And The Beat Goes On

7/28/2016

Once again, for those new to this blog site, at present there are 22 posts on the blog and each has its own set of comments. To read the comments you have to hit the word "Comments" at the beginning or end of the post. Somewhat confusing is that when you bring up the comments for a specific post it eliminates the other posts from the screen. To bring the other posts back up simply go back to the top of the page and click on Blog. Finally, to understand the development of the blog it is best to read it from the bottom post (Dr. Paul Kearney Case) up. One point of note here, to read the earliest posts you have to click on the word "<<Previous" at the very bottom of the posts available.
* Note: To see PDF Documents cited in this post simply click on the underlined segment

Well I have been a bit under the weather and not too diligent about keeping up with this blog. Because the comment section on the previous blog post was getting long I thought it might be a good time for a new post. There are 2 items of news that I thought I would bring up for discussion.

The first item is the most recent article in the Herald Leader that announces: “UK violated open meetings law at trustees dinner, attorney general finds”. Read more here: http://www.kentucky.com/news/local/education/article92139037.html . This article describes the Attorney General’s decision on a complaint brought on by the Herald Leader with respect to its open records request for minutes of a recent Board of Trustees meeting in which a presentation of the Hazard matter was made. We discussed this Hazard matter in the comments section of a previous post, and if you are unaware of this you can read about it in the Herald Leader article entitled: “Amid secrecy, UK pays $5 million to fix billing issues at Hazard clinic” (http://www.kentucky.com/news/local/education/article81581847.html#storylink=cpy ). In their denial of the Herald Leader's open records request, the university lawyers claimed that although this business matter was discussed at this BoT open meeting, no meeting minutes were kept. The Attorney General ruled that in not creating minutes of this meeting UK violated the Open Meetings Act. Then when the Herald leader requested a copy of the Hazard presentation made at this meeting the UK lawyers once again cited the old attorney-client privilege mantra they have perfected, and once again the Attorney General’s office wasn’t buying it, citing legal precedents for why it did not fall under this attorney-client privilege umbrella. So once again UK lawyers are deciding on whether or not to appeal this decision in circuit court. If they do, that would make 3 open records-related Attorney General decisions they are fighting in court. Someone earlier in the comments section questioned why, with a $192,000,000 profit, are they delaying physician raises till September? Well one reason might be because of all these pending legal matters they have chosen to engage in. Legal matters that cumulatively strive to to hide public records from the public. Of course here again is the question of why?

The second item of interest is actually some “perhaps” positive news in this same area. I received information that the university legal office, or at least the university open records custodian, Bill Swinford, has provided the open records requested by Dr. Hatemi that define physician salary and compensations. This as you may remember was an aspect of one of the above Attorney General decisions that the university lawyers decided to fight, claiming that KMSF is not a part of the university and therefore exempt from providing this information. Hopefully this means that the university has changed its stand on this and now are willing to acknowledge that KMSF is a part of the university and subject to public records laws. Because the above Hazard matter is also a KMSF-associated fiasco, it will be interesting to see how they eventually approach this latest Attorney general decision.

21 Comments

Curious George

7/29/2016 12:23:45 pm

So was there anything of great interest in these documents that Hatemi finally got?

Dan Noonan

7/29/2016 12:41:31 pm

Thanks for the comment Curious George. You will have to ask Dr. Hatemi about that. I personally did not see anything that surprised me. We all know that the hospital administrators receive obtuse salaries and bonuses. I have no idea of how these compare to administration salaries and bonuses at other public university hospitals, but I would not be surprised if it was about the same, especially if they have a KMSF like organization (meaning an agency independent of the university whose board is composed of these same administrators) in essence defining raises and bonuses. It is sort of like Congress defining their salary and benefits. Maybe this is part of the reason the hospital administration is fighting so hard to keep KMSF isolated from the university.

JFK

7/29/2016 02:29:12 pm

I am not sure what Hatemi's motivations are with respect to these many public records requests and Attorney General petitions, but one consequence is the increase in pressure to make this public university and hospital more transparent with respect to what they are doing with the public revenue they are producing. In my mind, and I am certain most others, this is a good thing.

7/29/2016 02:35:47 pm

Thanks JFK for your comment. I am in complete agreement. I think transparency is a good and important thing, especially at a publicly funded university and hospital.

