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O F KE NTUC KY University Senate Council

Office of the Chair

10 Administration Building

Lexington, Kentucky 40506-0032
Office: (606) 257-5871 or (606) 257-5872
FAX: (606) 323-1062

26 September 1995

TO: Members, University Senate

The University Senate will meet in regular session on Monday, October 9, 1995,
at 3:00 PM in room 115 of the Nursing Building (CON/HSLC).

Minutes (to be circulated)

Chair’s Announcements

Medical Center Update: Chancellor James Holsinger, Jr.


Academic Ombud Report - 1994-1995, Horst Schach.

Consideration and action on the plus/minus grading proposal from the College of
Arts and Sciences (circulated under date of 27 September 1995).

Report flom the Board of Trustees faculty representatives- Loys Mather and
Deborah Powell

New Business

Betty J. Huff

US Agenda: 10.9.95



An Equal Opportunity Llnivcmty


1' [1


The University Senate met in regular session at 3:00 pm, Monday, October 9, 1995 in Room 1l5
of the Nursing Health Sciences Building.

Professor Gretchen LaGodna, Chairperson of the Senate Council, presided.

Members absent were: Gary Anglin, James Applegate*, Benny Ray Bailey, John Ballantine,
Michael Bardo, Douglas Boyd, Carolyn Brock*, Dean Brothers, Joseph Burch, Mary Burke*, Johnny
Cailleteau, Joan Callahan, Berry Campbell, Ben Carr, Edward Carter, Shea Chaney, Louis Chow*,
Jordan Cohen*, Raymond Cox*, Carla Craycraft, Charles Davis, Frederick DeBeer*, Richard
Edwards, David Elliott*, Robert F arquhar, Donald Frazier, Daniel Fulks, Richard F urst, Thomas
Garrity, Philip Greasley*, Russell Groves, Issam Harik*, S. Zafar Hasan*, Christine Havice*, Clifford
Hynniman, Craig Koontz, Thomas Lester, C. Oran Little*, Jeff Lowe, Daniel Mason, Jan McCulloch,
Douglas Michael, David Mohney, David Nash*, Wolfgang Natter*, Anthony Newberry, Michael
Nietzel, William O'Connor*, Clayton Paul, Deborah Powell, Shirley Raines, Karl Raitz, Amy Rasor,
Elaine Reed*, Thomas Robinson, Horst Schach, Janice Schach, David Shipley, Todd Shock, Timothy
Sineath*, William Stober*, David Stockham, Craig Wallace, Charles Wethington*, Chad Willet,
Eugene Williams, Emery Wilson*, Mary Witt.

Chairperson LaGodna stated the minutes from the September 1995 meeting were on View, but
had not been distributed in paper form and they would be available for approval at the next meeting.

The Chair made the following announcements:

The General Education Certification Transfer is a statewide plan that will standardize the lower
division general education requirements and facilitate the transfer of students from one institution to
another. The plan for implementation is moving along. Dr. Lou Swift has agreed to be on the agenda
of the Senate for November 1995. He will give the details of the plan and how it will be phased in and
implemented. ' '

Last year the Senate passed a new rule which says all undergraduate students need to be informed
of their grades in courses they are currently enrolled in by the last day of class which is prior to the
withdrawal date. The withdrawal date is October 20, 1995.

The Senate Council has reviewed and discussed three proposed Administrative Regulations for
input to the Administration. The first one had to do with regulations, policies, and guidelines related
to establishing, changing, terminating, and delineating reporting relationships in multidisciplinary
research centers and institutes. There is no citation for this particular AR because it has not been
formally put into the ARs, but copies of the position paper are available for those interested in seeing
them. The second AR that was reviewed and discussed was a conflict of interest financial disclosure
policy for sponsored research. All faculty, particularly faculty who have sponsored research projects,
should become very familiar with this AR. It is AR 11 4.0.4. and it is on View. The third AR is on
information systems policies and procedures; it is AR 2 1.4.2.

* Absence Explained




 Minutes, University Senate, October 9, 1995

There will be a new category on View which will be called "Faculty". Under this category there
will be Senate news, announcements of meetings, agendas, all minutes from Senate related meetings,
and other items of interest. Please check View for these items.

