The Jefferson City group created last month in opposition to MU Health Care's proposed purchase of St. Mary's Hospital said it is encouraging Mid-Missouri residents to contact lawmakers and share concerns about the proposition.
"A Coalition for Choice" was created "to oppose health care monopolies and to advocate for consumer choice in Missouri health care," it said in full-page ads in the News Tribune and other area publications.
Hal Gibbs II, a board member and general counsel for the organization, and its spokeswoman, Connie Farrow, met with reporters at the newspaper's office late last week to share their concerns about the proposed sale.
The coalition was formed after MU Health announced in August it intended to purchase SSM Health's Mid-Missouri assets, including St. Mary's Hospital in Jefferson City and the former Audrain Medical Center in Mexico.
No details, other than that the hospitals are negotiating the purchase, have been announced.
The group, whose other two board members are Gibbs' father, Hal Gibbs, and retired local contractor Ken Otke, said the effort is for the betterment of the community.
"I'm very concerned about St. Mary's Hospital," Otke said. "It's been my hospital for many, many years."
Otke's entire family (including six siblings) was born there, he said.
When he read MU Health was considering buying the hospital, Otke wrote letters to the head of SSM Health, Gov. Mike Parson and Lt. Gov. Mike Kehoe, beseeching each to find a way to keep two hospitals operating in Jefferson City.
"It boils down to - we need two hospitals," Otke said.
Area residents have expressed concerns about A Coalition for Choice being a 501(c)(4) organization, because that status allows it to conceal who its members are.
Gibbs II defended why the organization chose to seek that status when it organized.
With the possible merger involving two local hospitals, organizers thought "it would be much more accessible for people to participate" in the process of opposing the purchase, he said, so long as they didn't have to put their names forward.
"This is not the type of dark money entity that you see in state elections, where you see that hundreds of thousands of dollars are being poured in," Gibbs II said. "This is grass roots, where you have individuals whose families have had children born at St. Mary's for generations."
They want to help in the effort - and this allows them to do so without being uncomfortable, Gibbs II explained, saying reports of major investors already having contributed to the organization are exaggerated.
However, he added, several people have pledged to contribute as much as $100,000 each.
"(Jefferson City Medical Group) will be participating in its own way indirectly, however they choose," Gibbs II said.
On Friday evening, JCMG told the News Tribune it is "committed to St. Mary's hospital staying open. The physicians of Jefferson City Medical Group have poured blood, sweat, tears, and financial support into St. Mary's hospital over the past several decades.
"St. Mary's is a pillar of Jefferson City, and JCMG stands firm - this community needs the St. Mary's facility."
JCMG's statement noted a number of connections between the doctor-owned medical consortium and St. Mary's Hospital operations, including:
- JCMG physicians generate "the overwhelming majority of St. Mary's hospital admissions."
- JCMG's surgeons "have operated on thousands of patients in St. Mary's operating rooms."
- JCMG's obstetricians "have delivered thousands of babies in St. Mary's labor and delivery" facilities.
- JCMG, as a company, made a $750,000 donation to St. Mary's Foundation.
- A JCMG doctor hand-carved the door of the St. Mary's chapel.
The JCMG statement also said that "keeping health care cost-effective for the Mid-Missouri community is a pillar of JCMG's mission. To that end, JCMG opposes a scenario in which MU Health operates a single hospital system in Mid-Missouri."
Like the coalition, the JCMG statement also points to what it called "irrefutable" evidence - that "numerous studies prove that in communities where hospital systems consolidate, the cost of health care rises. These increased costs are passed directly on to employers and patients in the community.
"JCMG opposes any legislation that invalidates existing anti-trust laws."
In a news release last week, the coalition said MU Health Care would merge Capital Region Medical Center with St. Mary's if the sale went through.
It has been his experience, Gibbs II said, that the university tells Capital Region Medical Center what to do, but he offered no specific examples.
When the News Tribune last week reached out to Capital Region Medical Center concerning the suggestion it would be involved in a merger, a spokeswoman for the hospital referred reporters to MU Health Care for answers.
Jesslyn Chew, MU Health Care's public relations manager, responded, saying the health provider consistently evaluates all potential opportunities to create a quality, sustainable health care model.
