Surely the end-game of the years-long efforts of Catholic Health Initiatives and KentuckyOne Health to sell some or all of their hospitals in Louisville must be coming to a climax. Transferring management of University of Louisville Hospital to KentuckyOne– a move that turned out badly for both institutions– was always as much or more about saving Jewish than ULH. Many outside entities came to kick the tires of what KentuckyOne wanted to sell but walked off the lot. The last acknowledged potential buyer whose keys KentuckyOne was holding was the tag-team of the private equity firm Blue Mountain and its spinoff for-profit hospital management company, Integrity Healthcare– now majority-owned by for-profit Nantworks Companies and Nantworks owner Dr. Patrick Soon-Shiong. Sound complicated? It is! Casting a very dark curtain over this potential transaction in Louisville is last week’s announcement that Blue Mountain & Co.’s first and only attempt to take over a failing non-profit Catholic hospital chain in California has failed– the hospital system has filed for bankruptcy. These six Verity Hospitals (formerly the Daughters of Charity) might be bought by their communities, taken over by others, liquidated for their assets, or otherwise close. I cannot avoid concluding that the same result would occur in Louisville and for much the same reasons.
CHI has played this one very close to its corporate chest. Fanned by anxiety about the future, rumors have been flying in increasingly disparate and desperate directions ranging from “Blue Mountain” has taken a second look and will sign on soon; or Blue Mountain has walked away for good; or that Nantworks and Dr. Soon-Shiong will move forward with the deal without Blue Mountain; or that CHI will give Jewish to the University for a song; and even that one or both of the sister Jewish & Sts. Mary Hospitals will soon shut its doors. None of the potential players is in a strong place right now as I will outline below. The one thing I am sure of is that the ground under the downtown hospital complex is going to quake hard, and that secondary seismic activity will be felt out in the county and beyond. The Louisville Community is going to have to make some public health decisions that are both difficult and expensive. Continue reading “Can Jewish Hospital in Louisville be Saved? Perhaps Not.”
Much will be written following the death of Sen. John S. McCain, the vast bulk of it of with sincere admiration for his personal courage and service to his country. I am among those admirers. His life was undeniably colorful– he was very much human. Equally undeniable was the magnitude of his service to his nation. He knew where his duty lay, and he gave palpably more than any critic to honor that obligation. He knew the difference between patriotism and nationalism or partisanism. Compared to his legislative peers, it is fair to say that few or none have displayed greater loyalty to the common good of our nation as opposed to any political party. In any world– but certainly in today’s political climate– he was a lion among sheep.
What Are CRS Reports?
I interacted with his Senate office one time in 1998 during my Congressional Fellowship and service to the Senate Finance Committee. Senator McCain filed a typically bi-partisan bill that would make most of the reports and issue-briefs prepared by the Congressional Research Service (CRS) available to the public. At the time, I had never heard of these. CRS reports are among those prepared by the Library of Congress, often in response to requests by federal legislators for background information about current or potential legislation. I had hundreds of these available to me at my networked desk in a Senate office building. The resources of the Library are stunning. The academician in me recognized these reports and issue briefs as extraordinarily useful. They are well researched, and clearly written in language that can be understood by non-technical people. Best of all, these reports are as balanced and nonpartisan as anything can possibly be on Capitol Hill. (The worst service a legislative aid can give their member is not to include all sides of an argument in their briefing.) I downloaded and read as many reports related to healthcare matters as I could find, constantly regretting that I had not had them available earlier as I began a second career in health policy research. Continue reading “Honoring Sen. John McCain’s Service by Making CRS Reports Used by Lawmakers Available to the Public”
Dr. Anis G. Chalhoub, formerly a cardiologist at KentuckyOne Health’s St. Joseph London Hospital, was indicted in Federal Court in June, 2016 for allegedly performing unnecessary cardiac procedures. A jury trial concluded last Wednesday with a finding of guilty on all 12 counts. (United States District Court, Eastern District of Kentucky, London. Criminal Case No. 16-cr-23). I do not yet have many court documents, but one of the counts must have been related to the civil lawsuit in Laurel County against St. Joseph and Catholic Health Initiatives which awarded a record $21.2 million to a Corbin man for unneeded surgical heart procedures at the London Hospital. (That case is still being appealed.) Dr. Chalhoub currently holds a valid medical license in Kentucky and practices in Louisville and Southern Indiana.
