•Only Nominally Over Executive Compensation.
•Trustee requests for information and oversight rebuffed.
•Audit called for.
Readers will note that I have not posted anything for over a month. In truth, I was in Europe for three weeks and am just now getting over a jet-lagged recovery. This was to be an “unplugged” holiday. My long-suffering wife likes to tell the story of how I once almost missed our connection in the Amsterdam Airport waiting to upload a post over the free McDonald’s internet connection. She has other stories too! Indeed, I admit to occasionally feeling guilty of insufficient spousal attention during our travels in these hyper-connected times.
Always something to write about.
I did cheat on this good woman a little by occasionally peeking at the news. It is not that there was nothing I like to write about! Several updates of existing hospital quality, safety, and performance ratings were released, as well as a new rating approach by U.S. News & World Report. Flanking these stories were scholarly reports addressing the same issues I have been raising about the reliability and usability of existing rating systems.
There was new data-hacking breach of over a million members at another health insurer. No one should feel safe! Medicare released a massive database of all outpatient drugs prescribed for those with Part-D drug coverage or in Medicare managed-care plans. The data is broken down by individual drug, healthcare provider, and cost and is already generating a flurry of attention. For example, it turns out that many of the top prescribers of specific drugs receive monetary payments from the manufacturer. [Naturally this does not influence their professional judgments!] I started looking at the drug database on the flight home– this wasn’t really cheating– and will have more to say future articles.
New Sunshine Act Data Release.
Entirely by coincidence, the next iteration of the federal database of payments to medical providers by device and drug manufacturers will be released in a month or so and will now list at least some payments to providers for continuing medical education (CME). These latter payments, previously undisclosed, provide a measure of the degree that manufacturers have taken control of what physicians and other providers think and do. If transparency and accountability is the goal of the Open Records Program (a.k.a. Sunshine Act), it was a critical error to have initially allowed payments for CME to remain hidden. The fact that such payments were exempted from disclosure attests to the lobbying power of both drug companies and the academic medical establishment.
UofL against the world (and its own Board?).
There were other items I filed away in my write-about-later folder, but the big-ticket item for Kentucky was the further unfolding, indeed explosion of nagging concerns over University governance and secrecy, fueled by revelations about executive compensation at the University of Louisville, and triggered by a recent call from a University Trustee and others for an external independent audit by Kentucky’s State Auditor of Public Accounts. The news reports of the Trustees’ meeting used words like “angrily,” “testy,” agitated,” “contentious,” “defiant,” and “lashes out” to describe the behavior or UofL President James Ramsey. All of this was in response to quite reasonable requests by responsible board members for information that either they or the public is entitled to. Comments to articles from the public on the three major Louisville markets were solidly against Dr. Ramsey’s positions, except for the reliable fan-boy or contract internet-troll for whom UofL can do no wrong. I found the reports of the apparent melt-down difficult to believe until, on my return, I had a chance to view a video clip of part of the encounter— it was worse than I thought. View it yourself. Was this justified indignity, staged outrage, or a hissy-fit? You be the judge. In any event, it must have been embarrassing for most of the folks present.
Don’t take it personal.
I have tried in my reporting and commentary over the last three years not to get personal. I have concerns, shared by many, about the management and direction of my University. However, I have at least tried not to directly point a finger at any specific person. In his performance at the Trustees’ meeting, President Ramsey portrayed it as very personal, as if any criticism of the University was an “attack on [his] integrity.” Focusing on or attempting to respond to his position deflects attention from the real underlying issues.
No one is saying it is all President Ramsey’s fault. However, it remains demonstrable fact that some things have been very wrong at the University of Louisville and appear to remain so. Readers of these pages will find what I believe are examples. President Ramsey cannot control everything that happens at UofL, but he does have a responsibility that is shared with his Board of Trustees and other administrative leaders. It does not help that every major external audit over the last few years seems to reveal serious problems. The audit of the University’s use of Passport Medicaid monies unearthed activity deemed illegal and senior executives and faculty were demoted or dismissed. Some clinical departments are still reeling from the financial restitution they were forced to make and now depend on loans from the UofL Foundation to stay afloat.
Some are in jail.
