Author: P Hasselbacher

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. Continue reading “Report of UofL Board of Trustee Committee on Governance Released Amidst Confusion.”

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

This appears to be the case in Ohio.

Summary:
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 “Is Prescribing Of Opioids To Medicare Patients Representative of Opioid Prescribing Generally?”

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

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 “Another Kentucky Invasive Cardiologist Facing Possible Jail Time.”