Big  Changes Coming For University of Louisville Board of Trustees.

Joe Gerth is reporting several block-buster announcements in today’s  on-line Courier-Journal regarding the UofL Board of Trustees.

  1. Kentucky Attorney General and gubernatorial candidate Jack Conway has apparently announced the opinion of his office that Governor Beshear “broke the law” in not re-appointing an African- American to the UofL Board of Trustees.
  2. Newly appointed Trustee Paul Diaz counts as a “minority,” but that the Board is still unbalanced. The proper standard is not yet announced.
  3. Established Board member Steve Wilson has resigned.
  4. Governor Beshear says he will appoint an African-American to replace Mr. Wilson.

As of this writing, this is still breaking news. I found no confirmation of any of this on the Attorney General’s or Governor’s official websites and I have no independent verification of any of the reported facts.   Indeed, specifics are still changing as of late this afternoon as to what would or should be considered a proper balance of race on the UofL Board – specifically whether a statewide or local standard should be considered.  Nonetheless, the situation presenting itself is one of the two possible solutions to a difficult solution that I proposed earlier this month.

[Addendum 9-30-2015: Several documents and responses became available confirming the above. Links to these are at the end of this article. Based on the relevant statutes, I come to different conclusions than the Attorney General and Governor and will discuss these further in future post.]

There will be much more said about this in coming days by many, but I offer the following comments at this time. Continue reading

Replacement Robley Rex Veterans Hospital– On Track Or Not?

It ain’t over ’til it’s over. (R.I.P. Yogi Berra, 1925-2015)

Earlier this month on September 10. the Robley Rex Veterans Hospital held a “Town Hall” to provide a forum for VA beneficiaries.  I went to see what was being said about the replacement hospital being constructed at the intersection of Route 42/Brownsboro Rd and the Waterson Expressway.  A tag-team of residents in the area have joined forces with University and business advocates who are still lobbying to have the hospital built downtown. These groups have been trying to scuttle the process including using the same strategies employed successfully by River Fields and others to delay and modify the construction of the new East-End bridge across the Ohio River.  For example, the big push now is for a second even more extensive environmental impact study or to try to find a possible burial site somewhere on the property!

The current partnership combines tenacious forces of anywhere-else-but-here with no-where-else-but-here and which have had some limited success.  It doesn’t hurt their efforts that the local Courier-Journal newspaper and city government aligned themselves with the downtown-only forces over 12 years ago when the replacement hospital initiative began.  Lots of free editorial ink has been assured.  As for the Veterans themselves, they have been largely unanimous in expressing their wishes to stay-where-we-are-now, or to go anywhere-except-downtown!  The local and Washington VA authorities are being pushed and pulled in every which way. One can easily feel sorry for them!  I have chronicled the process extensively elsewhere in these pages. Continue reading

Report of UofL Board of Trustee Committee on Governance Released Amidst Confusion.

In December 2014,  with a background of increasing concerns expressed publicly by several University of Louisville Trustees that they were not given the information needed, nor the opportunity to discuss issues central to the Board’s legislatively mandated oversight responsibilities,  a draft proposal was put before the full Board by several of the newly appointed Trustees to reevaluate the how the Board was performing its obligations. The proposal had the following overall goals:

  • Ensure that the board is acting under current national best governance practices in exercising its powers under KRS 164.830.
  • Demonstrate a deep commitment to improving the academic experience and outcome for our students.
  • Foster greater openness, dialogue, discussion, education and accountability with the board to allow us to better assist in exercising our duties.

The remainder of the two-page document offered concerns and suggestions to be considered.  These seemed pretty reasonable to me.  Indeed, one could reasonably ask why such issues should have to be raised in the first place!  Nonetheless, this modest proposal was immediately attacked by old-guard members of the Board who seem to act as President Ramsey’s “best-friends-forever” rather than as trustees with a fiduciary responsibility to the University of Louisville and its public. The questioners were in my opinion essentially told they were insufficiently informed, and had no business meddling with the operations of the University.

New committee appointed.
At the February 2015 meeting when the document was brought before the whole board, and with little or no discussion, Chairman Robert Hughes announced that he would appoint an Ad Hoc Committee on Governance.  I later expressed a concern that while seeming to address the concerns of both trustees and the public, that the move could just as easily be seen as a way to brush those concerns under the rug.  In my opinion that is exactly what has happened.  In fact, the two principle authors of the “Draft Request” also perceived the maneuver in that way and wrote to Chairman Hughes expressing their surprise and disappointment with the handpicked committee and believed the initiative was “misleading to the public and UofL constituencies.” Continue reading

Is Prescribing Of Opioids To Medicare Patients Representative of Opioid Prescribing Generally?

This appears to be the case in Ohio.

Cities and towns in Ohio in which medical professionals write opioid prescriptions to Medicare beneficiaries at the very highest rate per inhabitant are co-located in counties with the highest per-capita consumption of prescription opioids overall and those with problems of prescription drug abuse in general. In Ohio these areas are in southern Ohio and the I-77 corridor in eastern Ohio. These observations link by association the number of prescriptions by providers listed in the Medicare Part-D database, to opioid utilization and abuse in the general population.