The last announcement is a very sad announcement. Many are aware of the recent death of Dr.
Kawanna Simpson. There will be a memorial resolution at a later time. Many people have asked how
they might make a memorial contribution in her name. For those wishing to do so, checks may be
made out to the College of Education and sent to the Dean's Office. Indicate if they go to the
scholarship fund that will be set up and established in her name. A senator said that contributions may
be made out to the Kawanna J. Simpson Memorial Fund and there are actually two funds; the
scholarship fund and a library shelf in the College of Education library with books on gender equity.
This is an area in which she was interested.

Many are also aware of another very tragic happening, two of our students were killed in an
automobile accident this weekend. The two students are Allyson Adams and Joseph Ledford. We
certainly regret this unfortunate happening as well.

Dr. LaGodna asked the Senate to stand for a moment of silence.
Chairperson LaGodna stated that the sheer pace and volume of changes in the health care system

have had a significant impact on the Medical Center and on our Colleges in the Medical Center. It is
critical in understanding these issues to talk about them across sectors; that everyone have a clear idea

of what the impact has been. Chancellor Holsinger has agreed to spend some time with us today to
share his ideas and thoughts about both the present and the challenges ahead that will be faced by the
Medical Center. Following his remarks he has agreed to entertain questions.

Dr. Holsinger:

I really appreciate Gretchen's invitation to come and to speak to the Senate about a variety
of issues that are on us at the Medical Center. She gave me a few ideas she would like to
have covered. There will be certainly be time for questions when we are through and
whatever answers I can provide.

The first thing I would like to do is to remind you of an event that happened a little over 50
years ago. It was a dark night in December of 1944 and the battleship West Virginia was
inching its way back into port on the West Coast of the United States for refitting after
battle damage in the Pacific. The captain was on the bridge at the time and received a
message from the signal man who came to him and said "Captain we have just received a
message to steer 15 degrees to starboard." The captain of the ship, who was my uncle,
Raymond Holsinger answered back to his signal man saying send back the message "you
steer 15 degrees to starboard." Later the signal man return and said "Sir, I just received
another signal, it says no you steer 15 degrees to starboard." My uncle said you send back a
message "I am a Captain of the United States Navy, this is United States battleship, you will
steer 15 degrees to starboard." A message came back to him a little while later "no you
steer 15 degrees to starboard, I am a lighthouse."


 Minutes, University Senate, October 9, 1995

I tell you that story because change can be a variety of things in our lives and whether we
are willing to make the change that is required of us makes a big difference in how we meet
the future. As Gretchen indicated change is all around us when it comes to health care, we
do not have to think back but a little over a year ago to when the legislature here in the
Commonwealth of Kentucky passed health reform legislation that has set in motion a variety
of health care changes throughout the state of Kentucky. Those reform efforts on the part
of the legislature have had a major impact on what is going on in your academic health
center. Because of that one of the key elements of our multilegged stool we sit on at the
Medical Center as we try to deal with the issues of clinical care, the academic mission of the
medical center, our research efforts, and our community service, we have had to focus major
attention over the past year and a half on the issue of our clinical operation.

