End-of-Life Choice, Palliative Care and Counseling

Posts TaggedLouisville

Hospital mergers and protecting patient rights

In Louisville, Kentucky, Compassion & Choices is working to stop a proposed hospital merger from diluting patient rights. Under the proposed merger, the three hospitals would follow Catholic health care directives, including those that affect end-of-life care.

As government affairs director for Compassion & Choices, I want to give an update on our efforts in Louisville. I have been working with our partners MergerWatch and the National Women’s Law Center and many others in the Louisville area. We can’t let the imperatives of Catholic doctrine override patients’ end-of-life wishes. As reported this summer in the Louisville Courier-Journal:

Under the merger proposal, University Hospital will join Jewish Hospital & St. Mary’s HealthCare and St. Joseph Health System, whose parent company is Denver-based Catholic Health Initiatives. CHI will own 70 percent of the combined operations, assuming regulators approve.

When the merger was announced last month, officials said all the merged hospitals will follow Catholic health care directives. And while many wealthier patients could simply choose a different hospital, indigent patients have little choice but University Hospital for treatment, including end-of-life care.

“I don’t like what I’m hearing with this merger; patients have rights till the day they die,” said Lorri Keeney, whose 88-year-old mother died of natural causes in a nursing home under hospice care through Hosparus in May 2010 after numerous hospital visits. “I would’ve taken my mother out of the hospital if they had told me I had to abide by their doctrine.”

Keeney’s mother, Eleanor Caram, was Jewish and had a living will. But Catholic medical directives, which merger partners have agreed to abide by, say living wills won’t be honored if they go against Catholic moral teachings, which are open to interpretation.

If the merger goes forward, will the hospitals honor the carefully considered decisions people express in advance directives? We brought that question to the attention of the Louisville Metro Board of Health, Attorney General Jack Conway, Governor Steven Beshear, Secretary of Finance Lori Flanery, Louisville Mayor Greg Fisher and Kentucky lawmakers, Reps. Tom Burch and Mary Lou Marzian.

The Louisville public and others also raised questions. The American Civil Liberties Union and the Louisville-Courier asked Attorney General Conway to confirm that University Hospital is a public entity, and so must release its records related to the merger.

Conway, who is up for re-election, heard the message loud and clear. In a September 28th interview with the Courier-Journal editorial board he spent about 10 minutes of time on the proposed merger. Watch his response, beginning at around 5:00 minutes into this video.

On October 6, the attorney general issued an open records decision (ORD): University Hospital is a public institution and, therefore, accountable to the public’s interest.

Conway said University Medical Center Inc., which runs the hospital, “was established and created and is controlled by the University of Louisville.”

The decision does not directly address the merger but, as Conway suggested in the interview, it raises the likelihood patients’ rights advocates will challenge the merger, based on constitutional grounds related to the establishment clause.

The ruling could affect the merger because of the religious implications. Saint Joseph is owned by Catholic Health Initiatives, which follows Catholic directives that prohibit abortion, sterilization and euthanasia.

On October 19th, community members packed Louisville’s Memorial Auditorium at a forum sponsored by the board of health.

Partners in the controversial merger of three Kentucky hospital systems fielded dozens of questions about reproductive and end-of-life care, health insurance for employees and other issues at a community forum Wednesday that drew hundreds of people.

The following day in an editorial, the Courier-Journal distilled the concern we share with the public and other patients’ rights advocates:

The issue is whether a public hospital, operated by a public university and charged with care of the indigent population of this region (funded by tens of millions of public dollars) should have legal medical policies restricted by the rules of any religious group.

The Governor still must weigh in on the approval of this merger along with the Secretary of Finance and they have offered nothing to suggest a timetable. Compassion & Choices and its partners will continue to urge all parties to fully review the proposed merger and approve it only if the parties involved will preserve continued access to vital healthcare services, including care at the end of life.