Dr. Kearney Blog - Presidential Clarifications

2/25/2016

Once again, for those new to this blog site, at present there are 11 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.

I have to thank the president of our university, Eli Capilouto, for the inspiration of this latest post. To explain, in the comments section of the previous post the conversations migrated to the deteriorating atmosphere in the College of Medicine and the hospital that has precipitated the exodus or soon to be exodus of a number of talented physicians, especially in the trauma division of the Surgery Department. Recent emails and blog conversations suggest this desire to leave has extended to a variety of other departments and divisions in the hospital and even to academic departments. This bothered me enough that I sent an email last week to President Capilouto expressing my concerns, and yesterday I received his response, which I have copied in below:

Dear Mr. Noonan,

Thank you for your communication. Your allegations and speculations are unclear. Please provide details of these to William Thro, the University’s General Counsel who I have copied, by noon on Friday, February 25.

Sincerely,
eli

You see, I opened up this opportunity by mentioning in my email following my discussion of this exodus of talented trauma surgeons, “The bottom line is, it is going to begin costing lives, if it hasn't already”. Therefore, although I have already sent my clarifications to President Capilouto, I thought I would use a blog post to clarify it to the readers of the blog. To do that I have simply pasted in below the “clarifications” I emailed President Capilouto and Mr. Thro.

Dear President Capilouto and Mr. Thro:

Thank you for your reply to my email. As much as you may wish to construe my email as some form of threatening email, it is anything but that. I am sure you fully understand what I am talking about in the email, but to clarify, it is simply an effort to make you aware of the observation (by many throughout the medical center) that the morale of the hospital faculty, physicians and staff is so low that it is impacting both the recruitment and retention of highly talented physicians, faculty and staff. When a hospital loses the services of multiple talented level 1-trauma surgeons in a very short period of time, I cannot see any way this would not impact the quality of services of this unit. If this were podiatry I would say “no sweat”, but when you reduce the quality of care in the treatment of life and death scenarios you shift the balance to the death side of the equation. Thus the very straightforward conclusion that this could be impacting lives. Furthermore, unfortunately this exodus of physicians is not relegated to trauma surgeons, and from the news that I am receiving there are many other quality physicians and even academic scientists looking elsewhere for employment.

It is clear that much of this morale problem in the hospital and College of Medicine emanates from the threatening approach used by the administration and the university lawyers in handling the Dr. Paul Kearney situation. I am not condoning Dr. Kearney’s activities in the treatment of this patient, but it is clear that the disciplinary approach to handling it and the punishment imposed far outweighed the crime. This is strongly suggested by the response to it by the majority of university faculty (who following the indictment elected Dr. Kearney to represent them in the University Senate), the majority of Dr. Kearney’s physician colleagues (who following the indictment elected Dr. Kearney to represent them on the University HeathCare Colleges Council), the majority of medical students (who following the indictment awarded Dr. Kearney a lifetime achievement award), and even the Board of Licensure (who found the cumulative data presented by the university lawyers was insufficient evidence of a violation).

I write you not to cause trouble but to express my concerns and those of many others who have written me or posted anonymously to the blog because they fear retaliation. This Dr. Kearney situation is a festering wound to a College and former faculty colleagues I truly respect and admire. What is developing in the College and hospital is a situation where the people that can leave will and the people that can’t won’t. I really am saddened by that and have to ask, is there really nothing else that “you” could/should be doing to help resolve this.

I hope this clarifies my previous email and thanks again for reading my email. If I can be of any assistance in the matter feel free to contact me.

Respectfully,

Daniel J. Noonan, PhD

12 Comments

Mrs LT

2/25/2016 04:33:05 am

I think Karpf's position is that people can leave if they want and they can be replaced and if anything he has become more firmly committed to this philosophy as he enters the final phase of his career. And on top of that since its not very hard to find a job somewhere that is significantly better than UK its challenging to retain anyone once they have decided to leave. This concept is of course at odds with the institutional strategic plan which emphasizes recruitment and retention of "outstanding faculty". I don't think there is any possibility Capilouto will engage with you or anyone else in an email debate about whats wrong with the academic medical center. But good people leaving and their inability to recruit qualified people into leadership positions is clearly at odds with the strategic plan which has been widely publicized and is presumably something that Capilouto and Tracy will defend. So that might be the tack to take to stimulate some discussion.

P.F. Sloan

2/25/2016 07:41:32 am

Refrain Please:

But you tell me
Over and over and over again my friend
Ah, you don't believe
We're on the eve of destruction

You can never find an emoticon when you need one!

2/25/2016 09:30:27 am

What exactly do you think is going to be destroyed? Everything will just revert back to its natural level of mediocrity.

Dan Noonan

2/25/2016 12:10:57 pm

Thanks again for posting Mrs LT and P.F. Sloan. I likewise am not sure what is left to destroy, but I think I get where you are coming from. Not that it has any relevance to the blog, but I think Barry McGuire who popularized this song during the Vietnam era protests eventually became a born again and began rewording it. Not sure what they were though.

I totally agree Mrs LT, and I suspect that I am wasting my breath, or emails in this case, trying to present to President Capilouto anything other than the hospital administration’s perspective of the current atmosphere in the College and hospital. I do have to say that I at least received a multi-sentence response to this email. Progress of a sort, even if it they were more or less a threat. Likewise, no matter how many hurrah sessions, motivational speeches or parties they throw, I think the morale issues will not begin to improve until Michael Karpf either retires, resigns or is fired. I have to believe that this new Dean is fully aware of the situation, so it will be very interesting to gauge the independence they are willing to give him or he is willing to take from the authoritative controls of Michael Karpf.