Bill

8/3/2016 04:39:49 pm

Hello silence my old friend, I’ve come to talk to you again. Here is a topic that is a bit off the topic but might be worth discussing. It seems pretty clear that the new Dean is trying to establish a strong emphasis in translational research here in the College of Medicine. I can see where this might be a good thing from the perspectives of current NIH funding emphasis and also perhaps a potential vehicle for collaborative research projects, but I can also think of several arguments against it. One big one is that although NIH is currently emphasizing this area of funding, this is a limited pot of money that every university in the country as well as many research institutes are competing for, and NIH itself has an institute dedicated to this area of research. Add to this the biotech and pharmaceutical industries and you are talking about a lot of competition for a limited pot of money. Another consideration is the fickleness of NIH funding emphasis. Who knows how the next political lobbyist dictates might change the funding emphasis at NIH? Then there is the adage of “how do you translate something you do not understand”. As we all well know and understand, almost everything that happens biologically and biochemically in human beings is connect in some way or another, and without a foundation of the basic mechanisms of normal and disease processes, these fishing games for cures are asking for trouble. I think NIH is beginning to understand this and there are movements ongoing to restore funding to basic research, but we will see about that. Well anyway, I just saw that the blog has bogged, so I thought I would throw this topic out there. Any thoughts?

Mole Sauce

8/4/2016 09:33:50 am

UK COM has over 230 basic sciences faculty. There are less than 10 people with both and MD degree and NIH R01 level funding. Part of the Dean's motivation to support research with a clinical or translational component is to try to create a culture that will be supportive of and attractive to physician scientists. Of course basic sciences are important but the basic sciences at UK are weak, bloated with faculty who have been left behind and lacking any intellectual leadership. My understanding is that the Dean favors the academic service line structure that is the way the cancer center is organized and is planning to extend this to other medical/research areas. Of course, this could be a prelude to the nightmare scenario of doing away with the basic sciences departments altogether and then only reappointing faculty who are wanted. I think to some extent the only reason this has not happened to date is that the profits from UKHC have allowed the COM to support a lot of unproductive faculty and nobody had the stomach for the negative press that would come with a big shakeup. But once Karpf is gone and Capilouto gets his hands on the profits there will be much more of a squeeze in the COM as all the money migrates over to pay for the construction. Something will have to give.

8/4/2016 11:09:26 am

Thank you Bill and Mole Sauce for your comments. I agree, this is an interesting challenge for the new Dean. The translational sciences field is a highly competitive one and I have to believe the number of grants being submitted in this area is huge. I kind of like what Dr. Evers is trying to do with the research component of the Cancer Center. Independent research has become a difficult arena to get funded in and perhaps the way to go is through collaborative projects.

I personally think it would be a big mistake to classify basic sciences and the Basic Sciences departments as passé and of little profit to this University. UK is one of the few higher education facilities in the state that offers graduate education and one of only two that I know of that offers a PhD degree. Does everything at the university have to be driven by profitability? Do we not have an obligation as the states flagship university to provide graduate level education in the basic sciences areas? I really do not see the physician scientists filling this void. As has been noted several times on this blog, the medical school education component by itself brings in more than 20 million dollars per year in tuition revenue, and as opposed to grant revenue most of this is pure profit. I think a large number of these so called “unfunded senior investigators” might effectively argue that their teaching and service contributions to the university are as important to the university and the state they serve as those highly funded investigators that no longer have the time to dedicate to these functions. If we are lucky we all get old. Unless we plan on becoming nothing more than an online university we need both experienced and talented educators as well as researchers.

8/4/2016 12:07:30 pm

The new integrated medical school curriculum provides even less teaching opportunities for basic sciences faculty and the NIH's plan to "improve" graduate and post graduate research training is just going to make this experience "more selective" by limiting the number of positions and preventing researchers from supporting trainees directly from their grants. I've already told you that not a penny of the medical school tuition is returned to the COM. The efforts to involve COM faculty in large scale teaching of undergraduates have been a disaster. Do you have any other great ideas?

8/4/2016 02:09:14 pm

Thanks again for your comment Mole Sauce. Unfortunately you still have this propensity to be a dark cloud rather than constructive. Why downplay or interpret every contribution of basic sciences as either trivial, useless or a negative for this university? Again I ask the question, do we not have the obligation to maintain a comprehensive graduate program in this flagship state university?

