9/08/2011

Duke Health losing its Chief Medical Officer after just 8 weeks. New job, and enormous salary increase, for Dr Michael Cuffe at Hosp Corp of America

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Make sure you scroll down after reading this: first Potti Mess lawsuit filed.


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✔✔✔✔✔ Chancellor Victor Dzau said last night that he has "unofficial" word that Dr. Michael Cuffe -- named Chief Medical Officer for all of Duke Health just eight weeks ago -- was resigning.

In fact Dzau was just being careful and polite, leaving to Cuffe and his new employer, the Hospital Corporation of America, the formal announcement. The chancellor -- reached after FC received a flurry of tips from Loyal Readers -- joined others in contact with FC to express deep regret at Duke's loss and best wishes to Cuffe as he leaves for an unparalleled opportunity -- no longer in academic medicine but in the corporate world.

Word of Cuffe's resignation -- effective in November -- sent a shock wave through the medical campus, where Cuffe enjoys a sterling reputation. One source told FC his mood was one of disappointment; he praised Cuffe as "brilliant," and said he had seemed devoted to Duke and effecting change, and had been lured by high paying corporate offers before.

Cuffe, who had been vice dean of the Medical School (and holder of a couple other titles) leapfrogged over others at Duke Medicine to his post in the inner circle in July. He also was given the title of vice president for ambulatory care, with vast authority over the ever-expanding medical empire.

Cuffe -- an alumnus of the medical school '91 who took it upon himself to earn an MBA in 2009 -- is a cardiologist. He was regarded as having an inside track to succeed Dzau if the chancellor elects to retire in three years, when he will be 68 and his current five-year contract expires. We believe Cuffe is about 47 years old. We did not reach him last night, as it got pretty late before we put together elements of the story.

✔✔ Cuffe will join the Nashville based Hospital Corporation of America, a behemouth that runs for-profit hospitals, employs 180,000 people and had sales last year of $33 billion. He reportedly will hold the title of XXX president and chief operating officer, #2 in command under a board chair who will reach retirement age in six years. This position has been open for some time. XXX correction: While Dr Cuffe will hold the title of president, this is in a particular division, rather than being corporate wide. XXX

Correction: our original post, based upon what we understood to be his new job, estimated his new salary. We can no longer support those calculations and have XXX them to flag historians who value FC!

XXX Cuffe, who earned $535,201 in the last year for which we have information, can expect a rather hefty increase. His new boss, HCA chair Richard Bracken, earned a neat $38,201,047 last year.

Cuffe also does a leapfrog at HCA, landing ahead of eight group presidents. So far as FC can determine, the highest earning of those was Samuel Hazen, president of the operations group, who took down $15,001,816 last year. XXXX

✔ Fact Checker -- in compiling those numbers -- also spotted a rather serious diversity issue at HCA. There are 15 corporate directors -- all of them male, all of them white. Among the directors are two members of the Frist family, multi-billionnaires several times over, who founded HCA. The most notable family member is former US Senate Majority Leader Bill Frist. Republican of course.

The diversity issue also pervades the list of senior officers of the corporation, pictured on-line. Among 23 senior officers of the corporation, there are three females. As for males, one is named Juan, one conceivably might be black, and the rest are all white.

An important angle of this story involves the retired chair of HCA, Jack Bovender, Trustee of Duke and since July 1, vice chair of the board. The issue is whether he had any role in recruiting Cuffe, one of Duke's stars.

If so, it raises the question of Bovender's stewardship at the university. As a Trustee, he has a fiduciary responsibility to act totally in Duke's interests. In other words, we can't have Trustees going around stealing our key people for their profit enterprises!


Time will tell.

FC posted the following on July 13 when Cuffe was promoted to Chief of Medicine.

http://dukefactchecker.blogspot.com/2011/07/duke-medicine-makes-major.html

FC this weekend: No one knew what to do when Duke issued a tornado warning. One supervisor shrugged his shoulders.

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More damning information about Tuesday's fiasco.

And Kushan has become a four-letter word that administrators dare not speak.

