UK opening new operating rooms, including high-tech hybrid

The region's first hybrid operating room, one that adds imaging and robotics to traditional surgery, is opening this week at the University of Kentucky Albert B. Chandler Hospital. The only other hybrid OR in Kentucky is at the Trover Clinic in Madisonville, according to Kristi Lopez of UK Public Relations.

News media are being invited to see demonstrations and tour the facility, as well as eight new operating rooms opening in the next phase of the hospital's construction, on Wednesday afternoon. Those on the 1:30 p.m. tour will include Dr. Michael Karpf, UK's executive vice president for health affairs; Ann Smith, the hospital's chief administrative officer; Dr. Joseph "Jay" Zwischenberger, UK HealthCare surgeon-in-chief; Dr. Bernard Boulanger, surgical services director; Dr. David Minion, a vascular and endovascular surgeon; and Dr. Justin Fraser, a neurosurgeon.

"Advantages to a hybrid operating room include greater accuracy of surgical procedures, reduced recovery time, and reduced risk of postoperative complications," a UK press advisory said. "Vascular and endovascular surgeries will begin being performed in the new OR in the next few weeks."

Journalists wanting to take the tour and watch the demonstrations should park in the UK HealthCare parking garage at South Limestone and Transcript Avenue and meet university public-relations representatives promptly at 1:30. For more information or assistance, call or text Lopez at 859-806-0445.

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Beshear must reject hospital merger, C-J argues in huge editorial

Gov. Steve Beshear must say no when it comes to the merger of University Hospital, Jewish Hospital & St. Mary's HealthCare and St. Joseph Health System because it jeopardizes the separation of church and state, contends a lengthy editorial in The Courier-Journal. (C-J photo of University Hospital by John Rott)

The merger would mean the University of Louisville's hospital, a public institution, would be subject to Catholic health directives because St. Joseph is owned by Catholic Health Initiatives. "The result of merger would be that this community's public hospital, built only after voters approved a bond issue for its initial funding and with millions of taxpayer dollars flowing into it for decades, would be bartered away without public input, open bidding or any other formal procedures, to a religious group that limits standard medical care based on religious dogma," the editorial reads.

In order to take place, the merger requires the green light from Beshear, who must not give it, the editorial argues. Instead, he must remember when "he recognized the problem with posting the Ten Commandments in public school classrooms" while he was attorney general 30 years ago. "He needs to recall that brave and principled stance and tell U of L that no, you cannot sell the people's hospital to a religious organization."

The editorial, which took up the vast majority of the Sunday paper's Forum section, not the usual space on the first inside page of the section, also points out there is no other church-state medical complex anywhere else in the county because "it's unconstitutional."

The editorial also contends the merger is discriminatory. If it were to go through, women who have given birth to a baby at University Hospital would have to be taken to Baptist East Hospital if they wanted to receive a tubal ligation, a procedure that is often performed after a birth. "It is a deplorable solution to a problem that shouldn't exist to begin with," the editorial reads. "And it won't exist if Gov. Beshear has the sense and courage to reject this misbegotten scheme." (Read more)

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U of L spinal cord center brings in $13.7 million in 2011, $64.1 million since 2000

The University of Louisville's spinal cord scientists attracted more than $13.7 million in outside funding in 2011 alone, and have brought in a total of $64.1 million since 2000.

"This is tangible evidence of our effort to become a nationally recognized premier metropolitan research university," said U of L President James Ramsey. "We have taken the investment that the state has made in our program, brought in the best researchers to work on spinal cord injury, and begun to help people."

One major success story was that of Rob Summers, who played college baseball in Oregon and was paralyzed below the chest after a car accident in 2006. "In May, a team from U of L and two California universities announced that they had used electrical stimulation and rehabilitation to help (him) stand and take steps with assistance — a breakthrough with implications for millions of paralyzed people around the world," reports Laura Ungar of The Courier-Journal. (Read more)

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Center for Excellence in Rural Health marks 20th anniversary by adding new program in medical lab science

The University of Kentucky’s Center for Excellence in Rural Health celebrated its 20th anniversary this week and announced the addition of a new baccalaureate degree in medical laboratory science, which will start next fall at the facility in Hazard.

