Author: P Hasselbacher

New Documents Appearing In Kentucky Same-Sex Marriage Case.

Kentucky’s Appeal of Recognition of Legal Same Sex Marriage Decision.

Humans Merely Breeding Stock?  Say it isn’t so!

National and local media are reporting on the Commonwealth of Kentucky’s appeal of the February decision of District Court Judge John G Heyburn, II requiring the Commonwealth to recognize legal same-sex marriages performed in other states. The commentary available to me so far highlights a Commonwealth position that Kentucky has a legitimate interest in encouraging procreation to support long-term economic stability through stable birth rates. While that may be true of hog-breeding, I find the concept that the licensing of marriage for people of any sex be leashed to economic development to be outrageously offensive. I hope that a full reading of the brief will show that a misunderstanding of the text of the Appeal has occurred. After all, the appeal has our Governor’s name on it.

I have not yet read the brief in detail. The Courier-Journal gives a link to a site where the document can be read on-line, but I found a careful reading from the site to be difficult and it required me to give personal information to download the document. For my benefit and yours, I downloaded the 39 page brief from the Federal Court’s own website, along with the first of what is likely to be many Amicus briefs for or against. When I get an chance, I will comment more fully. Please feel free to do the same in the reply section below.

In the meantime, gay and lesbian healthcare workers in Kentucky are still being discriminated against at University Hospital at the same time we expect such employees not to discriminate against their patients!

[Addendum:  I had a chance to read through the appeal in its entirety.  Alas, a misunderstanding is not possible. The concept of humans as breeding stock is offered as the “legitimate state interest” that allows Kentucky to treat one group of citizens differently than another and therefore not to be in violation of the Equal Protection Clause of the Constitution. There is more, but “natural procreation” is the core of it.  If I can muster the stomach for it, I will outline the arguments later.]

What I fail to grasp, and what is not addressed in Kentucky’s appeal, is how refusing to recognize legal out-of-state marriages is going to increase the number of child worker-bees and improve the economy as argued. When our Kentucky legislators wrote these laws, did they actually believe that if denied the privileges of marriage, that same-sex Kentucky partners would otherwise dutifully engage in “natural procreation” with members of the opposite sex? Many children arise from same-sex marriages. Are we meant to assume that because “unnatural” artificial or surrogate methods are also often used in support of conception by same-sex partners, that their non-adopted children don’t count?  After a lot of blather about state’s rights and judicial activism, the appeal claims that the State’s action is “rationally based and free from invidious discrimination.” We’ve heard that argument before.  I don’t buy it for a moment. We know it for what it is. I am ashamed for Kentucky.

Peter Hasselbacher, MD
President, KHPI
Emeritus Professor of Medicine, UofL
May 9, 2014

Case 14-5291 Document #21: Appeal of Judge Heyburn’s decision.

Case 14-5291 Document #26: Motion to file Amicus Brief from North Carolina Values Coalition and Liberty, Life, and Law Foundation

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. Continue reading “Yet Another Lawsuit over Norton-Kosair Children’s Hospital.”

Is the QCCT Agreement That Supports Indigent Care Still In Force?

Current agreement outdated, parties in arguable default.

Is less or more support for University Hospital necessary?
The indefatigable and prolific reporter Laura Ungar covered last week’s board meeting of the Quality and Charity Care Trust (QCCT ) for the Courier-Journal. Apparently the meeting was largely informational with no formal action taken. It was reported to the QCCT board that the percentage of uninsured patients for the first three months of this year decreased to 13% from 23%. This is good news of course, but University Hospital, like all other hospitals and safety-net providers, remains appropriately concerned about the ultimate effects of the accountable Care Act on overall provider revenues. All of us have our fingers crossed. Time will tell.

The substantial decrease in state funding for the QCCT that emerged from the recent Kentucky legislative session from the current year’s $18 million to $6 and $4 million in the next two years was obviously a subject for discussion. Apparently Louisville Metro is also decreasing substantially its annual local government contribution from the current $7 million, but this the first I have heard of that additional reduction. [Anyone out there who can clarify things for us?]

Funding and implementation of current program obscure at best.
What caught my eye and stimulated this article was a statement that in addition to the specific yearly state legislative appropriation, that the University of Louisville augments the state total from its own “fixed general funds” in the amount of an additional $5 million. As hard as I have been trying to learn about the finances and administration of the QCCT, this latter source of funding was also news to me. I confirmed from a University spokesperson that this additional funding is linked to the controversial and mysterious “rent” that has been paid by University Hospital to the University. This “pass-through” of money from University Hospital to the University of Louisville, to the state, and back to the QCCT for clinical care is part of a long-standing intergovernmental transfer (IGT) mechanism used to pull down matching Medicaid money for the state’s use.

Note that previous declarations of the “rent” paid by the Hospital to the University spoke of $8,876,993.  I am not confident that everyone is talking about the same thing!  When talking about public money, it should’t be this confusing. Continue reading “Is the QCCT Agreement That Supports Indigent Care Still In Force?”

Status of UofL Medical School Probation Story.

Still Gathering Information.

Last month, the University of Louisville School of Medicine was placed on probation by the Liaison Committee on Medical Education (LCME), its accrediting organization. This was an embarrassing piece of bad news for the University, but one which in my opinion flowed inevitably from an overemphasis on the commercial research, real-estate development, and entertainment sports enterprises of the larger University at the expense of its traditional educational and training missions.

One of the several principal factors leading to the adverse decision by the LCME was that the educational facilities of the Medical School are inadequate. This is hard to deny. One look at the Health Sciences Campus (or the Belknap Campus for that matter) shows where the University’s priorities actually lie.   Renovations of the existing medical educational space are now underway.  The recent Kentucky legislative session awarded state funding for a new instructional building on the Belknap campus which was the University’s highest priority.  State funding for a new instructional building for the Health Science Campus was denied. State funding for a medical instructional building was not included in President Ramsey’s short list of UfoL’s general legislative priorities, even though the University already knew the LCME axe was falling. What was requested included a Belknap instruction building, more “Bucks-for-Brains” research funding, and restoration of funding for the QCCT indigent medical care program.   Paradoxically, the University was permitted to allocate its own funds for a new private practice clinical building along with other construction and renovation projects. It submitted plans to build  4 additional research buildings over the subsequent 4 years. To me that says it all! Continue reading “Status of UofL Medical School Probation Story.”