Education

University of Kentucky trustees asked to revoke medical privileges of controversial surgeon

In 2006, Dr. Paul Kearney, center left, a surgeon who is director of trauma and critical care at the University of Kentucky, performed a hernia repair in Lexington. Fifteen outpatient surgeries performed that day were provided for free as part of the Surgery on Sunday program which offered help for under or uninsured patients. From left are Belle Cord, certified registered nurse first assistant, Dr. Kearney, Shirley Ramsey, CRNFA, Richard Dickens, certified registered nurse anesthetist, and prenursing student Lisa Pippen.
In 2006, Dr. Paul Kearney, center left, a surgeon who is director of trauma and critical care at the University of Kentucky, performed a hernia repair in Lexington. Fifteen outpatient surgeries performed that day were provided for free as part of the Surgery on Sunday program which offered help for under or uninsured patients. From left are Belle Cord, certified registered nurse first assistant, Dr. Kearney, Shirley Ramsey, CRNFA, Richard Dickens, certified registered nurse anesthetist, and prenursing student Lisa Pippen.

Paul A. Kearney is one of the most experienced, respected and award-winning surgeons and professors at the University of Kentucky medical center. He built the trauma center from scratch, according to supporters, saved thousands of lives during his 27 years at UK, including one man who donated $1 million to UK to endow a chair in Kearney's name. He has inspired countless students and residents who rave about his dedication, advice and help with their careers.

He's also been described as rude, profane, verbally abusive to some staff and patients, and according to university administrators, he's a doctor who no longer meets the standards of UK HealthCare.

Kearney's complicated personality will come under scrutiny at 2 p.m. Friday, when a committee of three UK Board of Trustees members will decide whether to permanently revoke his medical privileges at UK, effectively ending his career.

Such a committee has not been convened in the medical center's 50-year history, according to UK officials, because no one has ever fought this long for their job.

UK administrators said Kearney, 61, has been warned, reprimanded and punished for 20 years, but his latest outrage, in which he allegedly cursed at a patient last August, left them no choice but to fire him.

"Hospital cultures have changed over the years, but we're at a point where we will not tolerate the verbal abuse of a patient," said Bernard Boulanger, UK Chief Medical Officer.

Kearney and his lawyer, Bernard Pafunda, fully expect the trustees to agree with the administration. But Kearney plans to continue pursuing a whistleblower lawsuit he filed against the university in February.

He argues that he should not be fired for having an abrasive personality, which medical center officials knew about for many years. His real crime, he says in his lawsuit, was to challenge the boss at the medical center, Executive Vice President for Health Affairs Michael Karpf.

"This is simple," Kearney said in a recent interview. "This is about Michael Karpf having access and control over a quarter billion dollars in physician revenues outside of the purview of the board of trustees. The reason people get beat down in this system is because they question Karpf. That's what's happened to me."

UK officials have denied any retaliation and have moved to dismiss the lawsuit. Karpf declined to be interviewed for this story.

According to documents in his personnel file, Kearney was cited in 1992, 2000, 2005 and 2009 for offenses against coworkers, including "rude, offensive, arrogant and loud" behavior toward a staff member, unprofessional behavior in the operating room and a "profanity-laced, totally uncalled for, outburst" during the care of a trauma patient.

In 2012, Kearney received a written reprimand following complaints made against him by three operating room nurses, one of whom accused him of smacking her on the shoulder when she called out the name of the wrong surgical procedure. Kearney denied hitting her, but Jay Zwischenberger, chairman of the surgery department, said he believed her, "even though no one else interviewed witnessed the smack."

Kearney agreed to an action plan to correct his behavior, pledging to "refrain from such unprofessional conduct when interacting with other UK personnel."

"I would be the last person to tell you I'm perfect," Kearney said. "But in my business, one wrong decision can kill somebody. Sometimes in the heat of battle, you say or do things that you probably shouldn't say or do. You can apologize for those things but you can't apologize if someone dies."

Kearney's personnel records also show that he has nearly always received stellar performance reviews and eight UK teaching awards. There is nothing in his personnel file that criticizes his patient care.

Questioning Karpf

Karpf, who came to UK in 2003, has overhauled nearly every aspect of UK HealthCare in the last decade, including how physicians are governed and paid under the College of Medicine.

In 2009, the board of trustees approved a framework for rules for what's known as practice plans, for the College of Medicine and five other health-related colleges. Under the policy, each college was supposed to elect faculty members to a committee that would oversee implementation of its practice plan.

In the College of Medicine, however, Karpf and top administrators decreed that the practice plan committee would be comprised of the six doctors who are elected to the Kentucky Medical Services Foundation Board of Directors. Although overseen by UK physicians, KMSF is considered an independent entity that handles billing and finances for UK physicians. According to its most recent tax filings, the foundation has annual revenues of about $225 million.

In 2012, administrators made further changes to the college's departmental practice plans, leaving the impression that clinical billing hours should be emphasized over teaching and research, said Davy Jones, a toxicology faculty member in the College of Medicine. In addition, faculty would no longer get to vote to approve changes to practice plans.

To Kearney and Jones, faculty had lost their voice in budget and planning decisions. Kearney opposed the plan vocally.

In 2013, through numerous requests under the Open Records Act, Jones determined that the College of Medicine's practice plan committee had not met for four years, therefore had not overseen any of the changes. Several members had not been told they were on the committee, Jones said.

In January 2014, Jones presented his findings to the College of Medicine Faculty Council. Members were concerned about university compliance, according to minutes of the meeting.