At a ceremony honoring current and former faculty, staff and students of the center, speakers include UK President Eli Capilouto, 5th District U.S. Rep. Harold "Hal" Rogers and Dr. Wayne Myers, the center’s first director and a former director of the federal Office of Rural Health Policy.

Capilouto, a dentist by trade, said “With approximately 80 percent of the center’s graduates working in Appalachia or other rural communities, it’s a testimony to the fact that this idea worked.” More than 550 people are graduates of the center's academic programs. The center also includes Kentucky Homeplace, a nationally recognized community health worker initiative; the Kentucky Office of Rural Health; and the East Kentucky Family Medicine Residency Program, a UK news release said.

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UK surgeons first to do life-saving lung procedures in tandem

Surgeons at the University of Kentucky are the first in medical history to perform two procedures in tandem to bridge a lung transplantation. The procedures were performed first on Wanda Craig, 68, who is now the oldest person to be "bridged to transplant using an artificial lung device, also known as an extracorporeal membrane oxygenation," reports research-reporting service Newswise. (Photo of Wanda Craig and Dr. Enrique Diaz by Julia Meador)

Craig, of Lexington, had chronic obstructive pulmonary disease and emphysema for which she has been treated for the past 10 years. In November 2010, she took a turn for the worse. "I was so out of breath from walking to the kitchen ... I didn't have enough energy to even scoop ice cream out of the carton," she said. Pulmonary hypertension, from which she also suffered, had caused the right half of her heart to fail, which prevented blood from going through the lungs to fill the left side of the heart, explained Dr. Charles Hoopes, director of UK's heart and lung transplant program.

To fix the problem, Hoopes and Dr. Enrique Diaz, the program's medical director, performed a procedure called an atrial septostomy, in which a small hole is created between the upper two chambers of the heart. This procedure, along with the extracorporeal membrane oxygenation procedure, saved Craig's life, the news release says. "These procedures are novel in terms of a bridge to transplantation, and the use of an artificial lung together with an atrial septostomy for cases of respiratory and right ventricular failure have not been performed together until now," Diaz said.

Three days later, Craig underwent a double lung transplant, and has been healing since. "More than anything I am looking forward to doing those normal everyday things like going to the grocery store and watching my grandson's T-ball games," she said. "And scooping my own ice cream." (Read more)

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Republican leader and former U of L trustee says university made poor argument that hospital isn't public

The University of Louisville made a “terribly flawed argument” when it claimed that University Hospital was not a public entity, former U of L Trustee Bill Stone told cable channel cn|2's "Pure Politics" program yesterday. "That argument has been central as university leaders try to finalize a merger with two private hospital groups, Jewish Hospital and Catholic Health Initiatives," Ryan Alessi notes.

Stone, a former Jefferson County Republican chairman, said he agreed with Democratic Attorney General Jack Conway's ruling in an open-records case that the hospital is a public entity, and “I don’t know of any lawyer of merit who wouldn’t agree with Jack Conway’s assessment. That has been the weakness in U of L’s selling point. The University of Louisville Hospital is part of the university.”

Alessi reports, "Stone said the university should be highlighting the positives of the merger." Stone told him, “I think this merger can be sold to the public on the basis of how much it will mean to this community economically, what it will mean from a prestige point of view, where it will be an incubator for Nobel Prize-winning scientists.” For the story and video, click here; for the video only, on the image above.

