Letters

Note: this editorial was published in the October 12, 2020 edition of the Toledo Blade.

Dr. Gregory Postel’s essay in The Blade on Sept. 27 constitutes a fresh and encouraging view of the academic affiliation agreement between the University of Toledo and ProMedica and its relationship to the future of the University of Toledo Medical Center, the former Medical College of Ohio Hospital.

Most importantly, he notes that this relationship does not necessarily need to be a zero-sum game in which UTMC must be degraded to facilitate UT’s cooperative ven-tures with ProMedica. Dr. Postel rightly points out the benefits of the UT-ProMedica relationship include an expanded range of patients and clinical experiences for UT’s medical students. ProMedica also benefits through access to medical resident physicians and the expertise of UT’s medical specialty faculty members. The relationship between UT and ProMedica should continue.

Dr. Postel’s expressed commitment to UT’s home medical institution, UTMC, is much appreciated. He recognizes the value of UTMC to medical and health-care education at UT as well as clinical care and research. He appropriately highlights some of the current strengths of UTMC including its programs in oncology, orthopedics, family medicine, urology, cardiology, and behavioral health.

In addition, Dr. Postel notes the developing relationship between UTMC and Toledo Clinic, which has already borne fruit in the form of an expanded Dana Cancer Center on the UT Health Science Campus.

In my last essay regarding UTMC and ProMedica I asked “Quo Vadis?”, a Latin Phrase meaning “Where are we marching?” or perhaps more generally, “What is the plan?”

Dr. Postel’s commitment to UTMC as a medical home of our own is clear, but what is needed is a comprehensive overarching plan for UTMC’s reinvigoration as a UT-affiliated academic medical center. Such a plan does not require abandoning or downgrading the academic affiliation with ProMedica but does require refocusing on the central role that UTMC plays in the UT College of Medicine and Life Sciences educational and research missions as well as the medical care of the residents of northwest Ohio.

I do not profess to know all that such a plan should include. In addition, I am aware that some planning is already taking place under the leadership of Dr. Postel and Mr. Richard Swaine, the CEO of UTMC. However, I would like to take the liberty of making a few suggestions:

● Developing a planning committee or committees that would include relevant stakeholders including administrators, faculty members, hospital staff, and residents of South Toledo who depend on UTMC for their medical care. Including persons with different perspectives will lead to more creativity and better solutions. The committee(s) should follow a problem-solving approach that includes identifying key issues, setting priorities, generating solutions, and evaluating them for feasibility.

● Staying any future moves of UTMC clinical, educational, or research programs to ProMedica hospitals until a comprehensive plan for UTMC is complete. We need to stop the bleeding before developing a longer-term treatment plan.

● Restoring key programs that have been removed from UTMC. The restoration of programs should be based on educational, clinical and research priorities identified by the planning committee(s) noted above.

● Developing new and innovative educational, clinical, and research programs that would serve as “centers of excellence” at UTMC with these programs being fully supported by the UT-COMLS and other UT health care-related colleges.

This will be the most important part of any plan for the reinvigoration of UTMC. Specialty programs in oncology, orthopedics, cardiology, urology, family medicine, and behavioral health are already in development and can serve as springboards for other programs to follow.

Interdisciplinary programs have particular potential for development as we recognize the complexity of diseases such as COVID-19 and its effect on all the major organ systems in the body, including the brain and cognition.

The question that all planners should keep in mind is “What can UTMC be?”

● Making a plan for capital improvements that have been deferred in recent years and that will be absolutely necessary for the development of the programs that will re-invigorate UTMC.

A vigorous search for funding sources including clinical income and grants as was suggested by Rep. Marcy Kaptur in her Blade essay earlier this year.

● Developing an aggressive marketing program for the oncology, cardiology, urology, family medicine, and behavioral health programs as well as other programs to be restored to and newly developed at UTMC.

Certainly, there are other features that should be part of a plan for a “new” UTMC. For example, the “Save UTMC Coalition” recently published a 12-point plan that may be useful to review.

However, the above steps can represent a beginning.

In conclusion, Dr. Postel’s recent essay is a cause for optimism given that he appears to value UTMC as an integral part of UT’s overall mission and not just an asset to be sold to the highest bidder.

In addition, there have been positive developments during his brief tenure as UT’s leader including the retention, support and development of the UTMC Dana Cancer Center and Orthopedics Center. He should now begin the planning process for the redevelopment of UTMC that will once again bring pride to the UTMC faculty and staff as well as the citizens of northwest Ohio.

Like many, I will look forward to seeing these plans develop and come to fruition. I also know that many of us stand ready to help if called upon.

