UIHC: 'Sick Brother, Can You Spare a Dime?'

October 31, 2009; November 20, 2009

Updates:

November 20: UI VP Medical Jean Robillard says patient-donation-dunning plan "canceled a week ago"; spokesperson "clarifies," says "canceled" means "under review," B.A. Morelli, "Leaders Address Employee Concerns; UI Officials: No Decision on Job Issues," Iowa City Press-Citizen, November 20, 2009, p. A3; Ashley Oerman, "UI Cancels Asking Patients for Money," The Daily Iowan, November 20, 2009, p. A1; UI's Funded Retirement Insurance Committee asks President Mason to "abolish rather than just delay" UIHC's "patient donation plan," B.A. Morelli, "Group Wants UIHC Patient Donation Plan Nixed," Iowa City Press-Citizen, November 19, 2009, p. A1;

November 4. This morning's media reports the UIHC's announcement that it will at least not immediately implement its unethical (in the judgment of a medical ethicist, quoted below) plan to ask incoming patients for cash contributions before receiving treatment. Cindy Hadish, "Patient donor plan put off at UI; Outpatients would be asked about giving," The Gazette, November 4, 2009, p. A3; Editorial, "Admission Isn't Time to Hit Up Patients for $$," Iowa City Press-Citizen, November 4, 2009; B.A. Morelli, "UIHC puts off plan to ask for donations," Iowa City Press-Citizen, November 4, 2009.

Rather than killing off this idea as soon as it became buried under an avalanche of outrage, hostility and ridicule -- in my opinion, what would have been its wisest public relations strategy -- the UIHC spokespersons chose (or were instructed) to defend it as perfectly legitimate.

Unfortunately, in doing so, they chose to misrepresent (either unintentionally or deliberately) the practices of other hospitals. Not that other hospitals' practices would have justified UIHC's (a variation of the child's plea, "But Billy's mother lets him play with matches").

Do hospitals receive gifts from grateful patients? Of course. That's never been in issue. But there is a continuum in the medical ethics of how they go about it -- a continuum that finds the UIHC at the bottom of the cliff on the wrong end.

(1) The medical ethicist, quoted below, and I, believe the most ethical -- and possibly most effective and remunerative -- approach is to make community wide appeals through the media and mailings to all citizens. This could include mailings to all UI alumni, or all donors to the UI Foundation. Particularly in the Iowa City metropolitan area an enormous proportion of the population would be, in fact, present or former patients of the hospital. Those who wished to do so, and they are a significant number, will respond to such appeals. But no one is singled out as a patient.

(2) Somewhat worse is accompanying this with telemarketing. Yesterday a faculty member became increasingly agitated while relating to me the harassment of repeated phone calls during weekends and evenings, ending with the exclamation to the unrelenting pitch man that this once-very-generous UI contributor would never again give money to the University.

(3) Worse still, in my judgment (and that of the ethicist), are personal appeals to present and former patients as patients with mailings or phone calls. The delivery of health care by the UIHC is ethically distinct from the delivery of football tickets by the Athletic Department -- which also not only requests, but demands, "contributions" as a condition of granting permission to a fan to buy tickets -- not to mention getting a seat that will optimize the experience.

(4) More questionable, obviously, are person-to-person appeals to patients at any time, as they become even more coercive than a personal mailing.

(5) Personal appeals in the hospital, by hospital personnel are worst of all, for all the reasons discussed throughout this blog entry. Because patients cannot know when they may need to return to the hospital in the future for one reason or another -- and in some instances are involved in a known series of treatments requiring return visits over a period of weeks or months -- personal appeals for funds when they are leaving the hospital are only marginally, if that, any better ethically than personal appeals at check-in.

(6) Clearly what the UIHC chose to do -- requiring/requesting the patient to make information about his or her clinic visit available to the UI Foundation for purposes of future solicitations -- at the time of check-in is the worst of all possible unethical options.

What's additionally very troubling, as I noted this morning in a comment on the Press-Citizen's online version of its editorial and story, is the repeated insistence that other hospitals are doing what the UIHC was proposing to do. ("To tell reporters (as they did) that others do this, when they don't, is either sloppy investigation of details, insensitivity to ethical nuance, or (hopefully not) deliberate disingenuousness.") As The Gazette's Cindy Hadish has repeatedly reported, below, "Moore said the idea was based on programs at other hospitals. Three of those he cited, however — the University of Michigan, University of Pennsylvania and Mayo Clinic — said they had no such system in place."

To equate a community-wide appeal, or a literature mailing, or a discovery that a high percentage of a hospital's donors have been, in fact, former patients, to equate that with a one-on-one discussion with a new clinic patient upon arrival, and cite it as justification for doing so, is shocking.

Nor has the UIHC yet offered an apology, or a mea culpa for this ethical embarrassment -- let alone stopped the idea cold. It's only willing to delay it a bit, to "listen" to the avalanche of concerns, to try to tweak it (presumably with the aid of public relations advisers) to make it acceptable to those with ethical sensitivity.

This sad, sad story is far from over.
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Update: November 4, 2009, 6:15 a.m.; Nov. 3, Nov. 2, Nov. 1; first posted, October 31, 2009, 7:00 a.m.

