 Now, the next speaker will be John Schumann. Dr. Schumann holds the Gussman Chair in Internal Medicine at the University of Oklahoma School of Community Medicine. At the University of Oklahoma, he served initially as program director of the Internal Medicine Residency program, then vice chair of the Department's Education program, before being named the president of OU Tulsa. Dr. Schumann has completed the McLean Fellowship in 2005. He's blogged in something called Glass Hospitals since 2010. His essays are frequently reposted on leading health and patient advocacy blogs across the country. He's written for Slate, The Atlantic, the radio program Marketplace, and NPR's radio blog Shots. And he's a frequent contributor to public radio in Tulsa. He's the developer co-producer and host of the radio show Medical Matters on the Tulsa NPR Station, which explores health care and the human condition. And he's going to talk to us in a fascinating, biographical sketch from ethics to president in Oklahoma. Please welcome John Schumann. Thank you. Thank you for sticking it out, those of you that are here in the post-snack phase. Late in the afternoon, let's see, OK. And the only disclosure I didn't put a slide in is, in fact, Glass Hospital, the name of my blog. I formed an LLC because of writing that I do freelance writing in lay press, magazines, and things, and for public radio content. So that's the only disclosure. So it is wonderful to be back in Chicago and at the McLean Center, see so many old friends and mentors. And when I got this new title president, Mark reached right out to me. And if you were here this morning and heard David Rubin, the usual email or pages, I'd like you to speak. What's your topic? This year, for me, the topic was, you'll be speaking, and here is your title. So that was the difference for me. So I had to shoehorn what I was going to say into this talk. The thing is, Mark probably realized that greatness was in store because I was a former McLean fellow, but I had to move to a sooner country in order to realize the dream. So today, I'm going to share with you a little bit about what it's like to be campus president of a flagship state university and how clinical ethics training comes into play actually on a daily basis. Particularly in recent days, if you're following the news events on college campuses, I don't have to tell you about University of Missouri or Yale, which spring to mind, there's been a lot of turmoil regarding racial and social justice and several movements, student-led movements, and then their precipitated backlashes from folks criticizing the students and then people criticizing the criticizers. Particularly in Missouri, which is a state that neighbors Oklahoma and at Yale, which I mentioned, which does play into this story. So to get to Tulsa from Chicago, one travels down the path of Route 66, once known as America's Highway. And in Oklahoma, we're at the western end of the Central Time Zone, though it can feel worlds away from the South Side of Chicago. And we're about halfway between Chicago and Los Angeles. We're 1,100 miles from Chicago. And 1,100 miles, as I was saying, from this campus here on the South Side of Chicago, you pull into Tulsa, which is Oklahoma's second largest city in the heart of what used to be called Indian territory before statehood for Oklahoma. Route 66 runs right through Tulsa. And the road in its history is a featured part of the city's renaissance. The city's mascot is the Golden Driller, pictured here. I've never lived in a place with such a bounty of natural wealth. Oklahoma's economy turns on oil and gas, exploration, drilling, refining, and transport. But not until the 1980s, the city was known as America's oil capital, a title now claimed by Houston. The very campus over which I preside was purchased from an oil company, the former Amaco. There's a small remnant of the company in our property, now part of BP, or what used to be known as British Petroleum, that controls this little part on our campus, controls all of the pipeline flow for BP across the continental US, including pipelines right nearby in Whiting, Indiana. So it's not hard to see the centrality of the oil business to Oklahoma's economy. This is the state capital, where there's an actual oil derrick on the grounds, and there are actual oil, there are actual pumps that are still drilling oil out from underneath the state capital. So the industry's effect on the state economy is profound. And in spite of very low unemployment, although that has climbed a bit in the last year or so, and economic growth that outpaces the national average, the last year of depressed oil prices has led to a rash of both industry consolidation layoffs and an unprecedented state budget crisis. Nevertheless, there are some positive aspects to the low price of oil, which is, sort of before I lived in Oklahoma, what I normally used to see, which is this. And this was, this photograph is taken on Monday, but as of today, the price of a gallon of regular inlet of gasoline is $1.75 in Tulsa. So I know it's a lot higher here. So I forgot to ask for a show, guys. How many have actually been to the state of Oklahoma? So actually quite a significant number of you. Okay, so when my wife, Sarin, and I, who was also a former McLean Ethics Fellow, said we were, you know, took these jobs in Oklahoma, a lot of people sort of said, what? You know, why? And how are you gonna do that? Why on earth would you do that? We decided to go for the adventure. So this, as I was saying, this photo is the filling station that's nearest our home. And the boom, really the boom in domestic oil production is so significant that many experts proclaim that the U.S. could and rightfully should become a net exporter of oil. After decades of relying on imports to sate our world's largest economy and our huge consumption of fossil fuels. This is due to a technological boom in oil extraction. New methods like horizontal drilling and hydraulic fracturing, yes, fracking, have brought a surge in new exploration, new efficiencies, and the ability to