From your negativity in these areas, I can only conclude that you do little to no teaching, and because you seem to monitor this blog on some religious basis, I can’t see where you have much time to dedicate to research or medical practice either. Hmmm, what does that leave…. oh yeh, administration! That explains a lot.

Why not try for once thinking constructively? Under your way of thinking we should eliminate liberal arts from this state university also. It doesn’t bring in much grant support, and of course teaching is non-profitable and, at least for medical students, unnecessary. Should profit be the most important factor in this nonprofit state institution?

Finally, I disagree with your hypothesis that medical school tuition revenue does not come back to the College. This was and I can only believe still is the foundation of the “Value Based Budget Model” implemented 2 years ago. I have had several long email conversations with the current and former Provosts on this matter. Furthermore, I had to sit through several University Senate and CoM Faculty Council meetings where this model was outlined and its implementation was discussed. Returning teaching revenue to the college producing it was a primary component of this model. This was also the incentive for the push for expansion of undergraduate teaching that you have for some unknown reason categorized as a disaster. So as an administrator, I ask you the question, do you have any “constructive” ideas on how to resolve many of the issues discussed above?

Sriracha Mole Sauce

8/5/2016 05:08:29 am

To be fair and balanced UK hospital did fairly well despite the horrendous Press Ganey scores in the newest rankings...

http://www.kentucky.com/news/local/counties/fayette-county/article93226407.html

8/5/2016 08:53:41 am

Thanks Sriracha Mole Sauce for this comment. This is good PR for UK Hospital. Of course this survey has no relationship to the press Ganey Survey in that it relates to the complexity and quality of care at UK Hospital, whereas the Press Ganey Survey reflects the morale of the physicians, nurses and staff administering this care. In other words, cumulatively these surveys suggest that we have highly talented and professional physicians, nurses and staff who are unhappy with the environment they are currently working in. I totally agree with Phillip Chang's statement:

“This honor belongs to our physicians, nurses and staff. Every day and every night, they go above and beyond to make sure our patients get the best possible care.”

In other words, it is not the buildings that made UK hospital number 1 in quality and complexity of care, but rather the physicians, nurses and staff working in these buildings. In the same vain, it is not the physicians, nurses and staff that gave UK hospital the worst ranking in physician engagement and satisfaction, but rather the administrative body overseeing these physicians, nurses and staff. I guess my greatest concern is that the administrators might interpret this to mean there exists an inverse relationship between how they treat their physicians, nurses and staff and the quality of care at UK Hospital.

8/7/2016 06:17:30 am

I disagree. The press ganey scores have a relationship to the quality of care. Research shows there is a relationship between the press ganey scores and quality...

"Highly engaged employees and physicians lead to improved teamwork, coordination of care and outcomes—essential ingredients for success in every pay-for-performance program.

Focusing on employee and physician engagement can help your organization boost patient experience of care ratings, improve quality of care and optimize value-based payments."

http://www.pressganey.com/resources/white-papers/online-physician-reviews-for-improving-care-and-reducing

There are many more links and PowerPoints on the internet discussing this issue.

But I do agree with you that the living beings inside the walls of UKMC are truly some incredible people doing incredible work if that despite scoring at the 1st percentile (messaging absolute last) in the press ganey survey they are providing the quality of care shown in the US News rankings.

In other words they have done this DESPITE the horrendous culture created by the current admin. Just imagine where they could go and do if they had a positive, supportive, and transparent admin culture?

8/7/2016 09:02:29 am

Thanks again Sriracha Mole Sauce for this comment. I see the point you and they are making, that being the Press Ganey Survey can be predictive of quality of care. One might expect that engaged and happy physicians, nurses and staff would correlate with quality of care. Interestingly, that appears not to be the case at our hospital. Like I noted above, I hope our administrators don't misinterpret this anomaly, or blow off the Press Ganey survey results because of it.

Truth

8/9/2016 01:11:54 pm

Those rankings are BS. Sadly, for all humanity, people do believe in them. Apparently UK has done a better job of checking boxes. The idiots making those rankings give greater weight to academic centers thinking they are on the cutting edge. Incredibly off based. Having an intern take out your gallbladder. Really advanced.