GO DUKE!

Keep scrolling down now. First lawsuit in Potti case.. is next.

Potti Mess: 8 patients file first lawsuit, naming University, Duke Health and five doctors as defendants

Search terms Anil Potti Duke University

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✔✔✔✔✔ Eight patients -- six of them dead and thus being represented by their families -- have joined to file the first lawsuit in the Potti Mess.

FC predicts this is just the tip of the iceberg. Potti had 109 patients in his clinical trials for lung, breast and ovarian cancer when Duke halted them last year. Earlier, an unknown number of other people had either completed the trials, quit or died. And still other patients underwent painful invasive tests to see if they qualified for the genome-based treatment.

In all instances, the patients gave "informed consent" to medical studies that were not what they were led to believe. The plaintiffs say Potti promised "better than the standard chemotherapy" that would have "a higher likelihood of a favorable response." He also promised that his work -- with huge grants from the American Cancer Society and others for cutting edge genome research -- was enhancing "the public good."

In fact, Potti had falsified both his theories and his tallies of patient experience. And the cancer society demanded and got its money back.

As Loyal Readers know, so far five of about 40 articles that Potti and colleagues wrote for distinguished medical journals have been retracted. There are at least two investigations underway, a public one by the Institutes of Medicine, and a faculty misconduct investigation held confidentially under federal law. We have no idea how many faculty are included in the latter investigation.

The defendants in the lawsuit are the University, its wholly owned Duke Health subsidiary, the cancer quack Dr. Anil Potti, his mentor Dr. Joseph Nevins, and three other Duke doctors with administrative positions. A cancer diagnostic lab, believed to be owned by Nevins, was also named.

The administrators are:

Dr. John M. Harrelson, a retired orthopedic surgeon who headed the institutional review board that gave a ringing endorsement to Potti's work in early 2010.

And Vice Deans Michael Cuffe and Sally Kornbluth of the Medical School who were among administrators who signed off on the Harrelson board's recommendations. (Dr. Cuffe is also in the news today because of his unrelated resignation to become president of the Hospital Corporation of America. See separate FC post)

Potti was finally uncovered last year, initially because The Cancer Letter spotted a faked Rhodes Scholarship on his resume. He resigned his faculty position several months later.

Duke has a tradition of refusing comment on litigation, so we did not even bother to ask. It also has a tradition of dragging lawsuits out, hoping to wear down plaintiffs and build up their expenses. This litigation will take years and years. The plaintiffs' complaint alone is 78 pages of legalese.

Yes, delay and delay. That's our university.

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Separately, by coincidence, the director of all genome research at Duke, Dr. Huntington Willard of the Institute for Genome Sciences and Policy, sent a lengthy and very candid evaluation of the Potti Mess to his colleagues yesterday, saying the start of a new academic year is a good time to reflect on "a teachable moment."

Fact Checker will post on this document over the weekend. Loyal Readers can jump the gun on us by reading the document themselves!

http://www.genome.duke.edu/people/faculty/willard/dirmessages/Message%20to%20IGSP%20Faculty%20-%20A%20Teachable%20Moment.pdf

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It is impossible to say how much money is at stake in the lawsuit already filed, which seeks actual compensatory and punitive damages. The plaintiffs ask innumerable times for "more than $10,000" but that is just pro-forma.

The cases were filed in Durham Superior Court. The plaintiffs are represented by the Raleigh firm HensonFuerst, and its partner Thomas W. Henson Jr. This firm has tangled with Duke before, most notably in litigation growing out of Duke's negligent use of used hydraulic fluid from elevators to wash sterile surgical instruments.

One of the most frequent questions asked of Fact Checker is whether Dr. Potti will pay for his own defense. While this gets bogged down in insurance and liability issues, the simple answer is "probably not." The school is going to be hit.

✔✔✔ The lawsuits go well beyond problems arising directly from the fake research and clinical trials conducted by Potti. Clinical trials are experiments on human beings to see whether a drug, a test or a procedure lives up to its promise, or whether risks outweigh benefits. And in Potti's trials, the plaintiffs say they were exposed to "improper and unnecessary chemotherapy."

