In the Beginning
IN THE BEGINNING:
The University of Kentucky College of Public Health
James W. Holsinger Jr.
Copyright © 2024 by James W. Holsinger Jr.
All rights reserved
Cover Photo:
Drs. Richard R. Clayton, F. Douglas Scutchfield, and James W. Holsinger Jr.
Frontispiece:
Photograph of the University of Kentucky College of Public Health Faculty, 2004
Copy Editor: Steve Claas
Designer: Miki Wright
Printer: Thoroughbred Printing
Publisher: North Broadway Press
For Those Who Went Before: IN MEMORIAM
Dr. Ray F. Garman II
Dr. Joel Lee
Dr. Robert McKnight
Dr. Rice C. Leach
Dr. F. Douglas Scutchfield
Mr. John S. Wiggs
Chapter
Appendix
IN THE BEGINNING
IN THE BEGINNING:
The University of Kentucky College of Public Health
INTRODUCTION
In the summer of 2022, Dean Heather Bush contacted me soon after she assumed the role of interim dean of the University of Kentucky (UK) College of Public Health. She informed me that she had been searching online and in the college’s files for a history of the College of Public Health and had not found one. She asked me if I knew where she might find it. I replied that I was not aware that a history of the college had been compiled, and she then (as I remember it), asked what I intended to do about it. After some discussion, we hit upon the idea of compiling an oral history with recordings of the remembrances of faculty and staff members, especially from the early days of the college. Dr. F. Douglas Scutchfield had recently passed away, and it was obvious that if we were to capture the memories of the early college pioneers, we needed to move forward expeditiously. I contacted the Louie B. Nunn Center for Oral History director, Douglas A. Boyd, who promptly provided me with recording equipment and encouraged me to undertake the project. (A list of recordings can be found in Appendix C.) Recognizing that Dr. Joel Lee had played a major role in the creation of the college, I quickly contacted him. He not only recorded two oral history sessions but shipped me boxes of documents from his home in Colorado. I am greatly indebted to him for the opportunity to richly document the origins of the college as, unfortunately, Joel passed away in 2024.
The early days of the School/College of Public Health were fraught due to the inability of the president and staff of the Council on Postsecondary Education to understand the dire need of the Commonwealth of Kentucky for the well-prepared and highly educated public health workforce required to make a difference in the lives of Kentuckians. The engagement that followed took its toll, particularly on Scutch, who returned to his native Kentucky with the goal of creating an accredited College of Public Health at UK. Worn out from the fray, he entered into a well-earned sabbatical leave just before the opportunity to create a standalone College of Public Health became a possibility. The people of Kentucky owe a debt of gratitude to a native son, who cared deeply for them and their well-being.
This project is dedicated to those early College of Public Health pioneers who have gone to their well-deserved rest. They are missed not only by their
families and friends but by the people of Kentucky to whom they dedicated their careers. It has been a pleasure to work on this project, telling the story of the creation of a great institution, and I deeply appreciate Dean Bush’s call that precipitated the effort that followed. I am grateful for all those who have provided information and reviewed the chapters. I am grateful to Steve Class, who did an outstanding job copy editing the manuscript and Miki Wright for designing the book.
Note: As a principal player in the events described here, I frequently found myself needing to describe my own positions and actions. I have chosen to write these passages in the third person, not out of any disassociation or hubris, but for the sake of narrative consistency.
James W. Holsinger
Jr.,
MD, PhD, MACP Chancellor-Emeritus
University of Kentucky Medical Center May 8, 2024
CHAPTER 1
EARLY EFFORTS
The University of Kentucky (UK) has a lengthy history of being interested in developing programs in the public health arena. As early as 1917, President Frank McVey (1917-1940) established the Department of Hygiene and Public Health in the College of Arts and Sciences. This program was designed primarily as a program to promote student health. The department established a laboratory in what was then called the “new dormitory” (Neville Hall). “Dr. P. K. Holmes was appointed head of this new department. He was a graduate of Bowden Medical School, and they hired a couple of additional physicians, Dr. Ireland and Dr. Eva Luck, and a nurse, Tillie Greathouse, was appointed”1 to provide a dispensary for the care of ill students. By September 1920, the Board of Trustees received a report stating that the department had been established with a subsidy of $11,000.00 from the United States Interdepartmental Social Hygiene Board. President McVey “considered the establishment of this department as one of the major achievements in the early years of his administration.” 2p54
In 1928, Dr. John Chambers was appointed director of the Department of Hygiene and Public Health, and in 1930, he “told McVey that thirty of Kentucky’s counties had an average of one doctor for 2,100 people, and that sixteen counties had only one for 3,100.” 3p189 Chambers was noted for saying that in Kentucky we care about our horses more than we do about the health of the public. By 1932, McVey had established a summer school for public health that continued to grow in the succeeding years. In 1937, the first public health nursing and community health education courses were offered with credit toward either a bachelor of arts or a bachelor of science degree. The Master of Science in Public Health degree (MSPH) was created in 1938 and was located in the College of Arts and Sciences. From 1938 to 1955, thirty-eight MSPH degrees were awarded at UK.4
During the first administration of Governor A. B. (Happy) Chandler (19351939), Chambers worked diligently to develop a medical school at UK, but due to the impact of the Great Depression, funding for such an endeavor was unavailable. President McVey learned of Chandler’s interest in opening a medical school in Lexington and moved rapidly to squelch the idea that the Commonwealth of Kentucky was in no position to establish such an institution. He would be in favor of doing so if it could be done properly, but he believed that the legislature’s appropriation would not
Born in Seattle, Washington, Dr. William Willard received his medical degree from Yale University in 1934. Dr. Willard built a distinguished record of service as founding dean of the College of Medicine at the University of Kentucky, where he established the first ever Department of Behavioral Sciences and Community Medicine. In 1966, Dr. Willard chaired the American Medical Association’s Committee on Family Practice. Their “Willard Report” is credited with recommending and establishing Family Medicine as the 20th medical specialty in the United States. In 1972, University of Alabama President David Mathews coaxed Dr. Willard out of his Kentucky retirement to move to Tuscaloosa and develop the University of Alabama College of Community Health Sciences.Today’s family medicine in Alabama is largely a product of the school Dr. Willard founded. One in eight family physicians in Alabama has trained at the Family Medicine residency program at CCHS. The program has provided over 360 family practice physicians to the state, with 50 percent remaining in Alabama.
allow the university to develop a quality institution.5 Following World War II, Chambers again raised the possibility of creating a medical school. However, President Herman L. Donovan (1941-1956) “was cautious about asking the legislature for an appropriation, because he feared that money allowed for a medical school might mean less for other branches of the University.”6p190 During multiple legislative sessions, bills were introduced to create a medical school at UK, but all failed to pass until the fall of 1955 when both candidates for governor promised to support the creation of a new medical school. Following his election to a second term as governor (1955-1959), Chandler recommended to the 1956 session of the General Assembly that $5,000,000 be appropriated to create the UK Medical Center, including a 500-bed hospital, which eventually would be named for him. The UK College of Medicine was established on June 1, 1954, by action of the Board of Trustees with the Colleges of Dentistry and Nursing being created in May 1956. “Dr. William R. Willard, dean of the College of Medicine at Syracuse University, was selected as Vice President of the Medical Center and first dean of the College of Medicine.”7, 8 The first class of medical students was accepted in 1960. Willard developed the Colleges of Medicine, Nursing, Dentistry, and Allied Health, and the College of Pharmacy was moved from Louisville, becoming part of the Medical Center. As may be seen from Willard’s original model for the Medical Center, he also indicated his desire to establish a College of Public Health. (See Figure 1.) Willard obviously had an interest in public health, as indicated by his creation of the first Department of Behavioral Science and Community Medicine in an American medical school. Prior to Willard’s departure for the University of Alabama, the Masters of Science in Public Health degree was established in the College of Allied Health Professions (now College of Health Sciences) in 1968. Unfortunately, Willard’s plan for creating a College of Public Health was not consummated, and by 1973 the MSPH degree was discontinued once again.
In 1970, Dr. Peter P. Bosomworth, Chair of the Department of Anesthesiology in the College of Medicine, was appointed Vice President of the UK Medical Center, later becoming chancellor of the Medical Center. Before he was appointed Chair, he served in the United States Navy and on the faculty at The Ohio State University. Bosomworth continued the interest in forming a College of Public Health, recognizing the significant health disparities within the Commonwealth of Kentucky, especially in rural areas of the state. In 1982, he established a committee to study the feasibility of creating a College of Public Health. The committee recommended that
such a college be established, but due to significant financial constraints resulting from reductions in the state appropriation for UK, plans for creating such a college were placed on hold. However, in an effort to move toward the formation of a college of public health, the Department of Preventive Medicine and Environmental Health was created by the Board of Trustees on April 6, 1982, in the College of Medicine with Dr. Arthur Frank as its first Chair.9 The Department offered the MSPH degree in 1988 with concentrations in health services administration, occupational, environmental health, health epidemiology, and toxicology. Willard and Bosomworth laid the groundwork for developing the UK College of Public Health, and the university was ripe for its creation.
CHAPTER 2
SCHOOL OF PUBLIC HEALTH
Dr. Peter P. Bosomworth received a bachelor’s degree from Kent State University and a medical degree from the University of Cincinnati. After completing an internship at Cincinnati General Hospital and residency at The Ohio State University’s (OSU) academic medical center, he earned a master’s degree from OSU. Bosomworth also served in the US Navy and was the chief of anesthesia at the Great Lakes Naval Hospital. In 1962, after a term on OSU’s anesthesia faculty, Bosomworth was named the first chairman of Anesthesiology at UK’s new College of Medicine. Recruited by Dr. William R. Willard, the medical center’s first vice president and dean of the College of Medicine, Bosomworth became the youngest medical school department chair in the United States. From 1967 to 1970, Bosomworth served as the College of Medicine’s associate dean for Clinical Affairs. In 1970, he was appointed vice president of the UK Chandler Medical Center and later became its chancellor in 1982. When he retired in 1994, Bosomworth was recognized as having the longest tenure of any senior medical center administrator at a single academic institution in the U.S. He was respected for his vision, honesty, and resilience. Because of his loyalty and leadership, UK flourished as his fortitude and thoughtfulness emboldened the impact of the institution’s work. Throughout his tenure, Bosomworth remained steadfastly committed to quality patient care. His dedication was evident through his personal interaction with medical students and residents, always promoting highly competent, attentive, and compassionate care. Over the years, staying at the forefront of medicine, he studied telemedicine extensively in the US and Europe. As chancellor emeritus, he remained on the College of Medicine faculty until his retirement (continued on page 12)
Following Dr. Bosomworth’s retirement10 as chancellor on June 30, 1994, James W. Holsinger Jr., MD, PhD,11 was appointed chancellor of the Medical Center. Dr. Holsinger had served for twenty-six years in the Department of Veterans Affairs, including serving as Under Secretary for Health during President George W. H. Bush’s Administration, where he had responsibility for the Veterans Health Administration. With his experience in providing population health to many veteran beneficiaries, he, like his predecessors, was concerned about the significant health disparities that continued to exist in Kentucky. He soon began to contemplate developing a college of public health.
During the nine years that Holsinger served as Medical Center chancellor, he met weekly with President Charles T. Wethington Jr. In an early meeting with the president, he raised the possibility of creating a college of public health in the Medical Center to impact health disparities in the commonwealth, particularly in eastern Kentucky. Dr. Emory Wilson, dean of the College of Medicine and a medical school classmate of Dr. F Douglas Scutchfield, informed Holsinger that Scutchfield was interested in coming home to Kentucky. Dr. Scutchfield was the founding director of the San Diego University School of Public Health and had previously served with Willard at the University of Alabama College of Community Health Sciences. Dean Wilson was interested in the possibility that Scutchfield would create a Center for Health Services Management and Research, while Chancellor Holsinger was interested in his creation of a college of public health.
Dr. Thomas Robinson, dean of the College of Allied Health, needed a chair for the Department of Health Services Management following the untimely death of Dr. James Suver. In the end, Scutchfield filled all three roles and served as the director of graduate studies for the Master of Health Administration degree in the Martin School of Public Policy and Administration. The opportunity to move ahead with creating a college of public health occurred on June 10, 1996, when Holsinger met with Scutchfield. The two followed up their initial meeting the following day for a more extended discussion of the Medical Center’s needs. Holsinger and Scutchfield met for a third time on July 12, 1996, to finalize the plans for Scutchfield’s appointment. On Scutchfield’s arrival on January 24, 1997, he met with Holsinger and had an immediate follow-up meeting with Chancellor Holsinger and Deans Wilson and Robinson. At this point, the way was opened for Scutchfield to begin working on creating a college of public health as well as his other assigned tasks.12
in 2000, when he served as a telemedicine consultant for UK’s telehealth program. In 2001, UK named the Health Sciences Research Building in his honor and in recognition of his contributions to the university. He was able to see the fullscale transformation of the medical enterprise he helped build into a national center. He was awarded an honorary Doctor of Science in 2000 from UK. Other awards and honors he received include the Boy Scouts of America Silver Beaver Award, Kentucky Medical Association Outstanding Educator Award, Key to Lexington, and the University of Cincinnati Daniel Drake Distinguished Service Medal.