8/8/2016 12:58:55 pm

Well I see we have made the news again. Another violation of the open records laws. http://www.kentucky.com/news/local/education/article94361187.html

Interestingly this was not about the hospital and not an open records request from Hatemi, but rather the UK student editor of the student newspaper requesting documents regarding a UK professor accused of sexual harassment by a student. According to the article:

"UK officials said they are reviewing the decision and had not yet decided if they will appeal. UK has lost at least five recent decisions on open records and open meeting laws, and is currently appealing two of them in Fayette Circuit Court."

What UK really needs now is a new General Council. It is clear that Instructor/Professor Thro has alienated the Attorney General's Office to the point to where it has become almost combative. The bottom line being it is costing the university time, money and credibility.

Spoon Snake

8/8/2016 02:58:48 pm

You would think that with all of the money they are spending on defending these cases they could come up with a better argument than the old classic bait and switch:
We can all agree that medical records should be private, educational records should be private, victims of violence are entitled to confidentiality (although goodness knows why this was picked as an example) client attorney discussions should be private.. but there is no mention at all of the substance of these cases which is the business operations of UKHC and KMSF.

What a load of bullshit.

Campus Community,

Our University has been involved in a series of legal actions regarding open records and meetings. When we make decisions about what records we share with the public, we are guided by the values we cherish, acknowledging that sometimes the values of safeguarding the privacy of members of our community and the need for transparency in the operations of public entities such as ours can be in tension with one another. When the media or private citizens request information and we decline to provide it, they can appeal to the state Office of the Attorney General.

Against that backdrop, we will be providing the following statement to the media and others who are interested in these issues and the university’s basis for our legal position:

Statement on appeal of recent Office of the Attorney General opinions

In the coming weeks, we will be appealing a number of opinions from the Office of the Kentucky Attorney General regarding questions about open records and meetings. In the issues before the Office of the Attorney General, and now the courts, the responsibility to share information is at odds with another sacred responsibility: protecting the privacy of our students, faculty, staff and those for whom we provide care. And in these moments of conflict, we believe strongly in the need to protect the privacy of members of our community: our students, patients, faculty, and staff.

We respect the role the Office of the Attorney General plays in ensuring the people of Kentucky have access in an open and transparent fashion to the actions of public agencies, including universities. And we respect the role the media and private citizens play in ensuring transparency and accountability.

As the university for Kentucky, a foundational value must always be the free, open and vigorous exchange of ideas. It is the bedrock of a university where people learn and discover each day and the values of academic freedom and creative scholarship flourish.

As the state’s largest university and its flagship, land-grant institution, we received about 800 open records requests last year alone, likely more than any single institution in the Commonwealth. And we fully and quickly complied with more than 90 percent of them.

But in a handful of very specific cases, we are faced with the decision of whether transparency is more important than the need to protect the privacy and dignity of individual members of our community. It is not. For example, we will never disclose the name of a victim of violence who comes forward to reveal a traumatic experience with an expectation of confidentiality. This protection is essential not only to the well-being of a particular victim, but also goes to the confidence other victims will have that they, too, can come forward, in safety and confidentially, so that we can investigate allegations of wrong-doing and enforce appropriate disciplinary action against perpetrators. It also goes to protecting the identities of those accused of wrong-doing.

In addition, we will not provide information about the course of treatment for a dire disease that a patient receives from one of our providers. And we will not grant access to private and preliminary information – whether it involves a grade point average or a disciplinary file -- concerning our students, faculty and staff. Moreover, we will not reveal the confidential communications with our attorneys – a privilege we all expect and share.

We believe the confidential nature of each of these instances is protected by both federal and state law. Protecting and preserving that confidentiality is fundamental to ensuring Kentucky’s flagship and land-grant research university effectively operates at all levels – from a first-year teaching assistant to the Board of Trustees. The Office of the Attorney General, in a number of recent opinions, disagrees with our stance as do media that are exercising their duty to pursue information.

That is why it is appropriate – and our responsibility – to now pursue a resolution to these respectful differences of opinion in a court of law.

Thank you for what you do to make these values real and tangible for all of us who call this special place home.

Eli Capilouto
President
University of Kentucky

8/8/2016 04:02:07 pm

Thanks JFK for your comment and information. Just so everyone who is not a part of UK is aware, President Capilouto has issued a response to this:

Campus Community,

Our University has been involved in a series of legal actions regarding open records and meetings. When we make decisions about what records we share with the public, we are guided by the values we cherish, acknowledging that sometimes the values of safeguarding the privacy of members of our community and the need for transparency in the operations of public entities such as ours can be in tension with one another. When the media or private citizens request information and we decline to provide it, they can appeal to the state Office of the Attorney General.