I am not sure how many of you read a particular Wall Street Journal article that appeared
about three weeks ago that reported that Duke University Medical Center Hospital had lost
57 million dollars last year. The result of which they were cutting 20% of their staff or 1600
people. The fascinating thing is that here at our academic health center, our university
hospital has not lost money recently under the leadership of the Director of the Hospital,
Frank Butler, who is also one of the vice Chancellors. Instead we have come out in the
black. It is fascinating when you look at over the past three years, not a single rate has been
raised at the University Hospital. How have we done this? As Frank looked at the future
and worked with Peter Bosomworth and Emery Wilson and they realized that things were
going to happen, change was going to occur whether we wanted it to or not. At that time
the Clinton Health Care Plan was working its way through Congress. It was necessary to
begin to look at how one could make changes that would be able to save dollars and be able
to keep us from raising rates, to help us to be competitive in a new competitive marketplace.
We have done that so far, quite successfully. The fascinating thing that goes with that, is the
fact that the Clinton Health Care Plan did not pass the Congress of the United States, did
not become law. Instead of having public policy driving health care reform in America we
have a marketplace driven health care reform that is underway. The market allows for no
phase-in. Everything that is happening it happening at light speed, nanoseconds do not quite
express it, they are too slow, it is going too fast for really ahnost anyone to keep track. As a
result of that it is a constant effort to try and stay even or ahead of the processes that are
driving where clinical health care is going in the future. As a consequence one of our major
priorities for this current academic year is to continue to maintain our efforts to put together
a broad commonwealth health care alliance in eastern and central Kentucky. It is in place
and it has already offered an HMO product within the health reform activities of the state. It
is ready to bid on various groups that might be required to come under it, depending on
what happens in the next legislative session of the assembly. It now includes 44 hospitals
and 1400 physicians across eastern and central Kentucky. It gives us the ability as the only
tertiary care referral center within that network of hospitals to maintain the flow of patients
for tertiary care to our facility which will enable us to conveniently train our students and all
types of health care professionals as well as our various residency programs.

Clinical Care has been a major driver of what we have been about. We can't sit back and say
that is the only thing of importance because the real reason we are here is because we teach


 Minutes, University Senate, October 9, 1995

students and our students are what we are really about. We must have a viable clinical
practice of health care, both among our practitioners as well as our hospital which is the
laboratory in which we train students clinically. Without the hospital being viable, without
Kentucky Clinic being viable, without having the clinicians available to train our students in
their clinical years, we simply would not be able to produce a quality product. Our
academic programs are the bottom line of why we are here and everything else is there to
support that major mission. Where do we stand on our academic programs? There is not a
single college in your academic health center, that is not heavily engaged in some form of
major change in the academic process. Let me give your an example, the College of
Pharmacy. The College of Pharmacy this year took its first Pharm D class. It was an
amazing operation. Those of you fi‘om the College of Pharmacy will know what I mean
when I say we accepted 80 students and 78 accepted a place in that class. One turned us
down to go to Cincinnati, since they live in Northern Kentucky. The other one is someone
who had applied a number of times before and had never been accepted, finally got accepted
and turned us down, we cannot figure that out. The point I am making is on a brand new
Pharm D program, we have had an amazing success rate in our attraction of students for
that program. Within the next several years we will have completely phased out the
bachelors degree program in Pharmacy, it will still remain a program in our books but each
class that follows now will be Doctors of Pharmacy, because we believe in the Medical
Center that the future of Pharmacy lies in clinical Pharmacy. As a consequence we want to
train individuals for the 21 st century, not for the 19th or the 20th century.

The College of Medicine has just gone through over the last several years a major revision
of the curriculum under the RWJ problem based learning grant. The result of that is there
are now 100% of our students in the College of Medicine being taught in that new
curriculum. It is not one of those things that gets done overnight and has all the bugs
shaken out of it, all of us who teach in that program, at some point realize there are still
bugs to be worked out and keep working to work those bugs out. One of the things we are
beginning to do is to try and make our RWJ program office a Medical Center wide problem
based learning curriculum office. One that will not only provide support for the College of
Medicine and to the four other colleges in the academic health center, but will provide that
kind of support to any of you across this university who might want to come to them if you
want to design problem based learning approaches to the courses you teach.

In the case of the College of Nursing, they never cease to amaze me in their ability to do
things that are unusual. The distance learning capability of the programs that we teach at
Hazard for example, the programs at Elizabethtown. The ability to take associate degree
nurses and take them through to a masters degree in a smooth approach is really a major
strength of our College of Nursing. It is not easy to be able to put together the pieces that
allow you to be able to use distance learning as well as faculty on site as well as faculty that
travel to places like Hazard to do those kind of programs. It takes a great deal of
administrative ability to make that all work out. We have now graduated a number of
nurses with masters degrees in Hazard. They have been able to go to school in a way they
would have never been able to go if they had to come to Lexington. It has been an
outstanding program.