"Once 'revenue is needed' is the Polestar for a university's financial decisions its moral compass begins to spin as if it was located on the North Pole."

-- Nicholas Johnson

From Nicholas Johnson, "UI Loves Gambling," March 7, 2007, and quoted in Nicholas Johnson, "Revenue is Needed; Putting a Dollar Value on Our Ethics: What Are the UI's Options?" August 2, 2007.
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Now [Nov. 1] with a sampling of Press-Citizen readers' comments appended (at the bottom of this blog entry).

This was the news November 3: B.A. Morelli, "Legislators criticize plan to seek donations; Program would ask patients to sign consent form to be contacted about contributions," Iowa City Press-Citizen,November 3, 2009; it's also in the Register as B.A. Morelli, "Is asking patients for donations 'tacky'?" Des Moines Register, November 3, 2009.

And this afternoon Cindy Hadish, who deserves the credit for breaking this story last Friday [Oct. 30] ,below, brings us the news that, "University of Iowa patient donor plan delayed," Gazette Online, November 3, 2009:

The University of Iowa Foundation is delaying a plan to ask patients at UI clinics for donations.

“We want to take additional time . . . to listen to suggestions for how we might improve the program . . .," Jean Robillard, UI Vice President for medical affairs, said today in a statement.

No timeline has been set for refining or resuming the process. . . .

Under the program, patients would receive a letter at registration from Robillard and a form that authorizes the UI Foundation to contact them about donating money to the hospital. Patients who do not want to receive the information in the future would have to sign a form to opt out. . . .

A national watchdog organization, Patient Privacy Rights, had voiced concern about the program.

Founder Deborah Peel said the idea sounded coercive because patients are in a vulnerable position and may feel like they can’t say no.

Several hospitals contacted by The Gazette, including the Mayo Clinic and other universities, said they did not have similar programs.

"Delaying the plan?" Better than Admiral David Farragut's "damn the torpedoes, full steam ahead," perhaps, but scarcely even an acknowledgment of error, of ethical problems, not to mention a decision to kill the idea. (And see, B.A. Morelli, "UI Will Delay Donation Plan," Iowa City Press-Citizen, November 3, 2009, 2:55 p.m. (describing the decision as "halting plans"); John Doetkott, "UIHC Pulls Back Donation Plan," The Daily Iowan, November 4, 2009, p. A1.)

I was especially impressed with the student editorial, "UIHC Donation Plan Would Inappropriately Pressure Patients," The Daily Iowan, November 5, 2009, p. A4 ("[it's] like a surgeon placing a tip jar in the operating room"). As I commented on the DI's Web page for the editorial, "Like the boy in The Emperor's New Clothes, our students can spot nakedness of which their adult administrators are either too blind or too frightened to speak. Good editorial."

The concern with which I am left is: If an idea like this could even flit through the mind of a hospital administrator, if having done so it was not immediately rejected, if it was reviewed, approved, and prepared for by numerous persons, and when the ethical dilemmas it poses are pointed out the response is to defend the project, if the UIHC's "moral compass is spinning" -- what other projects that the media and public have not yet heard of is the UIHC capable of creating?

Here's a rumor of one; the first choice of fund raising for the UI Foundation, for which the publicized plan was a reluctant fall-back for UIHC's administrators: doctors were to notify the Foundation of the names of their patients whom the doctors believed might be able to make substantial contributions. I can't know if it's true; but if so we can all hope that this one really has been killed rather than merely delayed.
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A Check-In and a Check
(brought to you by FromDC2Iowa.blogspot.com*)
As if there weren't enough pressures from hospitals and sickness insurance companies during this time of a national health care debate, as if we weren't paying enough in the ever-escalating premiums, deductibles and co-pays (for those of us lucky enough to even have insurance), none other than the University of Iowa Hospitals and Clinics (UIHC) has decided that repeatedly pressuring patients at check-in for additional money -- a "voluntary" contribution to the UI Foundation on UIHC's behalf -- is a really nifty idea.

The Gazette has once again brought us this scoop that appears nowhere else in this morning's [Oct. 31] Des Moines Register or Iowa City Press-Citizen or other papers (so far as I know).

[In fairness, this afternoon [Oct. 31] at 2:00 p.m., during the last quarter of the Iowa-Indiana game, I discover that four hours after I posted this blog entry the Press-Citizen had an online story: B.A. Morelli, "Some question soliciting UIHC patients," Iowa City Press-Citizen, October 31, 2009, 11:13 a.m. Presumably the paper will have even more on Sunday, in its first hard copy edition to be published after this morning's Gazette. [Nov. 1, 3:00 p.m.: Here is this morning's story, B.A. Morelli, "Some question soliciting UIHC patients," Iowa City Press-Citizen, November 1, 2009.] At this time [Oct. 31 7:00 a.m.] the Register still had no story; nor could I find anything on the Daily Iowan's online site, though this five-day-a-week-hardcopy-paper did manage to have a report of the Iowa-Indiana game at halftime. This morning [Nov. 2] the DI published, Sam Lane, "UIHC Solicitation Raises Eyebrows; UIHC to Begin Indirectly Soliciting Through the 'Philanthropy Contact Consent' Program," The Daily Iowan, November 2, 2009, p. A4 (including some new quotes from the defenders of the project; e.g., "[UIHC] rely increasingly on private gifts . . . This program will enable patients . . . to self-identify.").]

