DAYBREAK - UCSF to Focus on Smooth Transition for Mount Zion Patients, Physicians

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1st appeared 27 September 1999

UCSF to Focus on Smooth Transition for Mount Zion Patients, Physicians

Faculty and staff will meet this week to begin implementing a recommendation by Haile Debas, dean of the UCSF School of Medicine, to transfer inpatient and emergency services from Mount Zion Medical Center to the UCSF Medical Center at Parnassus.

The plan, unanimously adopted last Thursday by the UCSF Stanford Health Care board of directors, calls for reorganizing patient care services across both sites with Mount Zion focusing on the UCSF Cancer Center, ambulatory surgery, a new urgent care center, and outpatient clinical services.

While opinions on the reorganization plan differ widely, at least one patient looked on the bright side. "If they are going to make this a real comprehensive cancer center, focusing on providing outstanding care to patients, and if Parnassus can handle the additional volume without jeopardizing the lives of patients, then I applaud the decision," said Karen Wener. Past president of the Mount Zion auxiliary, Wener was born at Mount Zion and treated for malignant melanoma at the Cancer Center.

The recommendation, issued in a report by Debas with input by faculty leaders, maintains Mount Zion as a health care facility that supports the University’s missions of patient care, education, research, and community service, and contributes to the financial recovery of UCSF Stanford.

After posting an operating gain after its first year as a merged organization, UCSF Stanford now faces an operating deficit of $86 million -- of which $60 million is attributed to Mount Zion -- based on a $1.5 billion budget.

Debas’ recommendation was made as part of an agreement with the UCSF Stanford board of directors to allow UCSF to determine the future of Mount Zion since it is an integral part of UCSF. Meanwhile, a UC team led by William Gurtner, systemwide vice president of clinical services, continues to review the organizational structure of the entire merger and is expected to deliver a recommendation to UC President Richard Atkinson by October 1.

Those UCSF faculty asked to comment on the restructuring at Mount Zion say the decision, however painful for the community it serves and those who work there, is an economic necessity.

"I think everybody involved tried to do everything possible to keep Mount Zion’s inpatient services open while trying to respond to the severe financial challenges facing the north campus," said Neal Cohen, vice chair of anesthesia and chair of the School of Medicine Faculty Council. "I’m certainly sad that this is the position we had to take, but having reviewed all the alternatives, we were forced to make difficult decisions."

What Cohen and other faculty who took part in the Mount Zion review stress is that UCSF would have had to address Mount Zion’s losses regardless of the merger. "The problem is we don’t have sufficient volume to keep Mount Zion open as an acute care hospital and we were hoping to get state assistance but that didn’t happen."

Cohen hopes faculty and staff, working with hospital and campus administrators, will see this as an opportunity to revitalize clinical programs and services.

"On a positive note, I would hope we could now develop a long-term plan for UCSF and to use this as an opportunity to build programs and clinical activities at Mount Zion," he said. "We really need to think about the long run -- not only about the financial future -- but to develop a long-term strategy that would optimize patient care across both sites."

For those working at Mount Zion, the decision came as no surprise but as a major disappointment, marking the end of an era in San Francisco. Founded in 1887 by Jewish families, Mount Zion has long operated in the Western Addition as an acute care hospital with a tradition of providing personalized care to the disadvantaged and more recently, training future health care providers in the process.

"My initial reaction is one of sadness," said Ernest Ring, associate dean and assistant chief medical officer at Mount Zion. "We’re losing a real important opportunity to provide a new level of service that combines the best of community medicine with academic medicine. But all of us have a certain amount of exhaustion and sense that it’s time to move toward building an outpatient service and center of excellence."

Ring says that although the outcome is not as Mount Zion faculty and staff had hoped, they are focusing on the future. "We can now put pieces together and move forward," he said. "There is also a great sense of concern for Mount Zion employees who will lose their jobs. I was hugged twice in the hall in the past half-hour. Mount Zion is a family."

Mount Zion held several meetings last Thursday for faculty and staff and will offer more as needed. Many of the employees at Mount Zion affected by the changes will be offered transfers to the UCSF Medical Center or other UCSF Stanford facilities.

Cathryn Hilliard, president of the Mount Zion Auxiliary, said last week that she would call a meeting of its 485 members to decide what their future role should be. She says it’s possible the auxiliary, which cancelled its fall fundraiser because of the low morale of its community supporters, may carry on its mission providing patient support for the cancer center.

"I’m extremely disappointed with the decision as it ends an era," she said. "With a 100-year tradition, Mount Zion has been a landmark, one of the best medical centers that has been taking care of underprivileged and indigent members of the community."

As far as the faculty is concerned, the reconfiguration of services does not mean abandoning the needy.

"We’re going to do whatever we can to continue to provide care as best we can," Cohen said. "That may mean that patients will have to travel a little farther and faculty will have to change the way they do things, but this decision in no way changes our commitment to providing health care to everyone who needs it."

Debas and the medical school faculty leaders also proposed forming joint committees of faculty and hospital leaders to help with the integration process and ensure that educational programs are not compromised. One task force, headed by Lee Goldman, acting vice chancellor for medical affairs, and David Bradford, chair of orthopedics, is looking at the long-term strategy. Cohen and Ring are both members of a task force charged with dealing with the short- to mid-term impact of the reorganization. That group, headed by Ted Schrock, chief medical officer at UCSF, and Brian Goodell of UCSF Stanford, plans to adhere to several principles to guide the transition. Those principles are to:

Make every effort to relocate inpatient services from Mount Zion to Parnassus in a logical and orderly manner;

Continue to staff inpatient services at Mount Zion to preserve safe, quality patient care;

Make every attempt to ensure that Mount Zion-based physicians are not disadvantaged in terms of timeliness of credentialling, bed availability and operating room time as inpatient services move to Parnassus;

Ensure that physicians and services are not disadvantaged by the timing of their moves to Parnassus;

Create facilities and organizational structure as soon as possible to allow Mount Zion-based physicians and surgeons to use their time efficiently while working at Parnassus;

Preserve the educational experiences of residents and students at both Mount Zion and Parnassus to the extent possible.

Currently, the UCSF School of Medicine uses Mount Zion as a training site for 89 residents and for 15 percent of all medical student rotations. With the centralization of inpatient services at the UCSF Medical Center, the school will need to find new opportunities for this training, faculty say.

As for how the reorganization may affect the overall fate of the merger, faculty say that remains to be seen. "The future of the merger really depends on the decision of the two parent universities and they have staff trying to find a structure that will allow both UCSF and Stanford to meet their missions," Cohen said.

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