Against that backdrop, we will be providing the following statement to the media and others who are interested in these issues and the university’s basis for our legal position:

Statement on appeal of recent Office of the Attorney General opinions

In the coming weeks, we will be appealing a number of opinions from the Office of the Kentucky Attorney General regarding questions about open records and meetings. In the issues before the Office of the Attorney General, and now the courts, the responsibility to share information is at odds with another sacred responsibility: protecting the privacy of our students, faculty, staff and those for whom we provide care. And in these moments of conflict, we believe strongly in the need to protect the privacy of members of our community: our students, patients, faculty, and staff.

We respect the role the Office of the Attorney General plays in ensuring the people of Kentucky have access in an open and transparent fashion to the actions of public agencies, including universities. And we respect the role the media and private citizens play in ensuring transparency and accountability.

As the university for Kentucky, a foundational value must always be the free, open and vigorous exchange of ideas. It is the bedrock of a university where people learn and discover each day and the values of academic freedom and creative scholarship flourish.

As the state’s largest university and its flagship, land-grant institution, we received about 800 open records requests last year alone, likely more than any single institution in the Commonwealth. And we fully and quickly complied with more than 90 percent of them.

But in a handful of very specific cases, we are faced with the decision of whether transparency is more important than the need to protect the privacy and dignity of individual members of our community. It is not. For example, we will never disclose the name of a victim of violence who comes forward to reveal a traumatic experience with an expectation of confidentiality. This protection is essential not only to the well-being of a particular victim, but also goes to the confidence other victims will have that they, too, can come forward, in safety and confidentially, so that we can investigate allegations of wrong-doing and enforce appropriate disciplinary action against perpetrators. It also goes to protecting the identities of those accused of wrong-doing.

In addition, we will not provide information about the course of treatment for a dire disease that a patient receives from one of our providers. And we will not grant access to private and preliminary information – whether it involves a grade point average or a disciplinary file -- concerning our students, faculty and staff. Moreover, we will not reveal the confidential communications with our attorneys – a privilege we all expect and share.

We believe the confidential nature of each of these instances is protected by both federal and state law. Protecting and preserving that confidentiality is fundamental to ensuring Kentucky’s flagship and land-grant research university effectively operates at all levels – from a first-year teaching assistant to the Board of Trustees. The Office of the Attorney General, in a number of recent opinions, disagrees with our stance as do media that are exercising their duty to pursue information.

That is why it is appropriate – and our responsibility – to now pursue a resolution to these respectful differences of opinion in a court of law.

Thank you for what you do to make these values real and tangible for all of us who call this special place home.

Eli Capilouto
President
University of Kentucky

It will be interesting to see what they will do if the courts decide in favor of the Attorney General's office. I can fully appreciate protecting patient information confidentiality, but I am still trying to figure out what in the KMSF open records requests that they are currently fighting in court falls under the noble criteria President Capilouto discusses in his above letter of justification?

8/8/2016 05:34:47 pm

Ooops Spoon Snake, I posted before I checked the comments ledger. Thanks for the comment. I obviously tend to agree with you on this. This attempt to classify every open records case they have refused and are litigating as directly related to some "invasion of personal privacy issue" is a bit hard to swallow. It clearly appears to be a case where president Capilouto is trying to do damage control by claiming that 'we are doing the noble and honorable thing while the attorney general is trying to invade your privacy.' I'm not buying into it and I hope the courts don't also.

8/13/2016 06:25:39 am

Congratulations to Stephanie and Paul!!!! Much happiness to both of you.

This is clearly one thing the UK BoT, President Capilouto, professor/adjunct instructor Thro, Michael Karpf, Michael Karpf's sanctioning committee, and Jay Zwischenberger can't take away from Dr. Paul Kearney.

Cherry mole sauce

8/13/2016 07:36:51 pm

Looks like it's time for a completely new post topic. I think this deserves a refresh...

http://www.kentucky.com/opinion/editorials/article95386857.html

8/14/2016 10:28:20 am

The editorial just expands on the point I made above that the arguments presented by Capilouto (but presumably come from UK's in house and hired legal team) are weak and irrelevant. Is this really the best they can come up with?

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