take extinct wells and bring them back online. Massive shale formations like the Permian Shelf in Texas, the Bakken Shale in North Dakota, and the Anadarko Play as it's called in Oklahoma have provided an increase in the estimated U.S. petroleum reserves of trillions, that's trillions with a T, barrels of oil. So there is a strong local regional movement to repeal the ban on U.S. oil exportation. So all of this oil wealth and new technology comes at an unusual price. And you may have heard that in addition to contributing to its oil wealth, Oklahoma has become the nation's leader in earthquakes. Not something that we bargained for when we were moving there. The correlation, however, is extremely strong between our arrival and the rise in the number of earthquakes. This is a graph of seismic activity on the Richter scale greater than three. And I posited a strong correlation, however I do not think it is causative. The science community has been clear in attributing the cause of the surge to what are called disposal wells, which is oil field service speak for pumping massive amounts of wastewater and sludge back into the earth after it's done going into the oil wells to help fracture and produce cracks in the shale to loosen up the oil from what is known as its lattice rock. And in fact, in a somewhat surprising admission, our state's governor acknowledged this past August that there indeed is a correlation between disposal wells and the earthquakes. And so we have this, most of these earthquakes have not caused damage, fortunately. And as I said, they check in usually around three or four on the Richter scale. We have felt them in Tulsa, but they have done shut down these disposal wells in the most volatile seismic areas. So there's some good news in that earthquake story. So I can't talk about Oklahoma or tie it to clinical medical ethics or to my job as campus president without talking about Oklahoma's history, which is indeed very colorful. So this is actually just a historical map of Indian removal from the 1830s. And when the five so-called civilized tribes of Native Americans were forcibly removed from their home territory and brought to what was called then Indian territory, which is what became Oklahoma. So the state, before it was a state, was actually divided. On the eastern half of the state was Indian territory. As you can see, sort of the right of the purple line that divides this map. And then to the left was Oklahoma territory. And Tulsa is right there smack in the middle of where it says Muscogee Creek Indian territory. Oklahoma became the 46th state in 1907. Interesting, the university in which I am a part of was founded in 1890 before statehood, which as you know, the University of Chicago was also founded in 1890. So sticking with the theme of Native Americans, there are 39 federally recognized tribes in Oklahoma, most of which have their own license tags, which provides a very interesting cultural milieu, very interesting tribal politics, lots of politics, lots of money. The tribes, those that have open casinos tend to have a lot of wealth. Of course, there's a lot of oil wealth for some of the tribes as well. It also provides great I spy games for kids when you drive around. So this is just a signifier, a transition slide about the natural beauty of Oklahoma, of which there actually is some. It's got a widely variegated landscape. This is from Oklahoma's tall grass prairie in a place called Pahuska in the heart of Osage County, which is where Tracy Letts, who made his claim to fame at the Steppenwolf Theater, again a Chicago tie, is from Osage County. So I'm gonna segue here back into some of the history, some of the uglier history in Oklahoma. So this is not actually carpet bombed Dresden after World War II, but this is Tulsa's Greenwood District, the north side of Tulsa in 1921, after the Tulsa race riot, which is considered by many historians to be the worst race riot in the country's history. Here you can see some walk around. So this multi-block district of the north side of downtown was literally burnt down and a subsequent law was passed, which forbid black Americans from actually rebuilding this part of the town. And to this day, there are now historic discrepancies of disparities, which I'll share with you in a second. And this is a lot of what our particular branch campus has been trying to do to ameliorate. So this of course probably doesn't need an explanation if you were alive. This is the remnant of the Alfred P. Murrow building in Oklahoma City. And I'm just gonna read to you a salient quote there was another speaker this morning. I think it was Peter Uwell talking about the power of words. And so I'm just gonna share with you this quote, and that's gonna bear with me. 20 years ago when Timothy McVeigh bombed the Murrow federal building in Oklahoma City killing 168 people, the act was quickly understood as terrorism. The FBI webpage on the Murrow bombing listed as the quote, worst act of homegrown terrorism in the nation's history, unquote. That designation overlooks the Tulsa race riots of 1921 in which a white mob enraged by a spurious allegation that a black teenager had attempted to assault a young white woman was deputized and given carte blanche to attack the city's prosperous black Greenwood section resulting in as many as 300 black fatalities. From one perspective, the Murrow bombing was the worst act of domestic terrorism in our history. But as the descendants of the Greenwood survivors know, it was probably not even the worst incident in Oklahoma's history. And that is from Jelani Cobb writing in The New Yorker. So there's this strong history of both violence in Oklahoma, probably stemming from the fact that there was this rush for oil and the Great Land Rush and that's where we get the nickname Sooners were the people who went before they were allowed to go and make land claims under the Homestead Act. And this great history of racial violence that occurred in the early 20th centuries. And for decades, nothing was ever taught about the Tulsa Race Riot until really the Oklahoma