November 20, 2006

Perspective: WSU/DMC Crisis News
Med School Moves To Preserve Residencies
DMC Works To Save Hospitals, Remain Competitive
Directors And Chairs: Don't Sever WSU-DMC Ties
Residents Rail Against WSU-DMC Split
Don't Throw The Baby Out With The Bath Water
A Classic Lose-Lose Negotiation

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Perspective:
WSU/DMC Crisis News

By PAUL NATINSKY
This week's e-edition on the WSU/DMC conflict presents a number of pieces written and disseminated by parties involved with or with an informed opinion about the issue. We decided to present them with content unedited in an effort to bring readers the most direct news possible about events as they unfold.

As the crisis continues, so do developments -- seemingly hourly. Below you will find communications from Dean Robert Mentzer to medical school colleagues describing the why the orthopaedic residency dissolved and why several other residencies were expanded with new partners. You will find an explanation of similar events from the perspective of DMC CEO Mike Duggan in his second e-mail to DMC employees. You will also find from WSU/DMC residents and fellows and, in a separate letter from WSU department heads and DMC specialists-in-chief, urgings directed to the involved parties to not sever the medical school from DMC residencies. You will see a letter to Mike Duggan from the widow of a late chairman of WSU Orthopaedic Surgery that asks for the integrity and quality of the the WSU/DMC partnership to be preserved. Finally, we reprinted a well-written, perspective-laden Op/Ed piece from the Nov. 17 edition of the Detroit Free Press from Susan Hershberg-Adelman, MD.

A self-imposed and mutually agreed to media blackout by the negotiating parties unraveled a bit when reportedly DMC CEO Mike Duggan said DMC would sever its relationship with WSU and seek residency programs under the DMC banner. Several of the pieces published below were produced after reports of that statement became widely known.

At a Nov. 15 meeting with WCMSSM physicians, Deans Mentzer and Robert Frank provided a briefing on the issue and answered questions. A complete report of that meeting will be presented in the December DMN Magazine. Key points discussed included an underscoring of the potential devastation that a WSU-DMC breakup could cause for the region's health care; a detailed discussion of the mechanics of residency funding; and an assessment that the deal with the medical school is a solid bargain for the DMC.

Med School Moves To Preserve Residencies

Dear Colleagues,

On Nov. 14, the Accreditation Council for Graduate Medical Education conducted an on-site institutional review of GME programs sponsored jointly by Wayne State University and the Detroit Medical Center. Wayne's sole objective during this institutional site visit was to promote continued accreditation of those GME programs that remain under joint WSU/DMC sponsorship.

Early this year the DMC created five exceptions to our tradition of jointly sponsored residency programs when it abruptly severed its relationship with the School of Medicine's Department of Orthopaedic Surgery; and radically reduced financial support for dermatology, family medicine, otolaryngology, and urology. These DMC actions terminated the Orthopaedics Residency Program; and rendered it impossible to maintain the educational quality of programs in dermatology, family medicine, otolaryngology, and urology. As a direct result of these DMC actions, Wayne expanded its relationships with Oakwood Healthcare, Inc. and Crittenton Hospital Medical Center, which have independently partnered with us to continue these residency programs under Wayne's institutional sponsorship. The enthusiastic support of Oakwood and Crittenton has preserved the School of Medicine's ability to provide a comprehensive array of educational programs.

Nearly 65 GME programs remain under joint WSU/DMC sponsorship. Wayne is steadfastly committed to continuing these programs under joint WSU/DMC sponsorship. Our position will not change. Further, Wayne shall oppose any proposal by the DMC or its hospitals to further dilute our partnership.

Wayne and the University Physician Group have been negotiating in good faith with the DMC since May 2006, toward renewal of the agreements that support the teaching services of our faculty physicians. I was therefore deeply dismayed to learn that during active negotiations, and while our ACGME evaluator was still on campus, the DMC launched a strategy to terminate all programs remaining under joint sponsorship, and attempted to intimidate School of Medicine clinical department chairs into joining its pursuit of programs sponsored solely by the DMC. This action by
the DMC is inconsistent with good faith negotiations and places our jointly
sponsored programs at great peril. School of Medicine clinical department chairs have gone on record strongly opposing this action; the WSU/DMC Resident Council likewise opposes this action.