Initially, Scutchfield focused on creating the Center for Health Services Management and Research. On April 1, 1997, Holsinger directed Scutchfield to develop a proposal for the UK Board of Trustees for creating the center. By January 27, 1998, the proposal was developed, having been crafted by two groups: a faculty group consisting of representatives of the five Medical Center colleges (Medicine, Nursing, Dentistry, Pharmacy, and Allied Health Professions) and the Martin School of Public Policy and Administration, which served as a steering committee responsible for initial faculty guidance, and “External Advisory Committee composed of knowledgeable senior health professionals from around the commonwealth.”13 The proposal called for creating the center with “as its ultimate goal the improvement of the health status of citizens of the Commonwealth. It will do so by providing education, research, and service activities focused on improving efficiency and effectiveness of the system of delivering health care.”14 On May 5, 1998, the Board of Trustees approved the creation of the center.15
Scutchfield’s second assignment was based on an ongoing issue between the College of Allied Health Professions and the Martin School. Tension developed over the failure of the Martin School to provide joint appointments for the faculty in the college’s Division of Health Administration, who were an integral part of the Masters of Health Administration (MHA) program located in the Martin School. Following the death of Suver, the MHA director of graduate studies and director of the Division of Health Administration in the college, in February 1995, questions were raised as to the appropriateness of the MHA program residing in the Martin School. On December 23, 1995, Lexington Campus Chancellor Elisabeth Zinser determined that the Martin School would have sole responsibility for the administration and governance of the MHA program. By early 1996, the College of Allied Health Professions withdrew from the MHA program. By January 24, 1997, the issue had become so fraught that President Charles T. Wethington Jr. informed the chancellors that the Lexington Campus and Medical Center must work together for the MHA to succeed.”16
Based on President Wethington’s directive, Chancellors Holsinger and Zinser agreed to the appointment of Scutchfield as the director of graduate studies for the MHA program and professor in the Martin School of Public Policy and Administration in early 1997. As program director, he was required to meet the requirements of the Accrediting Commission on Education for Health Services Administration (ACEHSA) so that the MHA program would be fully accredited. In addition, as the director of the Division of Health Services Management of the College of Allied Health Professions, he, along with the Division’s faculty, would
James W. Holsinger, Jr. graduated with a Bachelor of Arts degree from UK. He holds a Master of Science degree from the University of South Carolina and MD and PhD degrees from Duke University. During his 55-year career, Dr. Holsinger served in a variety of academic and administrative appointments at several universities and federal and state governments. He served for 26 years in the Department of Veterans Affairs, holding appointments as chief of staff and medical center director of several VA Medical centers. In 1990, he was nominated by President George H. W. Bush and confirmed by the US Senate as the first presidentially appointed chief medical director of the Veterans Health Administration. In 1992, he became the first Undersecretary for Health in the Department of Veterans Affairs. From 1994 to 2003, Holsinger served as chancellor of the UK Medical Center. He was appointed chancellor-emeritus in 2003. In 2003, Governor Ernie Fletcher appointed Holsinger as the first secretary of the Kentucky Cabinet for Health and Family Services. In 2005, he returned to UK and served as the Wethington Chair in the Health Sciences and professor of Health Services Management in the College of Public Health until his retirement in 2017.
Holsinger served for more than 31 years in the United States Army Reserve, commanding units at the company, field hospital, general hospital, and US Army hospital levels in addition to other appointments. His Army Reserve career (continued on page 16)
continue teaching in the MHA program. As the turmoil subsided, the collaboration between the Martin School and the College of Allied Health Professions resulted in the continued accreditation of the MHA program.
As his third assignment, Dr. Scutchfield engaged in the creation of UK’s College of Public Health. In a Memo for Record17 dated January 24, 1997, relating his meeting with Holsinger, Wilson, and Robinson, Scutchfield stated: “The Chancellor has decided to move ahead with a school of public health.” The decision was made to develop initially a school of public health within the College of Medicine. He was tasked with developing a master plan for its creation with the goal of moving ahead rapidly. Although Holsinger anticipated that difficulties might occur in creating a public health entity within the Medical Center, he was unprepared for the level of concern that such an organization would detract from other colleges and centers. University funding was limited even though Governor Paul Patton called for UK to become a “Top 20” public research university by 2020. His call was codified by the enactment of HB1 Kentucky Postsecondary Education Improvement Act of 1997, which stated that the university would become “a major comprehensive research institution ranked nationally in the top twenty (20) public universities...”18 Holsinger believed that the creation of a public health entity within the Medical Center would be a major step forward in meeting the Kentucky Legislature’s mandate.
College of Medicine Dean Emery Wilson stated: “Once it became clear to me that a separate college was being considered and that faculty, students, educational programs, and research funding was being moved from the College of Medicine into the new college, I was not enamored with the idea.”19 Likewise, concern was raised by Thomas Robinson, dean of the College of Allied Health Professions, concerning the possible relocation of the Division of Health Management. The Martin School raised concerns over the possible move of the MHA program to the proposed new college. As a result, the decision was made to initiate the process of developing a public health entity by creating the School of Public Health within the College of Medicine, thus, for the moment, alleviating Dean Wilson’s concerns.
Following the January 24, 1997, meeting, Scutchfield began developing the proposed school, utilizing the development of the center as a prototype for its development. By March 1998, the proposal for its creation was prepared, and in a letter to the chancellor dated March 11, 1998, Dean Wilson supported its creation.20 Over the next several months, letters of support for the school were obtained from the other four Medical Center deans. However, in a letter
culminated in 1989 with his assignment to the Joint Staff as assistant director for logistics, J-4 (Medical Readiness), and his promotion to Major General in 1990. He is a graduate of the Army Command and General Staff College, the Army War College, and the Joint War Fighting course. He retired from the US Army Reserve in 1993. For his service to a variety of organizations, Holsinger received the Gold Medal of the American College of Healthcare Executives, the Exceptional Service Award and Distinguished Career Award of the US Department of Veterans Affairs, the Superior Service Award of the Kentucky Cabinet for Health and Family Services, the Distinguished Service Medal and Legion of Merit of the US Army, and the Founder’s Medal of the Association of Military Surgeons of the United States. He holds Mastership in the American College of Physicians.
to Holsinger (June 2, 1998), Scutchfield explained that Dr. Clifford Hynimann, Chair of the Senate Committee on Academic Organization and Units, was uncomfortable with the brevity of the proposal for the School of Public Health, and therefore the redrafted proposal was more extensive and explanatory.21
The Proposal to Create a School of Public Health at the University of Kentucky22 stated that since there was currently no school of public health within the Commonwealth of Kentucky, Kentucky students were forced to leave the state to obtain a public health education. This situation placed an undue burden, especially on non-traditional students who were already working within the public health system. Due to the interdisciplinary nature of public health, the initial step required by the proposal was the establishment of a school of public health. Following its establishment, the initial faculty would be identified. Several faculty members had been identified throughout the university who could serve as faculty members in the school while retaining a primary appointment in their respective colleges. The proposal called for strategic planning for the school following its approval by the Board of Trustees. A steering committee would be established comprised of stakeholders in the various Medical Center entities that would benefit most from its creation. The initial faculty of the school, with the guidance of the steering committee, would create its vision, mission, goals, and objectives. They would also make recommendations regarding the organization and administration of the new school. Primary faculty appointments would be made as resources for the school became available. The proposal called for initial funding of $753,700.00, including recurring, nonrecurring, and grant funds.
By September 1998, the proposal had been approved by the University Senate Council and was scheduled as an agenda item for the October 12, 1998, University Senate meeting.23 In a letter dated September 24, 1998, Holsinger assured Dr. Roy Moore, UK Senate Council Chair, that appropriate funding for the school would be available following the approval of the proposal by the Board of Trustees.24 The proposal was approved by the University Senate and forwarded by the university president to the Board of Trustees. The creation of the School of Public Health was approved by the Board of Trustees on October 18, 1998.25, 26
Although there was no school or college of public health within the commonwealth, public health education was beginning to move forward in the regional universities as noted in a letter dated September 28, 1998, from Sue Moore of the Council of Postsecondary Education to Dr. John Peterson, Associate Vice President for Academic Affairs at Western Kentucky University. This letter confirmed the addition of a Master of Health Administration degree and the replacement of the Master of Science in Community Health Liaison with
Dr. F. Douglas Scutchfield, 1943-2023, was a public-health leader for the world, the nation, and his native Kentucky. A native of Wheelwright in Floyd County and a graduate of Hazard High School and Eastern Kentucky University, Scutchfield earned a doctor of medicine degree from the UK College of Medicine in 1966, where he held the Peter P. Bosomworth endowed professorship in Health Services Research in the College of Public Health. He was the founding director of the School of Public Health, the college’s predecessor. He also served as a professor in the Department of Family and Community Medicine and the Martin School of Public Policy and Administration. He was the founding director of the Center for Health Services Research and Management, an associate dean of the College of Medicine, chair of the Department of Preventive and Environmental Medicine. He founded the Graduate School of Public Health at San Diego State University and was a founder of the College of Community Health Science at the University of Alabama. Scutchfield was a prolific author of scientific research papers and was co-editor of Principles of Public Health Practice and Contemporary Public Health, as well as editor of many academic health journals, founding co-editor of the Journal of Appalachian Health, and an editor of a recently published book, Appalachian Health: Culture, Challenges, and Capacity. Scutchfield and Paul Evans Holbrook Jr. edited The Letters of Thomas Merton and Victor and Carolyn Hammer: Ad Majorem Dei Gloriam, published by the University Press of Kentucky
the Master of Public Health (MPH) degree.27 Several years later Eastern Kentucky would follow suit. However, a firestorm was created one week following the action of the UK Board of Trustees when, on October 26, 1998, the University of Louisville Board of Trustees Executive Committee reactivated its School of Public Health, which had been founded in 1919 and absorbed by its School of Medicine in 1923.28 The Kentucky Council on Postsecondary Education (CPE) that had been created by the Kentucky Postsecondary Education Improvement Act of 1997 was still in its infancy with a new president, Dr. Gordon Davies. Davies had previously served as director of the State Council of Higher Education for Virginia from 1977 until 1997 and was appointed CPE president on June 16, 1998.29
The State Journal reported that the council spokesperson, Debbie McGuffey, stated: “We might need one school, but we don’t need two.” The article continued: “Legislators and others have complained that Kentucky wastes resources by supporting Schools of Dentistry at both UK and U of L and law schools at UK, U of L, and Northern Kentucky University. The post-secondary education reform law enacted last year was intended, among other things, to discourage needless duplication within the state’s higher education system. The law authorizes the council to close existing academic programs, and the council’s role as monitor of new state funding gives it increased leverage over universities’ ambitions.”30 However, the Lexington Herald-Leader reported on October 29, 1998, that McGuffey stated that “the council can’t stop universities from creating schools–but it can prohibit the schools from offering certain degrees.”31 UK’s Medical Center chancellor believed that the two institutions were focusing on different degree offerings based on differing missions. He stated: “Our degrees are focused on the professional aspect of the field…(U of L’s degrees) seem to be more academic degrees, geared to research…If that is the case, it seems that our different missions will complement each other nicely.”32 In an editorial entitled “Higher-ed reform test,” dated November 18, 1998, the Editorial Board of the Lexington Herald-Leader stated that the announcement of the two Schools of Public Health would test Patton’s higher-education reform by determining “who has power.”33
In an oral history interview, Holsinger stated: “Immediately this blew up with the Council on Postsecondary Education, which has responsibility within the Commonwealth of Kentucky for degree issues…so they were immediately concerned that there was duplication. And this went on and on and on about this issue of duplication. And we kept saying it’s not duplication. There are two sets of degrees. They are mutually compatible and not in competition with each other. but they are both needed. They [U of L] want to do the MS and PhD,
feeling that they would be going in an entirely different direction that we were. Their PhD degrees were very specific and very narrow…We were more interested in focusing on providing well-trained practitioners for health departments and in policy making…that was what Kentucky needed at the time.”34
On October 29, 1998, in follow-up to the action of UK’s Board of Trustees, Wilson appointed Scutchfield as acting associate dean for public health and acting director of the School of Public Health. In addition, he appointed the School of Public Health Steering Committee (See Figure 2) to:
James Applegate
James Cecil III
Terry Collins
Zed Day III
Joseph Fink III
Thomas Garrity
Lynn Hall
Tony Horstman
J. David Johnson
Douglas Kalika
Rice Leach
Sam Matheny
Robert McKnight
M. Raynor Mullins
William Pfeifle
John Poundstone
Robert Shapiro
Marcia Stanhope
David Watt
Constance Wood
Stephen Wyatt
Assist in the development of the vision, mission, goals, and objectives of the new school;
Provide input to Dr. Scutchfield in the design of the curriculum of the school, initially the sine qua non of a school of public health, the Masters in Public Health degree, MPH, and finally, the professional doctorate in public health, the Doctor of Public Health, DrPH degree;
Review the current programs and academic units that potentially should become part of a school of public health;
Examine the resources available to contribute to the creation of the school, specifically identifying faculty, etc.;
Review assets and recommend what additional resources might be required on a phased basis to establish the school; and
Provide input regarding the organizational structure and administrative character of the school.
