Board of Health Recommends Oversight for Merged Hospitals

The Louisville Metro Board of Health wants to add a new layer of oversight in the pending hospital merger.The board's decision comes after studying the pending merger between University of Louisville Hospital, Jewish Hospital and Catholic Health Initiatives. The panel was inundated with questions about how reproductive health, end of life care and a number of other issues would be handled with a Catholic partner controlling a majority of the hospitals.The board's final report concludes that the merger could potentially create barriers to healthcare equity and access. At least one procedure—tubal ligations for women—will be moved to another facility outside of the merger. But rather than say whether the merger should or should not happen, the board says the partners should agree to be monitored to ensure they keep their promises to preserve care. (Read the board's full report here.)“There needs to be a mechanism that is thought out in a collaborative way, in a proactive way, that can monitor and provide assurance that any of the commitments made are carried out in the way that they've been spoken and also that there isn't a change to health access in the community," says Board of Health Vice-chair Gabriela Alcalde.Alcalde says the exact means of oversight have yet to be determined. The board has sent its recommendations to the attorney general and governor, who could push to implement any changes. Alcalde says the attorney general's office will have to determine how the oversight will work and if there would be any penalties if the merged entity changes its practices.“Traditionally public health does have some level of enforcement. Certainly we would want there to be some consequence, some power and some impact to this sort of assurance," she says.At a forum last month, the partners announced how reproductive issues other than tubal ligations will be handled:

• Miscarriage management will not change
• Elective abortions are not performed at University Hospital and will not be performed after the merger
• Medically indicated abortions (when the life of mother is threatened or the fetus has a lethal anomaly) will be performed at University Hospital
• Emergency contraception (the morning after pill) will still be offered. “At this point in time it will remain the same,” said Dr. Makhija.
• Family Planning is usually done in outpatient centers and will not change.
• Vasectomies are out of office procedures and will not change
• In vitro fertilization will remain an out of office procedure
• Contraception counseling and prescriptions will be available, but the hospital will no longer fill prescriptions for contraceptives.

State and church approval of the merger are pending.A representative for University Hospital released a statement saying officials respect the board's actions and look forward to working with the state.Merger critic Honi Goldman released the following statement in reaction:

 This turkey of a merger is half baked and needs to be re-evaluated as this will affect Kentucky taxpayers as well as our health care for generations. There are just too many logistical and financial questions along with religious concerns for either the Governor or the Archbishop to sign off on. Let's put this bird back in the over to cook fully.

The Kentucky Alliance Against Racist and Political Oppression released the following statement:    On Tuesday November 1, 2011, the Board of Directors of the Kentucky Alliance Against Racist and Political Repression voted to oppose the merger of University Hospital and Catholic Health Initiatives. University Hospital is a public asset created with public dollars. It is not private in any way and can not be bought and sold on the open market. As a public asset there is no possibility that it can be operated under religious edicts of any kind at any time. There is no circumstance where women’s health issues can be sacrificed at a public hospital created by and owned by the public. There is no circumstance where the health care plans of current employees at University and Jewish Hospital can be reduced in value by eliminating the coverage of birth control and sterilization to satisfy any religious edicts. University Hospital has failed to make a convincing financial argument for merging the hospitals. It is very telling that University Hospital did not argue that the merger would lower the cost of health care for ordinary people. Any time a community says that certain members are expendable in order for the majority to make economic and or social progress, as with this hospital merger, we should investigate those claims. Usually it is people of color or women who are seen as expendable. It is very clear that the people of Louisville and the people of the state of Kentucky need to make sure that there is careful scrutiny of the financial records of University Hospital and that after this scrutiny University Hospital receives the careful guidance it so desperately needs. We encourage all Kentuckians to contact Governor Beshear and demand that he not approve the merger of University Hospital and Catholic Health Initiatives.