Wayne and School of Medicine leadership have honored the confidentiality
of negotiations. Our silence in the media must not be interpreted as any wavering from our unmitigated support of joint WSU/DMC sponsorship of remaining graduate medical education programs. We passionately support our School of Medicine clinical department chairs and the WSU/DMC Resident Council.

The Wayne and University Physician Group teams are committed to reaching agreements that will be in the best interests of the many constituencies to whom we are responsible. We remain committed to:

* Continuing our valued relationship with the DMC;
* Expanding our presence in the city of Detroit;
* Educating our students and training our residents and fellows in the best possible teaching environments;
* Recruiting and retaining outstanding physicians to teach our students and serve our community;
* Upholding our mission of delivering the highest quality patient care supported by education and research; and
* Providing compassionate care to the region's uninsured and underinsured.

Sincerely,

Robert M. Mentzer, Jr., MD
Dean, School of Medicine
Senior Advisor to the President
for Medical Affairs
Wayne State University

DMC Works To Save Hospitals, Remain Competitive

Dear DMC Employees:

Given recent articles in the press, this is a good time to communicate directly to employees what is happening in the WSU negotiations and to outline the principles on which DMC is acting. Those principles have driven the success of the entire DMC community in achieving our financial turnaround and are continuing to work.

I want to thank all DMC employees for the way you have continued to handle the stress of this period while still delivering wonderful patient care. I just marvel at the fact that our patient volume this month is running ahead of last November. Overall profitability is well ahead of budget and 2006 will be DMC's best year financially since 1997. Several hospitals are having an excellent year, but the turnaround at Sinai-Grace within the last 6 months has been nothing short of remarkable. We're doing a lot of things right under very difficult circumstances.

The DMC management team approaches every decision focused on one overriding mission: how do we protect our hospitals financially so we can make sure the DMC safety net will be here for years to come. I don't care how much orchestrated criticism I get, I will not agree to any contract with WSU that jeopardizes the future of Receiving, Hutzel, Sinai-Grace, or any DMC hospital and the DMC Board feels exactly the same way. The safety net is what is at stake here.

I wrote you in October that WSU had already abandoned its historic DMC partnership by moving medical services to Oakwood and buying a massive building in Troy. Since then, the picture has become even more clear. The total budget for the Troy development to be split between the WSU doctors and Oakwood now surpasses $60 million - enough to build a small hospital.

Last week, WSU advised us that it had applied for 6 new residencies to be solely sponsored by WSU without DMC to be located at suburban hospitals. WSU further advised us that it had unilaterally decided to end 4 current WSU/DMC residencies: ENT, Urology, Family Medicine, and Dermatology. As a result, the DMC team has started working to convert the residencies to DMC residencies because it is the only way to stop WSU from continuing to kill off the WSU/DMC joint Detroit residencies and starting new WSU suburban residencies in their place.

While we have differences with the WSU administration, I have the greatest respect for the faculty physicians now training our residents. Under DMC sponsorship of residencies, it is my intention to contract with those same faculty to continue the training program. I just don't want WSU to be able to cancel the programs and move them elsewhere.

We are nearing the end of the Governor's mediation process and we will see what results. It appears only outside intervention will solve this problem - whether it's the Governor, the Mayor, or a court. But our safety net hospitals will not survive if DMC caves into the WSU pressure, agrees to pay WSU $80 million to work at DMC Hospitals, and at the same time allows WSU to join Oakwood in building a competing suburban network to attract the same patients.

The DMC Board remains committed to its historic mission of operating a Detroit campus of specialty hospitals that support this community's safety net. We're going to figure out how to resolve this one way or another. Until then, please continue to do your best to set aside the distractions and continue to deliver the kind of care DMC patients have come to expect.

Mike (Duggan, CEO, DMC)

Directors And Chairs: Don't Sever WSU-DMC Ties

November 15, 2006

The Chairs of the Clinical Departments of the Wayne State University School of Medicine and the Specialists-in-Chief of the Detroit Medical Center are extremely concerned about the impending breakup of the partnership between the two institutions. The education of over 900 physician trainees and the healthcare of the citizens of Michigan are threatened by the current impasse in contract negotiations. Such a breakup will have dire consequences for the future of the graduate medical education programs and will threaten the viability of the School of Medicine and the Detroit Medical Center. In order to insure quality education, we only support an agreement that includes Wayne State University in the sponsorship of the graduate medical education programs and includes adequate institutional support. We strongly urge the Boards of the Detroit Medical Center and Wayne State University to reject any proposal that includes elimination of the University from the sponsorship of these programs.

