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Welcome to the latest edition of Investigative Roundup, highlighting some of the best investigative reporting on healthcare each week.

Inside Hahnemann's Demise

Was Hahnemann University Hospital's demise the result of an overconfident CEO, or was it a ploy all along to get at valuable Philadelphia real estate?

explores the question, focusing on the role of Joel Freedman, founder and CEO of private equity firm Paladin Healthcare Capital.

When Paladin bought Hahnemann in early 2018 -- through its subsidiary American Academic Health System -- staff were hopeful: they'd been unhappy with poor management by for-profit parent Tenet Healthcare.

Freedman had managed other hospitals with a substantial low-income population: Howard University Hospital in Washington, D.C., and some smaller hospitals in Los Angeles. Initially, he had proposed well-received reforms, but over time it appeared he'd made some miscalculations about the hospital's finances.

Freedman had expected to rely on a boost from Disproportionate Share payments, but possibly wasn't aware that Pennsylvania had capped these. He also had a revolving door of executive management, with few lasting long enough to make any changes. He folded tertiary care programs, which generated revenues from specialty services, such as heart transplantation.

"If Tenet couldn't get any more juice out of it, there was no more juice left to get," Jill Tillman, a healthcare executive at Drexel, told the New Yorker.

Hahnemann defaulted on one of its key loans in May 2019 and filed for bankruptcy a month later. Its valuable real estate was not part of the bankruptcy, as Freedman had placed it in a separate holding company when it was acquired (though this isn't an unusual move for private equity firms).

Like the pandemic that soon followed, the closure took its heaviest toll on the socioeconomically disadvantaged population it existed to serve.

"What I feel about this whole event is that it's moral injury at a corporate level," said Lia Logio, MD, a former internal medicine physician at the hospital. "Health care is supposed to be about taking care of the patients. Helping people to have long, flourishing lives, with limited illness and limited pain. Somehow, it isn't a priority."

Fauci: Society "Totally Nuts"

There were few surprises in a recently released trove of emails from Anthony Fauci, MD -- he responds at 1:53 a.m., he never directly criticizes Trump -- but the into what life was like for the NIAID director in March and April 2020.

The correspondence during the early months of the pandemic -- all 866 pages of it, obtained by the news outlet via a Freedom of Information Act request -- ranged from light to serious, and showed that Fauci was in high demand. PayPal wanted him to speak to its 23,000 employees. Walt Disney Co. executive chairman Robert Iger was very supportive of a Fauci documentary that's slated to air later this year. An advisor to Bill Gates expressed his concerns about Fauci's health. The medical director of the National Football League Players Association wanted advice on how to open the next season.

Rep. Fred Upton (R-Mich.) asked if anyone taking hydroxychloroquine for lupus had developed COVID-19. Fauci noted that the data weren't in yet, but that it was likely. Upton urged Fauci to "Keep being a science truth teller."

Fauci also maintained ties with George Gao, PhD, head of the Chinese Center for Disease Control and Prevention. When Gao learned Fauci was receiving threats, he wrote to check in. Fauci thanked him and assured him that, "All is well despite some crazy people in this world."

In one email, Fauci got a Google News alert with his name, with an article titled, "Cuomo Crush and Fauci Fever -- Sexualization of These Men Is a Real Thing on the Internet." Fauci forwarded the note, encouraging the redacted recipient to open the link: "It will blow your mind," he wrote. "Our society is really totally nuts."

Law Firm Rallies Anti-Vax Sentiment

One New York law firm is stirring up a substantial amount of attention around challenging vaccine mandates, .

Siri & Glimstad is serving as co-counsel in a vaccine mandate case against the Durham County Sheriff's Office in North Carolina, and has sent warning letters to a nursing home in Wisconsin and to Rutgers and Princeton universities in New Jersey.

One Texas non-profit, the Informed Consent Action Network (ICAN), has previously put out a call for plaintiffs who want to challenge mandates and pledged support to them. The group has connections to Siri & Glimstad; in their 2019 tax filing, the most recent year for which data were available, ICAN paid the firm $1.3 million.

In their letters and challenges, Siri & Glimstad have argued that mandating shots that only have emergency use authorization is illegal and unenforceable, and have also pointed to the Nuremberg Code when making accusations about violating ethics around human experimentation.

The firm, however, wasn't involved in a recent lawsuit by employees against Houston Methodist's vaccine mandate. Its influence also appears to be slowing in that ICAN has said it is no longer seeking plaintiffs, according to the Washington Post. In addition, the Equal Employment Opportunity Commission has said businesses can mandate vaccinations for employees, and both Moderna and Pfizer have submitted applications to the FDA for full approval of their vaccines.

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