UofL hospital patient goes into labor and the OB team assigned to her is tied up delivering at UofL.
5. In an Open Letter to the Jewish Community, Mr. Laird, Dr. Temes and Mr. Waterman, stated that after the merger, ectopic pregnancies can be treated “consistent with the ERDs.”  Directive 45 defines a “direct abortion” as any “procedure whose sole immediate effect is the termination of pregnancy before viability….”  Directive 48 states: “In case of extrauterine pregnancy, no intervention is morally licit which constitutes a direct abortion.”  Given that the standards treatment for an ectopic pregnancy is a direct abortion, which is inconsistent with the ERDs, how will an ectopic pregnancy be treated at the UL Hospital or Jewish Hospital after the merger?  If the answer is that the hospital will be able to perform an abortion in these circumstances, how is that position reconciled with Directives 45 and 48 of the ERDs?  Will the merger agreement guarantee that emergency procedures to save life of the mother includes pregnancy termination?