Author: P Hasselbacher

QCCT Fund for Indigent Care Takes a Further Beating in Kentucky Senate.

As reported in these pages earlier, the Governor’s budget (and that of the House) decreased QCCT funding for indigent care at University Hospital by 70% percent over the next two years. The justification for this decrease was that the new healthcare reforms being put into place would result in fewer patients showing up for care at Louisville’s designated poor-people’s hospital. Perhaps there were other reasons too.

QCCT gets zeroed out.
The Senate’s Budget Committee upped the ante by immediately eliminating this subsidy altogether! Senate Republicans justify this further decrease with an amazingly cynical bit of political sophistry. Senate Republicans argue that because every person in Kentucky is now eligible for some form of health insurance, that no patient will be eligible for QCCT funding in any case. Some folks may actually believe this. Of course not even the most ardent defenders of the Accountable Care Act (ACA) claim that everyone will be covered by the complicated system of programs and options that could be cobbled together against intense partisan opposition. Among other reasons, out-of-pocket costs to patients will still present a prohibitive barrier for many. Failure to fund the full “traditional” $21 Million program releases University Hospital from its obligation to provide care to all comers. There will still be plenty of work to go around for all Jefferson County providers to take their share. Continue reading “QCCT Fund for Indigent Care Takes a Further Beating in Kentucky Senate.”

St. Joseph’s London Discontinues Coronary Artery Bypass Surgery.

St. Joseph’s London Hospital has notified the state that it will no longer perform coronary artery bypass graft surgery (CABG), the traditional open-chest cardio-thoracic surgical procedure used to restore blood flow to the heart of people with severe coronary artery atherosclerosis. Before the advent of the the less invasive angioplasty and stenting, CABG was the main surgical approach to re-vascularization of a diseased heart. For certain combinations of coronary artery disease, and in some clinical settings, CABG remains the preferred approach today.

Why fewer invasive procedures?
In Kentucky, the frequency of both angioplasty and CABG have been gradually decreasing, presumably because the effectiveness of aggressive medical therapy is better recognized, and because research showed that the invasive approaches were being used in circumstances where they offered no advantage over non-invasive treatment. Treatment of coronary artery disease is lucrative for hospitals and physicians alike which unfortunately caused some to stretch the envelope beyond what could be justified medically, even to the point of fraud. That bubble is bursting and accounts for a some if not much of the overall decrease in invasive procedures.

Where will patients go?
The new plan in London is to transfer those patients requiring emergency surgery to one of the nearer hospitals capable of treating such a patient, presumably Pikeville, Hazard, Corbin, Asheville, Summerset, or Lexington. (Some of these hospitals perform fewer CABGs than in London!) For non-emergency surgery, patients will be referred to another KentuckyOne hospital– St. Joseph’s Lexington. Angioplasty and stenting will continue to be performed at St. Joseph’s London presumably with safeguards in place to make sure that the most appropriate procedure will be offered for medical reasons and not for convenience. Continue reading “St. Joseph’s London Discontinues Coronary Artery Bypass Surgery.”

Judge Heyburn Grants Further Stay of His Order Pending Resolution in Higher Courts.

Legal same-sex marriages in Kentucky will not be recognized on March 21st after all.

Breaking News, March 19, 5:40 pm

Late today, Federal District Judge John G. Heyburn issued an Order further staying his Order of Feb. 27 which found that Kentucky’s statutes and constitution prohibiting recognition of legal same-sex marriages to be unconstitutional. To allow the Commonwealth to prepare for practical administrative changes, he had already extended his Order until March 20th.

Observing that Judge Heyburn’s opinion “got it right,” Kentucky Attorney General Jack Conway declined to appeal the Judge’s decision. Subsequently, Governor Steve Beshear retained outside council to make such an appeal, and it was that to which Judge Heyburn was responding today.

Judge Heyburn found merit on both sides of the argument. You can read the four-page argument here and decide yourself where the greater merit lies. Ultimately, and recognizing that the Sixth Circuit Court of Appeals may take years before the appeals process is completed, the Judge decided to further stay his opinion. The Judge recognized how his decision would affect the married-couple plaintiffs.

“Perhaps it is difficult for Plaintiffs to understand how rights won can be delayed. It is a truth that our judicial system can act with stunning quickness, as this Court has; and then with sometimes maddening slowness. One judge may decide a case, but ultimately others have a final say. It is the entire process, however, which gives our judicial system and our judges such high credibility and acceptance. This is the way of our Constitution. It is that belief which ultimately informs the Court’s decision to grant a stay. It is best that these momentous changes occur upon full review, rather than risk premature implementation or confusing changes. That does not serve anyone well.”

I have no doubt about the ultimate resolution of this issue. History will render its own judgements upon those who stand either in favor or in opposition to same-sex marriage. I already have.

Peter Hasselbacher
March 19, 2014

Kentucky Files Appeal of Judicial Order to Recognize Legal Same-Sex Marriages

[Addendum- March 19:  The official proceedings of the telephone conference of March 17, 2014 have been published (Document 70)  summarizing two principal orders of business.  The deadline for filing an amicus brief on the intervening matter of whether prohibition of gay marriage in Kentucky itself is unconstitutional was extended until May 2, 2014.  The Family Trust Foundation of Kentucky apparently plans to file such a brief.  Additionally, the motion by the Commonwealth to further stay his opinion concerning recognition of legal (out of state) same-sex marriage was taken under advisement by Judge Heyburn who will issue a separate order.]

What Happened Today (March 17) in Judge John G. Heyburn’s Courtroom?

Gov. Beshear’s attorneys pledge an appeal to Sixth Circuit Appeals Court tomorrow, March 18, if Judge Heyburn does not further stay enforcement of his decision requiring Kentucky to recognize legal same-sex marriages on March 20.

Last Friday, March 14, attorneys for Kentucky Gov. Steve Beshear filed an appeal to Federal District Court Judge John G. Heyburn to stay enforcement of his decision that Kentucky’s statutes and Constitution forbidding the recognition of legal out-of-state same-sex marriages are unconstitutional. If Judge Heyburn does not grant their request, Governor Beshear’s attorneys declared their intention to appeal to the Federal Sixth Circuit Court of Appeals to overturn the Judges decision tomorrow, March 18. The existing temporary stay given to allow the Commonwealth to prepare its compliance expires on March 20. There is not much time left!

Today, attorneys for the married same-sex couples filed their response to the Governor’s request. A telephone hearing was held in Judge Heyburn’s chambers today, but I do not know what was discussed. The session may have been as limited as accepting the Governor’s consent allowing the withdrawal of Attorney General Jack Conway and other attorneys from his office to withdraw from the case. No further hearings are scheduled on the court’s docket as of this evening. Continue reading “Kentucky Files Appeal of Judicial Order to Recognize Legal Same-Sex Marriages”