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Of the Department of Pediatric’s budget, about one-fifth comes from Norton Healthcare and Kosair Children’s hospital. U of L is in court against Norton in a dispute over Kosair.

Increasingly, the University of Louisville under President James Ramsey is an opaque institution despite the fact it is a state school.

U of L media executives have told IL we will not be given access to top administrators.

So when insiders send us internal documents and videos, they get our attention.

In a video released last week, Dr. Gerard Rabalais, chairman of U of L’s Department of Pediatrics, discussed on June 13 the state of his department, which also staffs Kosair Children’s Hospital downtown along with Norton Healthcare. It’s a private video, which can’t be re-posted. But you can see it here on Vimeo.

At about the 25-minute mark, a clearly agitated Rabalais goes into a dissection of Kosair, which is a point of contention between Norton Healthcare and U of L, a dispute that’s now in Franklin Circuit Court:

There are too few inpatient beds at Kosair Children’s Hospital. We have people waiting for beds. We have an ER that’s overcrowded. We have a tent that goes up every year. Not just during influenza epidemics. We see patients in a tent! We have patients in the hall. In the ED. We have 15, 20, 25 patients waiting for beds in the winter in the ED because … we can’t get people out of the ICU. We can’t discharge people fast enough. We need more beds.

Rabalais notes there is an effort to get “the St. Matthews campus to help,” a reference to Norton’s new and improved Women’s and Children’s facility coming on line now at what was Suburban Hospital in the Dupont medical cluster. But his description is far beyond anything either side – U of L or Norton — has revealed about dysfunction at Louisville’s main children’s health care facility.

That’s an issue because this year, for the first time in a long time – Kosair Children’s Hospital downtown didn’t make the U.S. News & World Report’s list of top children’s hospitals.

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Also in the video, Rabalais reveals U of L has a new partnership with Kosair Charities to build a new pediatric medical office building. He doesn’t discuss the plan in detail other than to say the plan would revamp an existing building at Preston and Chestnut streets where outpatient services are located now.

But it appears U of L and Kosair – who both are in highly contentious, public disputes with Norton – are drawing closer together.

In his hour-long talk, Rabalais takes the 200-doctor Department of Pediatrics staff through a “SWOT analysis,” a business technique meant to identify organizational strengths, weaknesses, opportunities and threats.

Dr. Gerard Rabalais

Dr. Gerard Rabalais

In his address, Rabalais acknowledges criticisms that he only talks about “the good things, the things that are working. Not today.” Rabalais – a skilled public speaker – commences to tell the whole story candidly and clearly. (The final five minutes are inspiring. We’re not going to give it away, but some pretty cynical health care executives told IL they were moved.)

Early on in the video, Rabalais also acknowledged the disputes with Norton Healthcare over Kosair Children’s Hospital, as well as debt and operational deficits “we never had to deal with before.”

Rabalais notes, though, the largish pediatrics program – 200 faculty, bigger than 80 percent of pediatric departments – is getting national recognition for  its work in infectious disease, critical care, and other areas. “We have national visibility in many, many areas” including infectious diseases, critical care, forensics and diabetes research, he said.

“People know about us. It’s not just that we’re big. We’re actually doing things that people are paying attention to.”

He also acknowledge U of L has a tremendous advantage in having Kosair Children’s Hospital, a large children’s facility “instead of living inside a general hospital with one floor … 50 beds.”

But the most surprising revelation is that at a university Ramsey touts as a national research heavyweight, Rabalais bemoans the small number of Department of Pediatrics faculty who do research.

So, what things are we weak in? Turns out there are several  things were weak in. First is research. Out of the 200 faculty members at the Department of Pediatrics, only 6 basic science researchers. A half dozen. In relative comparison to most departments of pediatrics, that’s a tremendous imbalance. That should be a third of the faculty, not two percent or three percent of the faculty.

Calling it a “glaring weakness if we’re going to be a player in basic science research,” Rabalais noted that federal funding has decreased dramatically since the late 1980s and 1990s to the point even the best funded researchers don’t pay for themselves.

“We’re going to have to find money somewhere else. We’re going to have to increase our endowments – either endowed chairs, or in endowed infrastructure – and we do not have access to those resources,” he said.

Top 20 hospitals are recognized “not just because they’re good doctors. Not just because they provide good clinical care, but because of new discoveries. The new research that’s generated, that’s what brings the notoriety. That’s the key. That takes the money. In many, many institutions, the children’s hospitals pay for a large portion of that infrastructure.

“Unfortunately, that’s not the case here.”

There’s a lot more. Rabalais’ salient points include:

• A department of pediatrics “cannot have too many friends,” friends being philanthropic organizations that contributed to the program. “The money we bring in doing clinical work doesn’t come close to paying the bills. Doesn’t come close. You have to have friends to fill that gap.”

• “U of L’s Department of Pediatrics doesn’t have a single downtown building where all operations are consolidated. Go to any major academic pediatric center, they have those things. They have big beautiful buildings that are state of the art. We’re in a 40-ish-year-old building. It’s not optimal. It’s not what it ought to be. If we aspire to be a great academic center for pediatrics, this has to be on the list of things we’re gonna’ do.” Clearly, the new partnership with Kosair Charities is meant to address that.

Department finances are a weakness. The Department of Pediatrics has run an operational ongoing deficit for the past two years. “We don’t have enough money from our hospital, or from our university.”

• Under “threats” in the SWOT analysis, Rabalais listed competition from nearly every university in the region, including the nationally renowned Cincinnati Children’s Hospital and the University of Kentucky. U of L’s Department of Pediatrics has $20 million in endowments. Compared to other universities “it’s a pittance. Its’s so tiny as to be insignificant. Most departments at the Top 20 schools are going to have infrastructure endowments in the hundreds of millions. At Cincinnati, it’s a billion.

Rabalais said he’s depending on the support for diabetes research, for example, from large Louisville corporations. He also mentioned Chinese funding for doctors coming to U of L. “Money comes with them.”

Our sources — both U of L and Norton partisans – agree on one thing: Rabalais is a person of high integrity and values, stuck in a tough situation.