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State senator says U of L doctors used Medicaid funds to pay themselves $4.8 million in bonuses, seeks more oversight

State Sen. Tim Shaughnessy has questioned a $30 million transfer of surplus Medicaid funds to Passport Health Plan board members in 2008 and 2009. Shaughnessy, a Louisville Democrat, says doctors at the University of Louisville medical school paid bonuses to themselves using about $4.8 million intended for indigent care and used another $5.2 million to purchase an electronic records system, making them eligible for more bonuses from the federal government, Deborah Yetter of The Courier-Journal reported.

Since Attorney General Jack Conway ruled the transfer illegal, some groups have elected to repay. University Physicians Associates will repay $9 million over five years; U of L, University Medical Center and local hospitals that provided capital to start Passport have agreed to repay, but on different terms. Conway did not indicate whether the $4.8 million in compensation was bonuses or salaries, Conway spokeswoman Shelley Johnson told Yetter.

Shaughnessy said repayment is not sufficient to address the real problem — "that U of L's board wasn't involved in major financial transactions involving groups with which it is affiliated, including Passport, University Physicians Associates and the U of L medical center," Yetter reports. "We need to know how this happened, and we need to make sure it doesn't happen again," Shaughnessy said in an interview.

Shaughnessy is working on legislation for the 2012 General Assembly requiring public university boards to apply more oversight to groups like Passport. He has also written letters to Passport chairman Dr. Gerard Rabalais and U of L President James Ramsey. (Read more) To read Shaughnessy's letter to The Courier-Journal, click here.

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U of L prof earns $11.8 million grant renewal; has helped glean $100 million in federal grants in 17 years

A University of Louisville researcher has been awarded a $12.8 million grant to keep his adult stem cell project going.

The funds are from the National Institutes of Health and will allow Dr. Roberto Bolli, right, to continue to investigate how introducing genes into stem cells might improve stem-cell therapies; look at how diabetes affects stem cells; look at how proteins called cytokines affect stem cells during heart failure; and investigate the signaling pathways of stem cells in the body.

Bolli's project was granted $11.7 million in 2006. Since Bolli started working at U of L in 1994, he and his team have brought in more than $100 million in NIH grants. In one project, patients have reached the two-year mark after being infused with their own processed adult stem cells. That project is looking to find a way to use a patient's own cardiac stem cells to regenerate dead heart muscle after a heart attack.

"U of L has a mandate to become a national recognized metropolitan research university," President James Ramsey said. "One gauge is our faculty's ability to attract competitive grant fund from the NIH." Ramsey said the overall mission of the medical school is to improve the health of Kentuckians.

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3 universites and federal agency join to improve oral health in Appalachian Kentucky

With money from the Appalachian Regional Commission and some of their own, three very different Kentucky universities will collaborate "to enhance sustainable, collaborative dental health education and care" in the state's eastern coalfield, where both are sorely lacking, they announced in a press release.

Morehead State University, the private University of Pikeville, and the University of Kentucky's College of Dentistry will design the Appalachian Rural Dental Educational Partnership Plan "to train more dentists to practice in rural areas and give them the tools necessary to set up thriving dental practices in Eastern Kentucky," the release said. The funding is $400,000 from ARC, $127,293 from UK, $82,035 from UPike and $47,873 from Morehead State.

“The majority of Eastern Kentuckians have struggled to sustain quality dental health, and one of the barriers to maintaining good dental health is poor access of quality dental care,” state Department for Local Government Commissioner Tony Wilder said. His agency handles ARC matters in Kentucky.

Said new UK President Eli Capilouto, a dentist by trade, “We know that if we can break a cycle of poor health, we can begin to break cycles of poverty. Cycles of despair can become legacies of hope. We also, increasingly, know that partnerships and greater collaboration are the best – and, perhaps, only – way to address major challenges.” He called the project a unique partnership among a federal agency, a governor and “the state’s flagship institution, Kentucky’s public institution dedicated to serving the people of Eastern Kentucky, and a critically important college with deep roots in Eastern Kentucky.” (Read more)

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Markey Cancer Center at UK says its patients have higher survival rates than those treated elsewhere in Ky. and the nation

"Patients at the University of Kentucky's Markey Cancer Center who have certain types of cancer have higher rates of survival than patients with the same cancers treated elsewhere in the state or even the nation according to new data released today," Business Lexington reports.

