The Kansas University Hospital, KU School of Medicine and St. Luke's Hospital mess continues to simmer, and as the matter is debated, more disappointing and unfortunate details seem to emerge - none good for KU. It's like pulling a loose thread and ending up unraveling and damaging what once was an attractive garment.
In the case of the hospital mess, the unraveling is exposing more and more matters that don't reflect well on those pushing the affiliation with St. Luke's. It's an unfortunate situation that could have been avoided if those who dreamed up the plan had stuck with the primary focus of the much ballyhooed "Time To Get It Right" report and been totally open and honest in what they were trying to do. They did just the opposite!
They had hoped to get the deal done before the Kansas Legislature began its session in early January, they didn't discuss the plan with senior state lawmakers and they didn't consult with the Kansas Board of Regents.
Another factor was the arrogance of those at KU, such as Executive Vice Chancellor Barbara Atkinson, Chancellor Robert Hemenway and new Provost Richard Lariviere (who entered the fray in recent months), Kansas City business and philanthropic leaders such as Irv Hockaday and Bill Hall, and some at St. Luke's.
Eventually, some Kansas lawmakers - notably House Speaker Melvin Neufeld and Rep. Jim Morrison - had had enough of KU's arrogance and stonewalling and entered the picture. Neufeld asked the regents to measure up to their responsibilities in this mess, but when the regents were slow to act, both Neufeld and Morrison held hearings to find out what was going on.
St. Luke's people set several deadlines for when an affiliation plan was to be finalized, and all of the dates - early January, early February, then March 31 - have come and gone without any firm, printed agreement. Now, a new date of the end of May has been set.
There have been threats and false reports, the image of the School of Medicine has been damaged and state legislators are increasingly suspicious of what is happening. Several highly prominent KU Hospital and KU medical school staff members have resigned. Hemenway and Atkinson both have lost stature, leadership and political clout, and the regents have been exposed as being weak and having weak leadership. Gov. Kathleen Sebelius' actions are disturbing and puzzling, and several individuals who, in the past, have been extremely helpful to KU have been a big part of the plan to weaken the KU medical school and KU Hospital.
It's an ugly situation that likely will have lasting damage.
Consider the following.
From the outset, those pushing the plan have said the affiliation with St. Luke's was necessary if KU was to have any chance of gaining a Comprehensive Cancer Center or National Cancer Institute designation. However, according to a senior officer of a national consulting firm that works with schools of medicine and hospitals hoping to attain such a designation, those granting the certification "don't give a hoot" about a St. Luke's affiliation. "What they are interested in are teaching affiliates, a network of proven partners in research and discovery, a demonstrated record of research."
He said KU could seek this designation without St. Luke's and use a network of hospitals in Kansas City, Lawrence, Topeka, St. Joseph or elsewhere for clinical cancer trials and research. KU could use St. Luke's to gain patients for research but the status of St. Luke's as a private hospital presents some problems even for that.
He added that seeking an NCI designation was a worthy goal for KU because it would attract biotech companies and KU has the academic and research lead in this part of the country. He said the regents should exercise their authority and not allow anything in favor of St. Luke's that would weaken the KU Medical Center or KU Hospital.
This respected hospital authority said the St. Luke's effort was highly suspicious and that the real goal of those pushing the affiliation is to gain the services of residents trained by KU and the authority to use the KU brand to help their hospital business.
This points out the self-serving and phony arguments of supporters of the St. Luke's affiliation. St. Luke's is not needed for KU's drive to become a cancer center.
Also, this man indicated it's not likely the Dana-Farber Cancer Institute, Washington University or M.D. Anderson hospitals would see any advantage to KU affiliating with St. Luke's, another assertion made by Hockaday, Hall, Atkinson, Hemenway and St. Luke's boss Richard Hastings.