[Morelli's [Nov. 1] story contributes some pitiful quotes from UI spokespeople. As I noted in a comment appended to his story, "I don't know which is sadder: that anyone would try this in the first place, or that once it was exposed to the light of day UI spokespeople would actually try to defend it, whether on their own or because ordered to do so." Here are some excerpts from Morelli's Nov. 1 story:

"'It is very low key, low pressure, ethical approach,' Moore said. 'The patient will receive world class care whether they fill out the form or not.'

Susan Shullaw, a senior vice president at the foundation, said the aim of the program is to benefit medical care and research. She said it was surprising people would question the program the same week UI announced a $26 million donation from the Pappajohn family to a new facility aimed at finding medical cures.

'I find it surprising that the same week (the donation was announced) the university is also being questioned about offering the opportunity to grateful patients who want to help make a positive impact on the lives of others,' Shullaw said. 'And, that is what this is about.'"]

[Why not just admit the mistake and move on? Mistakes can happen in the health care industry, whether an amputation of the wrong leg, or . . . The Des Moines Register awards "roses & thistles" occasionally, and Sunday morning, November 1, awarded a "half thistle to Wellmark Blue Cross and Blue Shield for an incorrect phone number in a recent mailing. Seniors who called the number listed expected to hear about Medicare drug plans. Instead they got a recording that offered chats with 'nasty girls who will do anything you want for $3.99 a minute.' The insurer apologized and sent new mailings with the corrected number - but not before raising the blood pressure of the over-65 crowd." "Roses & Thistles," Des Moines Register, November 1, 2009. There, UIHC, do you see how it's done? If Wellmark can apologize for its mistake surely you can apologize for yours. After all, you're not even asking patients to contribute $3.99 a minute.]

There are many ways to revive the declining newspaper industry. The Gazette -- one of the few remaining locally-owned newspapers in America, competing with the likes of Gannett (USA Today, 83 daily newspapers, 850 other publications) -- is succeeding, in part, by bringing back the equivalent of the newsboy on the corner shouting, "Extra! Extra! Read all about it."

After all, it was only four days ago that The Gazette was the only paper to report that (a) a grand jury was looking into the 2004 Spence labs break-in, and (b) to bring us news from inside that grand jury's legally confidential proceedings (an almost unprecedented revelation). Nicholas Johnson, "UI Spence Break-In: Gazette Scoop Illustrates Issues," October 27, 2009.

A significant amount of newspaper content is "repeating not reporting." It's from an AP wire story, a release from a corporation's public relations firm, a White House news conference, or a U.S. Senator's text message.

The Gazette is reporting. (My response to the concept of "investigative reporting" has always been, "What other kind of reporting might there be -- non-investigative reporting?")

Although UI spokesperson Tom Moore is mentioned in the Gazette's story, the sense I get is that the exchange between the reporter and Moore, on this occasion, was initiated by the reporter, not Moore.

Anonymous, uninformed sources inside the UIHC were saying there were sketchy rumors of this patient shakedown plan, but I simply dismissed them. For starters, the idea was so outrageous I couldn't believe it would even quickly flit through the imagination of any respectable hospital administrator anywhere, let alone any of those at our beloved UIHC -- or that, if thought of, it wouldn't have been immediately rejected out of hand. Moreover, I had neither a credible source to confirm or deny the rumor, nor enough details (if true) to report.

The Gazette has now provided all of the above: Cindy Hadish, "UI patients will be asked for donations; UI Foundation says no pressure; watchdog groups aren’t so sure ," The Gazette, October 31, 2009, p. A1 (the link is to the Gazette Online version, as there are no direct links to individual articles in the online version of the paper; the quotes that follow, however, are from the hard copy edition).

"The donor program, known as philanthropic contact consent . . . could [start at over 200 outpatient clinics] this winter, spokesman Tom Moore said. . . .

[A] medical privacy advocate [Dr. Deborah Peel, founder of Patient Privacy Rights, a national watchdog group] said the practice is coercive to patients. 'They’re in a vulnerable position, and they may feel like they can’t say no. . . . One party is sick and scared . . . and they don’t want to say "no" to the system they’re dependent on for living.' Under the program, patients will receive a letter at registration from Jean Robillard, UI vice president for medical affairs, and a form that authorizes the UI Foundation to contact them about donating money to the hospital. . . .

Peel said the better approach is a community-wide appeal, and 'the people who are grateful will want to give freely.' . . .

Moore said the idea was based on programs at other hospitals. Three of those he cited, however — the University of Michigan, University of Pennsylvania and Mayo Clinic — said they had no such system in place. . . ."

The Gazette does not provide any documentation in the form of internal memos, forms or instructions for those who will be carrying out this program. But based on the rumors (which, I must say, now have a little more credibility than when they first came to my attention) I will add a couple of details.

(1) Although I don't know the form it takes, there are apparently some instructions, or training programs, for the check-in clerks -- or whatever you'd call those charged with putting the arm on the suffering patients.