He requested that the committee complete its work by May 1, 1999.35
As the School of Public Health Steering Committee began its work, Holsinger informed Davies of the creation of the school, stating that “this decision by the Board of Trustees was in [SIC] culmination of a nearly two-year planning effort for the development of such a school… The Chandler Medical Center has offered a master’s degree in public health (CIP 512201) for some years, focusing most heavily with [SIC] a concentration in environmental sciences. In addition, by program advisory statement (August 3, 1998), the University of Kentucky has indicated its intent to create a degree program of Doctor of Public Health. Consequently, by history and current intent, the University of Kentucky’s efforts in the area of public health have been directed to the professional degrees of Masters of Public Health and Doctor of Public Health…In summary, I believe that the creation of the School of Public Health is a key element in the Chandler Medical Center’s efforts to assist in moving the University of Kentucky forward to top twenty public university status by the year 2020. As one of only a handful of academic health centers offering all six health-related programs within a single institution, the Chandler Medical Center will continue to work to meet its mission statement.”36
By November 10, 1998, UK and U of L were informed by Davies that they should work together to develop some form of collaboration in the area of public health. Davies was quoted by the Louisville Courier-Journal: “We may indeed want one school…in public health. We most certainly do not want a duplicative effort. The great universities of future years are not going to be fortresses that stand alone.”37 By the end of 1998, a draft document entitled “Commonwealth Institute for Public Health”38 was being circulated among members of the steering committee.
The Commonwealth Institute for Public Health (CIPH) was proposed “to foster the development and coordination of high-quality graduate and postgraduate academic teaching, research, and community services programs that address the public health needs of the population of Kentucky.”39 The proposal included UK, U of L, and such regional Kentucky universities that developed public health programs and chose to collaborate. CIPH’s proposed responsibilities included advising the institutions regarding professional public health education; facilitating their teaching, service, and research missions; and reviewing and recommending joint programming to
include the health of the population of Kentucky.
CIPH’s board of directors included representatives from the participating four-year state institutions with approved graduate public health programs. The chief executive officers of the Schools of Public Health at UK and U of L would be permanent members of the board. In addition, the presidents of these two institutions would each appoint four members to the board, including two full-time faculty members at the rank of associate professor or higher and two selected from the local business or health communities. The presidents of other participating universities would appoint two faculty members to the board. Ex-officio members of the board would include a representative appointed by the presidents of state universities that did not have public health programs, as well as two public health officials appointed by the Secretary of the Cabinet for Health Services. The chair of the board would rotate between UK and U of L. The board of directors would determine the agenda and activities of the organization. Primary consideration would be given to those activities jointly conducted by UK and U of L. Based on a needs assessment conducted jointly by the by the two universities and CIPH. Joint education activities would be developed, including joint course and joint degree programs. Efforts would be made to develop a common concurrent admission pathway so that students could be admitted to both institutions. Likewise, joint research and community outreach efforts would be developed, including all institutions participating in CIPH.
Notes from a conference call on January 5, 1999, between the senior leaders at UK and U of L indicate that joint MPH and MSPH degrees could not be offered as U of L was pursuing the MSPH degree, which UK would be dropping in order to replace it with the MPH degree that U of L would not be offering.40 Only two days later a letter from Davies to U of L President John W. Shumaker and Wethington stated that the CIPH document was short on specifics for joint degrees and appeared to be an “empty shell into which some activities may or may not be put…the crux of the issue will be the proposals for degree programs. As I have indicated in previous correspondence, I am not prepared to recommend to the Council on Postsecondary Education approval of isolated degree programs in separate schools at the two universities.”41 He requested a meeting with the two university presidents to discuss how the proposed CIPH might be strengthened.
In the meantime, the School of Public Health Subcommittee on Academic Units continued its work. It noted that the Council on Education for Public Health (CEPH) accreditation requirements stipulate that the core faculty members
in the school must consist of at least 25 faculty members distributed in five programmatic areas: biostatistics, epidemiology, environmental health, health service administration, and social and behavioral sciences.42 Appropriate mechanisms for the relocation of administrative units (departments) were included in the report, including the need for a recommendation from both the dean of the college losing the unit and the approval of the appropriate chancellor. Such changes would require the approval of the University Senate, the president of UK, and the UK Board of Trustees.
On January 20, 1999, Wethington responded to Davies’s letter of January 7, in which he stated UK’s interest in clearing up any issues that stood in the way of UK’s public health program implementation. He continued:
“I am surprised at your comment regarding the tentative nature of our collaboration…we are early on in the development of the program. We have some idea of what might come next, but both ourselves and the University of Louisville are still in process of working through what the Schools will actually look like…We indicated a willingness to work with the University of Louisville in collaboration with our Schools’ education, service and research programs. I would call your attention to several statements in the CIPH documents that indicate that willingness…We have called for joint faculty appointments, joint admissions procedures and collaborative research and service activities under the CIPH umbrella.”43
Likewise, on January 20th, Dr. W. Paul McKinney, acting dean, U of L School of Public Health, informed Scutchfield that U of L’s School of Public Health Planning Committee would invite UK to join U of L in the development of several degree programs: MPH and PhD in biostatistics with concentrations in decision sciences and mathematical statistics and MPH and PhD in epidemiology with a concentration in clinical investigation. He also offered to develop joint MPH and PhD programs.44
During February 1999, the School of Public Health (SPH) Steering Committee and its subcommittees continued working rapidly to develop and implement the MPH program in place of the MSPH, with plans to admit the first MPH students for the Fall 1999 semester.45 At this time, a formal document laying out the MPH program of instruction was developed including the syllabi for new courses that would be required for the degree. The MPH curriculum included “1) a common core of course work, 2) studies in one of five specialty tracks, 3) a public health elective, and 4) a required field practicum. As a professional
degree, a thesis [was] not required.”46 In March, Dean Wilson recommended faculty appointments in the SPH to Chancellor Holsinger, and on March 18, 1999, Holsinger submitted a letter to the Association of Schools of Public Health requesting that the SPH be granted affiliate membership in the Association.47
As the development of the School of Public Health rapidly moved forward, on March 26, 1999, Chancellor Holsinger and Dean Harrison C. Spencer of the London School of Tropical Medicine and Hygiene signed an agreement to allow the two institutions to collaborate on research and educational programs. As noted by Scutchfield: “The cutting-edge research being done by the London School of Hygiene and Tropical Medicine will further spur the research at our school of public health” As a consequence, the SPH became the only institution in the United States affiliated with the London School, the oldest school of public health in the world.48
On March 30, 1999, Davies again requested that Presidents Shumaker and Wethington provide him with a substantive agreement between the two institutions demonstrating “institutional relationships that do not require regulatory oversight.”49 By April 8, 1999, the Joint Agreement: University of Louisville and University of Kentucky Schools of Public Health had been drafted. Following its submission to Davies at CPE, he responded on April 22, 1999, to the presidents of both UK and U of L, stating that the draft did not meet his requirement for a single school of public health in the Commonwealth of Kentucky.50 He requested that the two institutions develop a single school of public health approach that could be considered for accreditation by CEPH. On April 30, 1999, Wethington responded by letter in which he recommended that CPE place a moratorium on new public health programs while CPE and the two universities jointly studied the issue.51 On May 4, 1999, Shumaker responded, accepting Davies’s suggestion of a single school of public health.52 Consequently at the May 17, 1999, meeting of the CPE, Davies informed its members that “efforts to work out a joint plan for UK and U of L to operate a school of public health still have not jelled after months of negotiations.” 53 On June 7, 1999, Holsinger published an opinion in the Lexington HeraldLeader entitled “Public health school right for UK.”54 As the saga continued, the Lexington Herald-Leader reported that the CPE wanted the UK and U of L Schools of Public Health to merge. “Davies and the university presidents will continue to work out the details for one public health school…Part of the planning will be working out the nuts and bolts of two universities running a single school and making sure it can meet the national standards.”55
On June 24, 1999, Davies, Wethington, and Shumaker met to discuss the development of a single school of public health. A general agreement was reached that there would be a single school of public health administratively located at UK governed by the UK Board of Trustees and named the Kentucky School of Public Health. U of L would establish an Institute for Public Health affiliated with the Kentucky School of Public Health. The Kentucky School of Public Health would establish a public health planning committee that would function jointly and be composed of faculty members and administrators from both universities. Joint appointments for the faculty would occur, as well as joint opportunities for research collaboration and doctoral student supervision. UK academic programs would prepare public health practitioners, while U of L programs would be oriented toward research. Each university would be responsible for the accreditation of its programs, and UK would be responsible for the accreditation of the Kentucky School of Public Health. Any joint programs would result in the two universities seeking joint accreditation. 56
On June 29, 1999, Wethington informed Davies that UK was in full agreement with Davies’s letter of June 24 and would expeditiously make the required changes to the draft joint agreement that had previously been shared.57 He anticipated that the decision to move ahead with the Kentucky School of Public Health (KSPH) could be made at the July 19th CPE meeting. He stated that UK Board of Trustees approval was not required for the name change since the Board had not previously named the School of Public Health. Wethington concluded his letter by stating that Holsinger would meet with his U of L colleagues and Dr. Sue Hodges Moore, CPE Executive Vice President, to finalize the agreement. By July 1, 1999, the draft agreement for the creation of The Commonwealth of Kentucky School of Public Health was drafted for consideration by U of L and CPE staff.58 Likewise, on July 22, 1999, Shumaker assured Davies that U of L was committed to the approach outlined in Davies’ and Wethington’s letters except for the issue of governance of the KSPH. In his letter, Shumaker made several suggestions for establishing the governance of the KSPH and stated that his previous comments concerning the administrative location of the KSPH “did not assume the adopting of any particular governance model.” 59 On July 23, 1999, Holsinger and Dr, Joel Kaplan, U of L Vice President for Health Affairs, met to resolve the remaining issues. As reported in Shumaker’s letter to Davies on July 29, 1999, they were able to resolve virtually all remaining issues except thse regarding the governance of the KSPH. In his letter, Shumaker strongly suggested that the two universities request a consultation visit from Pat Evans, CEPH executive director, to “consult with us about our plans for a single, collaborative school
of public health: its programs, its administration, and its governance.”60 Between August 3 and August 19, 1999, a flurry of letters between Davies and the two university presidents resulted in U of L capitulating to the agreement that KSPH would be governed by the UK Board of Trustees and that efforts between Holsinger and Kaplan, to finalize the draft agreement would result in its approval by all concerned.61, 62, 63, 64, 65
The efforts to create both the KSPH and joint efforts between the two universities continued, assisted by the appointment of Dr. James Applegate, a long-time UK College of Communication faculty member, to the position of CPE Vice President for Academic Affairs. He had served as UK Senate Council Chair and brought his negotiating skills into the discussions. In a memorandum66 to Moore, Dr. Carol Garrison, U of L provost, emphasized the need to reach a final agreement of the KSPH as rapidly as possible. She raised issues about the nature of the UK degrees, noting that UK wished to pursue professional degrees, but finding that a joint MSPH degree would violate U of L’s effort to have research degrees (MSPH and PhD degrees). She reiterated U of L’s request to involve Pat Evans, CEPH executive director, and offered to set up the required meeting. On October 18, 1999, Kaplan provided a reworded draft 67 of the July 15 document for Holsinger’s consideration, indicating his desire to complete the agreement in time to submit it to CPE by the November 1 deadline for new academic programs. The redrafted agreement established each university’s responsibility for governance and accreditation of its programs. In it, UK offered the professional degrees (MPH and DrPH) and U of L academic degrees (MSPH and PhD). The institutions’ joint efforts would focus on a joint MPH degree in epidemiology with additional joint offerings to follow. The joint MSPH in epidemiology was dropped from the agreement. Agreement was reached that students enrolled in either university would be eligible to take courses at the other. U of L would establish a Research Institute for Public Health while the UK would develop the Commonwealth of Kentucky School of Public Health. Each university’s Board of Trustees would govern their respective public health institution. Holsinger signed the final agreement on October 25, 1999, and Kaplan on October 26. On October 29, the signed agreement was forwarded to CPE,68 and on November 5, 1999, Davies informed the two university presidents that “this joint venture will avoid duplication of programs between the two schools.”69 After more than a year of debate and discussion, the result of the Council on Postsecondary Education’s effort to force the creation of a single school of public health in the Commonwealth of Kentucky resulted in the creation of the Kentucky School of Public Health at UK and the Research Institute for Public Health
at the University of Louisville with each institution having the public health degrees each had sought in the beginning. However, all issues were not yet laid to rest.