 Minutes, University Senate, October 9, 1995

The College of Allied Health is constantly changing and molding their programs, the
Physical Therapy program is now going to a masters degree program. They take students at
Hazard at the Center for Rural Health. The amazing thing there was one of our graduates in
the PT program scored the highest score on the licensure exam of anyone who took the
exam in Kentucky. There is no question of the quality of the programs we are delivering at
the Center for Rural Health.

The College of Dentistry as many of you know has been working at a variety of ways to
establish a strategic position in regards to the University of Louisville School of Dentistry,
due to the difficult nature of having two schools of dentistry in the state both of whom have
been producing practitioners to go into practice here in the Commonwealth and across the
country. They have continued to struggle with how they might be able to define
strategically who they are in a way that would be able to help us to get past some of the
historic problems of the moves to close one of the colleges of dentistry within the state.
This biennium as you may or may not be aware both colleges of dentistry in the state had
their budgets frozen by the last session of the general assembly. We have worked very hard
during this two years and are still working hard to make some adjustments within the
College of Dentistry that will allow us to be able to get past this particular type of activity
on a biennial recurring basis.

As a consequence as you look across the academic programs, change is again in the air. We

can no longer in an academic health center sit down and teach and train our students to be
like we were. It just is not going to work. We have to train clinical practitioners as
physicians, nurses, dentists, physical therapists, physicians assistants, and on and on who can
practice in a new era in a new world in a different form of health care than we were trained
to practice in. If we are not willing to model those kinds of practices and get out in front
and teach our students to practice in the way they will need to practice in the next century,
we will fail. I for one am not willing for this great medical center to fail from that point of
view. We will continue to work to make sure that our students are trained in a way that will
allow them to practice effectively throughout their career. That is a major, major difference
that we have to keep in mind.

We have a number of things that have worked exceptionally well in this medical center.
When I came to the job of chancellor a year ago, it didn't take much to realize that I stood
on the shoulders of giants. There have been people here before me that have done a
fantastic job of turning out one of the most impressive academic medical centers in America.
The fact that we are a well kept secret is another problem that we have to deal with. I know
from having just been at the Association of Academic Health Centers annual meeting last
week that this medical center is far and away in advance of a vast bulk of the medical
centers in this country, particularly in dealing with health care reform issues. Does that
mean we need to sit back and rest on our laurels and be satisfied, we can't. As I told you the
change is occurring at light speed and that nanoseconds are too short. We have to
constantly be plugging away to stay ahead of the game. One of the new initiatives that we
have on the table, which was just approved to go forward as part of the biennial budget


 ' Minutes, University Senate, October 9, 1995

request of this University to the Council on Higher Education and the Legislature is the
House Bill 250, rural health initiative. We have been able over the last five years to
demonstrate conclusively that the Center for Rural Health in Hazard is an outstanding model
for the training of health care practitioners off campus from here in Lexington. We have
made a recommendation to the Council on Higher Education and to the State Legislature
that we form two more centers for rural health, one in Morehead, where we already have
Council on Higher Education approval to expand our nurse practitioner, nurse midwife, and
our physician assistant programs and one to another location within the state preferably
somewhere in the west. We will continue to work to try to make that come about, because
we believe we can make a difference in the lives of people in this state by taking our services
out into the state; by taking the teaching programs out into the state for students who may
have to work in order to go to school. They will able to continue to work either part-time
or full-time and go to school appropriately either part-time or full-time. Consequently we
will be able to keep people in place in rural portions of the state where we desperately need
additional clinical practitioners.

I could go on and on and tell you that nothing is ever going to be the same again. But I can
tell you one thing, it is going to fun as we move through these years ahead, because
whatever we do we are going to try to do it the very best way we can.