A series of embezzlements and other illegal acts demonstrated to all that there were little or no controls in place for financial accountability. One if not more employees went to jail. It did not help when Dr. Ramsey wanted us to disregard complaints about former School of Education Dean Felner as a “load of —-.” He was wrong then– perhaps he is not fully informed now either. I can assert that at least one of his former Vice-Presidents knowingly took actions contrary to state law to boost tuition income. I have already written about my concern over how the University plays fast and loose with Kentucky’s request for proposals and purchasing laws. Chris Otts of WDRB recently raised similar legitimate concerns about deals involving University insiders. How the University does its business is very much the business of its community. The University and its multiple affiliated corporations are not backroom entities for the benefit of a privileged few. In this regard, it doesn’t help that Dr. Ramsey is President of both UofL and the UofL Foundation that awarded him his generous compensation package. Even if permissible, someone should have pointed out that many would have perceived the deal as unseemly and asked for, as many corporations do, outside compensation review.
Just a bad idea, or really bad?
This is more than just an issue of how much University Executives get paid. It is abundantly clear that many University faculty, staff, and members of the community feel that the compensation of Dr. Ramsey and a select few of his associates is impropriate, improper, or immoral. Opinions on that will necessarily vary. However, Mr. Otts has unearthed documents with details about timing, vesting, and transparency that make me uncomfortable about whether forthcoming and proper procedures were followed. At least one trustee is reported to have said that they were not provided with relevant details of the financial transactions. Those with access to all the actual documents (Mr. Edelen?) can sort that out.
I am concerned with something more fundamental. When I was responsible for supervising UofL staff members, I was prohibited by UofL employment policy from supplementing the salaries of those for whom I was responsible. This was a bone of contention at the time, because other employees working side by side in the same department but paid by associated clinical corporate entities had no such proscription. How is it now that some University staff employees may receive substantial salary supplements? Perhaps all is proper, but if I were a UofL Trustee, I would want to know what University Counsel or my Vice-President for Human Resources had to say. (Alas, those individuals left or were fired.) If I were a Trustee, I would want to know how loans made by the UofL Foundation to the University were used, and be reassured that expenditures of all transferred funds complied with state and University regulation and policy. I don’t think this is too much for anyone to ask. I am asking. I would also want to know why a major change in University fundraising was made giving unprecedented diversion of funds and control of expenditure to the Office of the President. Auditor Edelen should ask all these things and more– I again encourage his office to do so.
Malcontents, or heroes?
What bothers me a lot is how those trustees who have been attempting to fulfill their responsibilities are being marginalized or dismissed as dissidents. “Why can’t we just get along?” one longstanding trustee asks in so many words. I and others simply want the Boards of the University and its various affiliates to fulfill their responsibilities to both the University, its students, and its public. They are responsible to us, not to President Ramsey or his lieutenants. I am concerned that the members of the almost too-numerous-to-count UofL affiliated boards rotate from a pool of University-controlled individuals who benefit from their participation, if in no other way than having preferred access and seats to UofL sports events, special lounges, and travel with the teams to post-season events. At least I enjoyed such benefits when I was a board member. I was told not to rock the boat. Some might consider there to be a potential conflict of interest in aligning unconditionally or uncritically with a University President. There– I have said it!
What turned me off the most in reports of the meeting, was a seeming defiant challenge by Dr. Ramsey that the Board can do whatever review it wants if it can “find the votes” to do so. Dr. Ramsey, in my opinion, if you had been doing your job properly, your Board and your community would not be in such an uncomfortable and even untenable situation. Is it at least possible that you are part of the problem? That’s as personal as I am going to get!
Where’s the rest of the beef?
The discussions of executive compensation, governance, and the Foundation were only a part of a long day of meetings. Board members were briefed on the partnership with KentuckyOne Health, the status of University Physicians Inc., the lawsuit against Norton Healthcare, and other matters. Who can provide us with any handouts that were provided or details about the briefings
As always, help me keep the record straight. In a world of secrecy, it is hard to perceive the truth, the whole truth, and nothing but the truth!
Peter Hasselbacher, MD
Emeritus Professor of Medicine, UofL
26 May 2015