Surprise Full UofL Board Meeting Today.

With 24 hours of notice, a meeting of the full newly appointed University of Louisville board of Trustees will be held. A main item on the limited agenda is approval of a budget for the current academic year. It contains the controversial 5% tuition increase and at least one other mandatory fee increase directly affecting students. I suspect that President Ramsey and /or his aids felt great pressure to approve a budget before the judicial hearing today in Frankfort following which the very legitimacy of the Board may be prolonged for some time more.

It is difficult to believe there has not been much discussion among Board members and the administration ahead of this meeting out of public view. I wonder how that could have been done without triggering open meeting requirements? The fiasco of the first meeting of this Board over apparent violation of open meeting law sharpens the focus on how the University and its Board of Trustees conducts their business. If the matter today is handled in a rubber-stamp manner we will be able to see the future. No human being can grasp the UofL budget in a single week! Continue reading “Surprise Full UofL Board Meeting Today.”

First Meeting of UofL Board. Fresh Start or Not?

Old habits die hard.bevin-bridgemen-07132016

For those hoping for a “fresh start” at the University of Louisville, last Wednesday’s Board of Trustees meeting must have been more than a little disappointing. Earlier in the day, the Attorney General requested that the Board take no actions with long-term consequences until the matter of the legality of its appointment process is adjudicated by the courts. The day before the meeting, one of the newly appointed trustees resigned, presumably because his public statements about science, religion, and minorities generated too much public opposition – in my opinion a failure of the vetting process. He was replaced by another nominee from the list of 30 generated by the Governor’s Postsecondary Education Nominating Committee who also happens to be a partner in the law firm that handles the bulk of the University’s outsourced legal work. The replacement trustee is a well-respected and competent individual, and there is absolutely nothing wrong with attorneys serving on nonprofit boards. However, if I were an attorney seeking some of the University’s business, or a party in opposition to the University in some litigation, I would see such an appointment as more of the inside baseball that is often attributed to UofL. Continue reading “First Meeting of UofL Board. Fresh Start or Not?”

President Ramsey Leaves Board Meeting Abruptly and Did Not Return.

Ibevin-ramsey07132016n what began as a routine initial Board of Trustee meeting in which Governor Bevin began in person with an expression of gratitude to the new members has progressed in a dramatic way.  In the middle of the Executive session in which personnel  matters were discussed, President Ramsey was quickly accompanied out without allowing opportunity for questions.  His spokesperson told the assembled reporters that Dr. Ramsey would not be returning to the meeting and would have no comment.

When the Executive session was over, the rest of us reentered the meeting room to a panel of very sober/glum/subdued faces. New Chairman Pro Tem Bridgeman reported that personnel and litigation had been discussed but that no decisions were made and that there was nothing to report. The meeting was concluded quickly thereafter. Continue reading “President Ramsey Leaves Board Meeting Abruptly and Did Not Return.”

Indigent Hospital Care in Louisville at a Crossroads.

Both state and city contributions to the QCCT charity care fund are no longer needed and have now been eliminated.  Will funding be needed again if Medicaid expansion is reversed? If so we need a better way to provide medical services to this population.

Perhaps the most innovative aspect of the 1983 contract under which Humana assumed management of our state-owned University of Louisville teaching hospital was the Quality and Charity Care Trust Agreement (QCCT).  In exchange for a fixed minimum of financial support from the City of Louisville and the State of Kentucky to fund indigent inpatient medical care, Humana promised to provide all necessary indigent care to eligible citizens of Jefferson County and to a limited number of out-of-county individuals.  It appeared to me at the time that the arrangement worked well, but I came to realize that as a consequence, the brand-new University Hospital would be explicitly defined for the community as a trauma center and poor-people’s hospital.  To the extent that University Hospital inherited the mantle of the formerly segregated Louisville General, University Hospital remained the place where people of color, those at the margins of society, or those served in the teaching clinics of the medical school were expected to be cared for. Private patients were admitted elsewhere. The Hospital has yet to shed this unfortunate constraining heritage. I have written a fair amount about this program. Continue reading “Indigent Hospital Care in Louisville at a Crossroads.”

New Board of Trustees at UofL.  A done deal?

Is it legal?  If so, where might it take the University?empty-chairs

Over the past few months The University of Louisville Board of Trustees has gone from 20 members to 20 sidelined members, to 3 “temporary” ones, and just last week to 13 possibly permanent members, 10 of whom were newly appointed by the Governor.  Although the sequence from dismissal to replacement was initiated by means of a questionable claim of illegal racial composition, none of the subsequent changes in Board powers or composition are authorized by existing Kentucky law controlling Board composition.  In its setting of a pending vote by the former Board of no confidence in President James Ramsey, the gutting and replacing of the Board can be reasonably interpreted as a way to protect the presidency of Dr. Ramsey, and to assert absolute control of the Board by the Governor.  I will suggest below that the method used for the recent appointment process and the fruits of its labor both reinforce these limited motivations. In my opinion, the outcome of the appointment process was never in doubt, and an attempt to legitimize the process through the Postsecondary Nominating Committee was a sham. Continue reading “New Board of Trustees at UofL.  A done deal?”