And the rumor was that there was at least some awareness on the part of whoever came up with this scheme that some patients might have anxiety about whether the existence, and amount, of their potential "voluntary contribution" might affect how much longer they'd have to wait to be seen, whether they'd be seen by a doctor or a medical student, and the quality of care they'd receive. (Presumably the clerks would be instructed how to respond to such concerns; although what reassurance could possibly be effective once those concerns entered a patient's mind is hard to imagine.)

Thus, the issue is not so much whether "donations" will affect the availability or quality of UIHC's service in fact ("of course not," we're assured); it's whether patients might perceive that to be the case.

On the other hand, such patient anxieties might be warranted. There was a CBS "60 Minutes" piece last night [Nov. 1] regarding a Yakuza (Japanese Mafia) godfather moved to the head of the liver transplant list at UCLA's Medical Center because of . . . well, a very generous "voluntary contribution." Here's the text from an excerpt:

Two families, Eisenberg's clients, both lost loved ones waiting for livers at another transplant center in the same area: Salvador Ceja was number two on the waiting list; John Rader was number five.

"Do you think, for one second, that this was legitimate? That they stood in line and waited just like your husband did?" Logan asked Rader's widow Cheryl.

"Absolutely not," she replied. "No. Because nobody gets a liver that quickly."

"I think they were playing God," Yolanda Carballo, Ceja's stepdaughter, added. "Now, I think they were picking and choosing who they wanted to give a liver to."

"So, in your minds, what was this about?" Logan asked.

"Money," Rader said. "Spoke loud and clear. And they listened."

"That's what it was all about. Money," Carballo agreed. Three of Goto's Yakuza cronies also got liver transplants at UCLA. For them, money was no object. UCLA says each of their transplants cost about $400,000 dollars; the Yakuza all paid cash.

The hospital also acknowledged Goto and another Yakuza each made $100,000 donations to the transplant center.

Adelstein says Goto paid even more. "According to police documents and sources, a million dollars for Goto. A million dollars," he told Logan.

"A million dollars for one liver?" she asked.

"A million dollars for one liver," Adelstein said. . . .

Lara Logan, "Yakuza: Japan's Not-So-Secret Mafia," CBS 60 Minutes, November 1, 2009.

Of course, I can't know if this story is true. But if not, CBS is looking at a rather formidable defamation suit.

Could cash affect UIHC care like it apparently did on this occasion at UCLA? Of course not. We're Iowans after all, not Southern Californians.

But we're talking about appearances here. And they're not good.

I don't know which is sadder: that anyone would try this unethical UIHC scheme in the first place, or that once it was exposed to daylight UI spokespeople would try to defend it, whether voluntarily or because ordered to do so. (It's one of those "which would be worse, in a way?" choices.)

(2) Hadish's story states that, "Patients who do not want to receive the information in the future have to sign a form to opt out." Obviously, her sources are much more authoritative than any rumors I've heard.

But my impression was that any patient who refused to sign the form -- granting permission for the Foundation to contact the patient repeatedly for contributions, presumably throughout the patient's lifetime (in other words, "to opt in") -- would continue to be asked at every visit whether they wished to do so.

There was to be no "form" to sign by which a patient could "opt out." The only "form" for opt-ing was the form to "opt in."

But it was not quite as bad as the lyrics of Michael Jackson's song in "The Wiz": a game in which "you can't win, you can't break even, and you can't get out of the game."



It would be possible to get out of the UIHC game, but only if the patient was willing to compose a letter, find a typewriter or computer with printer, prepare the hard copy, find an envelope and stamp, know the person and address to whom to send it, and carry it (or be pushed in their wheelchair with it) to the Post Office for mailing. (Apparently, the UIHC's new $60 million computer is incapable of receiving email.)

[The paragraph immediately above was written on Oct. 31, 7:00 a.m. At least some of those putting comments online following the Press-Citizen's story who have some pretty direct knowledge of all this seem to share my intuitive guess as to what's required. "JoeSchmoe5106" wrote on Oct. 31 at 6:13 p.m., "If the answer is 'no' they have to write a letter to the Privacy Officer. They can't just check a box and say 'no.'" And again at 7:10 p.m., "I have seen the form. Check the very bottom of the form where it says, 'If you do not want the UIHC or the UI Foundation to contact you for fundraising efforts, you must notify our Privacy Officer in writing,...' which is followed by the address."]

Fund raising is difficult -- in part because of the challenge of keeping imaginative and energetic folks within the bounds of moral and ethical decency in doing so. Heavy handed efforts usually backfire.

o The notion of locking potential donors in a room, embarrassing them, and keeping them there until a fixed amount has been pledged always seemed to me a little heavy handed.

o Iowa Public Radio and National Public Radio have started using an even more offensive approach. Listeners are urged to "turn in" friends and family members, Stasi-like, so that Ira Glass can call them on the phone, shame them, record the conversation, and then broadcast it to the nation -- a kind of entrapment into self-defamation. (And no, neither I nor anyone I know personally was subjected to this treatment.)

o Similarly, I don't think a hospital should ask individual patients, as patients, for financial contributions at any time under any circumstances. Putting aside the financial burden on patients of the charges already exacted for insurance and medical services (much of which, admittedly, is through no fault of doctors and nurses), asking them for contributions is always going to create at least some sense in a patient's mind that there may be a connection between the size of their contribution and the quality of the service they'll get. [See the reference to the Nov. 1 CBS 60 Minutes piece, above, regarding such a case at UCLA.]

