When I read your article "Trying to have it both ways" (March 24, p. 26), I was reminded of a childhood friend who asked Santa for a pony and got a puppy instead. Her father could have tried to convince her that a pony and a puppy are the same-both four-legged animals that begin with the letter "P"-but I don't think she would have believed him, any more than your readers should believe that the management contract Roper CareAlliance recently signed with Carolinas HealthCare System is the same as the proposed lease agreement between Columbia/HCA Healthcare Corp. and Medical University of South Carolina.
It is true that Roper CareAlliance and MUSC are both large healthcare institutions looking for strong partners. There is nothing wrong with that-it is happening all over the country. But that is where the similarity between the two deals ends. Please note these very significant differences:
Roper CareAlliance is a self-supporting private healthcare system held in trust for the community by the Medical Society of South Carolina, a group of 400 physicians who oversee its operation. MUSC is the state's research and teaching hospital, supported over the years by South Carolina taxpayers and donors.
Roper and its new management partner, Carolinas, are both not-for-profit systems that share similar operating philosophies. Neither system's operating status will change under the management contract-both will remain not-for-profit.
On the other hand, MUSC has been not-for-profit for the past 150 years, while Columbia, as we all know, is a 9-year-old for-profit corporation with shareholders and a very different operating philosophy. If the proposed MUSC-Columbia deal goes through, our state research and teaching facility will become a for-profit corporation, which raises the additional question of the propriety of state assets built up over the years potentially going to benefit an out-of-state, for-profit corporation and its shareholders.
This also raises questions about the treatment of indigent patients. Columbia officials have already indicated they would discontinue the management contract MUSC currently has to operate Charleston Memorial Hospital, the county medical facility that receives funds to treat indigent patients. Under the Roper-Carolinas contract, both systems will remain not-for-profit, and their commitments to indigent care will not change.
Apart from the obvious differences between the two deals based on the partners in each, there are also numerous legal questions about the terms of the MUSC-Columbia deal. (No one has raised legal questions about the management contract between Roper and Carolinas.)
South Carolina law prohibits joint ventures between state institutions and the private sector. Many believe the proposed "lease agreement" between MUSC and Columbia is a joint venture in disguise. That is one of the questions a court must decide before the deal can be completed.
In addition, the contract between Roper and Carolinas is a one-year renewable management agreement; none of Roper's assets are being acquired by Carolinas. The proposed contract between MUSC and Columbia is a 30-year renewable lease agreement in which Columbia would actually purchase the assets of MUSC's three hospitals. At the end of the lease, if South Carolina wants its medical university hospitals back, the state would have to buy back those assets at their market value at that time. Where would the state get that kind of money?
And there is the additional legal question of whether the state's assets in MUSC have been undervalued. This is something attorneys general in several other states have begun taking serious note of and is a question we believe has not yet been adequately answered regarding MUSC.
So you're right. Except for the fact that the partners are different; the lengths of the contracts are different (one year vs. 30 years); one is a management contract and the other is a "lease"; one involves the purchase and subsequent buyback of state assets and the other doesn't; and one means a major not-for-profit state institution will become a for-profit corporation-except for those facts, the subhead of your article is true: The Medical Society of South Carolina docs who oversee Roper are suing over a deal "just like their own."
Now, after I take my niece puppy-back riding, we're going to come home and teach her pony how to fetch.
ELLEN E. MOORE
Director of corporate marketing