On November 27, 1999, the headline of a Lexington Herald-Leader story read, “Schools of public health will combine.” In the article, Davies is reported to have stated: “This agreement requires that the two universities work closely together.” By November 30, Wethington clarified the signed agreement, in which he detailed that the longstanding MSPH degree at UK was not included in the signed agreement since the agreement only covered new degree programs. He also clarified that the UK degrees (MSPH, MPH, DrPH) fall into a different Classification of Instructional Programs (CIP codes, a taxonomy of academic programs developed by the US Department of Education) from those requested by U of L. UK’s degrees will all be general public health degrees, while U of L’s will fall into one of the other seven-degree specific CIP codes. “Consequently, there is no overlap between the degrees being offered by UK and U of L, as has been the intent of the two institutions from the beginning of negotiations over the Public Health agreement.” He affirmed that the UK MSPH and MPH degrees differed only in the requirement for an MSPH thesis and an MPH practicum. However, it is clear from his December 10 letter to Davies70 that CPE staff had rejected his interpretation of the agreement and were demanding that UK suspend its MSPH degree that had been offered since 1932. He agreed to suspend the MSPH concurrently with the CPE approval of the MPH and DrPH degrees. He requested that in “a demonstration of fairness and cooperativeness among all concerned that the Council’s staff facilitate the consideration for approval of both the programs from U of L (MSPH and DSPH) and UK (MPH and DrPH) at the same time.” In response, Davies, on December 15, by letter, informed the two university presidents that “The collaboration we have in mind involves core programs that are offered jointly by the two universities; a coherent joint program of public service; and coordinated research programs. These are the kinds of activities that I am prepared to recommend to the Council for approval.”71
At its February 2000 meeting, CPE72 approved the U of L proposal to create MSPH and PhD degrees in epidemiology and biostatistics, but it did not consider UK’s request to approve the DrPH degree.73 By the end of March, CPE staff members continued to hold UK’s degree proposals hostage to their concept of the KSPH.74 In a follow-up letter to Juanita Fleming and Garrison, Moore again raised the issue of a joint master’s degree as well as the need to describe KSPH as a collaborative initiative of UK and U of L and
called for a meeting of the involved individuals on May 8.75 Following the meeting, Scutchfield, in a memo to Holsinger, stated that he and Fleming were blindsided by CPE staff members’ concern about governance issues, not joint degrees. Moore insisted that Evans be brought in to confer on the possible CEPH accreditation of a collaborative institution. In Scutchfield’s view, the UK DrPH degree was being held hostage by CPE staff in an effort to drive a different governance model for KSPH. Scutchfield wrote, “We have been at this nearly a year and a half and what I thought was resolved keeps getting raised again.”76
On June 19, 2000,77 Holsinger, Garrison, Fleming, Scutchfield, and CPE Staff members met with Evans to discuss the accreditation of KSPH. In a letter to Moore dated June 26, 2000,78 Fleming outlined the results of the meeting which established CEPH’s inability to accredit a collaborative or joint school of public health. For accreditation, an institution must offer an entrylevel professional public health degree such as the MPH, and institutions exclusively offering academic degrees would not be accredited. As a result, KSPH would meet accreditation standards as long as it is governed solely by the UK Board of Trustees. U of L’s organizational structure and academic degrees would not be deemed accreditable by CEPH. As Holsinger described it in an interview: “Ms. Evans explained that no school or college of public health met CEPH accreditation criteria unless they offered a professional degree, the Masters of Public Health. Carol Garrison was stunned to discover that they could not be accredited. She slammed her notebook shut, stood up, and walked out…We knew going into the meeting that they could not be accredited… [An MPH] was a flat requirement of CEPH.”79
As a result of the Evans meeting in an effort to move forward UK’s CPE application for approval of the DrPH degree, on August 8, 2000, Scutchfield forwarded a memorandum of understanding 80 signed by Holsinger to James Applegate, CPE Acting Vice President for Academic Affairs, which outlined UK’s conditions for implementing the UK/U of L agreement for cooperative public health programs: (1) Dr. Paul McKinney to be appointed associate director of KSPH; (2) U of L to nominate faculty appointments at KSPH; (3) UK to support U of L’s efforts to have graduate programs accredited; (4) Material promoting KSPH to identify U of L’s participation; (5) MPH students to jointly enroll regardless of home institution; (6) UK to encourage its students to enroll in U of L courses; (7) MPH core courses obtained through the Kentucky Commonwealth Virtual University, U of L, Western Kentucky University, or Eastern Kentucky University; (8) UK faculty and staff
actively participate in joint service and research programs with U of L; and (9) accreditation to be sought for KSPH with UK seeking involvement of U of L faculty and administrators. The CPE minutes from the September 18, 2000, meeting approved Holsinger’s memorandum of understanding, which cleared the way for CPE approval of UK’s DrPH program. The CPE minutes 81 reported Davies as stating, “The original agreement concerning public health between UK and U of L called for a collaborative school administratively housed at UK but including both UK and U of L programs. However, the accreditation guidelines of the Council on Education in Public Health make it very difficult to construct a school of public health that is responsible to more than one university governing board. Approval of the doctoral program allows UK to seek accreditation for the Kentucky School of Public Health. The University of Louisville will seek accreditation for its graduate programs and be affiliated with the Kentucky School of Public Health under conditions set forth in the memorandum of agreement.” Finally, two years after the UK Board of Trustees approved the formation of the School of Public Health, its faculty and staff were prepared to move forward, offering the MPH and DrPH degrees to prospective students.
During the following year, both UK and U of L continued to develop their public health initiatives, but the inability of U of L to receive CEPH accreditation continued to be a stumbling block. As a result, Garrison approached Holsinger requesting UK’s support for U of L initiating an MPH degree program. At the time, KSPH faculty were developing strong research programs, and the possibility of developing PhD degrees was being considered. As a result, Holsinger informed Garrison that UK would support U of L’s request to initiate an MPH degree and thereby meet CEPH accreditation criteria provided that U of L supported any request from UK for PhD degrees in public health domains. With this agreement in place, U of L made their request. At CPE’s November 5, 2001, board meeting, Applegate noted in his staff action report that “accreditation at the University of Louisville requires creation of a practitioner-oriented master’s degree (the MPH). The existing MPH at UK and the new MPH at U of L will be collaborative or joint programs.”82, 83 The CPE Board approved the creation of U of L’s MPH, and the entire process of CPE’s injection of itself into the formation of schools of public health at UK and U of L had come full circle.
During the following year, both institutions continued to develop their respective organizations. However, it was not until the CPE decided that President Davies’s contract would not be extended beyond its termination
date of June 15, 2002, that the two institutions were able to move ahead.84 “Governor Paul E. Patton, a Democrat who had appointed the council’s members, suggested that Mr. Davies had accumulated too much political baggage in his clashes with college presidents and lawmakers to remain effective... Patton also said that Mr. Davies ‘has gotten into some difficult fights’ and suffered ’some scars‘ in his four years at the helm of the coordinating board.” Within months, U of L converted its Institute for Public Health Research into the School of Public Health and Information Sciences (SPHIS) and appointed Dr. Richard Clover as its first dean. By 2007, SPHIS had obtained CEPH accreditation.85 With the departure of Davies, both the KSPH and SPHIS were able to move ahead in developing public health educational, research, and service activities for the benefit of the people of the Commonwealth of Kentucky.
Development of the School of Public Health and its Programs
While the efforts of Davies and the CPE board and staff to force the union of UK and U of L’s public health programs were underway, Scutchfield and the faculty and staff of the UK School of Public Health were intent on developing the institution including academic, research, and service programs for the benefit of all Kentuckians. To clarify the relationship of the MPH as a professional vs. an academic degree, based on the recommendation of Dr. Michael Nietzel, dean of the Graduate School, the decision was made that the MPH degree would reside in the UK Graduate School while the DrPH would as a professional degree be the responsibility of the School of Public Health. 86 At the same time, the MD/MPH Task Force was created and began the development of a combined degree curriculum as well as admission processes. The combined curriculum was developed as a five-year program, with the third year spent in MPH studies and coursework.87 Scutchfield continued to work toward joint academic and research programs, including reaching out to the UK College of Agriculture Cooperative Extension Service.88 The KSPH Admissions Committee developed admissions requirements for the MPH Program requiring graduate standing, minimal undergraduate grade point average, and prerequisites, including two courses each in mathematics, biological sciences, social sciences, and physical sciences. Various other requirements depended on the student’s area within the five concentrations offered.89 By the end of July, Nietzel 90 requested that the Graduate Council approve the MPH degree and its curriculum, including new courses covering public health and disease prevention, public health practicum, injury epidemiology, and management of public health. In addition, several crosslisting of courses currently offered were requested. By the fall, the Graduate
Council approved the MPH degree as an academic degree and forwarded their approval to the Senate Council.91 At the recommendation of the SPH Steering Committee, Scutchfield proposed affiliation agreements with both the Kentucky Department of Public Health and the Lexington-Fayette County Health Department.92 On September 27, 1999, the University Senate approved the Senate Council’s request for the creation of the MPH degree and approval of the new courses and appropriate cross-listings.93 Immediately after that, the first meeting of the KSPH External Advisory Committee on Public Health Practice met. The original committee was composed of six staff members from the KDPH: Viola Brown, Glyn Caldwell, Steve Davis, David Klee, Rice Leach, and Pat Rickard; two staff members from county health departments: Debbie Acker and Melinda Rowe; Mark Birdwhistell (UK) and Robert Damron (Kentucky Legislature). This initial meeting focused on “the essential elements that must be in place if the KSPH is to meet the needs of the Public Health Practice Community.”94
As the fall 1999 semester continued, Wilson submitted to the deans, department chairs, and members of the University Senate the College of Medicine’s request for the approval of the DrPH degree and the associated new course proposals.95 The DrPH degree was defined as “a professional degree linking theory with practice, offering an extensive battery of courses based on the body of public health knowledge of the profession and integrating coursework with extensive supervised knowledge of the profession...UK DrPH graduates will provide leadership to protect and improve the health of the public in the commonwealth. Graduates will possess critical thinking and conceptual abilities to integrate new knowledge and methods into public health practice. Using a multidisciplinary approach, the degree will provide broad knowledge of the five core public health disciplines (epidemiology, social and behavioral sciences, public health management and practice, environmental health, and biostatistics) along with advanced knowledge in the student’s area of interest.” The document noted that the CPE’s 19992000 work plan identified public health as one of its four broad social goals for postsecondary education in Kentucky. The DrPH curriculum was composed of 63 semester hours of course and practicum work and, as a prerequisite for enrolling, required the applicant to have previously completed an MPH, MSPH, or an equivalent degree. The curriculum included 27 semester hours of required coursework in the core curriculum, including two advanced courses in the four core disciplines (excluding environmental health, which required one course), 15 hours of elective courses, a one semester-hour integrative professional seminar repeated each semester of enrollment, two supervised
public health field experiences, and a comprehensive doctoral dissertation or problem-based project paper demonstrating intellectual capability. Fourteen new doctoral level (900 level) courses were submitted for consideration following approval by the College of Medicine Faculty Council.96
Among other working groups established was the KSPH Structure Committee composed of Scutchfield, Terrence Collins, Pamela Kidd, Stephen Wyatt, Thomas Samuel, Becki Flanagan, and Regina Wild. At its October 21st meeting,97 the committee determined to establish SPH utilizing a matrix organization composed of five academic divisions: Epidemiology, Biostatistics, Occupational and Environmental Health, Health Enhancement and Disease Prevention and Health Services Management. Each academic division would be led by a director. The SPH director’s cabinet would be composed of an assistant director for academic affairs, an assistant/associate director of student affairs, an assistant/associate director for research and scholarship, an assistant director for partnership development, and an assistant director of administration. (See Figure 3)
As the year ended, the Senate Council approved the DrPH degree and requested assurance from Holsinger that funding would be available to implement the degree. In a letter98 dated December 1, 1999, Holsinger confirmed that the SPH and funding for its programs were his highest priority and that Wethington shared that commitment. Likewise, Rice C. Leach, Kentucky Commissioner of Public Health, affirmed his interest in the creation of a regional Public Health Training Center funded by a
grant from the US Health Resources and Services Administration.99 Dan A. Martin, medical director of the Hopkins County Health Department, executed an affiliation agreement between his health department and the KSPH.100 At its December 14, 1999, meeting, the UK Board of Trustees approved the appointment of Dr. F. Douglas Scutchfield as the director of the Kentucky School of Public Health.101 On a cautionary note, both Drs. Terrence R. Collins and S. W. “Tony” Horstman from the Department of Preventive Medicine and Environmental Health expressed concern that the potential loss of the MSPH degree would have a “devastating” effect on the Occupational Medicine and General Preventive Medicine residency programs and their funding by the National Institute for Occupational Safety and Health.102, 103
At the January 27, 2000, meeting of the KSPH Steering Committee,104 Scutchfield announced the appointment of senior staff members. Dr. Collins was appointed associate director for educational research, with Dr. Horstman assisting with the MPH and Dr. Joel Lee with the DrPH degrees. John Wiggs was appointed associate director for student affairs, and Dr. Stephen Wyatt was appointed to serve as liaison with the state and local health departments. Dr. Thomas Samuel outlined the search efforts for faculty members. The UKMC biostatistics unit was moved into the KSPH, and a search was underway for the departmental chair. Searches for senior and junior faculty members began in the Departments of Epidemiology, Environmental Health, and Behavioral Sciences. Differences in the MPH and MSPH degrees were ironed out for the MPH program to meet the needs of medical residents in Occupational Health, Environmental Medicine and Preventive Health. Wyatt reported on efforts to provide targeted Federal funding for the Prevention Research Center. Wiggs reported that the KSPH logo, homepage, brochure, and on-line student application were in development. The target for student admissions for the first class was 25 MPH and 12 DrPH students. In closing comments, Scutchfield announced that the Kentucky School of Public Health was finally ready to be launched. The final class of MSPH Students was admitted for the Fall 2000 semester.