"Markey officials said the data shows that the center's patients have significantly better five-year survival rates than those Kentucky cancer patients who were treated elsewhere for brain, breast, liver, lung, ovarian, pancreatic and prostate cancer, as well as for stage IV colorectal cancer." (Read more)

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Free conference on Alzheimer's in Louisville Sept. 17

A Washington-based geriatric researcher will join University of Louisville researchers and clinicians a free conference examining Alzheimer’s disease from 9 a.m. to 3 p.m., Saturday, Sept. 17, at the Crowne Plaza Louisville Airport Hotel, 830 Phillips Lane, near the state fairgrounds.

“The Journey: Alzheimer’s Disease and Caregiving” will provide information on the risk factors for Alzheimer’s disease, the reasons why certain populations are at greater risk for developing it, and current practices in caregiving. Admission, parking and lunch are free to participants at but pre-registration is required by Sept. 15 to info@alz.org or 1-800-272-3900.

Thomas Obisesan, M.D., chief of geriatrics at Howard University Hospital, will open the meeting. His research is focused on finding a cure for Alzheimer’s and "disentangling the overlap of cardiovascular disease with Alzheimer’s disease risk," a U of L release says. The conference is supported with grants from Eisai Co. Ltd. and the Signature Research Institute. It is co-sponsored by the university and the Greater Kentucky and Southern Indiana Chapter of the Alzheimer’s Association.

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Planned merger of Louisville hospitals grows more controversial; C-J devotes considerable space to it and Beshear steps in

UPDATE, July 27, 3:43 p.m.: Gov. Steve Beshear issued a statement saying "It is clear there are growing concerns within the community about issues related to the hospital’s future level of access to medical services, and those concerns need to be fully vetted before the Commonwealth takes the legal steps required to approve this merger," such as changes in leases of public property and agreements on operation of the hospital. Just as important as the legal issues, Beshear said, is "the public policy of how the University of Louisville Hospital will continue to honor its mission as a public teaching hospital that provides access and care to citizens, especially those who are indigent." The governor said his administration "will hold a series of conversations with the principals in the proposed merger and other interested parties," starting with a meeting among four of his cabinet secretaries, Mayor Greg Fischer, state Auditor Crit Luallen and Attorney General Jack Conway.

The merger that would put a Catholic health group in charge of the University of Louisville's hospital is growing ever more controversial, as demonstrated by today's edition of The Courier-Journal. The top story was about U of L President Jim Ramsey's uncertain response to a request by state legislators to answer questions of a legislative committee, accompanied online by a photograph of a somewhat sheepish-looking Ramsey, left. UPDATE, July 28: Ramsey says he will appear before the panel Aug. 17.

The paper's editorial page was mainly about the issue. The top editorial was headlined "Ramsey's silence," and it referred to the second 'editorial' on the page, actually a recitation of email correspondence between Ramsey and one of his Fern Creek High School classmates and her husband, who oppose the merger and questioned Ramsey's charcterization of an earlier C-J editorial as "not based on complete and factual information."

Next to that piece was a letter from the lawmakers: Rep. Tom Burch, chairman of the House Health and Welfare Committee and a Catholic who opposes the merger because of its implications for reproductive and end-of-life procedures; and Reps. Mary Lou Marzian and Joni Jenkins of Louisville. It was illustrated by a photo of Ramsey looking thoughtful. Above it was a letter, illustrated by a photo of Pope Benedict XVI, from Eugenia K. Potter, former executive director of the Kentucky Commission on Women, headined "Is it dogma or discrimination?" Conservative commentator Martin Cothran has a contrary view on his blog.

