Author: P Hasselbacher

UofL Medical School On Academic Probation.

Not All Details Made Public. School Minimizes Significance.

The headline above appeared in two local news outlets yesterday and is exactly the kind of publicity the University of Louisville does not need. The story was broken by David Mann of Business First reacting to a news release from the University. In a subsequent interview, Medical School Dean Toni Ganzel outlined some nine areas of concern to the Liaison Committee On Medical Education (LCME) that oversees the accreditation of American Medical Schools. It is by no means clear that all identified problems or their severity have been made public.

As it is, the deficiencies that were identified are fundamental to the basic mission of a medical school: teaching facilities were inadequate, the method of teaching was behind the times, the curriculum needed review, evaluation of students was uneven without appropriate feedback to the students, cooperation among different medical and scientific disciplines was not sufficient, faculty integration with off-campus teaching sites was sub-optimal, and academic affiliations with hospitals were not clear. What else is there to go wrong?

I have always admired Dean Ganzel. She did not create this embarrassing problem, but she was left holding the bag, probably without the authority or the resources to fix it. Control of the Medical Center, including its clinical activities, rests in the President’s office. She obviously needs to minimize the damage and present the matter honestly and in the best possible light. She was effective to the point that the Courier-Journal printed a sub-headline quote: “I don’t think this decision is based on the overall quality of the educational experience.” A medical student volunteered that “she had a good experience.” Would a student have dared say anything else?

Not a big deal?
The school’s understandable impulse is to make it sound like this is no big deal, and that most of the remedies have already been made or are on track. This self-portrait is belied by the language used by the LCME itself.

“Accreditation with probation is an action based on determination by the LCME, … that an accredited program is not in substantial compliance with accreditation standards. Such a determination may be based on the LCME’s judgment, … that the areas of noncompliance have seriously compromised the quality of the medical education program, or that the program has failed to make satisfactory progress in achieving compliance after having been granted ample opportunity to do so.”

We do not yet know whether or not the University of Louisville’s Medical School was placed on probation because of serious compromise of quality, or because it did not make satisfactory progress after having had a chance to do so. Which possibility is worse? Continue reading “UofL Medical School On Academic Probation.”

Does Donating a Kidney Increase the Risk of Kidney Failure For a Living Donor?

How good are we doctors in conveying the concept of risk to our patients and our community?

I recently met someone who donated a kidney to a person who was not a relative. My impression was that the recipient was previously a stranger, but I did not press that issue. I was overwhelmed by the staggering generosity of that gift. I am embarrassed to say that I do not know how I would respond if I were asked to donate.

Shortly afterwards in the impossibly large volume of medical journals that crosses the desk of even a retired physician, and proving the hypothesis that a person only sees what they are prepared to find, I noticed a research paper estimating the risk of kidney failure in a donor following the removal of one of the normal pair. The risk does not appear to be zero. I want to use that paper as a base to continue writing about conveying the results of medical studies and of risk to the public.

Why did Mother Nature Give Us Two Kidneys?
In medical school, and in common public wisdom, it is universally recited that we only need one of our two kidneys to live. That is true. As it happens though, there is little or no information about whether we would live as long or as well! It is known that as people age, there is an expected gradual decline in kidney function. It happens sooner and faster in people with hypertension, diabetes, and so on. It is reasonable to speculate that if starting out from a half-normal position, that a single remaining kidney might run out of steam sooner without it’s helpmate. The best way to definitively settle the matter would be to randomly divide in half a group of people who had committed to donate, only allow one group to do so, and then follow the lives of both groups to see if the donors develop kidney failure more frequently than the donor wanna-bees. I do not see that experiment happening, but the information would be relevant to a person deciding whether or not to donate. Continue reading “Does Donating a Kidney Increase the Risk of Kidney Failure For a Living Donor?”

Opponents of Brownsboro Location for New VA Hospital Going All-In.

p.s. It’s not about the neighbors or the disputed $3.1 million!

The Courier-Journal has long advocated for a downtown location for the replacement Mobley Rex VA Medical Center. The newspaper’s leadership and a variety of downtown-boosters are obviously disappointed with the result of a long-studied and reasonable determination not to place the hospital downtown, but rather on a site near the intersection of the Watterson Expressway and Brownsboro Road. A series of articles and an editorial earlier this month focused on the appraisal process used for the Brownsboro parcel purchased by the VA in July, 2012 for $12.9 million. The newspaper seems to insinuate that hanky-panky has occurred and that a cover-up is underway. Rep. Yarmouth has joined the fray asking for a governmental examination of the appraisal and purchase process. That is a fair request, especially since the reputation of some individuals has been questioned in unavoidable service to the interests of others, some of whom also wish to profit from a downtown location. Be well advised, that this controversy is no longer about the interests of the neighbors of the Brownsboro site who would have seen a major new commercial project there in any event.

Possible overpayment does not invalidate site-selection process.
I have been involved with or reporting on the site-selection process for the new VA since its inception. I believe my reports have been the most comprehensive available on the matter. Many of the public documents are available in these pages. I believe I have attended every public hearing and some non-public ones as well. The Courier-Journal and allied downtown-boosters are conflating the site-appraisal process with the site-selection process in a last ditch effort to pressure the federal government to relocate the hospital in downtown Louisville. The two processes are separate and very different things. Any inadvertent overpayment by the Federal Government for the land invalidates in no way the tediously careful process of site selection that went on. Continue reading “Opponents of Brownsboro Location for New VA Hospital Going All-In.”

The Other Boot Drops for Kings’s Daughters Medical Center.

Hundred’s of plaintiffs and a 70% drop in angioplasties.

kdmc-ptca-2012

We have known for some time that King’s Daughters Medical Center (KDMC) in Ashland Kentucky (Boyd County) has been under investigation by the Federal Department of Justice for the spectacular number of invasive cardiac procedures performed on its premises. In fact, the rate of angioplasties in that small city was one of the very highest in the nation and the highest in Kentucky. When other hospitals in Kentucky and elsewhere with seemingly anomalous high rates were looked at more carefully, it was found that that many, if not a majority of the procedures in some hospitals were not medically necessary or were even performed on normal or near-normal people!

The extent and progress of the federal investigation at KDMC is as yet unknown but it was not a complete surprise when a civil lawsuit was filed last September in Boyd County Circuit Court. It alleged that a medically unnecessary procedure with placement of a stent was performed in the hospital by its principal cardiologist, Dr. Richard E. Paulus, whose practice reportedly had been purchased by the hospital.

New lawsuits against King’s Daughters.
Earlier this week, a pair of related lawsuits listing some 42 pages of plaintiffs was filed against the hospital, Dr. Paulus, and a variety of business entities operating under the umbrella of the Kentucky Heart Institute. Naturally, a lawsuit tells only one side of the story, but given the precedent of essentially identical scenarios at other hospitals, including St. Joseph In Maryland and St. Joseph London here in Kentucky, the story is believable. The complaints themselves can be downloaded below. Continue reading “The Other Boot Drops for Kings’s Daughters Medical Center.”