On February 10-11, 2000, Pat Evans, CEPH executive director, made a consultation visit to KSPH to determine the current accreditation status of the school. In a letter105 to Scutchfield, she stated:
“The current organizational structure of the Kentucky School of Public Health within the College of Medicine, and headed by
a director rather than a dean, does not appear to provide status and decision-making prerogatives comparable to that which is characteristic of other health professions schools in your university and thus would not meet the requirements of Criterion II.A. Since CEPH judges independence and status based on the manner in which your university operates, we would be looking for lines of accountability, autonomy over budgets, ability to appoint and promote faculty, and rights to implement academic programs comparable to prerogatives accorded to medicine, dentistry, nursing, pharmacy, and allied health.”
The letter continues with concerns about assembling a faculty for the KSPH and utilizing courses designed for other degree programs:
“The courses were developed for other purposes and they may or may not be germane to the school’s degree objectives, even though the course titles and outlines suggest compatibility. Second, the school has built these courses into the required curriculum without having any quality control over who teaches them, whether they will be taught when your students need them and whether your students will continue to be admitted to the courses over the long term. Third, and most importantly, when the school starts with existing courses, it tends to emerge with a set of learning objectives that are essentially a compilation of the course-specific learning objectives, rather than establishing competency-based outcomes that a practitioner in a particular area of public health specialization needs to know and be able to do upon entering practice. The latter approach results in program-specific learning objectives which impact the curriculum planning process, the selection of courses and course content, and ultimately the evaluation of student attainment of learning objectives.”
The letter speaks to her concerns that the KSPH should not rush the effort to obtain accreditation but should clearly think through the timeline required. She suggested that the school’s leaders consider applying for accreditation following the graduation of the first student cohort. Scutchfield continued to move forward with developing the KSPH programs, including primary and secondary faculty appointments to the departments.
The KSPH faculty retreat minutes106 provide the KSPH vision statement:
“Kentucky School of Public Health will provide the leadership to improve the health and wellbeing of the population,” and its mission statement: “Kentucky School of Public Health, as part of a comprehensive land grant institution will achieve its vision through excellence in trans-disciplinary public health, education, research and practice, in partnership with communities.” The timetable for applying for CEPH accreditation was announced. KSPH was to be in applicant status in 2001 and conduct a selfstudy during 2001-2002. CEPH was to be requested to site-visit the KSPH in 2002 in order for the school to obtain pre-accreditation status. A second self-study would be conducted in 2004-2005 to achieve full accreditation status since no institution could remain in pre-accreditation status for more than two years. As of the date of the retreat, CPE had not approved the DrPH program. Horstman provided a list of proposed KSPH standing committees, including: (1) Administrative Council to assist in administering the school and to act on recommendations and concerns from the standing committees; (2) Academic Affairs Committee to formulate policy, criteria, and procedures for all KSPH degrees and to monitor the curriculum and admission to its degree programs; (3) Student Affairs to represent the KSPH pertaining to students providing liaison between faculty, administration, and student groups; (4) Evaluation/Accreditation Committee to evaluate the KSPH and make recommendations to the director concerning responses to feedback received from external evaluations; (5) Research Committee to establish schoolwide policy for the promotion, solicitation and dispersion of available research funds; (6) Educational and Functional Resources Committee to promote knowledge; set policy; coordinate and facilitate intra-school communication among faculty, students, and administration about all resources used in instruction, research, and office functions. Committee members were appointed to two-year staggered terms except for the Administrative Council, which was composed of the director, associate directors, division heads, and degree program directors.
The first cohort of MPH students matriculating with the fall 2000 semester consisted of 38 students, of which 33 were Kentucky residents; 12 fulltime, 15 part-time, 11 unknown; 24 male, 14 female; 10 minority; 3 African Americans; 11 health professionals. Students’ areas of interest (some indicated more than one) were: biostatistics (1), environmental health (3), epidemiology (11), health enhancement (3), health services management (8), undecided (9), and unknown (8).
In addition to matriculating its first students, KSPH expanded its
international partnership beyond Great Britain to create a partnership between United States partners (UK, Kentucky School of Public Health, UK Center for Health Services Management and Research, Kentucky Center of Excellence for Rural Health, Kentucky Area Health Education Center (AHEC), University of Louisville, Jefferson County Health Department, and the American Internaitonal Health Alliance (AIHA)) and the Romanian partners (Department of Public Health and Management of the Carol Davila University of Medicine and Pharmacy and its Institute of Health Services Management. The purpose of this international agreement was to “develop a productive and lasting cooperative relationship between the US Partners and the Romanian Partners…it is a symbolic expression of their mutual commitment to develop a productive working relationship, to collectively and separately make their best efforts to overcome obstacles to accomplish the agreed-upon project goals and within the means of the parties to contribute the necessary resources toward ensuring the success of this collaborative relationship.”107 The focus of the partnership was “(1) developing curriculum and carrying out training programs for health care providers in case and cost management and other key competencies and (2) developing and implementing health communications and community mobilization strategies essential to the implementation of effective health reform efforts in the region.” KSPH faculty were involved with their Romanian counterparts for the next five years, conducting training and teaching activities in Romania. Health-care management and health communications were key elements of the program. AIHA was a not-forprofit organization that created a partnership model to address healthcare issues in the New Independent States of the former Soviet Union and the Central and Eastern European countries.108 A key element in the agreement was efforts by KSPH to assist in the development of a new school of public health in Romania. Dr. Thomas Samuel, KSPH associate director for administrative services and associate professor of Health Services Management, was appointed to a board to develop the new school in Romania.
In addition to international cooperative agreements, KSPH worked with local higher educational institutions to create joint degree programs. On August 29, 2001, Dr. Joel B. Green, dean of the School of Theology at Asbury Theological Seminary, proposed joint degree programs integrating the MPH with its MA and MDiv degrees.109 On August 21, 2002, UK and U of L announced a cooperative agreement designed to complete a statewide telehealth network and critical care program, thus enhancing the visibility of KSPH.110 Thus, after four years of sustained effort, Scutchfield developed
the Kentucky School of Public Health within the UK College of Medicine, having faced internal as well as external opposition, and Holsinger’s plan for a medical center with all six academic schools had become a reality. But there was more to come.
CHAPTER 3
CREATING THE COLLEGE OF PUBLIC HEALTH
With the issues surrounding the establishment of the Kentucky School of Public Health fading into the background, questions concerning its future accreditation took center stage. [N.B: With the issues between UK and U of L resolved, KSPH was referred to as SPH going forward.] Due to concern for the College of Medicine’s potential loss of research and contract funds and following the visit of CEPH executive director Pat Evans in September 2000, Drs. David Watt, associate dean of the College of Medicine, and Thomas Samuel, associate director for finance and administration of the School of Public Health, developed A Plan for the Development of a College of Public Health 111 Their proposal was based on an initial report of the SPH Subcommittee on Academic Processes112 dated January 8, 1999, and initial draft plan113 dated July 25, 2000. In their proposal, they stated: “As the School develops, it will ultimately reach a stage where separation from the College of Medicine will be necessary in order to achieve accreditation. It is important as we move toward this goal to find a mechanism for achieving this separation while retaining certain ties that are integral to the College of Medicine’s patient care, education, and research programs. This document proposes a plan for achieving these dual objectives.” They proposed that (1) the School of Public Health provide the teaching services and research capacity to the College of Medicine that are currently provided by the Department of Preventive Medicine and Environmental Health in the College of Medicine; and (2) a Center of Excellence for Public Health be created to manage research grants and contracts focused on public health, environmental health, and health promotion. They also proposed that the School/College of Public Health train MD students in the College of Medicine in the area of preventive medicine and environmental health under a memorandum of understanding between the two colleges. In order to provide “credit” for research grants and contracts, a Center of Excellence for Public Health would be developed that would embrace all five of the public health core disciplines. The center would report to the dean of the College of Medicine, and thus, grant and contract activity within the center would be “credited” to the College of Medicine. All faculty members, regardless of their departmental home, who might choose to utilize the center’s staff and processes, would need to understand that their grants and contracts would be credited to the College of Medicine, not their “home” college. Under the School/College of Public Health, faculty members providing patient care would function under the auspices of the Kentucky Medical Services Foundation (KMSF) and be eligible for its benefits.
Under this proposal, the College of Public Health would be comprised of five departments: Biostatistics, Epidemiology, Environmental Health, Health Services Administration, and Social and Behavioral Sciences. Prior to accreditation, each of the five departments would be required to have, at a minimum, five faculty members, who could be “assigned” by the chancellor to align the faculty with the mission of SPH. Ultimately, faculty lines would require transfer between colleges. A key element in the development of the faculty of the proposed college was the offer to Professor Richard J. Kryscio, director of the Biostatistics Consulting Unit, to become the Chair of the newly created Department of Biostatistics and for Dr. Richard Clayton to assume the chairmanship of the Department of Social and Behavioral Sciences. The proposal anticipated that the Division of Health Services Administration in the College of Health Sciences and the Department of Preventive Medicine and Environmental Health would move en bloc to SPH. Their timeline proposed that in FY01, the administrative assignments of Preventive Medicine and Environmental Health and the Division of Health Services Management to SPH would be completed, the SPH standing committees be appointed, new courses for the MPH and DrPH be developed, and the hiring of division directors for Biostatistics and Social and Behavioral Sciences be completed. In FY02, the appropriate actions would be taken to terminate the Department of Preventive Medicine and Environmental Health in the College of Medicine, and appropriate faculty searches for the various divisions in SPH would be initiated. By FY03, faculty searches would be successfully completed, and in the following fiscal year, accreditation would be sought.