Duke's response to the accumulating evidence of fraud is deeply involved in the lawsuits.

The plaintiffs say Duke knew about issues with Dr. Potti as far back as 2006 but chose to ignore them because he was a rising star who roped in big grants.

There is also an allegation that Duke's internal review -- started in late 2009 -- which cleared Potti with a glowing report -- was conducted by a panel with numerous ties to Potti and his mentor.

The plaintiffs allege Duke "threatened staff with retribution, including legal action" if anyone spoke up about Potti to reveal his fraud.

"The entire response by (Duke) to the accusation of invalid and fraudulent science was deceptive. misleading and fraudulent conduct designed to protect its reputation and proprietary interests ... rather than protecting the safety of the patients involved in the clinical trials," the lawsuit states.

✔✔✔ Duke's motive allegedly included profit, a hope to create tests based upon Potti's research, that would tell precisely what drugs should be used against a given cancer, considering also the patient's DNA. This would replace the current trial and error evaluation that doctors use.

The plaintiffs say that had Duke been able to license these tests, it stood to gain "billions" of dollars, a substantial fee every time a test was given world-wide.

Six of the eight plaintiffs have since died, according to the lawsuit. All suffered from lung cancer and enrolled in the clinical trials under the belief that they would receive extra help fighting their disease.

The living patients are a Richmond County man with lung cancer and a Buncombe County woman with breast cancer.

After his resignation, Potti joined a cancer care clinic in South Carolina, that treats patients and does clinical research. He applied for and was granted a SC medical license.

Thank you for reading and supporting FC.

Confirmed: Medical Center shock. Dr. Michael Cuffe, just appointed Chief Medical Officer for all of Duke Health, is resigning

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✔ ✔ ✔ ✔ ✔ Chancellor Victor Dzau said tonight he has "unofficial" word that Dr Michael Cuffe, recently named chief medical officer for all of Duke Health, is resigning. He reportedly will become president of the Hospital Corporation of America, a giant in the health care field.

This is sending shock waves through the Medical Center, where Cuffe, extremely highly regarded, was seen as having the fast track to succeed Dzau if he decides to step down when his current contract ends in three years.

FC has also learned that Dr Paul Lee, opthomologist and a spear-head of the huge expansion of the Eye Clinic that is just beginning, is also leaving. That much is confirmed. We believe he is going to the University of Michigan.

Potti Mess: First lawsuits filed. Five doctors named. Eight plaintiffs, six of them dead

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✔ ✔ ✔ ✔ ✔ Developing. Post after 2 AM

Kunshan is now a four-letter word avoided by Administrators

We promised this post for Thursday. Our research and writing is not complete. Stay tuned.

9/07/2011

FC continues investigation into tornado fiasco. More deficiencies uncovered. Cavanaugh toughing it out, silent

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✔✔✔✔✔ Good day, fellow Dukies. FC here. Probative. Provocative. Pro-Duke.

A continuing Fact Checker investigation into the failure of the university's emergency notification system during Tuesday's tornado alerts has uncovered more deficiencies than were first apparent.

The university vice president in charge, Kyle Cavanaugh, ducked in his Allen Building cocoon for the second day on Wednesday, refusing to answer any FC inquiries. We even provided him with a cell phone number to reach us after hours. It's too early to tell if Cavanaugh will enlist Vice President L-Mo as he did during another failure last spring, and write a letter to the editor of the Chronicle trying to wiggle out of all accountability.

And Vice President Michael Schoenfeld, who has specific responsibility to provide information about alerts under emergency protocols established on April 15, 2009, also ducked us.

✔ The protocols provide for a three-tier alert system; we have been unable to find out basic information, like which level Cavanaugh or his designee declared when the National Weather Service first announced a day-long tornado watch for the entire region. As Loyal Readers know, a watch means a high potential for tornado activity. A warning is an escalation -- imminent danger to life and property -- because a funnel has been sighted or radar gives indications of formation.

