"Nevertheless, the Hospital continues to move forward with the termination which will take effect in just nine months, potentially placing City of Hope clinical and research programs at risk." The letter was signed by Weiss and CCSMG's Executive Medical Director Isaac Benjamin Paz, MD.
"This was a horrific letter, sent to every patient who has ever walked through our door," says Alexandra Levine, MD, City of Hope's chief medical officer. "They were saying to the patients that their care would be delivered by non-physicians.
"Well our phones started ringing off the hook like crazy. We had patients in the middle of their cancer treatment crying, 'What am I going to do?'"
For Levine, the letter and the lawsuit represented the end of attempts to resolve matters with the medical group's leaders, and as a result the hospital terminated negotiations. "We can't negotiate with a group that sues us and tries to destroy us," she says. "We have to formally end our relationship."
Levine says she and other hospital officials will take a different tact, going around the medical group's leadership to speak to each of the doctors, one-by-one in an effort to convince them to join the foundation's medical group when it is formed.
Levine emphasizes that she believes Weiss and several other CCSMG leaders do not have the support of most of the physician members, many of whom told her they didn't know about the letter to the patients in advance of it being sent.
"If Larry Weiss cared about the patients and this institution, he never would have written that letter in a million years," Levine says. "His motivation is power; his motivation is money." The real issue, Levine says, is that 60% of the doctors' income now comes from the hospital for teaching, administrative, and research services.
Weiss said in a follow-up interview that he regards Levine’s comments as “insulting,” and said the CCSMG doctors do care more about the patients and the institution than the administrators do. He said he signed the letter on approval of the 10 other senior members of CCSMG’s board.
“You may argue with the letter, say it’s too much or you may say it’s too little. But we needed to respond to Dr. Levine and the medical center firing the physicians for all their clinical and basic research, and firing all the hospital-based physicians, which are 40."
Weiss was asked if the medical group’s doctors will remain under contract until Jan. 31, 2011, and he replied that they will.
However, he asked rhetorically, “Are we not going to tell patients what’s going on at the City of Hope, or will they read it in the newspaper reading about the lawsuit? We felt the prudent thing to do was inform the patients.”
CCSMG COO Vince Jensen also corrects Levine saying that only 30% of the doctors' income now comes from City of Hope, not 60%.
Dauner of the state hospital association says that part of the issue is that in the earliest proposals, City of Hope used language that would have the foundation's governing body appointed by the parent corporation of the hospital, and did not specify enough doctors. "The other real sticking point that grated the doctors was that the parent board could replace any board member, and the doctors objected in the most visceral of ways."
But another underlying issue is that the physicians several years ago created a radiation therapy facility in South Pasadena, taking patients who otherwise would have received care at City of Hope.
Weiss says that that under the proposed foundation arrangement, care for those patients would be billed by the hospital, "at 40% higher cost for Medi-Cal patients, and 90% more for private insurance patients under Blue Cross."
Levine has a different view. She says the physician group leased that facility and started steering patients to the South Pasadena center without telling the hospital. "We didn't know about it until it was a fait accompli," she says.
Weiss disputes that as well, saying that City of Hope administrators knew about the South Pasadena facility a year before it opened.
Dauner summed up the dilemma: "This is a highly reputable group of doctors and a great institution with a reputation and a history and a long-standing ethic that certainly needs to be preserved for quality of care. And the best way for that to happen is for them to hammer out the things that are unresolved and put together a foundation that works."
Can that happen now that the relationship between the doctors and hospitals has been so shattered? "Sometimes," Dauner says, "you have to hit the bottom before you can come back. And though rarely do you come back, I'm hopeful that this one will."