Although Watt and Samuel had developed a feasible plan to lead to accreditation of what would be a new College of Public Health, with the creation of the Office of Provost in 2001, Neitzel and Holsinger were required to work together to determine the most effective means of obtaining accreditation. On August 13, 2001, a letter114 requesting CEPH applicant status was submitted, signed by President Lee T. Todd, Jr., Holsinger, and Scutchfield. The letter explicitly stated the university’s intention of developing “an organizational structure with assigned primary responsibility for curriculum development, admission standards, faculty selection and retention, and fiscal planning” indicating an “ability to meet accreditation criteria.” Recognizing the provost’s concern that adding an additional college to the university’s structure would add a significant burden to his office, in the fall of 2002, President Todd requested that Nietzel and Holsinger “consider alternatives to the development of a free-standing College of Public Health that would advance the university’s research and educational capacity in the
field of public health, and that would position the Public Health unit to become accredited and that would require a minimum of additional administrative resources.”115 As a result, Holsinger convened a workgroup to develop a plan for a college of public health and health sciences as a means of meeting CEPH accreditation criteria. By February 2003, a draft plan116 for combining the two entities was completed. Although the College of Health Sciences had been quite successful in attracting research-oriented faculty members and in growing its graduate programs, it was the only college whose mission and that of public health could be appropriately joined. Other universities had been successful in merging such entities. The proposal stated:
“The creation of such a college will also provide an opportunity to further enhance the critical mass of faculty needed to carry out the mission of the College and the University by bringing in new resources to further enhance the University’s ability to carry out its mission. It will also provide an enhanced opportunity for collaboration among and between faculty in existing campus academic units…It is proposed that the College of Public Health and Health Sciences consist of the current College of Health Sciences, the School of Public Health, the Department of Preventive Medicine and Environmental Health and the following Graduate and Research Centers: Center for Nutritional Sciences, Graduate Center on Gerontology, Women’s Health Center, Kentucky Iinjury Prevention Research Center (KIPRC), Center for Health Services Management and Research, Center for Toxicology, Center for Agricultural Safety and Health, and the Center for Prevention Research. Thus, such a College of Public Health and Health Sciences would be a large, multidisciplinary academic structure dedicated to outstanding academic programs, research, and service.”
Although the proposal was consistent with the report from the Task Force on the University of Kentucky Futures, the effort to create such a combined college was complicated. The proposal to create the College of Public Health and Health Sciences was viewed by many faculty members as a fiat accompli without sufficient faculty involvement in the proposal. Since Holsinger had always preferred the creation of a standalone college of public health, many saw the proposal as an effort to preempt the decision by proposing a solution that would not be acceptable to the university faculty.
Workgroup on Organization of Public Health
With the imminent retirement of Holsinger effective June 30, 2003, and the
university’s reorganization with the Medical Center colleges reporting to the provost, Scutchfield requested that he be relieved of his duties as director of the School of Public Health and granted a sabbatical leave effective July 1, 2003. Nietzel, by a memorandum dated March 12, 2003,117 informed Wilson, Robinson, and Dr. Douglas Kalika that the proposed merger of School of Public Health and College of Health Sciences resulted in questions being raised, suggestions for alternative arrangements, and a request by the affected faculty members “for more direct involvement in the process.” He recommended that a working group be established consisting of faculty members from the affected units with a charge to “determine the feasibility of various possible mergers and to develop structures that would promote opportunities in Public Health, facilitate accreditation of a Public Health structure, develop overall academic quality of the academic units involved, and allow for improved research opportunities through interdisciplinary collaboration…From my perspective, I believe a formal Public Health structure that can be accredited will be of significant benefit to the University and the Commonwealth.” He appointed Dr. Stephen Wyatt as the Working Group chair.
By April 1, 2003, Nietzel had appointed the members of the workgroup,118 which was composed of faculty members from across the university, including Gil Boisoneault, Gerry Gairola, and Judy Page (College of Health Sciences), Richard Clayton (School of Public Health), Richard Kryscio (College of Arts and Sciences), Scott Prince, David Randall, Nancy Schoenberg, and Stephen Wyatt (College of Medicine), John Watkins (Gerontology), Sarah Wackerbarth (Martin School), Juliann Sebastian (College of Nursing), and Terri Foxx, (School of Public Health DrPH student). The workgroup was convened by its chair on April 11, 2003. At its first meeting, the provost charged the workgroup members to consider ways in which Public Health could be organized such that CEPH would accredit it, as well as allow it to advance the university’s teaching and research interests.
“What we need to do is to go back to as much of a ground level as possible and have ideas originate from the faculty who have a vital interest in this and who are knowledgeable about it. The Chancellor recognized that [and] I tried to start meeting with groups to hear their concerns about this and identify a different way to move forward with it. So that is what this group is for, to develop one or more ideas about how to approach the issue of Public Health organizationally, structurally, conceptually on this campus. There
are no preconceived outcomes with this other than the fact that I believe that we would, as a University, be advantaged by somehow structuring public health in a way that made it eligible for external accreditation and some of the advantages that come with that… It is as open a charge as I can fashion…My perception is that the autonomous brand new College of Public Health idea has not been particularly well received. Now, maybe that was because of the way it was introduced, or because of the authorship and some of the concerns surrounding that, but no, it is not off the table. It certainly has not had the best reaction from some quarters in terms of the perceptions that it would be costly administratively to do it at a time when the institution has $6 million less from the state next year to do its business. Again, I think that has largely come from faculty groups.”119
Although discussion during the meeting suggested that Holsinger’s transmittal of the proposal to create a college of public health and health sciences was a final document, his letter to Drs. Wilson (dean, College of Medicine), Robinson (College of Health Sciences), Scutchfield (director, School of Public Health), Vore (director, Center on Toxicology), Rowles (Graduate Center on Gerontology), and de Beer (director, Center for Nutritional Sciences) clearly stated: “Attached you will find a draft document proposing the creation of a College of Public Health and Health Sciences in response to President Todd’s request. We believe that this proposal will meet the need for a strong public health presence on campus without the necessity for creating an additional college during a period of financial exigency. I have asked Jane Seltsam in my office to set up meetings with you and either your College Faculty Council or with your faculty for Dr. Nietzel and me to present the proposal and answer their questions. We would like to arrange such meetings in an expeditious manner in order to move forward with the proposal.”120 During the remainder of the meeting, the workgroup members discussed the need to move forward expeditiously. Chair Wyatt stated that, although there were time limitations, a good discussion of the various issues was paramount and that the workgroup members needed to build consensus not only among themselves but across the university. He indicated the need to have the public pealth organization approved by the Board of Trustees by January 2004 in order to meet the CEPH deadlines for an accreditation site visit in 2004 (a request had been made to CEPH to extend the applicant status by one year). Wyatt stated: “Our goal is to identify three or four options to choose from and capture their strengths and weaknesses. We don’t need to get into the
details or work out an organizational structure if we choose stand-alone: that is for the implementation side. If we talk about a merger we can look at other possible colleges to merge with. And if we need to go with doing nothing at this point, that is an option here.” In the discussion, the members were concerned with the accreditation issue as it applied to the enrolled students, who had matriculated based on their understanding that Public Health would become an accredited entity at the university. Foxx reminded the members that she, like other students were, denied fellowships and potentially public health workforce positions since they were not enrolled in or graduating from an accredited institution.
During its second meeting on April 18, 2003,121 the workgroup refined its charge to read, “Develop a proposed structure or structure options.” In doing so, it included three considerations:
1. Any proposed structure should ensure the continued quality of all affected academic programs;
2. Any proposed structure should facilitate interdisciplinary research collaboration; and
3. Any proposed structure should meet the Council on Education in Public Health (CEPH) independent reporting structure requirements. During this meeting, three agenda questions were proposed. Agenda question #1 stated: Is there consensus among the workgroup members that an accredited School of Public Health should be a priority for UK? Following a spirited discussion, a motion was placed before the group to table consideration of Question #1 and consider it following a discussion of Questions #2 and #3. The motion passed by a vote of 9 to 3. Agenda Question #2: What are the potential organizational structure option(s) for an accredited School of Public Health at UK? “From this discussion, two options were assessed: option 1a would be to go forward with a stand-alone college, while option 1b would be to merge the School of Public Health with an existing college, such as the College of Health Sciences. The options were chosen based on the accreditation criteria set out by CEPH. A few different options/situations were discussed between the group, but due to CEPH’s criteria were thrown out [SIC]…other colleges were discussed as possibilities for mergers, but Health Sciences was the most logical due to natural configurations relating to a merger between the two disciplines.”
Agenda Question #3 For each structural option, what are the strengths and weaknesses from an organizational perspective? The workgroup developed the following strengths and weaknesses of each organizational structure. Option 1a: Stand-alone college:
Strengths:
• Predominate organizational structure;
• Clearly accreditable by CEPH;
• No collateral problems due to merger;
• Distinct identity of the school is kept intact;
• Traditional public health content taught;
• Quality, recognition, clarity, and status of being an independent college;
• Benefits in terms of legitimacy across the country (our benchmarks);
• Possibility of attracting a larger student base;
• Return on investment due to grant monies, fellowships, etc. available to accredited schools and students.
Weaknesses:
• Small core of faculty, only about 7-10 faculty lines;
• Faculty lines will be needed;
• Very few primary appointments in Public Health, most are joint appointments (CEPH expects 25 lines, either primary appointments or joint with significant time in SPH);
• Burden on the provost, from his viewpoint, one more college to oversee from an administrative standpoint, especially challenging due to the changing environment as we move toward the provost model and the search for new deans and administrators of some colleges.
Option 1b: Merger with another existing college:
Strengths:
• Greater possibilities for collaboration/synergy between faculty; enhanced research proposals, with viewpoints from other disciplines, that garner grant dollars;
• Already an administrative core, including already existing student support services and additional resources;
• Larger student base, more student interaction between disciplines (many students not in the School of Public Health currently take Public Health courses);
• Some public health content could be beneficial for Health Sciences graduates, research methods in bi statistics and epidemiology, and survey courses on health services management, health behavior, etc.;
• Return on investment due to grant monies, fellowships, etc. available to accredited schools and students;
• Unique organizational structure as compared with U of L and their School of Public Health.
Weaknesses:
• Questionable accreditability by CEPH;
• Possibility of an impact on the accreditation of Health Sciences’ programs;
• Curriculum issues based on CEPH criteria that courses with the college must have public health content, impact on faculty and students in terms of larger class sizes, and additional hours/time added to complete degrees;
• Accreditation requires a dean from a public health background, which could provide an opportunity for bias and/or misplaced priorities in regards to Health Sciences and the flow of resources;
• Possible stress on the faculty tenure process and criteria; merging academic units with uncommon goals;
• Could be confusing in terms of faculty and student recruitment.
Following the development of the strengths and weaknesses of both options, the workgroup determined that its charge was to develop structural options without regard to financial considerations. The workgroup recommended that a thorough cost analysis be conducted on both options prior to a final decision of the structure of the public health unit at UK.
At the beginning of the workgroup’s third meeting held on April 25, 2003,122 Terri Foxx pointed out that the public health students were concerned about the slow progress toward accreditation. As a result, students were considering leaving the School of Public Health even though doing so would result in their needing to start fresh at a new institution. Some students were even considering litigation based on the verbal promise made then concerning accreditation. Mr. John Wiggs was the key staff person for recruiting and advising students, having served at the University of Kentucky for many years recruiting outstanding students to the university. Along with Laverne Carter, he advised MPH and DrPH students in program and course selection. He was an advocate for the students as they pressed the university administration to create an institution that would meet CEPH accreditation requirements. As associate director of admissions and student affairs, he
strongly believed that “verbally there has been a firm commitment made, and recruits have been clearly told by him, based on feedback from the chancellor and President Todd, that UK is in applicant status and is moving forward with accreditation as well as a site visit this fall (which has been pushed back to fall 2004). Mr. Wiggs feels that ethically the university has made a commitment to current and prospective students regarding accreditation.” Additional feedback from the faculty of the College of Health Sciences indicated that curriculum changes due to a merger to meet CEPH accreditation criteria would be unacceptable. Other feedback indicated that a stand-alone college would be the stronger of the two options. The workgroup decided that the Colleges of Medicine, Dentistry, Nursing, and Pharmacy would not be a good fit for a merger with Public Health, since public health focuses on the health of populations while the other four colleges focus on individual health clinically. Even without a vote, the group seemed to be moving toward a stand-alone college of public health.
Several senior university leaders were present to provide their observations to the workgroup. Dr. Douglas Kalika, representing the Graduate School, stated: “I’ve been inclined to look at this in a broader context, as in the other changes that have been taking place on campus. The issue with respect to the provost model, the reorganization of the chancellor’s office and all of the various flux going on within the university. I tend to be less inclined to see us creating a combined College of Public Health and Health Sciences because I think it would be one more not particularly defined entity or endeavor in an already destabilized situation…if we can afford it, we would be best served by a stand-alone college.” A second academic leader, Dr. Emery Wilson, dean of the College of Medicine, stated that there was no question that a school of public health was needed at UK to serve the people of the commonwealth. He was concerned that during the period in which the School of Public Health had been in existence, it had required an inordinate amount of the new funding available to the chancellor for allocation. As a result, those new funds had not been made available to the College of Medicine. He remarked: “I think the proposal of Public Health and Health Sciences makes a lot of sense to me. When you look at the organization of it and all the things coming together, personally I think it makes both colleges stronger.”