On April 14 that year, chairwoman Hollie Swanson called a faculty council meeting at Karpf's request. They discussed Jones' findings and the council's concerns, according to meeting minutes and later testimony from Kearney during an appeals hearing about his employment on May 27, 2015.. During the April 2014 meeting, Kearney also asked about possible remedies, including an audit of KMSF funds.

According to a transcript of the hearing in May 2015, Swanson said Karpf became agitated at Kearney's questions.

"What was said by Dr. Karpf was — they got into an argument about the practice plan, and what was said by Dr. Karpf was, 'if you don't like it, you can just leave,' and at that time I interjected and asked Dr. Karpf if that was a threat," Swanson said in the hearing. "He denied it was a threat."

'Inappropriate remarks'

Three months after the faculty council meeting, in August 2014, UK officials said they received a complaint from a student about one of Kearney's lectures, where he made "inappropriate remarks."

In September 2014, a patient's mother complained that Kearney had called a quadriplegic patient a "f---ing idiot," and yelled at staff during a procedure.

On Sept. 5, 2014, Kearney was put on indefinite leave with pay. The next month, a former nurse intern sent an email complaining about Kearney, saying that he called her names while she attended UK. UK officials were not able to find her to conduct an interview.

In January, Boulanger suspended Kearney's clinical privileges, blocked him from sending email, directed all incoming emails to the hospital counsel's office and locked his office. Kearney was banned from campus and forbidden from speaking with faculty, staff, residents or students. He continues to be paid $350,000 a year as a tenured faculty member.

UK officials and Kearney went into negotiations and mediation, which proved fruitless. According to the May 27 hearing transcript, Kearney testified that William Thro, UK's lead counsel, threatened him.

"What Mr. Thro said to me in front of Mr. Iler (hospital counsel) was, 'You negotiate a buyout and sign this confidentiality agreement or we're going to ruin your career,'" Kearney said in the transcript.

Thro denies the accusation, saying he merely explained that if Kearney declined to settle, UK would continue the revocation process.

In an interview Thursday, neither Thro nor Boulanger could explain why the college's practice plan committee makeup had been changed or why the committee had not met for four years.

'Why now'

In February 2015, Kearney appeared before the Medical Staff Executive Committee, a 13-physician group that voted to uphold the suspension of Kearney's clinical privileges.

"The MSEC's decision was based upon evidence of a pattern of your unprofessional behavior directed toward faculty, residents, staff and patients that the University of Kentucky has been attempting to address with you for over twenty years," according to a Feb. 10 letter from the committee to Kearney.

In May, Kearney appealed to the Fair Hearing Board, made up of three UK physicians, which shortly afterwards upheld the suspension.

As part of his testimony to the Fair Hearing Board, Kearney said that as part of any settlement, UK officials wanted him to write letters to donors, assuring them that everything was okay. In December 2014, Mount Brilliant Farm owner Greg Goodman, who endowed the Paul Kearney chair, wrote a letter to Karpf saying that he would wait until the investigation concluded before giving another $500,000 for research.

"If I agree that there is a fair and reasonable investigation, and Dr. Kearney has been given due process, and if at the end of that, you have enough legitimate evidence to terminate a tenured professor and doctor that has served UK Hospital for 27 years, or, if you reinstate Dr. Kearney, we will reconsider our gift," Goodman wrote.

Although some of Kearney's colleagues voted to revoke his clinical privileges, others have questions.

"What we're all asking is 'why now?'" said Anthony Bottiggi, a UK surgeon who also trained under Kearney. "There's nothing he hasn't said before. Why this sudden witch hunt?"

Boulanger said neither Karpf nor himself were involved with the hearings.

"Sixteen physicians upheld the suspension," he said. "That's a pretty powerful message and it is unprecedented."

'An egregious assault'

Last fall, numerous Kearney supporters started a letter writing campaign in his defense, including Kimberly Kyker, a family practice doctor in Greenville, S.C., who studied under Kearney and was cared for by him when she was hospitalized.

"Dr. Kearney is a passionate medical professional who strives to put his patient care first," Kyker wrote. "In my follow up with him after my illness, he was incredibly supportive to me and showed his caring and personal investment in my recovery ... Again, I am not familiar with any details of what has lead to his situation but I do want you to consider all he has done for me and many, many others like me. He has devoted years to UK College of Medicine and trained countless physicians."

Jones and others are also concerned about Kearney's academic rights. Because he's banned from campus and under a gag order, he can't interact with colleagues in due process hearings to defend his tenure.

Jones, a former trustee who has criticized UK's administration in the past, said this issue is "because Kearney was too aggressively pursuing the violations of faculty rights that the College of Medicine faculty council had uncovered," he said. "Why did he, year after year, win the many teaching awards and get the high annual performance ratings, if he has been such an ongoing performance problem? That's the contradiction."

More troubling, Jones said, is the ferocity of UK's attack against a tenured faculty member.

"I have never seen such an egregious assault on the academic rights of a tenured faculty member," he said.

UK's Thro countered that academic rights do not allow even tenured faculty members to be verbally abusive to patients.

Kearney said UK has established a pattern of "getting rid of people who speak out," including former UK HealthCare CFO Sergio Melgar, who left the university abruptly in 2012. When asked about the matter, Melgar said "I believe that I was treated unfairly and I am trying to resolve that with the university."

Following Friday's hearing, the full health care committee of the board of trustees will uphold or reject the three-person panel's decision.

Officials said it's not yet clear what will happen regarding Kearney's tenure status.

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