Kudos to Dr. Postel and all who have contributed to the beginning of UTMC’s Phoenix-like rebirth.

A. John McSweeny is a professor in the Department of Psychiatry at the University of Toledo. He also holds a law degree.

Note: this editorial was published in the September 27, 2020 edition of the Toledo Blade.

I’m a self-described lifelong learner. Since I arrived in Toledo two months ago, I have learned a great deal about this community, its leaders, and the people who make it an amazing place to live, work, learn, and enjoy. Above all, I have learned that there is a great deal of heart in this community.

With nearly 150 years of service to our community, The University of Toledo — Toledo’s only public research university — is home to the College of Medicine and Life Sciences and the University of Toledo Medical Center, which was the former Medical College of Ohio Hospital. While often misrepresented and inaccurately interchanged, the two entities fulfill distinctively different missions in northwest Ohio.

UToledo’s College of Medicine and Life Sciences is one of 13 academic colleges committed to providing students a world-class education, and one of three academic colleges housed on the UToledo Health Science Campus. The college is home to some 700 learners, similar in size to the University of Michigan’s Medical School, and offers LCME-accredited medical and graduate degrees, as well as premed, residency, and fellowship programs. As part of the university’s academic enterprise, the College of Medicine receives public funding through Ohio’s state share of instruction and tuition.

UTMC, the University’s community-focused teaching hospital with 247 beds, operates as a separate entity with a mission to provide patient-centered, university-quality health care. It’s funded by reimbursable patient services, not state funding. Also located on the University’s Health Science Campus, UTMC provides clinical learning experiences for some 200 health-care learners from the university’s Colleges of Health and Human Services, Medicine, Nursing and Pharmacy.

In the past, UTMC had been the university’s primary clinical training site, but because of its small size there has always been the need to partner with other health-care entities to provide enough learning opportunities for our students.

In 2015 UToledo, sought out a partnership with ProMedica, a locally managed hospital system, to provide learners access to the necessary patient volume needed to support the rapidly growing College of Medicine. The Academic Affiliation Agreement has increased and strengthened the clinical training experiences for our medical learners and is successfully building a pipeline of physicians for our region. Despite pundits’ criticism, the agreement was, and continues to be, a vital partnership for the continued success of our College of Medicine and health care in our region.

Meanwhile, UToledo leadership, including the Board of Trustees, have worked tirelessly the last several years to stabilize UTMC. As the only remaining independent hospital in our community, UTMC faces significant challenges as market shifts in health care favor large, corporate health systems. Our hospital has a unique and vital role in Toledo. While we are known leaders in specialties like orthopaedics, cancer treatment, and behavioral health, we also provide critical care for our community through our emergency department and primary care physicians.

Our stabilization efforts continue as we look ahead to expand Medicaid financing opportunities, our 340B pharmacy program and adding behavioral health offerings that are critically needed in our community. We also continue to look at ways to enhance our partnerships with the Toledo Clinic and Veterans Affairs.

An important part of those efforts is you trusting us with your care. If you need a specialist in cardiology, orthopaedics, or urology, we’re here for you. If you or your family need medical care, our outstanding primary care physicians at the Comprehensive Care Clinic are ready to care for you. And while I hope you don’t need it, we’re here for you in the event of an emergency. I also encourage you to refer your friends and family to receive outstanding service from our team at UTMC.

I continue to be amazed by the passion and support for the University and our hospital. Toledo is lucky to have a public research university with a community hospital. The goals of the UToledo College of Medicine and UTMC are not mutually exclusive. With the help of local, state, and federal officials, both the college and hospital can succeed. It has never been a question of either/​or. We can have both a successful academic affiliation that strengthens our College of Medicine and a strong UTMC community hospital. You can help us make both a reality, and in doing so, improve health-care access throughout our region.

Gregory Postel, M.D., is the interim president of the University of Toledo.

Note: this column by Carty Finkbeiner and Matt Cherry was published in the September 6, 2020 edition of the Toledo Blade.

The University of Toledo Medical Center is a team that has proven, once again, the worth of the hospital and the medical campus it sits upon as a research, teaching and healing institution. Not only has our research team of scientists developed a coronavirus test that yields much faster results than other tests in use today, but our hospital and the Dana Cancer Center just signed an agreement with the Toledo Clinic that will expand oncology services to patients in our region. The Save UTMC Coalition and the citizens of South Toledo and northwest Ohio all know the value of a strong and talented UTMC Health Science Campus.

This is the appropriate time, we believe, to put on paper our vision and plan to support and enhance the medical campus and its hospital:

We remain opposed to any plan to sell, transfer, or co-manage UTMC until all details of such a deal are made public and time is provided for appropriate review and community input.