The third guest speaker, Dr. Tomas Samuel, representing the School of Public Health, stated: “I think an accredited school is very valuable to UK.” For both the students and the faculty, being associated with an accredited institution would make a major difference in how they are perceived in
obtaining fellowships, grants, and contracts and in the sense of self-worth by the faculty. The letter, signed on August 13, 2002, by Todd, Holsinger, and Scutchfield, indicated that with all due haste, UK would seek accreditation for a school of public health. “The big issue is getting this thing accredited, everything else will follow. One of the things that has happened through all this is that there has been more discussion about the impact the School of Public Health will have on everybody here in the University rather than the impact on the state of Kentucky, the students, and the mission of the School. That has really bothered me.” The discussion following the guest speakers resulted in the group agreeing that “If UK was to have a public health program, then it should be accredited, and continuation of an unaccredited program was not adequate.” The workgroup adjourned until its next meeting on May 9, 2003.
The fourth meeting123 of the workgroup featured Dean Thomas Robinson, College of Health Sciences, and Pat Evans, CEPH executive director. Robinson strongly supported the development of an accredited public health entity. Already, the School of Public Health had broadened the academic milieu of the Medical Center, and he considered the addition of the DrPH degree a distinct advantage to his faculty, especially those teaching in the physician assistant program. He strongly recommended that the workgroup consider the stand-alone option, creating a college of public health as the preferred structure. He did not find the merger of his college with SPH to be an effective approach. Evans provided information concerning and comparing the creation of an accredited college vs. a program in public health. Both approaches provide an MPH degree that meets the same accreditation criteria. Programs offer accredited degrees, but the accreditation of a college results in all aspects of the unit being accredited. Thus, an accredited school or college of public health results in a single accreditation for all programs offered by the unit. CEPH does not require that the dean of the accredited school or college be credentialed in public health; however, the faculty must be credentialed in public health.
“A general rule of thumb is that you need to have at least 25 public health faculty lines for a school of public health. You can bring in other faculty through joint appointments and such, but that will not count as your core faculty. One of the mistakes that new schools and programs make in convincing the people who have to approve the process, within the university and at higher levels, making the argument that it can be done with existing resources and that additional resources will not be needed. If that entity is successful
it will need new resources, and the more successful a school is the more resources it will need. Conversely, it will be able to generate most of its own resources as schools of public health tend to be successful revenue generators and, in most universities, they are second only to Medicine in terms of research grants.”
She also reviewed the pre-accreditation and accreditation processes and recommended that, since they are lengthy processes, moving through the process be carefully thought out to avoid a negative outcome.
Following the conversation with the guest speakers, Wyatt shared with the workgroup the students’ letters he had received and shared with Provost Nietzel. “He also mentioned petitions that are circulating by way of the students addressing their concerns about how they would view not moving forward with accreditation as a negative and not consistent with commitments that were made to them as they made the decision to enroll.” Wyatt reviewed his discussions with the University of South Carolina and George Washington University regarding their Schools of Public Health, both of which were merged schools, including both public health and health sciences. Those interviewed by Wyatt considered creating a merged school to be extremely difficult and, in both instances, recommended that UK not attempt to do so.
The fifth and last workgroup meeting was held on May 19, 2003.124 In the discussion, the double counting of grants and contracts by both the College of Medicine and the public health entity would be unacceptable to CEPH; the example of the University of Iowa was discussed, where it was required by CEPH to discontinue the practice in order to retain accreditation. After a discussion concerning which units might have an interest in joining the SPH, the workgroup decided that a listing of units would not be included in the report. The cost of creating a college of public health was discussed, but again, the workgroup determined that implementation costs were not a focus of their charge. Student sentiments concerning the accreditation of public health were briefly discussed. The group members agreed that the report to Provost Nietzel would have four sections: Workgroup Findings, Structural Recommendation(s), Broad Recommendations, and Additional Considerations. Two motions were voted on by the group: (1) “The first motion was to not consider an administratively joined entity with the School of Public Health and the College of Health Sciences as a structural option.” The workgroup voted unanimously to remove the merger option from
Dr. Thomas W. Samuel received BS and MBA degrees from Indiana University and a Doctor of Jurisprudence degree from the University of Tennessee College of Law. He was the first dean of the UK College of Public Health (acting) when the college received full accreditation on the initial site visit by the Council on Education for Public Health. He retired from UK in 2006 as a full professor of the College of Public Health. He served in the US Peace Corps (1965-67) in Liberia, where he met and married Susan Schoenberg. He served with the Peace Corps in The Gambia (2012) as an Adjunct Lecturer with The University of The Gambia School of Medicine and Allied Health Sciences, Department of Public and Environmental Health, and as a consultant to assist in review and revision of the curriculum of The Gambia College School of Public Health. He also served as US Project Coordinator and visiting faculty member for grants and programs in Romania, Russia, Uzbekistan, and Kazakhstan with the American International Health Alliance Healthcare Partnership Program. He held positions in public and healthcare administration: assistant commissioner for administrative services, Tennessee Department of Mental Health and Mental Retardation; associate dean for administration, College of Medicine, University of Tennessee Center for the Health Sciences; executive vice chancellor for administration, Office of the Chancellor, UK Medical Center; special assistant to the president of UK for health benefits; associate executive director for health affairs, Tennessee Higher Education Commission. He served health organizations in local communities, including as secretary of Woodford County Hospital Taxing District Board, when he led a successful effort to save the community hospital.
consideration. (2) The second motion was to recommend a stand-alone college structure for public health, which was unanimously approved. A meeting would be scheduled with Provost Nietzel to present and discuss the workgroup’s recommendation. It was agreed that Wyatt would draft the report and send it to the members for review and revisions, with the final report completed shortly before the meeting with the provost.
The workgroup’s final report discussed its process, the background of UK and public health, the workgroup’s findings, and its recommendations. The report set forth four structural recommendations that summarized the areas of concern for Options A, B, and C and indicated the positive attributes of Option D, which had the unanimous support of the workgroup members. Option A stated that the university should abandon the concept of a school of public health, but since this option would not honor the clear commitment the university had made to students who had previously graduated or were currently enrolled, it was rejected. Option B would abandon plans to pursue an accredited SPH, withdrawing immediately from CEPH “applicant status” and “setting as the ultimate goal the development of an accredited Graduate program in public Health…The Workgroup did not view this option as being consistent with an institution seeking top-20 research institutional status” and the workgroup rejected it. Option C would administratively join the School of Public Health with the College of Health Sciences. “After an extensive review of CEPH criteria, consultation with other universities who have taken this approach, and the CEPH executive director, the Workgroup determined that this was not a feasible option.” Option D recommended the creation of a freestanding college of public health that would be clearly accreditable by CEPH, and that makes a strong statement of the university’s commitment to public health, providing a focused organizational unit to recruit both faculty and students. The workgroup unanimously supported Option D and recommended as a primary approach the immediate development of a freestanding College of Public Health, initiation of CEPH self-study, and plans to continue preparing for the recently rescheduled CEPH accreditation site visit in 2004. “They suggested a secondary approach that would require the immediate withdrawal from CEPH “applicant status,” pursuit of an accredited graduate degree program in 2005, and the establishment of a freestanding college of public health as soon as feasible. The workgroup recognized this action would require two self-studies and CEPH site visits during a two-year period.
During the remainder of the summer of 2003, several additional events
occurred. Effective July 1, 2003, the provost model of academic leadership at UK was consummated with the retirement of the chancellor of the Medical Center, and new leadership for the School of Public Health occurred as Scutchfield took a sabbatical leave, resulting in Dr. Thomas Samuel’s appointment as interim director of the School of Public Health. In a letter125 to the faculty, staff, and students of the School of Public Health dated August 25, 2003, Provost Nietzel accepted the workgroup’s recommendation for creating a standalone college of public health at UK. He stated: “I have requested that Tom Samuel, Interim Director of the School of Public Health, proceed with assembling the necessary documents for submission to the University Senate no later than January 2004 and, in parallel, to organize the faculty to begin work on the self-study that must be submitted prior to CEPH accreditation.” In addition, he indicated that he would provide additional faculty lines and initiate searches to fill four faculty positions immediately. His letter stated that efforts would immediately begin to
Figure 4, College of Public Health Organizational Chart
work through the faculty and administrative processes to move the Department of Preventive Medicine and Environmental Health from the College of Medicine to the new College of Public Health and that a similar effort would begin to move the Department of Health Services Management from the College of Health Sciences to the new entity. The creation of the new College of Public Health would require the action of the appropriate faculty councils, a recommendation to create the college from the University Senate, and the approval of President Todd and the Board of Trustees. Samuel, Watt, and Nietzel were in the position of pressing forward the recommendation of creating a standalone college of public health as recommended by the workgroup.
As the summer of 2003 came to an end, Nietzel, in a letter126 to the CEPH president, requested reactivation of the university’s request for an accreditation site visit to occur in the early Spring of 2005 for what would then be the College of Public Health. Samuel and Watt were commissioned to develop the final plan to put forward the proposal to create the College of Public Health. In the meantime, Samuel moved forward with designing the structure of the College (see Figure 4) as well as enabling the university’s faculty to understand the need for such an entity. As noted in Nietzel’s letter to the faculty, staff, and students of the School of Public Health, as well as the faculty of the Colleges of Medicine, Health Sciences, and Arts and Sciences and the various centers affected by its creation, he and Samuel were available to meet with and discuss the proposal with them. Nietzel oversaw the development of the comparison costs of creating a standalone college of public health and the merging of the School of Public Health with the College of Health Sciences. His review determined that the creation of a standalone college of public health would be the most cost-effective approach.
The proposed College of Public Health would be led by a dean, whose cabinet would consist of business officer, an associate dean for research, and an associate dean for academic affairs, who would oversee the director of admissions and student affairs and the coordinator of public health practice. The college would consist of five departments: Preventive Medicine and Environmental Health, Epidemiology, Social and Behavioral Health, Health Services Management, and Biostatistics, and the Graduate Center for Gerontology. Internal advisory groups to the dean were proposed to be an Administrative Council, Faculty Council, Student Public Health Association, and the Appointment, Promotion, and Tenure Committee. A College of Public Health External Advisory Board would be established to provide advice and counsel to the dean of the College of Public Health.
During the fall 2003 semester, Samuel and Watt developed the Proposal to Create the College of Public Health at the University of Kentucky. As required by UK’s Governing and Administrative Regulations, the affected faculties of the various colleges and centers were required to vote to approve the proposal. Along with their tireless efforts, Dr. Joel Lee, a College of Health Sciences faculty member, was an early advocate for the creation of a public health institution at UK that would meet CEPH accreditation standards. He had lengthy experience dealing with accrediting bodies while serving as a faculty member of the College of Allied Health Professions (later College of Health Sciences), and his knowledge of accreditation and its requirements made him an invaluable contributor to the ongoing process of meeting CEPH accreditation standards. He tirelessly engaged with the faculty of the College of Health Sciences to obtain their acquiescence to the creation of a college of public health and the move of the Department of Health Services Management to the new college. Dr. Richard Clayton, Interim Chair of the Department of Preventive Medicine and Environmental Health, worked diligently to assist all those who would be affected to understand the proposal and to answer the innumerable questions that were raised by it. In addition, he coordinated obtaining letters of support for the creation of the College of Public Health from college and center faculty and staff members as well as the affected students.
As a result, by the end of December 2003, the proposal was completed, including letters of support signed by faculty members from the Department of Preventive Medicine and Environmental Health, the Division of Epidemiology of the School of Public Health, the Division of Health Behavior of the School of Public Health, the Division of Health Services Management of the College of Health Sciences, the PhD Program in Gerontology, all of which would be transferred to the new College of Public Health. In addition, letters of support for the proposal and the relocation of their positions were received from the staff of the School of Public Health and the Center for Prevention Research. As early as the Summer of 2003, efforts were made to move the Center for Health Services Management and Research and the Division of Health Services Management to the School of Public Health.
By December 22, 2003, a fully developed Proposal to Create the College of Public Health at the University of Kentucky127 had been prepared by Dr. Thomas Samuel, interim director of the School of Public Health, and Dr. David Wyatt, associate provost for academic affairs. This comprehensive document provided a history of the effort to create a college of public
health at UK, including a timeline for the work that had been accomplished, including the report of the Workgroup on Organization of Public Health.128 Thus, the stage was set for the proposal to move through the Senate Council to the University Senate and on to President Todd and the Board of Trustees following the tireless efforts of Nietzel, Samuel, Watt, Lee, and Clayton.