¢Next, do Kansas senators want to vote on the confirmation of three nominees for the Kansas Hospital Authority board who have been nominated in violation of Kansas statute? The statute establishing the board says a hospital nominating committee shall submit a slate of two or three nominees for each opening on the board. The governor then "shall appoint" one member from each slate and forward those appointments to the Kansas Senate for confirmation. It says the governor "shall" appoint someone from the slate, not "can" or "may." Also, no person appointed to the board "shall exercise any power, duty or function as a member of the board" until confirmed by the Senate.
The KU Hospital nominating committee did what it was supposed to do for three board vacancies. The committee sent its nominations to Sebelius and she sent them back to the board with the names of people she would approve.
Whether they were being careless or thought they had no choice but to bend to the governor's wishes, the committee accepted the governor's three preferred nominees: Lariviere, Lt. Gov. Mark Parkinson and Johnson County banker Bob Regnier. All were nominated by the governor in violation of the state statute in an apparent effort to load the board with members she thinks will vote as she wishes.
None of the three has been confirmed by the Senate. Will senators vote to confirm the three individuals who have been nominated in violation of state statute? Or will they demand the law be followed?
¢It is a huge mystery why Hemenway, Atkinson and others are so obsessed about forcing through a one-sided, unnecessary affiliation agreement with St. Luke's This became even more puzzling when it was learned the St. Luke's association is not needed for KU to pursue its goal of receiving a cancer center designation. In fact, St. Luke's brings little to the table, and KU could get all the cancer clinical research results it needs from other area hospitals without agreeing to commitments that would weaken the medical center and/or hospital.
What is driving the effort?
¢Prior to coming to KU, Barbara Atkinson was dean for the MCP Hahnermann School of Medicine at the Allegheny University of the Health Sciences. In fact, she had been with the University of Pennsylvania School of Medicine for 13 years. She came to KU in January 2000.
This is, in no way, to suggest that during her time at Pennsylvania (where she held many distinguished positions) she was part of the mess and unlawful actions at that school and the statewide health system. Nevertheless, she was there during events that were chronicled in a 35-page report in the January/February 2000 issue of "Health Affairs":
"On July 1998, the nonprofit Allegheny Health, Education and Research Foundation (AHERF) and several of its affiliate operations in Philadelphia filed for bankruptcy. AHERF's filing papers revealed a $1.3 billion debt and 65,000 creditors. This qualified AHERF as the nation's largest nonprofit health care bankruptcy and second largest overall. In addition to the enormous debt, the bankruptcy signaled the end of the largest statewide integrated delivery system in Pennsylvania, the largest medical school in the country, and the strategy of aggressive acquisition of physicians, researchers and hospitals in the Philadelphia area."
It is an exhaustive report detailing everything that went wrong and the lack of oversight, supervision and illegal actions. What did Atkinson learn from this experience and could it, in any way, play a role in her ambitions in Kansas City with the KU medical school? There are some surprising similarities.
A new deadline to work out an alliance with St. Luke's has been set for the end of May. By now, the threats of St. Luke's proponents have been proven to be shallow and false. KU does not need St. Luke's in order to seek a Comprehensive Cancer Center or National Cancer Institute designation. Although Hockaday reportedly told a Kansas City audience otherwise, a failure to affiliate with St. Luke's would not weaken the accreditation standing for either KU Medical Center or KU Hospital.
There still are many matters to be resolved at the medical school and hospital before there is any chance of these parties agreeing to any plan with St. Luke's. Also, there's the matter of the Kansas Legislature's demand that any agreement must be approved by the KU Hospital board and the Board of Regents. This is terribly important. The hospital board will not be a pushover for the governor, but who knows what the weak Board of Regents will do? The governor may veto this proviso, but lawmakers must have the resolve and courage to override the veto.
Should there be an independent audit of the medical center to establish its true fiscal position before any negotiations, giveaways, infusions of new dollars or expenditures are even considered? Did dollars play any role in the initial secret planning? What is the fiscal health of the medical school? We know the hospital enjoys an exceptional fiscal record. How about the medical school?
To the charge that the Legislature should not be meddling in hospital affairs or that it is impeding the agreement, Kansas lawmakers are quick to say they would not be involved if the weak Board of Regents had carried out its responsibilities.