City bombing put terrorism on the map. And this plays into today, but it's since the 1990s, the Tulsa Race Riot and the Greenwood District has really found a place in the curricula of our kids' schools. It never used to be taught. It was something that was just not talked about in Tulsa. So that brings our story to this historian. We're talking about history. This is historian Howard Lamar who will be 92 next week. And he is Sterling Professor Emeritus of History at Yale University. So that's one of the other campuses where there's been a lot of turmoil. And Howard Lamar served as acting president of Yale 1992, 93 right after I left there where I majored in history. And one of the coincidences and probably one of the truthful ways in which I got this job was that the president of the flagship campus in Norman, Oklahoma of the University of Oklahoma, David Boran, who in his 30s was governor of the state and his 40s was the US Senator from Oklahoma and in his 50s became president of the University of Oklahoma is now probably the longest tenured sitting president of a major university in the United States. He also majored in history at Yale in 1963. His thesis advisor, the same Howard Lamar. So I bring you fast forward to today. This is just a photograph from last April, actually it was last March, the SAE house, returning house in Norman. Now this is not on my campus. The great thing about the Tulsa campus of OU is we're mostly graduate campus. The average age of our students is 30 and we're 80% women. Our biggest program is social work. But the SAE house had an incident where some frat brothers were singing a racially charged song and this was videotaped on a cell phone and quickly broadcast on social media. President Boran seen here, David Boran the man I talked to you about, immediately expelled the students, shut down the fraternity house, took off their charter and closed the building, reacting very swiftly making many national news media appearances. Now contrast that with the recently resigned president of the University of Missouri who apparently due to the racial strife on his campus said he would form a commission and come up with a plan for enhancing racial diversity at the University of Missouri by April, next April. I should say too that here President Boran is talking with a representative from a student group in the Norman campus called Unheard. And African American students on the Norman campus were feeling particularly that way that the administration was not listening to their concerns so they formed this group. And he did a pretty good job of listening. So that's something I think that is a lesson from this past week in fact of many people throwing accusations at one another but not doing a good job of listening. So I'm taking you back to our state capital just to tell you about my job. So now as the president of a campus of a state university I'm very reliant on state budgetary appropriations. So my job inherently is political so I have to actually spend time at the capital which to this point I like, I'm still in the first year on the job so I work with our state legislators. Now we have a state legislature, it's by caramel, there's a Senate and a House. The Senate has 40 of 48 of its members are Republican and 72 of 101 of its representatives are Republican. I only tell you that the governor is also Republican so it's a very red state. In fact, Oklahoma is the only state that in both 2008 and 2012, all 77 counties voted for either McCain in 2008 or Romney in 2012 and I only tell you that just to contrast that with Chicago in Illinois which Chicago particularly which tends to lean democratic. Our state is very tries to be physically prudent. Raising taxes is something that's entirely anathema. Last year when the price of oil plummeted there was a law that passed that was going to allow for a quarter percent income tax cut and the state revenues did not hit their threshold which should have disallowed the state revenue cut but the revenue, the tax cut went to basically the wealthiest 1% in the state. That led to a budget shortfall of about $611 million. Now that doesn't sound like a lot probably in Chicago but in a state where our entire state budget is $7 billion, this year's budget shortfall is predicted to be $1 billion so 15, 16%. And so we're having to prepare our campus for probable budget cuts and mid-year what's called rescission where they're actually going to take money back to the state from academic programs which is very distressing to say the least. One other thing you should know about the state of public education in Oklahoma, two other things. One is that in the 1970s state budget appropriations covered 50% of the cost of an OU undergraduates tuition or the cost of educating that student. It's now down to 15%. We've had eight successive years of budget cuts in public education. In our public schools, our secondary schools, the average teacher makes about $5,000 less than annual salary than they do in the neighboring states which include Kansas, Texas, Arkansas, and Missouri. So in order to address that, President Boran who is now thought to be an apolitical figure is fighting his one last great statewide campaign. He's trying to put on the ballot a sales tax raise to actually pay for education, about a $900 million sales tax that would go to raise the salaries of public school teachers and some of which would go into the pot for higher education. And he says that this is polling at about 70% approval. It will make our sales tax close to the highest in the nation, which also reminds me of Chicago. This is a photo of Mr. George Kaiser who is the second wealthiest man in Oklahoma and he considers himself a winner in the Ovarian lottery and he has committed to give half of his billions in wealth away to philanthropic causes and has founded a family foundation that bears his name. He has three areas of giving. One is, you can see here, early childhood education. He is an advocate of Jim Heckman's, thank you, theory about every dollar invested in early childhood education saves $7 of future