The Day Editorial: Hospital affiliation, library loans, and indignation

July 6, 2015

The Day

When Bruce Cummings, president and CEO of Lawrence + Memorial Hospital in New London, sat down last week with the editorial board to discuss the pending affiliation between the Yale New Haven Health System and L+M Healthcare, I asked him exactly what will be the nature of the business arrangement.

“Well, it’s not an acquisition,” said Cummings. “And it’s not a merger.”
So what does that leave?

“It’s actually referred to as a sole member substitution,” said he.
Huh?

It appears to be a term of art reserved for a growing number of hospital affiliations. I tracked down the definition in a legal paper written by a couple of experts in the field of hospital affiliations, attorneys Christopher B. Anderson and Fatema F. Zanzi, of the national law firm Drinker Biddle & Reath. The words in parenthesis are mine.

“The parent (Yale) will reserve certain rights over the subsidiary (L+M) as specified in the governing documents of the subsidiary. In a membership substitution model … the target hospital (L+M) … becomes a subsidiary of the health system parent. Both entities will remain separate legal entities with separate governing boards.”

The paper describes it as the model that provides the subsidiary the largest degree of autonomy. The “definitive agreement,” which Cummings said is still under review, will define where L+M’s autonomy ends.

The local community should be encouraged, however, that the two sides are utilizing a model that rejects heavy-handed outside control.

Libraries

In my April 19 column, I wrote about the big hit that libraries stood to take in the budget proposed by Gov. Dannel P. Malloy. In particular, it eliminated support for the Connecticard program. This program allows you to use your local library card to take out books and other items from libraries in other towns.

In terms of the $20 billion annual state budget, this program provides much bang for relatively few bucks. Last year, according to the Connecticut State Library, towns loaned out 4.5 million items under the program. As an incentive for libraries to participate, a library that loans out material to someone from another community receives a 22-cent transaction fee from the state.

Without that state subsidy, many libraries would likely stop participating. Beholden to the taxpayers or, in the case of private nonprofit libraries, donors, library boards would find it hard to justify lending out material to people who contribute nothing to operational costs. The program turns large libraries in towns with strong tax bases — such as Groton and Waterford — into regional libraries.

The adopted budget provides $900,000 for the program, a $100,000 reduction. The state spent $950,000 to subsidize the program last year.

The bottom line, it will survive, which is a good thing.

Also slated for elimination by Malloy was the $332,000 the state spends to provide administrative support for the Connecticut Library Consortium. Formed in 2003, the quasi-public CLC coordinates bulk purchasing of library books and other products, such as research databases and equipment. The Connecticut Library Association estimates the program is saving libraries about $7 million annually, not a bad return on the $332,000 investment. The legislature cut the funding to $185,844.

Last rites

In one of the more nasty cuts, the Democratic majority trimmed the allocation provided to poor families to dispose of their indigent dead from $1,800 to $1,400. The move saves $800,000 annually. That led to these comments from Republican Minority Leader Len Fasano of North Haven, speaking on the Senate floor.

“We give a million-point-five (dollars in) raises in the executive branch, but we can’t find $800,000 for these people to bury members of their families? The poorest of the poor, the ones who need the most help. And we’d rather give people making six-figures in this building more money than … to give $800,000 so people can be buried with some dignity,” said Fasano.

His indignation is justified.