Retchin spoke Monday afternoon during a town-hall meeting at VCU's medical campus that was called to answer questions about the university’s decision not to participate in a proposal assembled by a private consultant for an alliance of local pediatricians who are pushing for the hospital.
Retchin’s and VCU’s decision to reject the proposal was made public Friday in an email sent by the executive committee of PACKids, the alliance of area pediatricians.
“If you take another governing body … then in 15 years, let’s just say funding becomes tight, and the Medicaid funding goes down,” Retchin told an assemblage of about 60 or so pediatric medical-staff members who gathered in a theater-style lecture room at VCU’s Sanger Hall for about an hour of questions and answers. “If you have an independent hospital and your bottom line has to be your bottom line, who’s to say they don’t drop academics?”
Retchin envisioned a future economic scenario in which the children's hospital’s currently stated mission to serve poor and indigent patients might need to be compromised to maintain the bottom line. In contrast, he said, VCU has at its unshakable core a commitment to medical research and training, and to serving an often uninsured and poor clientele: “Our missions don’t mesh.”
Retchin’s explanations were not roundly accepted by the doctors and other medical personnel who attended.
“If you’re rejecting a model that exists in 44 successful [children’s] hospitals, what’s your basis?” one attendee asked. “That doesn’t seem empirical.” He referred to PACKids' cited justification for a Richmond children’s hospital — that Richmond is alone among similarly sized cities in not having such a hospital, and that most operate independently of other hospitals or hospital groups in their areas.
But Retchin defended VCU’s position, saying that because of regulations governing the number of hospital beds in a community, “we were asked to shut down” the recently opened VCU neonatal intensive-care unit under the proposal presented.
“Of the 44 hospitals … show me one where the successful model meant shutting down all other pediatric services in the community,” Retchin said, noting too that nearly all of the top children’s hospitals nationwide were co-located with a teaching hospital like VCU. “The consultant had a very hard time with that.”
He responded to another suggestion that VCU could have negotiated to participate as a sort of third-party provider by saying that a similar proposal from the consultant offered a “thorny” situation, since any such contract would need to be very long term.
Retchin also looked the promised gift horse of a local philanthropist associated with the proposal straight in the mouth: “It is unusual to rely on a single philanthropist for a thing like this,” he said.
That philanthropist, who spoke to Richmond magazine last year, has pledged hundreds of millions of dollars toward the project, which by his own estimate could cost as much as $500 million. That donor, who has spoken with Richmond magazine on the condition that he not be identified by name, has insisted on VCU’s participation as vital to the project’s success but also has stipulated that the consultant’s recommendations should guide all decisions.
Only one person in the crowd voiced support for VCU’s decision to reject the PACKids hospital governance proposal as a disaster averted. But that person also asked Retchin whether nixing the proposal so soon might have eliminated an opportunity for Bon Secours and HCA to express similar concerns and to perhaps force a compromise.
“We’ll never know, I don’t think, with certainty” how Bon Secours and HCA might have responded to the proposal, Retchin said. But he indicated no desire for “playing chicken” in the process of negotiations. “The other two systems by and large don’t have our mission.”
He cited statistics that indicate only a third of the patients at the other two systems are on Medicaid, whereas that statistic “is flipped” at VCU.
He called the decision made by himself and VCU’s board “heart-wrenching.”
Representatives of PACKids also attended the town-hall meeting and spoke up toward the end of Retchin’s question-and-answer session to pledge their commitment to continuing the effort to create an independent children’s hospital in Richmond.
“With all due respect to what you describe, I don’t think it’s quite over yet,” one doctor who identified himself as a PACKids board member told Retchin.
“I can say we will stay in conversations about a children’s hospital and look for ways to make it happen,” he told Richmond magazine. “We never stopped the conversation.”