Trust and verify

Large corporate bodies like Yale-New Haven Health and Lawrence + Memorial Hospital necessarily regard health care as a business that must stay solvent, while their customers think of themselves as patients and their employees think of themselves as caregivers.

Transparency and a sense of shared mission are key to easing the creative tension of seeing the mission from different angles. Perhaps the hospitals' management has not yet realized that's particularly vital during a time of transition.

That's the kindest construction we can put on the way the Yale-New Haven Health Services Corporation and the state public health department have treated the coalition that was granted intervenor status in the process of the two hospitals' affiliation under the Yale-New Haven network. The coalition includes consumer activists, union officials and medical personnel.

The members are legitimate stakeholders in the new arrangement, not just gadflies out to stall the process. Yet that's the way they have been treated in recent weeks by the network and the state Department of Public Health.

The coalition requested a meeting about the independent monitor, independent consultant, and community representative to the L+M board called for in the affiliation agreement, and about two other issues: clarification of what clinical services will still be available at L+M and whether the new affiliates will carry out the recommendations of a recent community health needs assessment. Those are details the public, not just the coalition, wants to know.

Dr. Raul Pino, the state public health commissioner, told coalition members to take their concerns to the two hospitals, but while they waited for a response to their request for a meeting, the hospitals were going ahead with the selection of the monitor and consultant.

As a further brushoff, the spokeswoman for the state health department and its Office of Healthcare Access said that intervenor status didn't give the group legal standing to object — intervene — in the process of selecting the monitor or the consultant.

Whoa. A double run-around from the principals in the deal and the oversight agency? How is the public supposed to find confidence in the new arrangement if it seems the deck is stacked against an independent group equipped to ask legitimate questions?

The coalition itself is less focused on the manner in which the matter was handled and more on what happened while they weren't in the room.

State regulators approved the actuarial firm Milliman as the independent consultant to set caps on price increases at L+M for the next five years — the initial period in which the local hospital is functioning as a member of the network. For the role of independent monitor, they approved Deloitte & Touche, which is to verify compliance with the terms of the agreement between the Yale-New Haven network and the state.

The firm has a long history of working with Yale; the public would have more reason to trust that it can operate as a monitor, independently, if there had been transparency about the choice as it was made.

During the months that the two hospitals awaited the state's decision to allow affiliation, officials of each institution said that one thing they couldn't legally discuss with each other or the public at that stage were the financial details that would ultimately be part of the deal. Under the legal requirements, it was reasonable to accept that.

However, large institutions have a natural bent toward secrecy about their proprietary information, and secrecy always has creep.

Many longtime patients, staff and supporters of Lawrence + Memorial swallowed their concerns about losing the independence of their local hospital because they trusted that the new arrangement would improve access to even more advanced health care, as promised. They didn't sign up to be told to mind their own business.

The Day hopes that Lawrence + Memorial officials will explain to their new colleagues that southeastern Connecticut looks forward to being neighborly — not to having to stand at the door, knocking.

The editorial board is composed of the publisher and four journalists of varied editing and reporting backgrounds. The board's discussions and information gained from its meetings with political, civic, and business leaders drive the institutional voice of The Day, as expressed in its editorials. The editorial department operates separately from the newsroom.


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