On July 1, Ohio Attorney General Dave Yost halted transfers of physicians and programs from UTMC to ProMedica Toledo Hospital for 90 days. Based upon anti-competitive constrictions written into the 2015 Affiliation Agreement between UT and ProMedica, the ban on transfers should remain in place until all UTMC stakeholders’ concerns are addressed.

As for the affiliation agreement, we support the initiative of state Sen. Teresa Fedor with Mr. Yost and ask UT leadership to invoke arbitration if ongoing, anticompetitive decisions are not ended and past harmful actions are not corrected.

Finally, we request that negotiations between current UTMC management and Toledo Clinic officials be encouraged and supported by UT administration and trustees, and that doctors of both institutions be welcomed to practice at both campuses as respective services are needed. Initial discussions between UTMC and Toledo Clinic centered upon the Dana Cancer Center, but additional opportunities to address physician shortages at UTMC, sue to forced transfer of doctors to ProMedica Toledo Hospital, must also be on the table;

Moreover, we must re-establish Level 2 trauma support status at UTMC as soon as possible, in conjunction with physician support from the Toledo Clinic Association.

As we continue to look at all thoughtful and forward thinking ideas and solutions in creating an even stronger Health Science Campus, we believe we can become a model for the rest of the country, moving forward into the twenty-first century. The Save UTMC Coalition is looking ahead, knowing full well that community partnerships, teamwork, and increased revenue are necessary in moving the medical campus forward.

We are confident that our best hopes and aspirations can be realized if we all work together.

Mr. Finkbeiner is a former mayor of Toledo. Mr. Cherry is president of Toledo City Council. This essay was endorsed by 12 other community leaders as well as U. S. Representative Marcy Kaptur.

Note: this editorial was published in the August 5, 2020 edition of the Toledo Blade.

The fate of the University of Toledo Medical Center, the former Medical College of Ohio Hospital, has been the talk of the town. Despite the cacophony of myriad voices, no one except U.S. Rep. Marcy Kaptur (D., Toledo) has proposed a clear path for its survival. The big elephant in the room however, has not responded to the public concern.

There is much confusion in public discourse about the overall objectives: Should UTMC morph into a small community hospital or should it be resurrected as a teaching hospital that it is meant to be?

The two objectives are not the same. Teaching hospitals stand apart from community hospitals.

It has been a long-standing desire of the Toledo Hospital to become an academic medical center. During the tenure of Roger Bone as president of the Medical College of Ohio (1993-96), an agreement was forged where the Toledo Hospital and Medical College of Ohio Hospital would merge to create a “world-class medical center.” Within a short time it unraveled.

The latest effort by ProMedica to transform its flagship ProMedica Toledo Hospital into an academic medical center began in 2015 when ProMedica brought an attractive offer to designate Toledo Hospital as the main teaching hospital of University of Toledo College of Medicine and Life Sciences. It stipulated that the College of Medicine would relocate academic departments from UTMC to the campus of Toledo Hospital. ProMedica committed to pay $50 million a year to the UT for 50 years and committed to construct buildings on its Toledo Hospital campus to accommodate academic departments.

UTMC was left out from the negotiations.

So according to plan, most of the residents in training were transferred from UTMC to Toledo Hospital. Now the federal government pays a hefty sum to academic institutions to train future doctors. With the transfer of residents, that money found its way to ProMedica. In addition, by transferring most of the academic physicians to Toledo Hospital, their patients followed them to Toledo Hospital.

The irony is that most physicians at Toledo Hospital did not welcome academic staff from UTMC. Where there was dire need for certain specialties such as neurology at Toledo Hospital, those specialists were gladly accommodated.

However, the medical staff of Toledo Hospital put all sorts of roadblocks in the way of other specialists. I have learned that highly competent and internationally recognized cardiologists from UTMC could not get privileges to work at the Toledo Hospital.

There are physicians at Toledo Hospital who have worked there for decades and are deeply entrenched in the medical-staff hierarchy. Most of them are fine clinicians but are not academic physicians. However, they have the power to delay granting privileges to UTMC physicians. If these physicians were doing research, publishing in prestigious journals, and had recognition beyond the greater Toledo area, one could accept them on par with their academic counterparts.

It takes years of hard work to develop the kind of reputation that leading academic centers have. Toledo Hospital can’t compete with the likes of Cleveland Clinic, University of Michigan, or Henry Ford Hospital. It is only by morphing into a true academic center that the Toledo Hospital will be able to attract patients with complicated ailments that now seek care outside Toledo.

Back in 2010, it was estimated that Lucas County loses about a billion dollars a year to academic medical centers located elsewhere.