We do know that at some point -- how early we do not know -- the watch was listed on Duke's website, but no other steps were taken. People who had signed up for e-mail advisories, for example, received nothing at this point.

We have also not been able to find out, in building a timeline, if Duke still subscribes to a private weather service -- revealed last April in an earlier fiasco -- and if so, when alerts from this service arrived.

And we do not know if Cavanaugh or his designate moved Duke to a higher tier in its internal protocols when the National Weather Service escalated to declare tornado warnings. The warnings occurred twice during the morning and once in the afternoon.

✔✔✔ We demanded to know why no notice whatsoever was given of the morning warnings.

✔✔✔ We asked about the afternoon warning, why some methods of notification that the emergency plan provides for were employed -- and others were not. We demand to know why this discrepancy occurred.

One method is the internet. We did not monitor Duke's three websites providing DukeAlert information at the time, so we are unable to provide an assessment. In the past, a student writing on the Chronicle blog noted "The "Duke Alert" page was a challenge to find"

We know that people who signed up for e-mail alerts received notification of the afternoon warning. A half hour late.

✔✔✔ But the sirens that surround all areas -- West, East, Central and the medical campus -- were not employed. At UNC, in the same forecast area as Duke, the sirens sounded twice. As we noted in our report yesterday, these procedures and the sirens were put in after the Virginia Tech massacre, and are used for any life-threatening situation on campus. If someone pushes the button.

And we have been unable to trace where Cavanaugh -- who is at the vortex of the university's emergency planning -- was at the time, and what methods there are to communicate with him. If there was a duty officer, we cannot find out his or her name.

✔✔✔ Deputy Fact Checkers have picked up on a debate among Dukies -- whether tornado activity was in fact close enough to campus to merit great concern.

This discussion is beside the point: the National Weather Service having upgraded to an alert, it was incumbent upon Duke to provide this information. And having decided to fulfill this responsibility -- as Duke did on one of three occasions on Tuesday -- immediate notification was required -- not a lackadaisical half hour delay.

We want Cavanaugh to explain precisely why the earlier alerts were ignored, and the last acted upon. There is nothing in the official Weather Service bulletins that would allow FC to make that distinction.

✔✔✔ Last spring, another failure involved a good dose of stupidity.

The siren system is tested once each semester and once during the summer. The purpose is two fold: to make sure the sirens are working and to familiarize people with them.

So far this semester, there has been no test. Meaning one/fourth of all undergraduates have no orientation.

Last spring, the test was scheduled for April 21st, with advance notification throughout Duke and the surrounding neighborhoods. No, we have no idea in hell why the tests aren't held on the first day of the semester.

April 21st. But three days earlier, a severe storm smacked its way through North Carolina, and at the height of the rain, wind and fury, someone at Duke got the bright idea to test the sirens right then. To make sure they would work in case they were needed.

This caused -- to put it mildly -- a great deal of confusion on what was happening, and how individuals should respond.

As a Chronicle editorial noted, at least students had the Weather Channel on cable TV. We are checking, but believe that is no longer available since Duke has given up cable TV service and substituted transmissions over phone lines that do not include all cable channels.

More from the editorial: "Whether or not students are in real physical danger is beside the point. Students deserve to be made aware of severe weather activity. This is all the more important when the campus is buffeted by wind, rain and talk of tornadoes. DukeALERT could allay much of the student anxiety generated by imminent severe weather by updating students on the status of the weather and, more importantly, by letting students know what to do if the worst does happen."

On Tuesday, it was deja vu: OK we hear the tornado alert, we want to take action, but what?

✔ Our list of failures would not be complete if we did not note a major continuing snafu during 2010. On many occasions, alert e-mails sent out by L-Mo did not go through.

We tried to inquire at that time, but he squiggled away: we wanted to know precisely when L-Mo discovered this and what he did about it.

✔✔✔ The administrator in charge of this mess, the emergency coordinator, Vice President Kyle Cavanaugh, has a deep obligation to explain these failures to the entire community. We are sad to report that he apparently views his job differently.