On the other hand, I see no problem with accepting gifts from grateful patients who volunteer to do so without any contact from health care providers; as Dr. Deborah Peel puts it (quoted above), "the people who are grateful will want to give freely." Nor do I see a problem with including information about the UI Foundation in a literature rack along with pamphlets about diseases and healthy life choices -- so long as patients are not directed to it by employees. I see no problem with including literature sent to all UI alumni, or past UI Foundation donors (not just those who happen to be patients; even though a significant percentage of them will have been UIHC patients at one time or another), about UIHC programs and needs.

I do see a problem with fund raising appeals going to patients, as patients.

This is not the equivalent of the pay-to-play bribery exacted from citizens in Afghanistan, Iraq, and third world countries for goods and services that should be free from the state, or provided at posted prices, and I'm not asserting that it is. (In Washington, D.C., it's legal; the payments are called "campaign contributions.") But it does have a bit of that aura -- or might reasonably create it in the patient's mind.

And what is truly unconscionable, in my judgment, is to do this fund raising at a patient's time of greatest anxiety, stress -- and often pain: when they are checking in to a clinic.

Equally baffling is how and why such a proposal did not lead to the immediate firing of the person proposing it -- or at a minimum an immediate and unequivocal rejection of it by top administrators.

Presumably, what Paul Harvey used to call "the rest of the story" will gradually emerge as the other local media get on it and track down how it came to pass that one of America's greatest academic research hospitals is now as down on its luck as the unemployed Americans of the 1930s:



Bing Crosby sings the 1931 song, "Brother Can You Spare a Dime?" lyrics by Yip Harburg, music by Jay Gorney.

[Press-Citizen readers' comments below:]
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* Why do I put this blog ID at the top of the entry, when you know full well what blog you're reading? Because there are a number of Internet sites that, for whatever reason, simply take the blog entries of others and reproduce them as their own without crediting the source. I don't mind the flattering attention, but would appreciate acknowledgment as the source, even if I have to embed it myself. -- Nicholas Johnson
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Online Comments of Press-Citizen Readers Regarding
B.A. Morelli, "Some question soliciting UIHC patients," Iowa City Press-Citizen, November 1, 2009

Note: These readers' comments are reproduced here as merely a sample of the range and consistency of at least these readers' disapproval of the UIHC's patients "voluntary" contributions program. I neither represent, nor reproduce them here (1) because they are factually "true" (because I cannot know), although they seem intuitive when factual, (2) because I share all the opinions, for I may not, or (3) because they are a scientific sampling of public opinion (obviously they are not). They do, however, represent, merely by their number (compare the number of news stories in local papers that get no online comments), and content, that what the UIHC has done in this instance has struck a nerve with at least these readers.

There is a shared, almost instinctive, reaction that what the UIHC is doing is wrong, and that it ought to have been equally obvious to those who are doing it that it is wrong. Although I have no one's approval to reproduce these comments here, because I could not find out, and do not know, who any of them are, I feel the authors have knowingly made them public, albeit anonymously. (If anyone wishes me to remove theirs from this blog entry, just let me know and I'll delete it.) -- N.J.

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Dave, The Elder wrote:
If the group or department in charge of this planning is surprised at the response, that should say much about their knowledge of people and appearances. They are, it is perceived, taking advantage of of sick folks. They should go back to the drawing board and come up with a different plan. This one is sick.

Dave, The Elder
11/1/2009 5:03:28 AM



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NickIowa wrote:
I don't know which is sadder: that anyone would try this in the first place, or that once it was exposed to the light of day UI spokespeople would actually try to defend it, whether on their own or because ordered to do so.

For an analytical look at what's going on, what's wrong with it, some ethical judgments, and alternative approaches that could save this ethical and public relations disaster, see

"UIHC: 'Sick Brother, Can You Spare a Dime?'; A Check-In and a Check," October 31, 2009, 7:00 a.m.

http://fromdc2iowa.blogspot.com/2009/10/uihc-sick-brother-can-you-spare-dime.html
11/1/2009 7:06:37 AM



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sparkymalone wrote:
Shullaw, go home. Dave and Nick are exactly right.

Why is it that every week UI gives me something new to be ashamed of? Just yesterday I was reading about the plagiaristic exploits of a tenured English prof, Kevin Kopelson, laid out last year by himself in psychologically ill memoir fashion in the London Review of Books. He's still on faculty here, still being funded to wander off to conferences and talk, presumably, about how ludicrous is academe, which shakes a stern finger at undergrads about plagiarism and then continues to employ a lifelong plagiarist like him. I suppose this is transgressive and clever, you see. No doubt Lacan has something to say about it. Makes up for filthy theft. I actually have the issue of LRB and never read the piece, mustn't have looked interesting.

Anyway, that, & employing undergrads as TAs for no money, & pushing the kids to go dig themselves deeper debt holes, and now this. I expect greed in a U, but all this is just in poor taste.
11/1/2009 9:19:45 AM



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sparkymalone wrote:
Oh, and very nice. This from the Gazette (what's going on, P-C? Brian and the rest, are you muzzled, or just asleep?):

"Moore said the idea was based on programs at other hospitals. Three of those he cited, however — the University of Michigan, University of Pennsylvania and Mayo Clinic — said they had no such system in place."