costs or has a $7 return on investment. So he has brought, he has worked and lobbied to make both universal pre-K or reality even in a conservative state like Oklahoma and we now have four education centers which provide free education to kids zero to three. His other areas of investment are in Tulsa, the city itself and a real renaissance that's going on and lastly in community health of which my particular campus is a large beneficiary. He gave a $50 million seed gift to take us from the OU Tulsa Regional Campus and College of Medicine and now calling it the School of Community Medicine, the idea of being wanted to train doctors. We're the number one challenged primary care shortage state, believe it or not and we have very low health indices we're like usually 46th best out of 50 states in terms of smoking, obesity, diabetes and those things. So he has made a concerted effort to address those things. This is one of the payoffs of that investment. All told, this is not just his investment but this is public and private dollars. 46 million dollars have been spent in the last 10 years and one of the reasons my wife and I were moved to move to Oklahoma was that there was this disparity. These are two different zip codes. This is 74137 on the south side of Tulsa, one of the wealthiest areas and 74126 in that historic north area of Tulsa that was part of the Tulsa Race Rat. And in the year 2000 there was basically this 14 year gap in life expectancy and over 13 years with 46 million dollars of investment, two new health facilities, 29 physicians and a specialty health center all in that zip code. They've amazingly, when the health department went and recalculated the life expectancy disparity it had gone down by about three years. So that shows you, I mean, this is the kind of thing that takes generations and at about half of the generation we were actually able to move the needle about three years so that's pretty remarkable. This is just a photo of our campus and just the final thing to tell you about is what I do. So I was a residency program director and had most of my career up to this point had been in medical education, teaching residents and students, teaching a little bit of medical ethics. And when I met President Boren, the one fact that he had remembered about me was that we shared the same thesis advisor. So the, my predecessor as the president of the campus was also a physician, he was a psychiatrist, fought many of the political battles to get our campus to be accredited as a school of community medicine. What that meant was we were gonna have first year medical students on our campus for the first time ever. Our campus is an amalgam of really the health sciences programs which are based mostly in Oklahoma City and then what we call our Norman based programs based on the flagship campus. Most of our degrees are graduate but we have programs and I oversee these which is kind of amazing. If you think about it, we have arts and sciences which has five different programs and 19 faculty members, education, engineering and architecture. In addition to our medical campus which we have our first year class on campus this year we have a college of public health, nursing pharmacy and allied health. So it's an amalgamated campus representing really disparate streams. Interestingly, it's an administrative challenge because we get funding from both sides of those campuses. We have different payroll systems, different software systems, different email systems and because we're the satellite campus and we have the smallest budget and the smallest enrollment of any of the three campuses nobody really wants us to kind of solve that problem but we make do with what we got. So just the last word I'll tell you about is that it's been a great challenge. People ask me do I like the job? My answer is yes, I still practice medicine. I still do have a very small, what you call a private practice about a half a day a week. It's really a faculty practice and I see patients, I see all comers but the practice is pretty small, it has to be. I'm available for meetings. I do a lot of bully pulpit kind of stuff like this. I'm involved in the Chamber of Commerce because in Tulsa the university presidents of the universities there are seen as civic partners so we're the Chamber of Commerce which I initially went in as thinking this was just sort of the very old school style thing. It's actually very progressive because the Chamber of Commerce really is doing, wants to do what's best for business but in turn is best for families and in turn it's best for families as education, opportunities and new businesses and business growth. So there's kind of a win-win strategy there and so they automatically grant the university president seats on the board. So I'm involved in civic affairs, meeting lots of people that I never thought I would ever meet in my sort of my regular previous job and then the last thing I would say is that the city's undergoing this one type of clinical ethics is that I think of Mark's four box model and so one of the analytical tools that we use in our strategic planning on campus is the so-called SWOT analysis which I'm sure most of you know but strengths, weaknesses, opportunities and threats and I just when I see it people do these SWOT analyses on paper I always think of the four box model and so what are the medical indications but we always have competing interests right so people come to me with problems, they also come to me with opportunities and so the best part of the job is really being a facilitator between people who have resources and want to donate them and then people who have ideas but don't necessarily have the funding and trying to marry those two ideas and make them work is really the best part of the job so I think I'll stop there and be happy to take any questions. Thank you. We'll probably have time for one question or comment. I'll just say on behalf of Mark that I think this is the first graduate of the McLean Center Fellowship who is a university president and we're very proud of that. Thank you.