"Our intent is to create an integrated health system in Mid-Missouri," she said. "MU Health Care has had a strong clinical affiliation with Capital Region Medical Center for more than 20 years, and individuals from CRMC have been part of our discussions about the future of health care in Jefferson City."
She added the potential transaction with SSM Health would strengthen MU Health's ability to deliver personalized care that meets local needs.
The coalition said the existing relationship between MU Health and Capital Region is a concern.
"Capital Region is so closely aligned with the university, regardless of what the legal structure is - (that) from a practical standpoint, it is the university," Gibbs II said. "I've been representing physicians for my entire legal practice, which is 31 years.
"This is coming from physicians, not only in Jefferson City, but also in Columbia."
St. Mary's was concerned about its financial viability, Gibbs II said. In February, Brent VanConia, then-president of the hospital, resigned "to pursue other opportunities."
Philip Gustafson was named as interim president.
For the fiscal year ending in 2016, data on focusonhospitals.com show St. Mary's Hospital operated at a $20.9 million loss.
The interim president made "bold strides in stabilizing the hospital," Gibbs II said.
The coalition would like to see another successful health care system get an opportunity to buy the hospital.
Farrow said studies have shown when a hospital holds a monopoly in a community, the community experiences rising costs and decreases in health care results.
There are two things that are causing the group to work urgently.
"The first is that the university is working on its lobbying effort and moving forward. They are lobbying legislators on this issue," she said. "Second, when a monopoly exists in a community, residents lose."
Some of the legislators seeing lobbying efforts may not have even been sworn in, yet.
Rep.-elect Rudy Veit, R-Wardsville, won election to the 59th District seat Nov. 6. He will be sworn in on Jan. 9, the first day of the 2019 General Assembly. But, during freshman orientation for new lawmakers Wednesday, Veit said he and others were made aware of a possible upcoming struggle.
"We're already getting input from the relationship between St. Mary's and MU Health Care," he said. "It's going to be a political issue, sooner or later."
Coalition concerns are that MU Health is trying to "grease the wheels" in case lawmakers will be required to pass legislation approving or clearing the way for the purchase.
The coalition and other critics of the proposed sale say it would violate Missouri's anti-trust law. That law kicks in when "a dominant seller seeks to maintain or increase its market power through anti-competitive tactics that tend to foreclose the market to competitors and are not justified by pro-competitive benefits for consumers," according to the Missouri Attorney General's website.
One violation happens when agreements are made to restrain competition.
"In the case of a merger, a combination that would likely substantially reduce competition in a market would also violate antitrust laws," the website states.
Rep. Jay Barnes, R-Jefferson City, who is an attorney, admitted he had not studied the legal issue.
"It is not clear to me whether the legislature must pass legislation," Barnes told the News Tribune.
However, whether a merger would be good for Mid-Missouri is a little clearer, he said.
"Data from around the country show that regional hospital mergers are bad for consumers - causing price hikes from 11 to 55 percent. It's also unlikely to be a good deal for doctors in the long run," Barnes said. "This should not be surprising; monopoly power affects both consumer prices and wages.
"Rather than two hospital systems competing for patients and doctors, there would just be one - and the only real alternatives would be more than an hour's drive away."
Whether legislative approval would be required for the sale would be determined by a lot of factors that are far down the road, according to Christian Basi, a spokesman for the University of Missouri System.
What may be clearer is any purchase has to be approved by the university's Board of Curators.
MU Health Care is leading the process for a transition, Basi said. So, it will have to make a recommendation to university administrators and curators.
"They will make a recommendation on what the agreement should look like," he said. "As with many other significant decisions with the university, those recommendations are subject to approval with many levels that go up to and include the Board of Curators."
The JCMG statement urged SSM Health's directors to "pause and consider other options before moving forward with a merger that would permanently saddle Mid-Missouri with a government-sponsored hospital monopoly. Initial announcements about the merger led the community to believe that MU Health is St. Mary's last and only hope.
"The community deserves to know that other options exist and must be considered."
Bob Watson of the News Tribune staff contributed information used in this story.