Yeah. Trust us, reporters. And patients, trust us, no one will know whether you've opened your wallet to the hospital or not. I think any such form should carry information about Shullaw's salary ($143,325) and Moore's ($70,644) along with the Gazette stories, and ask patients whether they'd like to contribute to Shullaw and Moore's future employment.
11/1/2009 9:46:13 AM



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tvolm wrote:
The plan lacks conpassion, understanding and empathy for the sick and ill.

All I can say is it is amazing how callous people can be to the plight of others.

The University Hospital is acting like a private business, operating like a large corporation, perhaps the State should privatize the hospital?
11/1/2009 11:00:22 AM



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IowaCityGirl wrote:
"The consent form allows the hospital to pass information to the UI Foundation, a philanthropic arm of UI, so the foundation can contact the patient with medical programs and research to which the patient might want to contribute, Moore said.
The program would not disclose any diagnostic or medical information about the patient"

They may not disclose specific diagnostic or medical information, but in order to decide which programs a patient might want to cotribute to even discolsing which clinic they were in is too much information and reveals what that patient was seen for. Without some pertinent information how are they to decide where that patient might contribute? It is disgusting that they would even consider approaching a patient in any way, shape or form. If a patient has extra money and chooses to give it to the hospital they already know where it is located.

11/1/2009 11:31:27 AM



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IH8IC wrote:
This completely negates internal training called "Service Leadership." In fact, it's plain disgusting. This from two "frontline" UIHC employees. The program is designed as an "opt-out" and the Gazette reported that patients must sign a form to refuse the information being revealed to the UI Foundation. It should be an "opt-in" at best, and perhaps would be better received if the request came along with a "patient satisfaction survey" after the healthcare was provided.

The UI Foundation has had some disgusting methods of raising money, including selling off all of the student information in credit card campaigns. This just goes to show how the UI Foundation conducts itself. It has no shame and will do whatever possible to keep its internal salaries funded.

Absolutely disgusting. If I was a patient, I would take my business elsewhere. The UIHC can't be trusted to provide the best of care when these disgusting things happen.
11/1/2009 12:11:25 PM



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iowahawkeye wrote:
The only acceptable method would be a mailing. Shouldn't be forced to say no to someone at the hospital. By the way, UIHC has been sending "begging" letters to employees for at least the past year.
Next thing UIHC will probably try is to have the atm programmed for a 5% withdrawl fee/donation.
11/1/2009 12:58:30 PM



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guyinic1 wrote:
The next thing with their begging, UIHC will be trying to tell us they are one of the original mendicant orders of friars and nuns. IMHO, there is no place where begging should come into the UIHC patient care equation. Isn't the local, state and federal support they receive enough? Evidently not! This is another example of the University and UIHC's bureaurocratic administrations gone bizerk! If UIHC was privatized like some have suggested, they would fall flat on their face inside a week. They can only compete with the private sector because of their tax subsidies and the special treatment they receive by Medicare and other third party payors. Now they are going after individual patients trying to solicit "donations"! Geesh!
11/1/2009 1:37:02 PM



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rd2serfdom wrote:
No wonder UI just announced a change to the employee health plan: co-pays for UIHC office visits are going down from $10 to $5, while co-pays for Mercy or another hospital (with better patient service) will go up from $15 to $20. There are other financial "penalties" for out-of-UIHC care, to "encourage patients to utilize UIHC's services". Maybe unethical practices like these are a good reason they need to incorporate these penalties to force their own employees to use UIHC?
11/1/2009 2:19:23 PM



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JoeSchmoe5106 wrote:

Replying to rd2serfdom:

No wonder UI just announced a change to the employee health plan: co-pays for UIHC office visits are going down from $10 to $5, while co-pays for Mercy or another hospital (with better patient service) will go up from $15 to $20. There are other financial "penalties" for out-of-UIHC care, to "encourage patients to utilize UIHC's services". Maybe unethical practices like these are a good reason they need to incorporate these penalties to force their own employees to use UIHC?

Having a lower co-pay to incentivize employees use UIHC as their preferred provider is NOT unethical. THIS plan is unethical.
11/1/2009 2:41:46 PM



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guyinic1 wrote:
Soliciting "donations" and "gratuities" from patients and their family's is not the same as twisting the arms of University employees to use UIHC facilities. I think denying UI employees total freedom of choice in selecting their health care providers is wrong and another of the University's cheap tricks. I think that approaching any patient for money for any reason other than what is due for their care is unethical. How would any of you feel if you went to your private physician anyplace other than UIHC and your doctor or their office staff ask you for a "tip"? You'd be appalled at their audacity and I think the Board of Medical Examiners would hear about it---and act on it! What's the difference here?
11/1/2009 4:22:27 PM



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iowamars wrote:
Kopelson hardly admits to being a life-long plagiarist. It is a handful of examples - across his entire academic career. None are pertinent to his career. Inexcusable - maybe. But hardly unusual - and have little to no bearing on his current success.
As far as the plan to reduce co-pays at UIHC and increase them elsewhere - P/S and faculty are self-insured. The FRIC committee is made up of staff and faculty appointed by both governing bodies. The governing bodies are in turn elected by those they represent.
The committee has to address the hyper-inflation in health care costs with limited funds.
I would expect no less of them - then cutting the best deal possible to keep health care costs to employees down. Co-pays go to the provider - and offset the cost of insurance to the individual. All Mercy Hospital has to do is accept the same reimbursement rate as UIHC with a $5 co-pay -it is Mercy's decision not to do that, not the FRIC committee or UIHC.