UPDATE, July 27, 8 a.m.: The C-J editorial page is again mainly about the issue, with an editorial urging the state auditor, governor and attorney general "to thoroughly scour and bring transparency to the negotiations with Catholic Health Initiatives;" an article by former University Hospital nurse Beverly Glasscock saying that the hospital wouldn't be able to perform emergcy abortions needed to save a woman's life; and a letter from former university trustee Bill Stone defending Ramsey from what he calls an "over the top" attack by the paper's editorial board.

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UK finally wins $20 million grant to translate medical research into action at the bedside and in the field; now 'a member of the club'

The University of Kentucky announced Tuesday that the National Institutes of Health had awarded it $20 million over five years to help move research discoveries from the laboratory to the bedside. The grant, one of the largest research awards in the university's history, will support the UK Center for Clinical and Translational Science.

The grant, which UK had sought for five years, will support research to apply or trnslate discoveries into practical applications. “Translational research, often referred to as 'bench to bedside,' means turning laboratory findings into preventions, treatments and cures for patients through collaborations across academic units with interdisciplinary research teams,” said UK President Lee T. Todd Jr.

UK Executive Vice President for Health Care Michael Karpf told the Lexington Herald-Leader that, in addition to provide funding, the grant acknowledges UK's excellence in translational research. "This grant is recognition by the NIH that we are one of the places," Karpf said. (Read more)

The grant could mean better care for patients, not only in the UK hospital. Dr. Philip Kern, left, director of the center, told Mike Wynn of The Courier-Journal that it will affect community engagement, information management and direct patient care. "One focus of the community-based research involves improving the delivery of treatment for patients who don't receive the health care they need, Wynn reports, quoting Kern: “That is probably the one form of research that will impact Kentuckians most quickly.”

Wynn notes that 60 universities have received such grants, and writes, "The university would have lost any prospect of ranking among the top 20 research institutions without Tuesday's grant and recognition, said UK Provost Kumble Subbaswamy." (Read more)

Until now, the center has had to compete with other university units for funding. Now it will have a stready stream of money, and that goes beyond the grant, because some grant opportunities are open only universities with such continuing grants, and that usually gives each of them anotrher $2 million a year, Kern said. "This gives us much greater stability," he said. "There will be opoportunities that will come down the pike because we are now a member of the club."

The grant will help research both at the UK hospital and in the field. Patients involved in research must have beds dedicated to that purpose, to make sure the hospital has room for regular patients, and that requires not only dedicated space, but funding, Kern said.

He said one example of the type of field research that the grant can support is a project being run by Dr. Nancy Schoenberg, right, in Letcher County, using faith-based organizations to find the best ways to help individuals and community groups fight obesity.

The grant will also help UK partner with other schools, especially those in a new Appalachian translational science network. Kern said Schoenberg and a colleague at Ohio State, which is in the network, have already received a pilot grant for a community-based project to leverage social networks to increase colorectal cancer screening in Appalachia. For a description of the project, click here.

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Partnership between UK and Norton extended, further defined

They still haven't agreed on how to spell "health care," and don't do it as we do, but the partnership announced last November between UK HealthCare and Norton Healthcare to implement stroke, cancer, transplant, obesity, obstetrics and heart initiatives has been extended and further defined.

"We have worked to identify opportunities for collaboration to improve the access and quality of care for Kentuckians close to their homes while making sure that patients with the most complex medical issues receive the care they need without have to leave the state," said Stephen A. Williams, Norton's president and CEO.

The partnership will establish and extend stroke and obesity education programs; expand teaching programs for UK medical students so they can do a rotation at Norton hospitals; and establish a transplant and specialty clinic in Louisville. Research initiatives in obesity and cancer are also part of the collaboration.

