Dispute could mean trouble for UofL trauma center

By Lori Lyle - bio | email
Posted By Mike Dever - email

LOUISVILLE, KY (WAVE) - Trauma care in Louisville is facing grave danger, and that could soon put lives in grave danger too. University Hospital's level one trauma center will be forced to close its doors if UofL is unable to quickly recruit neurosurgeons to replace others no longer employed by the school.

It's a soon to be life-risking contract dispute between the University of Louisville and the Neurosurgical Institute of Kentucky. The 8-member group made up the entire neurosurgical faculty at UofL. The surgeons say they were fired - but UofL says they quit March 1st, when the group announced a contract signed with Norton HealthCare, making it the group's primary employer.

No matter the terminology, the risk is clear, and UofL's Chairman of the Department of Surgery, Dr. Kelly McMasters says without faculty neurosurgeons to staff the trauma center at University Hospital, "we will not be able to maintain our level one trauma center verification and if that happens, patients will die."

Dr. McMasters, like many faculty members, is routinely on-call for trauma at University Hospital.

"We provided care for over 2,400 trauma patients from around the region last year," McMasters said.  There are only two (level one trauma centers) in the state of Kentucky. It would be criminal for us to discontinue providing care for the most traumatic, life-threatening injuries sustained.

"The center saves the lives of patients across the region everyday. And everyday on rounds in the ICU, McMasters says he "sees patients who would have died had they gone somewhere else."

That's the real possibility trauma patients now face.

There is disagreement on how the situation got to this point. "We were basically fired from the University as of March 1st," explains Dr. Christopher Shields, former Chairman of UofL's neurosurgery department.

Dr. Shields is one of the eight neurosurgeons with Neurosurgical Institute of Kentucky providing the neurosurgical trauma care at University Hospital. It's the responsibility of UofL's full-time neurosurgeons and one he's spent 35 years fulfilling.

In addition to trauma patients, Dr. Shields' team of neurosurgeons and residents also staff the neurosurgical clinic at University Hospital, offering help to patients who are uninsured or under-insured and can't afford the care elsewhere.

Donna Horton is one of those patients. A car accident in January left her taking five doses of pain medication a day. She was already suffering with degenerative disc disease and had steel rods in her back from a previous surgery when the car slammed her from behind. She can't work or get insurance. "I was turned down by both Blue Cross and Humana."

Donna says she'd already been examined at the neurosurgery clinic, and surgery had been planned for a week later - but that was six weeks ago.

And Donna says her pain is getting worse. "It's become almost unbearable. Some days I think if I start crying I don't know if I'm gonna be able to quit."

The surgery is likely Donna's only hope for relief, but until the situation is resolved McMasters doesn't know what Donna and others will do. "Patients that don't have the means to go elsewhere, I don't know where they go now."

Dr. Shields says he never expected any of this to happen, that "it just seems an inappropriate and unanticipated action on part of the University."

He says his group teamed up with Norton to advance neurosurgical care in Louisville by creating the Norton Neuroscience Center. Over the next 10 years, Norton will invest $100 million for training, research and care. The possibilities the center holds have already enticed five neurosurgical recruits to Louisville, something that hasn't been accomplished in years.

In fact, the number of neurosurgeons in Louisville has decreased from 21 to 13 in the past 10 years.

At a news conference on March 19, UofL's Dean of the Medical School, Edward Halperin, spelled out the problem with the plan Norton offered. He says it's just not possible to be full-time faculty and have a primary employer other than the school.

"A full time faculty member will see patients at multiple hospitals and bill for patient care through the faculty practice plan," Halperin said.

Last year the school adopted a single-point contracting plan for billing, something the majority of Medical Schools use across the country. It should help the school negotiate higher managed care reimbursement dollars. Under the contract with Norton, the neurosurgical group would bill through Norton, not UofL.

Dr. Shields says while managed care reimbursements are higher through Norton than the University. "We feel we've given the University of Louisville this wonderful gift at no cost to the University at all."

In fact, Shields says with their plans to recruit and expand the neurosurgical faculty,  they would triple the so called Dean's tax, which is money the school receives from patient care profits.

Dean Halperin disagrees, saying the plan he saw was a contract that could greatly limit the group's role. Despite Dr. Shields' insistence that the group only wanted to increase its involvement with the school and continue its responsibility at the University Hospital, Dean Halperin says the Norton contract required written consent from Norton for any of the doctors to practice in other hospitals.

Halperin says "no medical schools are organized where faculty are employed by somebody other than the medical school, where somebody else decides where the faculty practices, and where someone else says 'oh by the way, you can't do your billings and collections and basic operations through the University, we'll do it someplace else.'"

But again, Dr. Shields disagrees. "The plan that we have with Norton Healthcare will allow us to work at all hospitals, there's been no restrictions on the part of Norton Healthcare to limit our practice. That has been clearly stated to the medical school repeatedly, that there is no attempt to limit the practice of our group to any hospital in the community. We have put that in writing and made that very clear to the University."

However, McMasters feels "the proper way to have negotiated that would have been sit down and negotiate it up front, rather than sign a contract and present it after the fact to the University."

Meanwhile, the clock is ticking for the crucial healthcare provided in University Hospital's trauma center.

With just over 100 new neurosurgeons graduating each year, recruitment isn't easy. Shields' group has offered to continue their roles with University Hospital through May 12.

Meanwhile, UofL has formed a search committee, but says it could take several months to find replacements - and both sides are still talking.

McMasters says "it's still my hope we can resolve this issue, but it's going to take some compromise on both sides, and it's going to take some pressure from the public. We can't use the public's safety as a bargaining chip in these negotiations between Norton and University Hospital, just can't be done."

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