11/1/2009 6:04:33 PM



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fnmct wrote:

Replying to guyinic1:

The next thing with their begging, UIHC will be trying to tell us they are one of the original mendicant orders of friars and nuns. IMHO, there is no place where begging should come into the UIHC patient care equation. Isn't the local, state and federal support they receive enough? Evidently not! This is another example of the University and UIHC's bureaurocratic administrations gone bizerk! If UIHC was privatized like some have suggested, they would fall flat on their face inside a week. They can only compete with the private sector because of their tax subsidies and the special treatment they receive by Medicare and other third party payors. Now they are going after individual patients trying to solicit "donations"! Geesh!

The only tax subsidies UIHC receives is Medicare, Medicade, and IowaCare. And they lose money on those.

11/1/2009 6:42:08 PM



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NickIowa wrote:
Would "volunter contributions" ever affect the quality of medical service -- or, indeed, the availability of medical service at all? Of course not, we are assured.

But I'm sitting here at the moment watching a CBS "60 Minutes" piece about a Yakuza (Japanese Mafia) godfather who was moved to the head of the list for a liver transplant at the UCLA Medical Center (another leading academic medical school/hospital like UIHC) because of . . . well, a very generous "volunteer contribution."

Is the story true? How would I know? But CBS is looking at a significant defamation suit if not.

Could money help improve your medical treatment at Iowa? Of course not. We're Iowans, not southern Californians, after all.

Still, even Iowans would be well advised to avoid the risk of the appearance of that possibility.
11/1/2009 6:52:34 PM



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tvolm wrote:
A sick solution to a sick business in a sick state in a sick nation.

All good christian greed, god bless, mr bush.
11/2/2009 8:48:52 PM



Here are some more highly edited comments from Morelli's October 31 version of the story (to which readers were continuing to attach comments on November 1):


monashaw wrote:
Sounds fairly ghoulish to me. Not to mention out of touch with reality. Most patients are already too stressed about money . . ..
10/31/2009 12:25:30 PM


guyinic1 wrote:
I think it is totally inappropriate for UIHC and/or the University's foundation to solicit "donations" from patients. The next thing they will be doing is putting up signs that say "Gratuities gladly accepted!" Even suggesting such a move to me indicates their desparate, juvenile way of thinking. I'll bet anyone the idea came from bureaurocratic administrators and not from the health care providers. More and more I get the idea that most if not all University administrators need to be housed together in a facility adjacent to Psych Hospital. They are bizarre to say the least!
10/31/2009 1:42:01 PM

NickIowa wrote:
I don't know which is sadder: that anyone would try this in the first place, or that once it was exposed UI spokespeople would (whether voluntarily, or in response to orders) try to defend it.

For an analytical look at what's going on, what's wrong with it, along with some value judgments, written early this morning in response to the Gazette's scoop, see

"UIHC: 'Sick Brother, Can You Spare a Dime?'; A Check-In and a Check," October 31, 2009, 7:00 a.m.

http://fromdc2iowa.blogspot.com/2009/10/uihc-sick-brother-can-you-spare-dime.html
10/31/2009 2:17:19 PM

mak52245 wrote:
They might as well install a toll booth at each entrance. Then they could get money from visitors and staff as well.
10/31/2009 3:12:35 PM


JoeSchmoe5106 wrote:
"Susan Shullaw, a senior vice president at the foundation, said the aim of the program is to benefit medical care and research. She said it was surprising people would question the program the same week UI announced a $26 million donation from the Pappajohn family to a new facility aimed at finding medical cures...I find it surprising that the same week (the donation was announced) the university is also being questions about offering the opportunity to grateful patients who want to help make a positive impact on the lives of others,” Shullaw said. “And, that is what this is about.”

This quote proves that these people are so out of touch! How many patients are of the status of the Pappajohns? The Pappajohns are not indigent patients, unemployed Iowans, patients on their Nth round of chemotherapy owing UIHC thousands already.

Shullaw is unbelieveable.
10/31/2009 3:43:15 PM


pharma wrote:
UIHC should take a look at their extraneous expenses and make appropriate cuts, instead of counting on patients to pick up the mismanagement slack at UIHC. . . ..
10/31/2009 3:58:19 PM


thetruthman wrote:
Here's my donation; Get serious. Thanks for making the hospital look second rate.
10/31/2009 4:15:35 PM


Curls wrote:
What lack of class.