When Cavanaugh first arrived at Duke from the University of Florida in 2008, he earned praise from Fact Checker. Specifically we mentioned his role at forums for worried employees facing possible layoffs.

Cavanaugh seemed particularly helpful, a far cry from the humppphh that we heard from his boss, Executive Vice President Tallman Trask.

That has changed. Cavanaugh has turned either indifferent or arrogant. He -- like Shoenfeld -- has gotten a severe case of Brodheaditis. This is an unctuous disease that spreads from the head down, for which there is no medicine. Rather, it requires surgical removal of the host. More and more, we believe this is going to be necessary.

Thank you for reading FC.

9/06/2011

Big lag in tornado alert. Administrators duck FC questions

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✔ ✔ ✔ ✔ ✔ An initial Fact Checker investigation shows very serious -- and potentially life threatening -- deficiencies in Duke's response to three tornado warnings from the National Weather Service -- high level alerts meaning imminent danger -- on Tuesday.

Late yesterday afternoon and last night, Duke's emergency response coordinator, Vice President Kyle Cavanaugh, and the Brodhead Administration mouthpiece, Vice President Michael Schoenfeld, ducked e-mails and phone calls seeking a minute-by-minute timeline of the university's response and other information.

Their refusal to be transparent, however, will not shield them from accountability. FC is on the case!!

✔ During much of the day, the entire central region of North Carolina was under a tornado watch as remnants of Tropical Storm Lee pounded the area. By definition from the Weather Service, this means that conditions are ripe for the development of a tornado.

On three occasions, the Weather Service upgraded the alert to a tornado warning, meaning tornadoes may be imminent. (Relax, either spelling with or without the e is correct.)

This level alert can be issued after a tornado or funnel cloud has actually been spotted, or after radar shows indications of tornado formation. The warning means that people should take immediate precautions.

One of these warnings was issued at 1:31 PM by the weather service. By 1:35, WRAL-TV and other outlets had broadcast the alert.

Duke has several methods in place to notify people of extreme danger -- a system similar to that developed by many universities after the massacre at Virginia Tech on April 16, 2007, that killed 32 and wounded 25.

One of these methods is an e-mail blast.

A Deputy Fact Checker who has subscribed to receive these e-mails reports that the first one was not sent until 2:01 PM -- meaning people were exposed for a full half hour to a danger that was established and known. The tornado warning was cancelled at 2:15 PM, meaning people were exposed two/thirds of the time it was in effect.

Duke apparently did not deploy another of the methods of notification: sirens that have been placed strategically all over campus. We say apparently because our survey was limited and none of our Loyal Readers who responded heard the sirens where they were.

At the University of North Carolina -- just seven miles away and covered by the same forecasts as Durham -- the sirens went off twice, once around 11:30 AM and then around 1:37 PM for the alert where Duke did not get out an e-mail until 2:01 PM.

With more urgency than at low-key Duke, Carolina buildings were evacuated, classes were ended and people hustled to the interior on lower floors. On one occasion everyone in the student union -- a building with particular exposure -- was rushed down to a part of the building that seemed safer. It was a text and twitter's paradise, ending when one person said, "Thank you for visiting our basement."

✔ Duke Today, the on-line "newspaper" for Duke employees, posted the following at 12:30 PM, "Since this morning, two tornado warnings have been issued and subsequently cancelled by the National Weather Service for Durham County."

We do not know about these warnings since we sleep late and then go to morning meetings.

But we do know that Cavanaugh and his emergency preparedness team did not take any proactive steps when faced with these two warnings of imminent danger.

Afterward, the "newspaper" Duke Today asserted "these storms were actively monitored by Duke officials and were determined, based on the direction of the storm, not to pose a threat to the Duke campus."

Bullshit.

Pure bullshit, Mr. Cavanaugh. As the Weather Service website tells us, tornadoes are volatile and unpredictable. This is not a hurricane that sets a path, and a week later is still aiming at its target.

Rather, "Some tornadoes have changed direction mid-path, or even backtracked. A tornado can double back suddenly, for example, when its bottom is hit by outflow winds from a thunderstorm's core."