Professor Jacqueline Noonan asked about the effects of Medicaid and Medicare cuts and what is

Chancellor Holsinger: I can tell you something about what has happened so far. You may recall
from a few months back, the state made a decision to reduce the Medicaid payments to physicians by
about 52 million dollars. That impact on us was over 8 million dollars in our clinical practice. That
gives you some idea of what the impact of Medicaid cuts within the state have on our practice here,
clinically. The reason for that simply is we have such a large Medicaid practice, we are the largest
Medicaid provider within the state. The result of that is that anything that impacts on Medicaid dollars
will impact heavily on this medical center. We have grave concern about what would happen with
block grants of Medicaid dollars, particularly at a time when the special session of the legislature cut
about 240 million dollars in taxes and both gubernatorial candidates have said they will stop the
practitioner provider tax if they are elected governor. I am having a hard time understanding exactly
where all this money is going to come from. It seems to me as the legislature works to deal with
budgetary issues there are two places where they most likely look for money, one is higher education
and the other is health care. In the case of an academic health center, we get the double blow. It is
extremely important to us, what happens in those arenas. I might also point out that we have been very
successful this past year and so far the first quarter of the current state fiscal year in getting
disproportionate share payments and being reimbursed for our uncompensated indigent care. You read
about that in the newspapers, we got an additional 14.9 million dollar payment to the hospital that was
not anticipated at the tail of our state fiscal year. We have been successful in a similar although much
smaller payment for the quarter which just ended September 30, 1995, in the fiscal year ending of the
federal government. As I have watched how we in this state have been able to handle rolling up some
of those Medicaid payments, I became very aware if 50 states were doing this I can understand why
there is a huge problem at the national level and why there are efforts moving to constrain the


 Minutes, University Senate, October 9, 1995

expenditure of Medicaid dollars. Medicare is not as big a program for us, we don't treat as large a
percentage of Medicare patients as we do Medicaid, but major changes in those will also have an
impact on us as it would for any group of clinicians across the state. We will have to wait and see what
happens over the next six weeks.

Professor Loys Mather stated there was a news piece on NPR this morning on medical education,
it was suggesting that at the rate that medical schools are turning out MDs that by the year 2000, at
least in some areas there is going to be a significant oversupply and suggesting that some medical
schools will be closing. I do not know how accurate that is, but how well postured are we in case that
comes about?

Chancellor Holsinger: Every study that we are dealing with right now, indicates that we have an
over supply of physicians, one number is as high as 160 thousand. It comes down to, we have enough
primary care physicians, a certain amount of distribution problems, but we have enough and we have a
significant abundance of specialists, if indeed managed care moves across the country at the rate at
which it is expected to. To be honest about it, it will move faster than expected. Everything that has
happened in the past year and half has moved far faster than anybody expected it to. As we have gone
into a market driven health reform program, it is at a speed that is just almost incomprehensible at what
we would have expected had it been a public policy driven effort. The result of that is, we have already
under House Bill 250, the Health Reform Legislation here in Kentucky we have already capped
specialty residency positions, both here and at Louisville. The only place that we are allowed to
increase residences is among primary care residents and that is outside of Fayette County and outside of
Jefferson County. Specialty training programs will shrink across the country and there is an effort to
shrink the number of residents to not more than 1 10 percent of the graduating class of around 15,000
medical students a year. If we can move to 110 percent and we can go to 50/50 with 50 percent of our
classes going into primary care and 50 percent into specialties, we will probably be able to smooth this
out over a period of years. There are even some that are recommending that we reduce class size of
graduating medical students to 80 percent of the current level, which would drop us from about 15,000
to about 12, 000. One of the things we need to remember about specialty training is, although we will
not need the number of physician specialists, we will begin to train more specialists in other clinical
professions. We already see that with the strong movement towards family nurse practitioners, the
increasing number of nurse midwives being trained. There will be an increasing number of nurse
anesthetists being trained. I think that before we get through this decade, we will be seeing masters
degree prepared specialty trained physicians assistants, because they will fill specific niches in areas
where we need the work, mostly because of the loss of specialty residency physicians. In the case of
nurse practitioners, it is clear that we need a large number of nurse practitioners because as managed
care flows across the country, we will be reducing the bed days of care in hospitals by probably half if
not greater. The result of that is there will be a shrinking number of inpatient beds and a reduced need
for bachelor degree, diploma prepared, and associate degree nurse RN 5, but at the same time we will be
sending patients home far sicker. We will be using a lot of nurse practitioners to provide in home care
in a way that we have not in the past. There is a growing market for specialties in a number of areas
but not in medicine.

Professor Hans Gesund asked if they would be training lawyers in medicine because as the sicker
patients go home, there will be a lot more lawsuits.