As patients of UIHC myself and my family already receive letters requesting donations to the "patient care fund." These letters are also tacky. . . .
10/31/2009 4:27:52 PM


TWinter wrote:
It would be fine if they wanted to put donation brochures in the waiting rooms or even include them in mailings, but asking medical personell to get involved is extremely tacky. I hope most doctors and nurses at the hospital would simply refuse to do this because it would be so unprofessional.
10/31/2009 5:02:13 PM


IowaCityGirl wrote:
“I find it surprising that the same week (the donation was announced) the university is also being questions about offering the opportunity to grateful patients who want to help make a positive impact on the lives of others,” Shullaw said. “And, that is what this is about.”
Ummmm, I am pretty sure that any grateful patient can locate the Hospital once they are fully recovered to make a donation, if they choose. They should NOT ask for them. Comparing the everyday patient to the PapaJohn family is ridiculous!
10/31/2009 5:04:26 PM


JoeSchmoe5106 wrote:

Replying to hawkigirl05:
"I wish people would realize . . . If they say no, they sign a paper and they will not be contacted. . . ."

If the answer is no they have to write a letter to the Privacy Officer. They can't just check a box and say no. The simple fact is, it shouldn't be done. It's inappropriate and sick and/or confused patients shouldn't be bothered with this at the time of a clinic visit. Period.
10/31/2009 6:13:37 PM


JoeSchmoe5106 wrote:

. . . I have seen the form. Check the very bottom of the form where it says, "If you do not want the UIHC or the UI Foundation to contact you for fundraising efforts, you must notify our Privacy Officer in writing,..." which is followed by the address. It's the fine print . . ..
10/31/2009 7:10:36 PM


sparkymalone wrote:
Oh, for shame. Shame on Shullaw and Moore both. This is unconscionable. To take sick people by the arm, in the hospital, and say "Come on out and say out loud you don't want to be bothered, and see what kind of care you get next"? Because that'll be how it's perceived.

Oh, I love the excuse-making, too. "Well, my mendacious friends over there do it, so it must be OK, Mom." My God. I hope they're both paid well for the ordure they have to make come out of their mouths.

Shame, shame, shame. Next we'll see one of them giving a course in medical ethics!
10/31/2009 9:50:20 PM


Lina58 wrote:
Patients are in the hospital to heal and anticipate when they are well enough to go home where they feel they belong. The very LAST thing they ever need is to be asked for a monetary donation to the UIHC when they haven't even gotten a bill for the current visit there. Perhaps in the back of their mind they are wondering where they are going to get the money to pay for this visit.
TOTALLY out of line and insensitive. Keep asking 'The Papajohn's" of the world for money. NOT SICK PEOPLE!!!!
11/1/2009 8:41:50 AM


IowaCityGirl wrote:
They should NOT be bothered with this at all. As I previously stated...Should a gratefull patient be fortunate enough to have expendable/extra money that they wish to donate they know where the hospital is. This should not be happening.
11/1/2009 11:13:26 AM

wardedinburgh wrote:
Foundation fundraising is a necessity, and has to be handled very sensitively. Soliciting donations from current patients is NOT a sensitive way to go about it.

I'm currently an Oncology Patient, with a semi-orphan form of ovarian cancer. If I had the income, and if Title 19 would cover it, I'd be going to Mayo. Each time I hit the UIHC for a visit, I feel as if I'm being trampled by a herd of clowns who are unable to navigate in their floppy shoes. The quality of care is relatively good, but the various departments seem unable to communicate with each other, or with me. Some of the problems are probably due to lack of funding for enough staff members--perhaps the executives should take paycuts so that the "grunts" who really have patient contact, and who most closely affect proper communications, can be rehired or have their numbers increased to an acceptible level. This institution doesn't have a hope of becoming a MAGNET MEDICAL CENTER until there are more support staff.
11/1/2009 3:16:37 PM


ahhah wrote:
As often is the case, it is the method not the objective in dispute. It used to be you made an appt, checked in, sat down, waited for your name to be called, were seen, and if lucky went home. You felt anonymous and you felt your care was objective not subjective. It has become such an offputting process from beginning to end for both patients and employees. They should have made it a letter plus envelope handed to the patient and checked off on the computer by the receptionist with the date of delivery. Once a year after expiration date, you hand them another one. You also have them available in the racks and on the tables for those who like to read while waiting.
11/1/2009 4:01:48 PM

IowaCityGirl wrote:

Replying to ahhah:
Nope...it is the objective I disagree with as well. NO health care facility should ask patients for donations, EVER. If someone has the money to donate they know where the hospital is.
11/1/2009 6:36:15 PM


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NickIowa wrote:
Could "donations" affect the availability or quality of UIHC's service? Of course not, we're assured.

But there's a CBS "60 Minutes" piece tonight about a Yakuza (Japanese Mafia) godfather moved to the head of the liver transplant list at UCLA's Medical Center because of . . . well, a very generous "voluntary contribution."

I don't know which is sadder: that anyone would try this UIHC scheme in the first place, or that once it was exposed to daylight UI spokespeople would try to defend it, whether voluntarily or because ordered to do so.

For an analytical look at what's going on, what's wrong, value judgments, and some readers' comments from this and the Nov. 1 versions of the story, see

"UIHC: 'Sick Brother, Can You Spare a Dime?'; A Check-In and a Check," October 31, 2009, 7:00 a.m.

http://fromdc2iowa.blogspot.com/2009/10/uihc-sick-brother-can-you-spare-dime.html

Could cash affect UIHC care like UCLA? Of course not. We're Iowans after all, not Californians.

Appearances matter.
11/1/2009 8:08:05 PM


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