And this line, "Tornadoes can appear from any direction." So your watching and waiting, Mr. Cavanaugh, was the wrong move.

See http://www.spc.noaa.gov/faq/tornado/

We believe that Duke also subscribes to a private weather service, and one of our interests -- had Cavanaugh or Schoenfeld thought enough about the safety of students, faculty, staff, patients and visitors to respond -- was to find out what additional information was provided. We also wanted to know what departments of the university were alerted, for example Duke Police, and what mobilization meant.

According to a PR handout, Duke tests its sirens three times a year. Once each semester, and once during the summer. The aim is to make sure that everyone is familiar with this system. However, at the moment one fourth of the student body has never experienced a test, and we have no idea when one will be scheduled.

This morning's post concerns a specific set of circumstances yesterday. We regret to say the lack of response from Cavanaugh and Schoenfeld has become the general rule of an imperial administration. In the past, a legitimate inquiry of such urgency would not be ignored and indeed it would have been welcomed; in the Brodhead years, people asking questions are regarded as pests.

This is a festering sore that shows no signs of healing, and probably will only be cured by surgical removal of its source.

Thank you for reading FC and loving Duke!

Duke plans big blow-out for 9-11 anniversary, in sharp contrast to ignoring Veterans Day and Memorial Day.

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✔ Duke University is planning several events to mark the 10th anniversary of the 9-11 attacks, culminating with a program in the Chapel next Sunday afternoon. Dukies should attend these observances and contrast them with the continuing neglect of our heroic classmates, faculty and staff who gave their lives in the nation's wars.

In the Chapel, the program will include a performance of Mozart's Requiem -- symbolic of mourning and consolation -- by the Chapel Chair, Duke Chorale, the Choral Society of Durham and the Orchestra Pro Cantores.

There will also be remarks by President Brodhead, Durham Mayor William Bell, Dean of the Chapel Sam Wells and Duke's Muslim chaplain, Imam Abdullah Antepli.

FC has long pointed out that while Duke promptly erected a memorial to the six Dukies who happened to be in the World Trade Center on that September day, and while the Alumni Department has laid a wreath every year, Duke neglected for more than half a century the campus memorial to our war dead. That is, the memorial not to people who per chance were attacked, but to men and women who deliberately stepped into harm's way.

It was only after intense pressure -- intense -- with repeated batterings of Brodhead in newspapers and blogs -- that Duke fixed the war memorial and rededicated it two years ago.

But then it fell into neglect again. There were no observance of Memorial Day nor Veterans Day until another furor. And then a minimal effort, just an Alumni Department wreath.

Aside from the re-dedication of the war memorial, Brodhead has never spoken out about Dukies who gave their lives in the nation's service, possibly because he -- and just about everyone else in his administration -- never had the honor of wearing a uniform in the Armed Forces.

Neither has Dean Wells, who came to Duke from Cambridge, England, spoken. Nor has the Chapel been used.

This is a study of contracts. FC thinks 9-11 is overdone, and Duke continues to neglect its veterans.

On a national scale, we point out that a member of our Armed Forces who is killed in battle will only leave his family a small life insurance policy that he or she has paid for personally through payroll deductions. In some instances, there will be continuing salary benefits. But the families of those killed in 9-11 have gotten multi-million dollar awards, from a federal fund set up to keep them from suing the airlines whose jets were hijacked during the attack, and from generous public contributions. Another study in contrasts.

(The 9-11 memorial was temporarily moved to allow for construction of the new Keohane Quad dorm)

Superb editorial in Chronicle takes aim at Brodhead Administration

It's the kind of editorial that we usually have to wait until second semester to see.

It's well conceived, well executed, emphatic. And it takes direct aim at the Brodhead Administration for top-down control, leaving students out of decisions that directly affect them.

Loyal Readers, this contempt by the administration for the proper role of others in the governance of Duke also infects relationships with the faculty and with alumni. It is tragic.

Here's a link. The first time that FC has posted a link to the Chronicle!

http://dukechronicle.com/article/transitions-exclude-student-voice