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January 8, 1998


The goals of UPMC Health System and its allies, as health care providers, may not always be consonant with the University's interests. It is possible, though, for UPMC to achieve its goal of being the dominant health system in this area without jeopardizing the medical school's academic goals, as long as negotiations between them are conducted at arm's length, in an open and honest manner. Last March the ad hoc compatibility committee, which I chair, was created by then University Senate President Keith McDuffie and charged with looking into the relationships between the UPMC Health System and the University, particularly the School of Medicine. The committee provides a vehicle for expressing University faculty concern about the resolution of the health center issues at Pitt. I write as an individual, not on behalf of the committee. Some observations follow about where we are, how we got here, and the future.

1. The respective views of each other held by medical school faculty and faculty of other University schools, often referred to as the lower campus, have not always been positive. Envy, distrust, ignorance and disdain have been evident from both sides in the past. During the first collective bargaining election process in the 1970s, medical school faculty obtained separate bargaining unit status, asserting that it had little in common with lower campus faculty. Today, some faculty see increased power of UPMC over medical school faculty as a signal that tenure for all University faculty may be at risk, and that lower campus and medical school faculty do have common interests.

2. Communications to the compatibility committee reveal serious concern of medical school faculty about the future, particularly regarding the practice plans, the effect of UPMC's control of finances upon the academic functions, and fear that those who publicly assert their concern, and raise questions about UPMC, will suffer reprisals. 3. Compatibility issues first arose publicly in the 1991 Syria Mosque site acquisition dispute. Then Chancellor Wesley Posvar and Jeffrey Romoff, currently UPMC president, gave greatly different accounts about whether the University was aware that Presbyterian University Hospital, fronted for by National Development Corp., was bidding against Pitt to acquire that site. Leaving aside which account is accurate, this dispute demonstrates that compatibility requires trust. Note that Posvar served on the hospital board and that Romoff, technically a University employee serving as a UPMC manager, also held a senior Health Sciences management position.

Posvar, at the time, was in a weakened position, caused by revelations about his retirement compensation and some of his perks. Senior Vice Chancellor Thomas Detre, then also UPMC president, and Romoff, abetted by Farrell Rubenstein, who became chairperson of Pitt's Board of Trustees, appeared to gain complete control over anything involving the Health Sciences.

4. Enter former Chancellor J. Dennis O'Connor in August 1991. Not knowledgeable about the University's financial affairs, he relied on information and advice from Romoff and his staff. O'Connor then created a new position, senior vice chancellor for Health Administration, and installed Romoff, who also was serving as operational chief of UPMC.

5. Compatibility was involved in the decision to drop HealthAmerica, thereby curtailing health benefit options for Pitt faculty and staff, on the grounds that it did not accept medical school faculty and the UPMC hospitals as providers. Michael Blackwood, then HealthAmerica's CEO, offered to include the faculty and the hospitals as providers for Pitt enrollees, but to no avail.

In the compatibility context, several matters need further examination.

A. Does the University's minority representation on the UPMC's board and the "joint board," the body that serves as the board of UPMC Presbyterian and UPMC Shadyside, represent the University's interests well? Some knowledgeable health field people believe it is preferable to have straight-forward contractual relationships between parties to a joint endeavor, rather than interlocking boards that raise questions of fiduciary responsibility. Contractual relationships allow both, or all, parties to a particular agreement the opportunity to decide separately their positions on its terms. When individuals are on both sides of a transaction, such as had been the case with Romoff and Detre simultaneously holding positions in UPMC and in the University's Health Sciences area, fiduciary questions surface.

B. Does the University's board and administrative leadership recognize the impact of UPMC actions on the University, and that it appears that UPMC dominates the joint enterprise between it and the University? Concern expressed to the compatibility committee reflects the belief that the University's interests are not clearly recognized or effectively put forward. If this belief is unfounded, some signal to the faculty will do a great deal of good.

Nathan Hershey, a professor of health services administration in the Graduate School of Public Health, is vice president of the University Senate.

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