2/26/2016 03:08:24 am

Getting rid of Karpf will be messy and nasty. I don't think there is any strategy in place to do this yet. The default option, if Karpf dropped dead today, would be David Moliterno which would be a disaster since he has even less interest in research and academic activities than Karpf. While Karpf is still around its possible that the New Dean can be trained by Karpf to do the job and in that case we might have someone who is a bit more interested and credible when it comes to research and scholarship. Or the President and BOT will have to recruit from the outside to replace Karpf which might be tricky now since most people who do this kind of job either want to be CEO and Dean or would want to hire their own Dean.

However all this plays out, the New Dean was definitely not hired to be a foil to Karpf. He has been given some money to recruit and I think thats going to be his primary role. It will be interesting to see how he handles faculty retention, particularly if he is spending money at the same time to hire faculty who are not obviously better than the people who are leaving.

2/27/2016 01:27:23 am

Well I did hear some promising news tonight. It appears Dr. Andrew Bernard has opted not to at this time take the job up in Cincinnati. This is a very positive thing for the trauma center at UK. With the loss of Dr. Kearney to the Karpf vendetta and the promotion of Dr. Chang to an administrative position, the loss of Dr. Bernard would have significantly reduced the experience and quality of care in the UK trauma center. I feel certain this has very little to do with the great administrative skills of our university president or our EVPHA, but rather Dr. Bernard's dedication to our university. Thank you Dr. Bernard.

2/27/2016 09:42:41 am

Dan, I'm not sure where your deification of the trauma surgery program comes from (or for that matter what qualifies you to make an assessment of the "standard of care" in the unit) but all these people can be feasibly replaced with other people who have the same minimal level of competence. Whats happened here is that someone decided that it would be more costly and inconvenient to let Bernard go than retain him so something will have been done to make it worth his while to stay (ie more money). Its all just business.

2/27/2016 04:22:25 pm

Hi Mrs LT and thanks again for posting. It does sort of sound like I am placing trauma on a pedestal, doesn’t it. In reality it is anything but that. I view trauma when Kearney was there as being good. I had a close up of this when my graduate student was in a serious car accident (see blog post 5, My Dr. Kearney story). When they drove Dr. Kearney out I saw it as a big loss, but should the trauma center shortly after this further lose its two most experienced trauma surgeons in Andrew Bernard and Phillip Chang, I think it is safe to say the quality of care in this trauma center is going to suffer. Like I mentioned to Capilouto, if it was happening in podiatry, no big deal, but trauma really benefits from experience and this is a lot of experience leaving at one time.

With respect to replacing these people, I know for a fact that this is currently an ongoing priority, but as you know, these things take a considerable amount of time, and the current atmosphere in the college and hospital isn’t helping this any.

With regards to my qualifications to make such an assessment, beyond the blog post 5 cited above, I am feeding off of information provided by multiple personal acquaintances that either work or have worked in this trauma center, as well as multiple people who have emailed about this situation.

But qualifications or no qualifications and knowledge of trauma or no knowledge of trauma, I still believe Dr. Bernard staying is something good for the trauma center. Like you, I suspect he didn’t do it for free, but buying its way out of trouble has sort of become a tradition at the university, especially in the hospital.

2/27/2016 05:32:40 pm

Geeze, I hope he settled for something more than basketball season tickets.

2/28/2016 05:13:42 am

The issue with the Trauma Surgery is that its a prime example of the "complex care" mantra that UKHealthcare has been pushing to distinguish itself from the higher volume less complex providers, like Baptist for example. So keeping it going, like the Heart Transplant program has value beyond whatever these programs generate in revenue. Thats probably a large part of the motivation for whatever retention arrangements were made for Bernard.

Of course, this contrasts dramatically with the unwillingness to spend money on recruiting research leaders like department chairs or retaining excellent faculty researchers when they decide to leave.

John #2

3/6/2016 07:01:59 pm

The complex care mantra is crap, or course. It's only complex in that there are layers upon layers of students, residents, fellows, attendings and other care providers struggling to provide coordinated care. It's a no brainer marketing push by Karpf. I wonder in how many meetings he's explained that if you market complexed care then people assume you can do the bread and butter stuff better than everyone. UKHealthcare is behind in so many areas as compared to other Lexington hospitals. They just have a large marketing budget to tell you otherwise. I'm sure Karpf believes his recipe for success is...1) build a big shiny new building, 2) seek every accreditation possible, 3) obtain a handful of surgeon with unique skill, 4) market the hell out of 1,2 and 3. Sadly, none of these mean practicing good medicine and taking good care of the people of Kentucky. Even sadder, it's all incredibly expensive and our state will be paying for it for generations.

3/7/2016 10:18:58 am

Thanks for the posts BJ, Mrs LT and John 2. I’ve been away for a while and see it has been pretty quiet on the western front. Not being a physician, this complex care issue is clearly out of my expertise. I do tend to believe that the administration places much more value in buildings than those that occupy them, and in their avarice to finish these buildings they are pushing quantity of care, which often impacts quality of care. But here again, I am only speaking from the cheap seats, that being what I hear on the blog and what I saw in the budget meetings and the Faculty Council. What might be nice would be to hear from yourselves, or any other university physician monitoring the blog, your suggestions for what you think needs to be or should be happening in the hospital to address quality of care issues, morale issues and administration issues. You know, sort of ‘if I were running this place’ scenario. Who knows, maybe the new COM Dean or unbelievably Dr. Capilouto may be monitoring the blog. I’m sure his lawyers are.

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Dr. Kearney Blog - Presidential Clarifications

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