Archive for Thursday, December 7, 2006

Pivotal issue

The situation at the Kansas University Medical Center grows more and more complicated.

December 7, 2006

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The situation at the Kansas University Medical Center grows more and more complicated.

It's becoming increasingly clear that members of the Kansas Board of Regents know little about what is going on at the Kansas University Medical Center and KU Hospital - and they don't care. It's also clear that Kansas legislators know little of what has been going on in recent years and months.

Likewise, relatively few KU School of Medicine and KU Hospital staffers have been included in conversations about what might be in store for the two entities.

It is not known how much Gov. Kathleen Sebelius knows about the situation, although it is understood Irv Hockaday, a Kansas City business executive, was to visit with the governor to sell her on the idea of merging the KU School of Medicine educational program with St. Luke's Hospital in Kansas City, Mo. The idea is strongly supported by Hockaday and St. Luke's officials but opposed by a large number of KU School of Medicine staff members.

There is a dangerous level of mistrust, discontent, lack of confidence and serious concern about what might happen to the School of Medicine, KU Hospital and the reputation of the institution.

The debate and growing anger centers on several factors; money is No. 1. Barbara Atkinson, KU executive vice chancellor for the Medical Center, doesn't think she is getting enough money and support from KU Hospital, which is doing exceptionally well under the leadership of CEO Irene Cumming.

Representatives of hospitals in the greater Kansas City area agree research is terribly important and that there are many ways representatives of various hospitals could work together to discuss and execute sound plans to increase and improve research.

However, St. Luke's officials have said they want more than just a collaboration on research. They want a firm tie with the KU School of Medicine to supply a certain number of residents and interns to help staff their hospital.

KU Hospital officials do not want to agree to anything that would diminish the supply of interns and residents coming from KU and other medical schools. They do not want to be pressured into accepting something they think is bad for the school. KU Hospital is growing in patient loads, physical size and excellence and needs a steady supply of well-schooled interns and residents.

Many in the KU School of Medicine point out the school has spent many years and millions of dollars to build a brand for KU graduates, interns and residents at the KU complex. They do not want to agree to anything that would tarnish this reputation or in any way disenfranchise the KU graduates moving to St. Luke's.

KU Hospital officials offered a $400 million package to the School of Medicine to lock in a formal relationship between the School of Medicine and KU Hospital. St. Luke's interests countered by offering $200 million, but only if the education part of the deal was firm. No educational ties, no money.

Morale at the School of Medicine and the hospital is not good. In fact, that's an understatement. There is great criticism of how Atkinson has handled and engineered the deal with St. Luke's. Most of this planning has been done behind closed doors. There has been little, if any, transparency to the dealings, and few medical center staff members have been asked for their advice and comments.

Atkinson, Hockaday, Executive Vice Chancellor for External Affairs David Adkins, Kansas City businessman Bill Hall and probably Chancellor Robert Hemenway are all strong supporters of the St. Luke's merger. KU people want the money and don't want to offend anyone or any interest that is generous in its fiscal support of the Medical Center.

Personal egos have been a part of the struggle for some time, with Atkinson trying to give the cold shoulder to Cumming. In fact, Cumming was not included in most of the discussions, and it wasn't until this was made public that Atkinson invited her to a limited number of meetings.

To illustrate how serious the matter has become, consider the following:

A survey asking medical school personnel what they thought about the St. Luke's efforts was distributed late last week or early this week. Dr. Roy Jensen, who is heading the KU Cancer Center effort, sent an e-mail to the staff urging them not to vote. When Atkinson learned of the survey, she also urged staffers not to vote. Both Jensen and Atkinson claimed the staff did not have a good enough understanding of the plan to make an informed vote.

Those favoring the survey have said Atkinson is far too "insular," pointing out the staff has not been included in discussions, that they have not been able to offer any input and that the only reason she informed them now about the offers from KU Hospital and St. Luke's is that the story had been broken the previous Saturday.

There is the feeling among many staffers that Atkinson's policies are building "tunnels" rather than "bridges." Others claim that residents being interviewed now are asking what is going on at the School of Medicine and hospital and if they accept an offer from KU whether they would be assigned to KU Hospital or St. Luke's.

And, to make the matter clear, some KU staffers are adamant in saying, "St. Luke's is not a peer institution in education and research with the KU School of Medicine and KU Hospital."

Others have questioned the domino effect in all of Kansas City if St. Luke's give sthe cold shoulder to Truman Medical Center, the University of Missouri's hospital in Kansas City. Several at KU were complimentary of Truman, saying it offers a different kind of medicine than KU but that it is "vibrant" and an important medical school. They question how Truman doctors will react if they are shown the door by St. Luke's. They suspect Truman may lose some of its doctors, which raises the question of what would happen to the large amount of indigent medical care the hospital provides in Kansas City. Would St. Luke's absorb this indigent patient load?

Monday, a panel of seven state legislators will meet in Topeka to try to learn more about what is going on at the KU Medical Center. Do they know enough to ask the right questions? It is interesting, as well as suspicious, to note that the KU Medical Center and St. Luke's are represented by the same paid lobbyist, Kathy Damron. Is the respected lobbyist playing both sides of the fence or are her two clients walking hand-in-hand in this effort?

It may be the medical school has the right to do whatever it wishes. Maybe that's what Atkinson and Hemenway - and perhaps the regents - will choose to do.

It is a pivotal meeting in many ways, but it will do little, if anything, to settle the growing civil war at the Medical Center. It has gotten to the point some in the Medical Center have even suggested a petition to indicate a lack of confidence in Atkinson's leadership.

Seven members of the Kansas Legislature can't solve this problem and, according to Regents Chairman Dick Bond, the Regents don't get involved in such matters.

Who does?

Kansas taxpayers have allocated millions, perhaps billions, of dollars to the medical school and hospital over the years. It's a good school, although according to various surveys, it has slipped in recent years. It is reported Atkinson referred to the school as a mediocre institution, one that can build its excellence only if it has more money.

One has to wonder about the role of leadership and vision - along with money.

This editorial was incompletely published online owing to a technical glitch. The complete editorial is published above.

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