Wayne State University School of Medicine
Clinical Department Chairs

Detroit Medical Center
Specialists-in-Chief

The following physicians signed the above letter:
Gary Abrams, MD, Ophthalmology
Michael Cher, MD, Urology
Stephen DeSilva, MD, Orthopaedic Surgery
John Flack, MD, Internal Medicine
David Grignon, MD, Pathology
Murali Guthikonda, MD, Neurosurgery
Robart Lisak, MD, Neurology
John Malone, Jr., MD, Obstetrics & Gynecology
H. Michael Marsh, MBBS, Anesthesiology
Robert Mathog, MD, Otolaryngology
Darius Mehregan, MD, Dermatology
Jay Maythaler, MD, Physical Medicine & Rehabilitation
Maryjean Schenk, MD, Family Medicine
Wilbur Smith, MD, Radiology
Manuel Tancer, MD, Psychiatry & Behavioral Neurosciences
Andrew Turrisi, III, MD, Radiation Oncology
Donald Weaver, MD, Surgery
Suzanne White, MD, Emergency Medicine

Residents Rail Against WSU-DMC Split

November 16, 2006

Dear Detroit Medical Center Board of Trustees and all other involved parties,

An emergency meeting of the WSU/DMC Resident Council was held on November 15, 2006 to address information that Mr. Duggan, on behalf of the Detroit Medical Center, had begun a campaign to convert all existing fellowship and residency programs from “WSU/DMC” sponsorship. The results of our discussion affirm the following by unanimous decision (35-0), as determined by resident delegates representing 10 departments and five fellowship divisions:

As indicated in our September 12, 2006 correspondences to leadership of both Wayne State University and the Detroit Medical Center, the WSU/DMC residents and fellows have chosen to pursue training in this institution to gain exposure to the academic excellence provided by the Wayne State University School of Medicine with a clinical mission to improve the health and well being of the patients we serve through affiliation with the Detroit Medical Center. As such, we support jointly sponsored WSU/DMC training as indicated in our contract. Further,

It is recognized that this action by the Detroit Medical Center is outside the purview of the negotiation process. According to Gov. Granholm’s suggested mediator, David Fink, negotiations are still ongoing. Further,

The Detroit Medical Center move for solely sponsored residency and fellowship programs outside of ongoing mediated negotiations is devastating in light of ACGME demands for institutional stability. There is no way to guarantee adequate teaching faculty as well as the cadre of departmental leadership, program directors, program coordinators and other support staff prior to the expedited review of the institutional review board of ACGME, to occur in the last week of November. This greatly jeopardizes graduate medical education across all departments. Further,

Placing graduate medical education in jeopardy is detrimental to the well being of the residents and fellows who currently train here. Should graduate medical education be disrupted as a result of this campaign, it will be at the personal, professional, psychological and financial expense of WSU/DMC residents and fellows, which would not be quantifiable in dollar amounts. Further,

In acknowledging all of the above, we the WSU/DMC Resident Council, on behalf of the resident and fellow body in all co-sponsored programs, will not actively participate in, nor do we support, the formation of new applications for solely sponsored DMC training programs.

We appeal to the Detroit Medical Center Board of Trustees to undo this action and resume good faith negotiations with Wayne State University-University Physician Group to achieve agreement which protects the viability of our WSU/DMC medical training and clinical mission.

Sincerely,

Paul Bozyk, MD
President, WSU/DMC Resident Council

Ben Atkinson, MD
Vice President, WSU/DMC Resident Council

Don't Throw The Baby Out With The Bath Water

Nov. 14, 2006

Dear Mr. Duggan:

I write this letter with great sadness for I’m witnessing the destruction of the quality of the Wayne State University School of Medicine.

My husband, Dr. Herbert E. Pedersen, was professor and chairman of the Department of Orthopaedic Surgery from 1963 through 1982. When he became professor orthopaedics was a branch of the Surgery Department.

