Kosair for Web*304Editor’s note: Terry Boyd wrote the majority of this opinion post, collaborating with health care insiders.

U.S. News & World Report has released its latest Best Children’s Hospitals list for 2014-2015, and Kosair Children’s Hospital in Louisville is nowhere to be found.

Health care insiders are beginning to ask some tough questions.

badge-best-ped-hospitals-wmThe closest top-rated hospital to Louisville on the list is Cincinnati Children’s Hospital Medical Center. Cincinnati Children’s Hospital made the list under multiple specialties including cancer, gastroenterology and GI surgery, neonatology, nephrology (kidneys) and pulmonology.

Cincinnati Children’s Hospital ranks No. 3 on the USN&WR list behind only Boston Children’s Hospital, and the Ann and Robert H. Lurie Children’s Hospital of Chicago. The list includes Johns Hopkins Children’s Center in Baltimore, Texas Children’s Hospital in Houston, and Children’s Hospital of Philadelphia.

Kosair Children’s Hospital didn’t get a mention this year after being ranked in several clinical categories last year. The reason? Norton, which manages the hospital, didn’t participate in the USN&WR survey.

From Norton:

Kosair Children’s Hospital opted not to participate in the 2014 US News & World Report evaluation of children’s hospitals. Although we have enjoyed favorable rankings with this news organization in the past, Kosair Children’s Hospital has turned its attention inward this year to focus on our improvement agenda and some major renovations to our building. We are also looking at ways to enhance those service lines previously recognized by US News & World Report so we can make an even more compelling application next year.

Norton’s statement adds that several medical organizations have recognized Kosair Children’s Hospital’s excellence, including the American Nurses Credentialing Center, the American Association of Critical Care Nurses for exceptional patient care, the U.S. Department of Health & Human Services for successful outcomes with kidney transplants.

But one insider very close to the situation was skeptical:

There are intangible aspects to the US News rankings and reputation and good public relations are certainly considered. Norton’s executives are experts at positioning themselves for awards and one can be sure they at least suspected Kosair wouldn’t hit the charts this year. I mean these guys are pros.

At this juncture, Norton is indeed focused on other things besides magazine lists, embroiled in a three-way dispute with U of L and Kosair Charities, with the downtown Kosair Children’s Hospital the common element.

Last August, University of Louisville fought back after Norton executives reached out to the University of Kentucky, discussing how the state’s only two children’s hospitals could collaborate going forward. Physicians from both U of L’s Department of Pediatrics and Norton’s pediatric practices are on staff at the downtown Kosair Children’s Hospital.

Norton attributed the UK move to U of L’s deal with Denver-based Catholic Health Initiatives, which Norton says threatened its control of Kosair Children’s Hospital.

U of L immediately challenged the talks with UK as a violation of Norton’s agreement with the state to lease the downtown hospital. The lease agreement also requires that the U of L Department of Pediatrics physicians serve as medical staff to the hospital.

There were claims and counter-claims and ultimately, Norton executives responded with a suit to block what they construed as an eviction, a suit that’s now in Franklin Circuit Court.

(This is also an economic-development story. Cincinnati Children’s Hospital Medical Center currently is building a $180 million research tower.)

Then to really muddy the waters, last month Kosair Charites sued the Norton system, charging their Norton counterparts directed millions of dollars from the charity into Norton’s general fund without accounting for how the money – meant solely to aide Kosair pediatric patients – is being spent.

One insider’s take:

I wonder whether the Board members at the university and at Norton are asking the right questions of their leaders. Much of what’s happening tracks back to personal animosity and hubris. For goodness sakes, these are local public institutions all of which are focused on helping children and young people and yet there actions are robbing our kids of a top notch  children’s hospital. If that’s not enough, consider that we are losing economically as parent opt to take their kids to Cincinnati and Indianapolis.

The question becomes, “How much of an impact is the legal wrangling having on Kosair?”

Back in May, Kosair Charities attorney Donald Cox, with Louisville-based firm Lynch, Cox, Gilman and Goodman, said in a press conference the funding dispute has not impinged on the quality of care, but has kept Kosair from advancing into the top ranks of national pediatric facilities: “We want to see Kosair become a top-ranked children’s hospital.”

This is a story you won’t be reading much about in the conventional media because journalists need a binary narrative – the Good Guys and The Bad Guys. The White Hats, and the Black Hats.

More and more, the health care world is like Antonioni movie. Players make decisions that lead to their getting caught up in circumstances beyond their control, which is the crux of existentialism, after all.

The questions about Kosair are out there, and unanswered. How long will it take the courts to unravel disputes that are largely the result of years of personal and institutional rivalry? Will U of L ultimately emerge victorious at the downtown Kosair Children’s Hospital? Will U of L replace Norton as Kosair Charities’ main partner? What will happen to the Kosair Children’s Hospital Medical Associates in Brownsboro Crossing?

There are, of course, two sides to every story.

In a private Vimeo video released last week, Dr. Gerald Rabalais, chairman of U of L’s Department of Pediatrics, discussed on June 13 the state of his department. In his hour-long talk, Rabalais does what he terms a “SWOT analysis” of strengths, weaknesses, opportunities and threats.

IL will follow up with Rabalais’ observations in a separate post.