The Toledo Hospital, for all practical purposes, is a community hospital and an excellent one at that. It has not been an academic center in the past five years. It will happen only when ProMedica recruits nationally recognized specialists in the fields that are not available locally. One could start with advanced neurosurgery, heart-assist devices, and heart transplantation.

So, what to do with UTMC?

In a full-page open letter to the governor of Ohio published in The Blade on June 14, Congressman Kaptur outlined a way forward. Dr. Gregory Postel, interim president of the University of Toledo, should seize the opportunities outlined by the congressman.

It has also been said by supporters of UTMC, including The Blade, that the 2015 affiliation agreement between ProMedica and the University of Toledo is grossly flawed.

The university should seek help from the Ohio Attorney General to renegotiate the agreement. UT should insist that UTMC would be part of the teaching and training along with Toledo Hospital. Some of the academic departments and residents in training should be brought back to UTMC. The physicians at Toledo Hospital who are not interested in teaching should move aside and allow physicians who could bring new services and research to Toledo Hospital.

The Health Science campus of UT, with its architecturally acclaimed buildings, should not be allowed to deteriorate into another Scott Park campus of the University of Toledo.

S. Amjad Hussain is an emeritus professor of surgery and humanities at the University of Toledo. His column runs every other week in The Blade. Contact him at aghaji@bex.net.

Note: this editorial was published in the July 17, 2020 edition of the Toledo Blade.

The collective sigh of relief you just heard in Toledo came after the University of Toledo announced it is no longer entertaining proposals to sell, lease, or outsource the management of the University of Toledo Medical Center.

The decision followed four months of shock, anger, and citizen action, which began when university officials announced that the former Medical College of Ohio hospital was running a $25 million deficit, which forced UT to consider drastic options.

What the university didn’t say was that it had caused the deficit.

The university’s board and acting president deserve credit for changing their minds and doing the right thing.

Thanks to the efforts of the Save UTMC Coalition and a few local politicians, federal state and local (Rep. Marcy Kaptur and former Mayor Carty Finkbeiner, in particular, deserve props), the university now says it will instead focus its efforts on stabilizing UTMC’s finances and preserving a hospital in South Toledo.

Cheers all around, but this is just the first step in saving UTMC. Whether the hospital can survive long term depends on what happens next.

First, the audit that hospital-sale critics have been demanding must go forward, regardless of Thursday’s announcement. The five-year-old affiliation agreement with ProMedica and its impact on UTMC’s operations requires thorough scrutiny to understand how the hospital’s finances got to be as bad as they are now.

Without such an audit, how will UT officials have the information they need to find a way to make it profitable in the future?

Second, the hospital’s staffing, which has been depleted in recent years, must be replenished. The specialty services that have been moved to ProMedica Toledo Hospital must be restored, and UT officials should consider upgrading the trauma center to a level one facility.

How does the hospital find a way forward without adequate staff and other resources?

Finally, UTMC must have its own board, separate from the University of Toledo board of trustees. It would be advisory, not governing, like the Wexner Medical Center affiliated with the Ohio State University. UTMC needs a board that understands medicine and science and the economies of modern hospitals. Some entity must exist that protects UTMC and actually advocates for the institution.

It does not exist now.

So, a battle is won. But the effort to save and enhance the medical college and its teaching hospital has just begun.

Note: A PDF of this letter can be seen and downloaded here.

Dear Auditor Faber:

We can recall no legitimate instance in which a law enforcement agency such as yours allowed an entity under review to set the parameters of that review. That arrangement, however, appears to be how your office repeatedly handled allegations of felonies, financial irregularities and conflicts of interest involving the academic affiliation agreement between ProMedica and the University of Toledo for the UT College of Medicine and Life Sciences.

Your office recently conducted a cursory audit that you concede left many “unanswered questions,’’ and you publicly stated that UT officials declined your recommendation for a full performance audit that could help explain why the agreement, marketed as a means of improving the finances at the University of Toledo College of Medicine, is having the opposite effect. As you stated in a June 22 letter accompanying your findings: “A performance audit may have elicited additional information and provided the Auditor of State with the ability to make meaningful observations and recommendations regarding the financial status and operations of the medical center and affiliation agreement.”

The Auditor of State does not need UT’s permission to examine how it has been spending the public’s money. As your website clearly states, “Any public or quasi-public entity in Ohio that receives funds from or through the state may request a performance audit. The Auditor of State’s office may also elect to exercise statutory authority and conduct a performance audit of an organization.’’