The 25 providers who wrote the largest number of opioid prescriptions to Medicare beneficiaries in 2013 practice for the most part in the big cities, especially near Cincinnati. In contrast, Columbus has a surprisingly low opioid prescription rate for Medicare patients– a difference that begs to be understood. Continue reading

Prescription Of Opioid Analgesics In Ohio– More Of The Same.

In one of the news-feeds I receive from various medical organizations was the notice that the parents of a young women in Middletown, Ohio added as the cause of death in their young daughter’s obituary that she died of a heroin overdose.  This heartbreaking disclosure is newsworthy because is is part of a growing movement to bring the curse of opioid addiction further out of the shadows, specifically to emphasize that all communities and all families are vulnerable to this societal and medical problem. One can only imagine the grief of this family and be grateful for their courageous and generous act.  They hope to help prevent other deaths in this way.  As an aside, I am reminded that the Journal of the American Medical Association used to list the cause of death of all physicians who had died. As a boy I used to read these notices every week. Frequent causes were suicide, medical complications of alcoholism– and if my memory serves me– drug overdose.  These problems have not gone away and remain as occupational hazards for physicians. We should be so open today as these parents were as we physicians attempt to heal our brothers and sisters.

The notice stimulated me to look at the pattern of opioid drug prescription to Medicare patients in Ohio to test the hypothesis that prescription drug abuse is the forerunner if not the fellow traveler of heroin and other illegal drug use.  Using the same protocols I describe for Kentucky and Indiana, I extracted from the Medicare Part-D database all Ohio providers who prescribed every listed individual opioid drug to more than 10 patients in the year 2013.  The totals for this subset were 2,362,795 opioid prescriptions costing $66.3 million. That information is further summarized and discussed below.  In summary, based on the size of its population, Middletown was not an obvious hot-spot for opioid prescription but it was the business home to a family practitioner who was the 10th highest prescriber in the state.  Other apparent problem areas did emerge from the data including southern Ohio where the epidemic of prescription drug abuse was recognized early. Continue reading

Another Kentucky Invasive Cardiologist Facing Possible Jail Time.

A reader shared a notice that the Ashland doctor at the center of the angioplasty-abuse scandal at King’s Daughters Hospital was indicted by a federal grand jury for allegations of performing unnecessary cardiac stent procedures and associated billing fraud. If found guilty, he faces up to 15 years of prison and financial restitution and penalties. Dr. Richard E. Paulus allegedly participated in this scheme from at least 2008 when he sold his practice to King’s Daughters Hospital until 2013 when he retired. He preformed more cardiac stent placements than any other physician in Kentucky, and placed his hospital among the highest in the nation for the number of such procedures.

In 2014 King‘s Daughters had settled with the Justice Department for $40.1 million to resolve claims of false billing for medically unnecessary cardiac procedures.  This new criminal indictment of a physician involved represents another dimension of that investigation. Other civil and probably criminal actions are proceeding. Dr. Paulus has not yet had a trial and should be considered innocent until then. In previous federal settlements with the two Kentucky Hospitals accused of false billing for cardiology services, the parties were not required to admit guilt.  What are we to think? How bad is this?  Is it nothing more than reckless billing or perhaps over-aggressive law enforcement? I don’t think so and offer the following thoughts as opinions. Continue reading

Norton vs. UofL Lawsuit on Front Burner Again.

Is accreditation of UofL Medical School hanging on the result?

This case has been slowly grinding through the court system since it was filed in September of 2013.  Although things had been brewing for some time, the trigger event was a letter of agreement between Norton and the University of Kentucky to work more collaboratively at Kosair Children’s Hospital.  An indignant UofL fired off a letter threatening to evict Norton physically from its hospital and retain the hospital’s equipment for itself.  UofL’s self-righteous demand was much discredited when it emerged that the University had earlier promised to turn over its pediatric service to KentuckyOne Health– Norton’s chief downtown rival that badly needs a children’s hospital for its planned statewide system.  Norton responded by filing a lawsuit requesting a judicial determination that UofL had no standing to take over the hospital to use with its new best friends. The festering boil is more than ripe to lance! Continue reading

Highest Prescribers of Opioid Analgesics in Kentucky & Indiana by Specialty.

Is there any rational justification?

This article in a series further examines the prescription of opioid analgesics in Kentucky and Indiana, I identify the individual prescribers in each of some 70 different Medicare-designated specialties in both states who prescribed the highest number of opioid prescriptions. The differences within individual specialties, between specialties, and between the two states are staggering and beggar any obvious explanation. Single or small numbers of prescribers are outliers that shift the averages of their specialties significantly.  Even within their own peer group, some pain-management providers are far-outliers. Some cities seem to have more than their share of highest prescribers. Cancer and designated hospice providers to not appear to be big users of opioids in this data. Much “pain-management” probably occurs within specialties traditionally considered as generalist. Generalist specialties should not be considered differently than pain-management specialties in public health and law enforcement efforts to deal with prescription drug abuse and diversion. Continue reading