Governor Bevin Launches Appointment Process for New UofL Trustees.

The curtain is rising on who the newest University of Louisville Board of Trustee members will be.  In a barely disguised attempt to legitimize the appointment process, the Governor’s office released a notice of the meeting of his Postsecondary Education Nominating Committee 12 hours before it was scheduled to be held this morning (June 28) in Frankfort. at 10:00 am.  That would give the members of the Committee who live at the far ends of the state barely enough time to make it to Frankfort even if they woke up early to drive.  Of course, some may participate by video link only. The public and press are likely not to have that privilege.

The concept of legitimacy stifles this process like a wet blanket. After declaring the UofL Board of last spring illegal, and demanding it take no significant action (except to grant degrees and raise tuition), the governor reconstructed the Postsecondary Nominating Committee in ways vastly different than demanded by existing law. What is supposed to be a multiply-diverse committee was turned into a white, male, and Republican entity.  I suppose the thinking must have been that two wrongs do make a right.  The whole principle of whether the Governor has an absolute right to do what he wants with existing boards and committees regardless of of existing law is currently in the hands of the Kentucky Supreme Court.  Governor Bevin appears to have chosen not to take a chance that the outcome of this judicial review will be against his plans– possibly following the strategy that it is better to act wrongly and ask for forgiveness later than to ask for permission and be refused. Continue reading “Governor Bevin Launches Appointment Process for New UofL Trustees.”

How Did Prince Get His Opioids?

Outlying prescribers of opioids and their drug-dependent patients are easy to find, but it is the standard of medical care in America that is fueling our current epidemic of opioid abuse, diversion, crime, and overdose deaths. These tragedies will not be solved by education, treatment, and law enforcement alone; nor by any amount of money we throw at the problem. The standard of care itself needs to be reassessed by the medical professions and the number and nature of first opioid exposures much reduced.

Long live the Prince.All-Prescribers-TM-62316
He gave us the gift of his music. Might he give us anything else? Is there anything to be learned from his untimely death? As of this writing, there’s no longer any doubt that he died of opioid narcotic poisoning – more specifically of fentanyl overdose. It has also been reported that his addiction to opioids was long-standing, even as it was well hidden from his public. Current popular accounts attribute his opioid addiction to prescription drugs that were begun to treat unspecified injuries related to his vigorous stage performances– as if this somehow automatically legitimizes the use of opioids for musculoskeletal injury or chronic degenerative disease.  A claim that “I can’t live without my opioids,” is in my experience generally a symptom of the opioid dependance itself, not the underlying disorder for which the drug was begun. That is why we use the term addiction. Of course there is a place in medical care for narcotic opioids, but we have strayed far from that place today.

Fentanyl is the new bad boy.
Many other current reported deaths attributed to opioid overdose involve fentanyl, either by itself, or added to preparations of heroin. There has been no evidence reported that Prince was a heroin-user, although the investigation into the circumstances of his death is not over.  Fentanyl is, milligram per milligram, the most powerful opioid available on the market. It is well known that its potency takes some opioid users by surprise with not-infrequent fatal results. (A weekend full of deaths in a given community is commonly the result of a fentanyl-augmented batch of heroin.) It is not yet publicly known how long Prince might have been taking fentanyl.  Did he come by his fentanyl illegally? Was it provided to him unlawfully by friends or supporters who obtained the drug in otherwise legal ways?   Was the unscheduled landing of Prince’s airplane the day he died the result of a fentanyl surprise, or had he not yet been exposed to the drug. Did he acquire the medical disadvantage of being a “special” patient?  I suspect we will find out.  I also suspect that he acquired his fentanyl the same way innumerable other patients do – from their own local healthcare providers.  Often, but certainly not always, the initial exposure to opioids is done with the best of intentions. In Minnesota, there are a few providers who have written colossal numbers of fentanyl prescriptions.  From publicly available data, it does not appear that the physician whose name has most often been associated with Prince’s death is one of those. Continue reading “How Did Prince Get His Opioids?”

UofL President Ramsey Steps Down– Or Does He?

Is the long nightmare over, or has it just begun?  The blockbuster announcement yesterday by Governor Matt Bevin that University of Louisville President James Ramsey had “resigned” shook the Louisville and Kentucky communities. The issues surrounding beleaguered President Ramsey’s tenure had effectively left the University rudderless.  The possibility of change was received with relief by those wanting it, and surprisingly, accepted in concept by a few Ramsey supporters in the name of a clean sweep that included dismissal of the entire Board of Trustees of the University but which kept the UofL Foundation intact. However, as the executive orders that directed the dismissal of the Board and outlined the planned path forward were released for public examination, to some of us, no resignation was apparent and it appears likely that Dr. Ramsey will remain in place for the forceable future.  Illegal as it certainly is but including a Catch-22 paradox, any efforts to challenge Governor Bevin’s fait accompli may prolong indefinitely Dr. Ramsey’s presidencies of both University and Foundation.  Allow me to explain. Continue reading “UofL President Ramsey Steps Down– Or Does He?”