HCA, Nashville, made its case last night for its proposed $1.1 billion acquisition of Health Midwest, Kansas City, Mo., during a public hearing. But the 500 or so people who attended the hearing -- many of them nurses -- were denied the chance to hear from their preferred target, Health Midwest management. Missouri Attorney General Jay Nixon said he told Health Midwest officials not to bother appearing. Nixon said there was no point in hearing from Health Midwest until it files a plan for governance of the healthcare foundation that will be endowed with about $800 million from sale proceeds. Nixon also said his analysis of the deal is being hampered by the lack of a definitive sales agreement. Notwithstanding, Nixon said he is "deeply concerned" that a sale to HCA "could fundamentally change the nature of healthcare in Kansas City."
HCA Chairman and CEO Jack Bovender Jr. played to the crowd's doubts. "If I were in your position, I would be skeptical, too," Bovender said, adding, "We don't want to force ourselves on you." Bovender made a series of commitments beyond the $450 million in capital that HCA has pledged to invest in Health Midwest facilities during the five years following the deal. The commitments included opening an HCA division office in Kansas City, a 10-year pledge to spend at least as many dollars on indigent care as Health Midwest spent in the past 12 months, a three-year pledge to keep the system's three inner-city hospitals open, and a three-year pledge to keep the other 10 hospitals in the system open, unless they are replaced by a new facility. The strong contingent of nurses who attended the hearing called on Nixon to require HCA to agree to high nurse-staffing ratios to ensure quality care. Many of the community leaders who spoke at the hearing focused on how the foundation that would result from the sale would be governed, what it would spend its money on and how that money would be spread around the Kansas City area. Health Midwest owns seven hospitals, leases two hospitals and manages four hospitals in Kansas and Missouri. -- by Vince Galloro