He quickly engineered the separation of orthopedics into its own department, later becoming the chairman until his mandatory retirement as chairman in 1982. He remained as a professor until his death in 1985.

Under his auspices, 109 residents were trained, many now practicing in the Detroit metropolitan area. In the early years he worked with such brilliant visionaries as Gordon Scott, Ernest Gardner, Lawrence Weiner and Jay Chasen, and many more. These people had the foresight and energy to develop WSU into a highly accredited teaching and training facility.

Now, destroying the orthopedic training program will spread unease in all departments of the school. It is not true that all doctors with the same training are created equal. Attracting quality faculty and top students is impossible when the academic focus is displaced by emphasis on the bottom line.

I understand that you took this position to put the DMC on a financially sound basis. However, you’re throwing the baby out with the bath water.

Surely there’s a more intelligent way to help finances while maintaining quality. If not, the whole system will collapse. What dedicated faculty or ambitious students want to waste their time, energy and money on a deteriorating shell of a school?

You could hardly be proud to preside over such a situation. You have a golden opportunity to build, not destroy. I hope you will be up to the challenge.

Sincerely,

Eleanor Pedersen
(Mrs. Herbert Pedersen)

A Classic Lose-Lose Negotiation

By SUSAN HERSHBERG-ADELMAN, MD
(Editor's note: The following opinion piece originally appeared in the Detroit Free Press, November 17, 2006. It is reprinted here with permission.)

The DMC and the WSU Medical School are in the throes of a mutually destructive negotiation in which the choices are stark. Either they find a way to renew their contract or the DMC dies. WSU Medical School still could negotiate a new contract with another major institution in Southeast Michigan, one that has been anxious to have a medical school anyhow. The school could go on, limping a bit, but viable. The residents could relocate, losing at most a year of their training.

The DMC would lose the cheap labor of residents, would lose major federal grants, would lose whatever prestige it has, would lose most of its best doctors, and would lose the ability to recruit new doctors. No nationally recognized doctor in his or her right mind would come to the DMC as a replacement under the circumstances.

The city of Detroit, with one of the worst economies and the highest unemployment rates in the country can hardly afford to take this kind of hit. Health care is the number one source of employment in the city. Moreover, how do the people survive when their health care safety net is torn up?

So where are we now? The DMC has pushed WSU to work out residency contracts with suburban hospitals, and WSU now stands accused of trying to take business away from the DMC. The DMC has let it be known that it can get rid of the WSU residencies and set up its own. That is a pure fantasy, unworthy of being entertained by supposedly mature executives. Doctors and residencies are not widgets - fungible and tradable. Relationships must be built over years, even if they can be destroyed in minutes. None of the accreditation agencies in charge would permit the DMC to set up new residencies of its own until the whole situation shakes down, settles, and the DMC has again acquired staff of high academic quality. Meanwhile, the Receiving Hospital ER loses its level one accreditation, the DMC loses millions of dollars worth of residency training funds, and DMC hospitals will fold.

The DMC accuses the WSU doctors of being greedy. Any psychologist could recognize this as projection – a mechanism by which the accuser projects his or her own fault onto the accused. WSU is not exactly in an opulent facility or location. Its history is one of attracting doctors who feel good about an urban mission and who are willing to make sacrifices in order to be part of it.

Where are the grownups? The president of WSU, Irwin Reid, has not been at the table. The governor has handed the two parties a mediator who has ties to the DMC leadership. The mayor has been hands off. Nobody seems to care enough about the health care of the city of Detroit or the fate of one of the major medical schools in the country to do what is necessary. Nobody cares that this school is one of the most important training institutions for blacks in the country. Nobody cares that new employers will be deterred from coming to the city if its health care starts to approach post-Katrina New Orleans. Nobody cares if the people of the city will go without care.

What needs to be done? The governor or the mayor, or both, must sit down the obdurate parties and butt heads. If they cannot agree on a new contract with each other, one or both officials need to simply tell them what the agreement should be. Or, heads should roll at the highest levels. To allow the principals in this dispute to blow a hole in the middle of this poor suffering city would be a crime.

This publication brought to you by Natinsky Publishing Network.

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