 Minutes, University Senate, October 9, 1995

Professor Holsinger: One of the biggest ethical issues, moral dilemmas in health care today and
into the future is going to be: Are we withholding care that a patient should appropriately have because
of the way we are going to financed, which is on a per capita basis. All of a sudden, the less you do,
the more you make. Right now it is the other way around, the more you do, the more you make. I do
not know that either one is right or wrong, that is not the issue. The moral dilemma is going to be over
the issue that you are talking about, the sending of a patient home at the earliest possible moment. I
think the point you are raising is a very real one, the moral dilemma is a major ethical issue that health
care is going to have to face. Not in the decades to come, but in the months to come.

Chancellor Holsinger was given a round of applause.

Chairperson LaGodna stated she hoped Chancellor Holsinger could be invited again later for an

The Chair stated she had a correction about ARs being on View, they are not on View yet, but are
being prepared for View and the Web and should be on in a week or so.

Professor Jesse Weil asked if Professor LaGodna had said that the Senate Council were reviewing
the ARs prior to them being adopted or had they been adopted, where are they in the process.

Juanita Fleming stated the Senate Council reviewed the ARs before they were adopted, they are all
approved and now they are being sent out for distribution. They should be in the library as soon as
duplicating finishes with them. They should be on View and Web soon.

Chairperson LaGodna said Professor Schach was unable to attend the Senate Meeting to present
the Academic Ombud report for 1994—95. The written ombud report will be appended to the minutes.

The Chair recognized Professor Enid Waldhart for the first action item. Professor Waldhart stated
the action item concerned establishing a plus/minus grading system in the College of Arts and Sciences.
This is the same thing that was talked about in the April meeting. At the time it was being talked about
it was being discussed as possibly being University wide. A straw vote was taken and the proposal
went back. As a result, the College of Arts and Sciences has asked if the Senate would consider the
proposal for the College of Arts and Sciences whether or not anything is done further. The Senate
Council recommends approval of a plus/minus grading system for the College of Arts and Sciences
only. This is for undergraduate courses. You will note that all university undergraduates taking
College of Arts and Sciences courses will be graded according to a plus/minus schedule. Each of the
letter grades stand at the same point they now have, the plus and minus go between. This is for the
College of Arts and Sciences only, the Senate Council recommends it for your discussion and approval.

Chairperson. LaGodna said there were a number of people in attendance who could help speak to
this issue. Ellen Rosenman, Who is the chair of the Arts and Sciences Council, and other members of
the College of Arts and Sciences as well.


 Minutes, University Senate, October 9, 1995

The Chair asked that when speaking concerning the recommendation that individuals identify
themselves by name and college and indicate support of or opposition to the proposal.

Professor Jess Weil stated he was very much in favor of the proposal. He found himself in the
situation of teaching courses in general physics with enrollment of 100 to 200 with four examinations
given during the semester. There are very large homework assignments and laboratories. They end up
with numerical grades of all of the work which is apportioned according to a predetermined formula
that the students are given. They end up with a continuum of grades on a scale of l to 100 where the
differences between students go as small as a tenth of a percent. He and his recitation instructors are
then left with the dilemma at the end of the semester of deciding where to put the cut lines between the
As, Bs, Cs, and D5. The unfortunate choices often have to be made of distinguishing between students
who have less than one percentage point difference in terms of an A or B or C, know it will affect their
quality point in this five credit course on a 20 percent level. He does not like doing that and ends up
looking for places in the continuum where there are gaps of three or five percentage points because of
the fluctuation in how the grades come out. He ends up putting the cut points at places where there is a
gap and he can feel if he made a mistake of a couple of percentage points one way or the other, he isn't
being arbitrary. But now he is being arbitrary in putting the grade cuts where the gaps occur and not
where he feels the letter qualification or letter criteria for these grades really occur. If there are
plus/minus grades to deal with then there is not such a big distinction between a B+ and an A-, it is
more at the five or ten percent level in their quality point, rather then at 20 percent.

Professor Jacqueline Noonan (Medicine) asked if there was any reason why the A+ was not

included. Pro