Posted on 03/08/2008 9:42:59 AM PST by Eyes Unclouded
Shortly before the unexpected departure of Princeton’s top chief medical officer this summer, an investigation by the State of New Jersey revealed that since 2003, Princeton’s McCosh Health Center has failed to comply with state laws for reporting STDs. The state investigation, which involved a visit from a surveillance team and an official warning, was concealed from students and administrators. Vice President Janet Dickerson, who directly supervises the head of McCosh, did not learn of the state investigation until three months after it occurred. When a Tory reporter asked her to comment on the case she was caught unawares. “I’m looking surprised here,” Dickerson said, “and it’s not often that I look surprised.”
McCosh’s motive for concealing the event was not clear, but details gathered over several months provide context for what was a major breach in protecting public health at a health center harried by ethical difficulties. The investigation comes at a time of instability. A month after the investigation, Daniel Silverman, head of University Health Services and McCosh Health Center, left Princeton to work for a consulting firm that he had assisted in winning no-bid contracts from the University.
On June 25, the State of New Jersey sent a surveillance team from its STD program to meet with officials at McCosh. Sexually-transmitted diseases, or STDs, is the official term used by the state of New Jersey for what McCosh calls sexually transmitted infections. The surveillance team instituted a plan of “corrective action” and “remedial measures” to ensure that all past cases were reported. They also instituted a plan requiring McCosh to submit to quarterly reviews in order to ensure continued compliance. The warning Princeton received is the first step in a process that can lead to fines and even revocation of the license for Princeton’s University Health Services and its clinic, the McCosh Health Center. Such steps will be pursued if University Health Services (UHS) fails to remedy its reporting failures.
New Jersey law requires that STDs be reported within 24 hours of diagnosis. While most communicable diseases can be reported to local officials, STDs like gonorrhea, chlamydia and syphilis are grouped with tuberculosis and hepatitis C in a more serious class that must be reported directly to the state. For the eighteen months before last June, the state had received no STD reports from McCosh. Local health officials were also not notified.
Janet Finnie, interim director for UHS, downplayed the importance of the state’s investigation, saying in an email, “We make every effort to be in compliance with state health policies.” According to her statement, reporting STDs was the responsibility of Quest Diagnostics, the lab that the University hires to conduct STD testing on samples collected from students. However, since 2003, state regulations have required reporting directly from the heath provider. New Jersey law, which is similar to most states, requires doctors to file confidential reports that include the name, age, race and home address of any person diagnosed with an STD.
The reports are the state’s primary means of tracking infection rates and preventing outbreaks. Thomas Slater, press secretary for the state Department of Health and Senior Services, stressed the importance of the STD reports: “It gives us an overall picture to see what disease we need to address, to see whether or not there are public health emergencies.” Due to McCosh’s reporting failures, there has been no such protection for most of the time current students have been on campus.
A Conflict of Interest
Around the time of the investigation, Silverman left the University for a job at Keeling & Associates, a higher-education consulting firm that Silverman helped gain several no-bid contracts in violation of University ethics rules. As a consultant for Keeling, Silverman will be advising Princeton on how to improve its health services. Keeling & Associates provides consulting services to universities seeking advice on how to improve their operations. It has provided Princeton with a range of services, going from reports on how to improve McCosh to organizing retreats and conferences.
Janet Finnie, Silverman’s former employee and temporary replacement, said that she expects Silverman to be working with Princeton in his capacity as a Keeling employee.
Silverman’s relationship with the firm violated University ethics rules designed to prevent unfairness and conflicts of interest. They state that any contract exceeding $2,500 be awarded through a bidding process. This ensures that contracts are awarded to the person with the lowest price, not with the most influence.
If for some reason the contract cannot be awarded by bid, a form must be filed explaining why. In one case in 2004, Silverman endorsed Keeling for a no-bid contract worth $15,000 for which no exemption form was filed. None of the people involved in the contract could offer a reason for why no bid was asked for. Though others also favored the contract, only Silverman was the only one who later sought to benefit financially from his dealings with the firm. In the end Keeling received the contract for $15,000, and did so without facing any competition.
University administrators flatly denied that Silverman’s dealings with Keeling involved a conflict of interest. Vice Presidents Janet Dickerson and Bob Durkee both pointed to Keeling’s “sterling reputation.” The contract for the Health and Well Being Task Force was awarded at the urging of Silverman and Dickerson. Dickerson had dealt with Keeling & Associates at Duke, where she worked before coming to Princeton. Vice President Bob Durkee, whose office handled the contract, declined to produce it, citing a change in secretaries.
Silverman’s dealings with Keeling continued as late as this August, when he hired Keeling to organize a retreat for staff at the health center. Silverman is also continuing to work on an intercollegiate health panel that he joined as a representative of Princeton. Silverman did not respond to phone calls and emails requesting comment.
A Student Inquires
The events that led to New Jersey’s censure of McCosh began on a Saturday night last April. Then-Princeton sophomore Kyle Smith was studying with a group of friends. When conversation turned to Princeton’s ‘hookup culture,’ someone remarked that the one in four students on campus is believed to be infected with an STD. The one-in-four figure reflects campus health administrators’ belief, affirmed in multiple conversations with McCosh officials, that Princeton’s rate of infection reflects the national average. Concerned by such high figures, Smith decided to learn more.
At the campus health center, triage nurse Miriam Torres told Smith that state regulations require the reporting of new STD cases. Months later, Finnie and Silverman, who ran the clinic, claimed ignorance on changes in the state reporting law. State law requires that administrators take responsibility for STDs on campus. In addition to physicians and certain types of nurses, people overseeing institutions of higher education are required to report cases of STDs.
When Smith called the state to learn how many STDs McCosh had reported, state officials—who later cited Smith’s inquiry as the impetus for their investigation— discovered that McCosh had broken the law.
Danger from STDs
The problems that would lead to the state investigation were noted over three years ago in a University report. The report, written by the Health and Well Being Task Force cited failings in regulatory compliance and data collection. According to the report, there was “simply no way for UHS to operate” without hiring additional staff. The University heeded this warning by giving $195,291 to health services. Just a year after the warning and funding increase, the state stopped receiving any STD reports for Princeton students.
Princeton’s failure comes at the same time other colleges face problems with STDs. Miriam Grossman, a psychologist with UCLA’s Student Psychological Services, argues in her book Unprotected that during her tenure at UCLA, administrators did not do enough to make students aware of the physical and psychological consequences of casual sex. Last year, nearly 10% of students at ten southeastern colleges tested positive for chlamydia. Grossman faults campuses nationwide for the lack of medically accurate health education: “Too many young people, especially young women, are paying a very high price.”
Months after Silverman’s departure, the University is well into a search for his replacement. In January it convened an informal dinner meeting that included administrators and applicants for Silverman’s post. Notably absent, according to one participant, was any mention of the state investigation of McCosh or of Silverman’s history with Keeling & Associates.
Another example why we have no need for the idiot government in our health care....friggn’ liberal paradise of NJ!
A very useful thread of information for one member of my family. Thankyou for posting this.
Survival-of-the-fittest BUMP
Anyone see some left-wing bias in this “mistake”? This looks like a huge coverup of an inconvenient problem.
My relative who deals with some of these Princeton people would not have been privy to this info. I laugh that It irks her liberal pride that this behind the scenes newsbit derived from a conservative blog and news source. She, cocooned in her liberal orb, would not have gotten the whole scoop otherwise.
Oh there is more to come on this one...
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