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?

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?”

Issues of Quality and Safety at University and Other Hospitals.

Is Rome Burning While Nero Fiddles?

Screen Shot 2016-06-07 at 10.24.46 PMKentucky’s Hospitals have not done well in the past on national Hospital Rankings including the Leapfrog Hospital Safety Score.  Things seem to be getting worse. In the most recent iteration last month, once again Kentucky had fewer ‘A’-rated hospitals than the national median and more hospitals rated near the bottom with increasing numbers of ‘D’s.  More troublesome is the observation that 5 of the 6 hospitals receiving a ‘D’ are in the same hospital system. Three of these are in Louisville including two of our major teaching hospitals. Continue reading “Issues of Quality and Safety at University and Other Hospitals.”

More Fireworks Over Executive Salaries at UofL.

The matter of compensation to UofL President James Ramsey that tipped public opinion of the University in a more critical direction is back in the news.  Both Chris Otts of WDRB and Andrew Wolfson of the Courier-Journal reported yesterday on the release by the University of Louisville Foundation of its Form 990 Federal Tax Return for 2014.  The University knew it would not be pretty and began to prepare the way with letters to supporters and posts to various social media.  Pretty it was not– except for Dr. Ramsey and his senior supportive staff.  Numbers taken directly from the compensation pages of the return listed President Ramsey’s salary from the Foundation alone as $2,428,886 with additional benefits of $362,500.  His compensation included tax “gross-ups” to make up for any personal income tax he would have to pay.  A great deal if you can get it, but not offered to most faculty or staff!

Even before the ink hit the page, Foundation Chairman and former UofL Trustee Chairman Robert Hughes broadcast an email to the UofL world at large highly critical of Mr. Otts.  He accused Mr. Otts him of missing the point, vastly overstating Dr. Ramsey’s salary, having an agenda, and misleading the public with fairy tales.  (I am accused of much of the same by the University’s internet trolls.) In my experience,  Mr. Otts and Mr. Wolfson are both knowledgeable and careful reporters.  If they have an agenda, it is in providing accurate and relevant information to their public. Continue reading “More Fireworks Over Executive Salaries at UofL.”

No Progress in Reconstituting Functioning UofL Board of Trustees.

I was traveling out of the country the first part of this month.  When I returned, I expected, or more perhaps accurately hoped that some progress has been made in restoring the governance and oversight responsibilities of the University of Louisville Board of Trustees.  Unfortunately, last week the Board was forced to meet once again for “informational” purposes only.  Alas, as far as I am able to determine, nothing has come out of the Governor’s Office or the newly constituted Governor’s Postsecondary Education Nominating Committee indicating an intention to resolve in a timely manner the deadlock that has placed the Board in limbo.  I can find no required public notice that a meeting of the Nominating Committee has been scheduled.  An email inquiry yesterday morning to the Governor’s office has not been answered, nor was a phone message earlier in the month requesting notice of a date.

Based on what I have observed, I must assume Governor Bevin’s higher priority is to protect an embattled and increasingly desperate-appearing President James Ramsey.  By delaying the appointment of an African-American trustee further, Governor Bevin will have an opportunity to appoint a larger and controlling block of additional trustees as existing terms of office expire thus effecting political capture and control of the University.  Surely such a potential goal must not be perceived as delaying the resolution of a matter of social justice which is in my opinion now being used as an excuse to sideline the current Board of Trustees.  In my 36 years at the University, now is the worst possible time to allow the University to flap ineffectively in the breeze. Continue reading “No Progress in Reconstituting Functioning UofL Board of Trustees.”

Update On The Rising Prices of Insulin Between 2013 and 2016.

Earlier this month I published a survey of the cost of insulin to the Medicaid and Medicare programs of Kentucky and the nation.  Fully 9.1% of the total cost of Kentucky’s outpatient Medicaid drug program went to pay for the several brands of Insulin still available. It was obvious that some brands cost a lot more per prescription or claim than others and that the most expensive brands were prescribed most often!  I used this critically important drug as an example of how the market for prescription drugs in America is badly broken.  Since then I stumbled on two additional federal databases that provide additional insight into how much these drugs cost at the local pharmacy counter where the rubber hits the road. These are federal surveys that determine the National Average Retail Prices paid by the consumer (NARP), and the National Average Drug Acquisition Cost (NADAC) for the pharmacy.  Both these programs provide data at the cost per milliliter level, and otherwise facilitate apple-to-apple comparisons of the different brands.  In brief, the additional data confirm that in 2013, for the same size bottle, the newer insulin analogs cost 71% more than the older “human” insulins.  By 2015, all prices had increased; some substantially.  Valuable information about the retail prices of drugs is being kept from public inspection. Continue reading “Update On The Rising Prices of Insulin Between 2013 and 2016.”

UofL Board of Trustees Deemed Powerless, Left Hanging by Governor.

The process of replacing a trustee who resigned to allow appointment of an additional racial minority to the Board of Trustees of the University of Louisville and replace a number of trustees whose regular terms in office are expiring is invalid on its face for exactly the same reasons that the UofL Board was neutered.  Governor Bevin has not filled the open position with a minority candidate.  Although my reading of the statute that controls gubernatorial appointments to our state Universities allows a Governor to fill unexpected vacancies without having to wait for nominees from the Governor’s Postsecondary Nominating Committee (Nominating Committee), the Governor has not explored that route but neither has he called for a meeting of the Nominating Committee to present him with names.  A sceptic like myself might wonder if he was stalling to further protect his coreligionist, embattled UofL President James Ramsey.  After all, it was by declaring the Board of Trustees was illegally constituted that Governor Bevin derailed an earlier attempted vote of no-confidence in Dr. Ramsey by the Board.  By failing to appoint a replacement trustee and failing to involve the Nominating Committee, the Governor now finds himself in the happy place of being able to replace or reappoint five of the seven-member Nominating Committee itself, thus shaping it to his own policy and preference. Continue reading “UofL Board of Trustees Deemed Powerless, Left Hanging by Governor.”