It was a dark and stormy afternoon last Saturday when as many as a thousand or more Louisville students, their families, and supporters marched a cold wet mile up Main Street to Louisville Metro Hall where a spirited rally was held. One could only be impressed with the student’s passion and justifiable anger. (I was taken back 50 years to the protests of my generation against the Viet Nam War.) The students had a right to be angry. In addition to the apparently unstoppable drumbeat of shootings here and elsewhere, the day before the march a student brought a loaded gun into Louisville’s Valley High School, and a credible threat announcement was made against Manual High. This is not somebody else’s problem. We own it too!
Similar protests took place all around the country. In Washington, DC, the turnout was impressive, and may have been the highest for a one-day protest ever. Despite the passion and powerful rational rhetoric of the students, pundits are generally pessimistic that little more than cosmetic changes will result in the near future– if not the foreseeable one. I suspect however, that weaknesses in the defenses of the NRA/Industrial complex and their legislative partners are forming. Some in the Republican party and other NRA enablers of any party must be at least a little nervous. The students know that they will soon be able to vote, and I suspect they will not have forgotten the promises they are making today. If you were one of their parents, why would you not support them?
I believe if this generation of students can keep it up, that change is possible. It is already starting to happen! The spending bill signed by President Trump a few days ago reversed the previously unexplainable prohibition of federally sponsored research into gun violence. Now that such violence is a formally recognized issue of public health, I have a legitimate justification to write about it in these pages!
North Oldham High School’s Zoe Kuhn was the principal student speaker at the Metro Hall rally. She delivered a powerful, articulate address in which she expressed her recurring fear, and that of her peers, that the prospect that gun violence might occur at any time in her school. There was, however, no trace of fear or lack of courage in her delivery! I was immensely impressed and proud of her. Her admission of fear did not ring as contrived to me, but her vulnerability did not inhibit the handful of pro-gun individuals in the crowd from attempting to shout her down in a derogatory manner. Their camo-uniformed presence was the sole face of resistance to rational gun policy visible that day. I suggest to other opponents of rational gun control that they not allow these counter-protestors to speak for them on this matter. Your silence can suggest that you are happy for them to do your work for you. [I am not aware that any Republican official spoke that day, but I had to leave before the end of the rally because I was shaking too hard from hypothermia! My endurance and commitment paled before that of the students.]
I confess to feeling a twinge of sadness from one statement in Ms. Kuhn’s speech when she told opponents of reform that it was not a goal of the students “to take your guns away.” She is not alone in accepting this narrowing of possible outcomes before the debate has truly begun. A principal goal of a think tank, lobby, or advocacy group is to establish what issues are on the table and to define the vocabulary of any political debate. To be able to do so is to win. This has been a great success of the NRA. Taking the possibility of decreasing the number of guns in our country off the table is premature, indeed an abdication.
In my opinion, and as is becoming even more clear to me as I pay attention to the daily reports of gun violence, that the suggested reforms already on the table will not have a significant impact. Of course the mentally ill should not be able to buy guns, but neither should they be able to own the guns they may already have. Indeed, how do we decide if someone is mentally ill? I lived in mental hospitals for 13 years and assert from experience that there is no bright line between normal and mentally ill. There are not enough mental health workers in the world to do all the checking necessary– even if we had accepted criteria to turn someone down. There are not enough FBI agents or similar investigators in the country to do all the background checks necessary expose past criminality or violence, let alone a reliable, accessible registry for them to use. An individual defined as sane or reliable at the time of purchase may not remain so in the future. Having teachers carry guns makes no more sense than having flight attendants do so. Shooting galleries in planes or schools make for collateral damage. Even if schools become armed citadels, airport-grade security procedures will still be necessary. If visitors with guns are not permitted in the Senate or House chambers, why should concealed or any other carry be permitted in a public place anywhere? [What is good for the goose…?] How long a waiting period is necessary before buying a gun legally? Is there a shred of evidence that any waiting period will make a dent in gun violence? There are just too many guns lying around for the mentally ill, the criminal, or the angry to pick up and use. I remain to be convinced that anything other than decreasing the number of handguns and weapons of war in private hands will diminish gun violence in any meaningful way.
I walked away from Saturday’s rally feeling that a glimmer of hope had been lit. However, my uptick in enthusiasm was dashed when upon turning the corner at 4th Street on my way back to my car, the visible glimmer on the ground turned out to be a spent 45-caliber bullet cartridge lying in the street. Thus the pendulum lurches back and forth. Change will be neither easy or quick, but the experience of other countries tells us we can do better. We need to start somewhere and its painful to imagine things could get worse.