At a general faculty meeting of the College of Medicine on February 12, 2004, concerns were raised by the college’s Faculty Council concerning the creation of a standalone college of public health, particularly concerning the funding of the new entity in a time of scarce state resources 129 However, On March 24, 2004,130 the proposal was approved without dissent by the University Senate Council for submission to the University Senate meeting on April 12, 2004. At the University Senate meeting, Samuel presented the proposal with the statement:
“I think we all know the status of health in Kentucky. We rank right down there. We, obviously, need to find a way to work with the state. We’re lucky to have a Governor right now who’s a physician willing to move forward with some activities in terms of public health. There’s a Council of Post-secondary education plan going forward on public health that will move public health, I think, to a priority in terms of funding at the state level, whatever that might be. We feel for the University of Kentucky to take full advantage of that, it is essential that we go to college status. Now college status, the reason for that, is that we need to have an organizational structure at the University of Kentucky that permits the dean or the chief academic officer of that particular organization to be equivalent to other deans at the University of Kentucky so we can go forward with accreditation. Accreditation is important in that it’s important for our students in terms of practicum placement. It’s important to the college in that we are eligible for certain funding that is only specified for accredited colleges of public health. We feel this is the time to do it in terms of the events after 9/11 and all the federal funding, the kinds of emphasis that is on public health, and, particularly, the status of public health in Kentucky, that it is the time to move forward. And we have adequately laid out that 31 different groups have, in fact, endorsed our move to go to a college, and we bring it to you and hope you will favorably consider the college status of the School of Public Health.”131
Following a spirited discussion, the Proposal to Create the College of Public Health was approved by the University Senate with one “no” vote and no abstentions and sent forward to President Todd for his approval and submission to the Board of Trustees. With President Todd’s recommendation for approval, the UK Board of Trustees approved the creation of the College of Public Health on May 4, 2004.132 The Board of Trustees’ action brought to fruition after six years of intense effort Holsinger’s and Scutchfield’s determination to create a standalone college of public health. With the support of Provost Nietzel, Dr. Thomas Samuel as interim director of the School of Public Health, Dr. Joel Lee, serving as director of the Division of Health Services Management, and Dr. Richard Clayton, both director of the Division of Health Behavior and interim chair of the Department of Preventive Medicine and Environmental Health tirelessly worked to bring about the creation of the college. Their efforts, both behind the scenes and in countless meetings with faculty and staff of the various entities that would comprise the College of Public Health, as well as with the members of the University Senate Council and the University Senate, bore fruit with the creation of the college. On May 8, 2003,Dr. Clayton, at the College of Public Health Graduation Recognition Ceremony, stated on behalf of the college’s faculty:
“Last year we had an opportunity to thank Scutch (F. Douglas Scutchfield) and Jim Holsinger for their work developing the School of Public Health. This year, we have an opportunity to express our thanks to two other individuals…To David Watt I express our profound gratitude for the visionary and incredible organizational role you have played in helping make our dreams come true…Tom Samuel …While the foundation was laid well for the emergence of a College, we collectively believe that achievement of college status would not have happened without your clear vision, your incredible ability to get colleagues to work together, your amazing organizational skills and a work ethic that is inspiring, your infectious sense of humor and ability to make everyone feel comfortable and a part of the team…you are an inspiration to all of us.” 133
CEPH Self Study
Following the action of the Board of Trustees, Dr. Thomas Samuel was appointed the interim dean of the College of Public Health (CPH). While the process of creating the CPH was underway and following Nietzel’s request, Samuel and his team of SPH faculty and staff prepared the initial College of
Public Health Draft Self Study Report dated April 2004 in preparation for the CEPH site visit. In meeting CEPH’s first criterion, Mission Goals and Objectives, CPH stated its mission: “The Mission of the College of Public Health at the University of Kentucky is to provide public health education, research, and service that enhance the health status and Quality of life for individuals, families, and communities. The College commits itself to the University’s land grant mission and to promoting human and economic development in partnership with public health practitioners and communities, through a diverse model characterized by fairness and social justice.” Its vision was stated as “Through its focus on the most salient public health problems in Kentucky and active participation in creative ways of addressing them, the College of Public Health at the University of Kentucky is recognized locally, nationally, and internationally for its demonstrated outcomes, reflecting quality in discovery, outreach, learning, service, community engagement and leadership.” The CPH faculty and staff stated the following values: academic excellence, democracy, veracity, organizational cohesion, community engagement, accountability, trans-disciplinary discovery, and educational opportunity. In accordance with UK’s Strategic Plan, CPH faculty and staff developed four goals for the succeeding three years:
Goal 1: To educate individuals for professional careers in public health through the MPH and DrPH programs; for research careers through the PhD program in Gerontology; and to advance public health practice through the workforce by expanding and enhancing essential knowledge and skills in public health through professional education, information dissemination, collaboration, and distributed education. Goal 2: To conduct basic and applied research to define health issues, test intervention strategies, and evaluate outcomes pertinent to the recognition, characterization, and resolution of health problems in human populations; Goal 3: To serve individuals, families, and communities by advancing pubic health practice through planning, managerial, programmatic, and other support to individuals and local, state, federal, and international organizations. Goal 4: To establish, organize, and develop the College of Pubic Health so as to position it to fully contribute to the University’s quest for national prominence. The Self Study determined that progress under each objective pertaining to the College’s mission and goals would be measured and reported annually to the University’s Institutional Effectiveness Office and its report to the Provost.
As required by CEPH’s standards, the College of Public Health “possesses the same level of independence and status accorded to other professional
Dr. Stephen Wyatt was appointed Chief Research Executive at Norton Healthcare in Louisville, Kentucky, in 2017. Norton Healthcare maintains one of the largest research portfolios of any community hospital system in the US. Prior to joining Norton Healthcare, Dr. Wyatt was a faculty member at UK in Lexington for 20 years. During his tenure at UK, he held several senior leadership roles, including Founding dean of UK’s College of Public Health from 2004-2014, Markey Cancer Center associate director for cancer control (1998-2004), and senior associate director (Co-PI) of UK’s NIH-funded Clinical and Translational Science Award (2014-2017). In addition to his senior administrative roles at UK, Dr. Wyatt maintained an active research program at UK from 19982017 with continuous federal cancer research funding over that period. Included among his cancer funding portfolio as a PI were several large cancer control grants, including the NCI-funded Appalachian Cancer Network and Cancer Information Service and the Centers of Disease Control and Prevention (CDC)-funded, Prevention Research Center and Comprehensive Cancer Control. Prior to his appointment at UK, Dr. Wyatt was a commissioned officer in the US Public Health Service, retiring at the rank of Captain (0-6). During his twenty years of service, he experienced public health at the local, regional, and national levels, with assignments to the National Health Service Corps, Bureau of Prisons, Health Resources and Services Administration, and the Centers for Disease.
schools within the institution and is able to maintain the integrity of its programs through autonomous and well-informed decision-making regarding budgeting and resource allocation, personnel recruitment, selection and advancement and establishment of academic standards and policies. The CPH dean is responsible to the provost of the university concerning budget, space, finances, and academic matters. As a member of the provost’s monthly meetings with deans of colleges and directors of units reporting to the Provost, the dean shares in the governance of the university.” The Self Study reported strengths, including college’s organization, which was conducive to the development of interdisciplinary efforts in teaching, research, and service. It was noted that faculty members in CPH represented a variety of disciplines that would assist in the collaborative nature of a public health institution. Also noted were the frequent seminars and presentations within the college that were available to faculty members throughout the university. The centers housed in the college also promoted interdisciplinary research, teaching, and service opportunities.
Governance of the college would be based on the Faculty Council, which had not been elected at the time of the Self Study but would be shortly after the Board of Trustees’ approval of the college. SPH had established both an Academic Affairs Committee and an Appointment, Promotion, and Tenure Committee. Both had been functional for several years under the chairmanship of Drs. Joel Lee and William Pfeifle respectively. The Admissions and Student Affairs Committee would be shortly established, led by John Wiggs, who served the then School and future College of Public Health tirelessly. Now accredited and with its organization fully staffed, the UK College of Public Health was prepared to move forward, placing its focus and efforts on developing outstanding degree programs, recruiting and educating outstanding students, engaging in important research endeavors, and providing service that would make a difference in the lives of the citizens of the Commonwealth of Kentucky for many years to come.
With the creation of the College of Public Health, staffing its organizational chart became a significant priority. After a national search, Dr. Stephen W. Wyatt134 was appointed the first permanent dean of the college effective December 14, 2004. He immediately began filling the key administrative positions135 in the college: Dr. Richard R. Clayton, associate dean for research, director of the Center for Prevention Research, and chair, Department of Health Behavior; Dr. Linda A. Jouridine (Alexander), associate dean for academic affairs and director of graduate studies; Dr. Richard Kryscio, chair,
Department of Biostatistics; Dr. Julia F. Costich, director, Kentucky Injury and Prevention Center; Dr. Robert H. McKnight, director, Southeast Center for Health and Injury Prevention; Dr. Graham Rowles, chair, Graduate Center for Gerontology; Dr. Thomas C. Tucker, chair, Department of Epidemiology; Dr. Joel Lee, chair, Department of Health Services Management; Dr. Scott Prince, chair, Department of Preventive Medicine and Environmental Health; Thomas Rogers, business officer; John Wiggs, director, admissions and student affairs; and Eula Spears, coordinator of public health practice.
The CEPH Self Study was the culmination of the creation of the College of Public Health. The CEPH external site visit occurred September 1-3, 2004, and “the CEPH Board of Councillors acted at its June 9 to 11, 2005, meeting in Vancouver, British Columbia, to accredit the College of Public Health at the University of Kentucky. The Councilors conferred accreditation for a five-year term, extending to July 1, 2010, with an interim report in two years. This is the maximum term possible for an initial accreditation under our current procedures. The Councilors join me in congratulating you and your colleagues for this impressive achievement.”136 The original CEPH report by the visiting team included six criteria that were “partially met.” From December 2004 through Spring 2005, Dean Wyatt137 led efforts to address these areas of weakness identified by CEPH, and at the request of CEPH, he visited with the CEPH Board at their meeting in Vancouver to provide information on strategic actions taken following the site visit and providing information on additional future efforts. The CEPH Councilors recognized the efforts of the college faculty and administration by changing the final report concerning four criteria from “partially met” to “met with commentary.” Only Criteria VII, Service and VIIIC. Faculty Diversity were deemed “partially met” and would require additional effort over the next two years. Effective June 11, 2005, the College of Public Health was fully accredited by the Council on Education in Public Health.138
APPENDIX A: COLLEGE OF PUBLIC HEALTH FACULTY
Department of Biostatistics
Charnigo, Richard Kim, Mi-Ok
Kryscio, Richard J.
Mahfoud, Ziyad
Mendiondo, Marta
Department of Epidemiology
Barron, Andre Caldwell, Glyn
Fleming, Steven
Hopenhayn, Claudia
McKnight, Robert Tucker, Thomas Tyas, Suzanne
Wyatt, Stephen
Department of Health Behavior
Belendez, Zaida
Clayton, Richard R.
Crosby, Richard Jones, Jeff A.
Jouridine, Linda A.
Swanson, Mark Teaster, Pamela
Department of Health Services Management
Costich, Julia Fleming, Steven Graham, George
Ireson, Carol L. Knight, Evelyn Lee, Joel
Pfeifle, William Pittman, Anne
Samuel, Thomas
Scutchfield, F. Douglas
Snider, Lyle
Tucker, Thomas C.
Department of Preventive Medicine and Environmental Health
Allweiss, Pamela
Brion, Gail
Cole, Henry P. Collins, Terry
Curd, Phillip R.
Danner, Deborah D. Early, Karen
Garman, Raymond
Greider, Thomas Lee, Ki Young
McKnight, Robert H.
Pollack, Susan
Prince, T. Scott
Riley, Kathryn Perez
Spengler, Susan E. Wyatt, Stephen W.
Center for Health Services Management and Research Costich, Julia
Fleming, Steven Ireson, Carol Knight, Evelyn
Samuel, Thomas
Graduate Center for Gerontology
Guttmann, Rodney Harrison, Anne Jacobs-Lawson, Joy Rowles, Graham D. Stiles, Nancy Teaster, Pamela B. Telling, Glenn Tyas, Suzanne, L.
Watkins, John F. Zanjani, Faika