All of the work being done is meant to target what outgoing UK President Lee Todd calls "the Kentucky uglies," the state's most troubling and chronic health issues. According to Business Lexington, Kentucky ranks 15th nationwide in deaths per 100,000 caused by stroke or related disease. Kentucky is in the top five for cancer incidence and leads the country in lung cancer. In 2009, Kentucky's obesity rate was the fourth highest in the country and cost the state about $1.3 billion in health costs. And there is a shortage of obstetricians in the state, with as many as 71 of the state's 120 counties without an obstetrician. (Read more)

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Rural Training Track programs get more health professionals to rural areas, but live 'on the edge' of funding and personnel

By Tara Kaprowy
Kentucky Health News

With the Obama administration offering more funding to improve rural health care, Rural Training Track programs to steer medical students to rural areas are hoping to expand, a move that would benefit underserved areas of Kentucky.

"Over 62 million Americans live in rural America and there is a significant crisis in terms of having access to care for these people," said Amy Elizondo, vice president of program services at the National Rural Health Association. "There is a very uneven distribution of health care professionals and an acute shortage of primary care physicians in rural areas. If we can recruit and retain physicians to serve rural areas, we improve access for rural America." (University of Washington map; click for larger version)

RTT programs aim to educate family physician residents in rural environments with the hope they will continue to practice there, Candi Helseth reports in a deailed article for the Rural Assistance Center. "These residency programs are a proven model for addressing rural family physician workforce shortages, with more than 70 percent of graduates praticing in rural areas," Helseth reports. The first such program started in Colville, Wash., in 1985. There are 25 RTTs in 17 states, including one in Morehead by the University of Kentucky and St. Claire Regional Medical Center. Eight physicians have graduated from the program there since it was established in 2000, five of whom are practicing in Kentucky. Of those five, three have joined the SCR medical staff.

There are similar success stories across the country. In Caldwell, Idaho, 95 percent of graduates have chosen to practice in rural areas over the past 16 years. "We heavily recruit residents who are rural-oriented," said Dr. Samantha Portenier, a practicing physician and director of the Caldwell RTT. "We've had some who were not and we converted them. Part of it was that they really saw where the training we give them and the skills they learn are so needed in rural areas. I emphasize that in rural areas you can specialize in areas that particularly interest you."

Despite the success, 10 RTT programs have closed in the past 10 years. "Every RTT lives on the edge in terms of funding," said Dr. Randall Longenecker, who is project director of Rural Training Track Assistance Demonstration Project. "In general RTTs are small, have limited faculty and are vulnerable to personnel changes, a bad year for recruiting, loss of funding and many other factors beyond their control."

Morehead's RTT is funded by St. Claire. Residents spend their first year at the UK College of Medicine in Lexington and their second and third years at St. Claire, which is accredited by the Accreditation Council for Graduate Education. Carla Terry, St. Claire's graduate medical education coordinator, acknowledged the difficulty in maintaining an RTT program. "The reason why the RTTs are in jeopardy is that all the faculty that teach them are voluntary," she told Kentucky Health News. "They are not paid to teach, they still have to keep their patient load. If it were a university program, all the faculty would be paid."

But St. Claire physicians believe strongly in rural-based education and also see how they can benefit from their investment. "We actually had a physician that when he came here he was interested in starting a residency because he wanted to use that as future recruitment," she said. "We look at it as training future partners."

Now, RTTs are under a federal microscope. The health care reform law created the Rural Training Track Assistance Demonstration Project, a three-year pilot program that plans to "collect comprehensive information to better understand the collective forces challenging RTT models and develop solutions that will strengthen existing RTTs and encourage development of new RTTs," Helseth reports.

The time is ripe, given that more medical students are choosing to be family medicine physicians, up by 11 percent last year and 8 percent the year before. "We have a real opportunity here to redefine the importance of primary care being foundational in rural workforces," Dr. Ted Epperly, past president and past board chairman of the American Academy of Family Physicians, told Helseth. "Right now, only 9 percent of physicians are choosing to practice in rural areas while 20 percent of the population lives there. RTTs offer a way to give family physicians a broad scope of practice, which they need practicing in a rural area, and to get them to stay in those rural areas." (Read more)

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