May 28, 2003
Dear Colleagues:
Last week, I promised to update you on events as they unfold regarding the DMC financial situation and the impact on the School of Medicine. Since that communication, there has been significant activity, both from the DMC administration and, by way of response, from the School of Medicine leadership. Much of this has been reported in the press, with varying degrees of accuracy. I want to clarify recent announcements and reassert my commitment that the School will maintain its missions of education and service without compromise to our current level of excellence.
On Tuesday, May 20, Detroit Medical Center administration outlined a plan for reduction in services at the medical center’s central campus. Essentially, the plan as outlined calls for the elimination of inpatient beds and a drastic reduction in the number of emergency cases at Detroit Receiving Hospital as well as the elimination of all but high-risk births at Hutzel Women’s Hospital. Also included in the plan is a staff reduction of 1,000.
In a subsequent meeting last week of the School of Medicine Clinical Department Chairs, there was consensus that the DMC plan is not in the best interests of either the community we serve or the long-term viability of the academic medical center. The consolidation of services as outlined would drastically reduce or eliminate access to care to our most vulnerable population, presenting a morally and socially unacceptable solution. Further, the plan as outlined does not sufficiently address the financial drain on the DMC and in fact will likely cause further and irreparable fiscal harm.
As the academic partner of the Detroit Medical Center, the Wayne State University School of Medicine has been both vocal and active in its support of our clinical partner in its efforts to address the critical issues facing health-care delivery in our urban setting. We continue to acknowledge the severity of the financial crisis of the DMC and to advocate plans for viable and immediate solutions. However, because an academic medical center, by definition, is highly integrated in both clinical and academic enterprises, the business strategies must be driven from both perspectives. The clinical chairs, who serve as the medical leadership within the DMC, had no input into the announced plan and thus could not provide a strategic vision for a reasonable solution. Similarly, I did not feel that I could reasonably represent the School of Medicine as a member of the DMC Board of Trustees, having been excused with increasing frequency by the Chair during deliberations germane to the DMC/WSU relationship. Without meaningful authority in the governance and management of the clinical enterprise, the School of Medicine cannot be considered a true academic partner.
It must be said that while the situation has come to a boil in the past few weeks, the causal issues have been brewing for some time. The DMC/WSU Agreement for Academic Services and the DMC/UPG Professional Services Agreement were mutually forged more than two years ago in recognition of the essential nature of our partnership. Along with these agreements, the joint DMC/WSU Liaison Committee was established for the purpose of management and resolution of issues and disputes in administrative areas such as faculty recruitment, program development, property leases and information technology, among others. Although meetings of the Liaison Committee were to occur monthly, we have been continually frustrated by the DMC’s reluctance to discuss or resolve such issues through this mechanism. As a result, the issues list has grown longer and the chasm wider.
This past February, the DMC established a WSU Discussion Task Force to address extension or renewal of our professional services agreement, which expires in December 2003. The Task Force includes David Page and Lloyd Semple of the DMC board; Drs. Fernando Diaz and Patricia Maryland; Michael Herbert and Cindy Pavlovich; and me. The Task Force, in good faith, negotiated an extension to the professional services agreement. This consensus document includes an overall reduction of seven percent in reimbursement to both the School and the faculty. The university has signed the consensus documents, along with a similar extension of the graduate medical education contract. While the contract for graduate medical education has been signed by DMC, we await DMC signature on the negotiated professional services contract.
However, as recent events have borne out, our contracts for essential professional services – including administrative and educational leadership and partial reimbursement for service to the indigent population – is not the defining component of our partnership. The School of Medicine administration and faculty must be able to participate significantly in the clinical enterprise, including decisions about programs, resources and budgets, in order to develop efficient, revenue-enhancing delivery systems. As external changes in health care organization, financing and delivery jeopardize the academic and clinical missions, we must take immediate action to ensure the viability of our urban mission, as well as our long-standing relationship with the DMC.
For these reasons, the university and the School of Medicine leadership advocate an alternate strategy for the DMC. Such a strategy will be underpinned by the commitment to continuity of health-care service to our population, and will be the basis for rebuilding a fiscally sound academic medical center. We expect that this strategy, as well as the governance and management of the DMC facilities, will be conducted in full cooperation and partnership with the medical and academic leadership of the School of Medicine and its faculty physicians.
To this end, School of Medicine also supports the establishment of a regional, publicly-responsible entity for health services to the under-and uninsured population of our community. Such an entity, or health care authority, would have fiscal accountability for the delivery of care to this population across all affected institutions.
The School of Medicine remains committed to our clinical partner, even as we are forced to explore other viable alternatives for the sake of our future. By working in true partnership, and with the establishment of an independent, regional health-care authority, I believe we can sustain our growth, now and over the long term. More importantly, we continue to do so while remaining steadfastly responsible to our patients in the metropolitan region that we serve.
Sincerely,
John D. Crissman, MD
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