Even your cursory audit generated new financial questions and concerns among doctors. In a June 29 letter to the Dean of the College of Medicine, UTMC Professor Dr. James Willey cited your audit findings that suggest UTMC made a profit in 2016-2018 but interdepartmental transfers caused the medical college to operate in the red. The bulk of Dr. Willey’s letter centers on an estimated $30 million that Medicare paid annually to help fund Graduate Medical Education. The letter asks if the payments were “used by UToledo to support resident training or were they used for some other purpose?’’ If used for another purpose, it would undermine the medical school’s ability “to meet their educational obligations to resident training,’’ according to Dr. Willey’s letter, which is attached.

We are officially requesting your office conduct a forensic audit and performance audit of the agreement. These audits must determine the status of UTMC’s finances before the affiliation agreement, the impact the agreement has had on UTMC and answer the specific questions raised in Dr. Willy’s June 29 letter.

Your failure to produce an audit that answers these questions marks the second time that you have been dismissive of serious allegations about the affiliation agreement’s purpose or effect.

In March 2019 – 16 months ago – your office received an official complaint from a whistleblower and UTMC physician. The complaint centers on the 50-year affiliation agreement signed in 2015. It alleges possible felonies, conflicts of interest and breaches of fiduciary duty involving two UT Trustees who championed the agreement, Stephen Cavanaugh and Mary Ellen Pisanelli. While serving as Trustees for a state college supported by taxpayers, both Trustees had a fiduciary duty to UT but also had strong financial ties to ProMedica and helped advance the agreement in ways that hurt UTMC. Gov. John Kasich appointed both Trustees.

As the whistleblowing physician pointed out, soon after Cavanaugh’s appointment as a Trustee, Cavanaugh donated $500,000 to UT. About two years after his appointment, Cavanaugh became chairman of the UT Board of Trustees and continued to help steer the affiliation agreement in favor of ProMedica. In 2018, ProMedica paid approximately $4 billion to rescue Cavanaugh’s employer, HRC ManorCare from bankruptcy. In 2019, ProMedica made Cavanaugh its CFO and soon after he resigned from the Board of Trustees and cited “conflicts of interest.”

Pisanelli succeeded him as chair of the trustees. Gov. Kasich appointed her to the Board of Trustees in 2015 while she was a partner at a law firm that counted ProMedica among its more important clients. In March 2017, while still serving as a trustee, Pisanelli left the law firm to become senior vice president at Welltower, a real estate investment trust, that had partnered with ProMedica under a complex deal to wipe out HRC ManorCare’s debts. Soon after, Welltower gave $30 million to the University of Toledo. The following year, Pisanelli became chair of the UT Board of Trustees.

In his March 26, 2019, complaint to your office, the whistleblower asks these questions:

• Did the $500,000 “charitable” gift (from Cavanaugh) lead to $7.1 billion in debt relief? Did Cavanaugh steer the UT-ProMedica contract in favor of ProMedica/HRC ManorCare in exchange for $7.1 billion in corporate debt relief for Cavanaugh’s HRC ManorCare?
• Was that $30 million payment from Welltower to UT “a bribe or equivalent illegal payment’’ as defined by Ohio law?

Your office referred these questions to the Ohio Inspector General – who dismissed the case and said, “The Ohio Ethics Commission stated that prior to entering into business agreements with ProMedica both Trustee Cavanaugh and Trustee Pisanelli sought advisory opinions with the Commission.” Neither you nor the IG pointed out that the advisory opinions were requested in May 2018 – several years after the alleged conflicts of interest began. Moreover, the advisory opinion clearly states that the “business relationships between the Trustees and ProMedica was (sic) permissible, provided the Trustees recused themselves from voting on any matter which directly affected ProMedica.’’

Cavanaugh voted at least two times to advance the deal with ProMedica.

Since you declined to properly investigate these matters, we have come into possession of public records that raise new questions about Mr. Cavanaugh’s appointment as a UT Trustee. Gov. Kasich appointed Cavanaugh on April 15, 2014. The person who recommended Cavanaugh was none other than his boss, HRC ManorCare CEO Paul Ormond. In an email to long-time Kasich adviser Jai Chabria, Ormond wrote, “Governor Kasich called me twice this week, and one of the subjects he brought up was the need to find top candidates for the University of Toledo Board of Trustees…. ‘’ Ormond alluded to Gov. Kasich’s knowledge of UTMC’s financial issues in the same email: “Sorry to be so long in this message, but the Governor encouraged me to share this with you because of the very real challenges UT is dealing with and the need to have strong and capable Trustees to help lead the university through its tough road ahead.’’

Soon after, Gov. Kasich appointed HRC ManorCare COO Cavanaugh to the UT Board of Trustees. The records do not show whether Gov. Kasich and his former Wall Street ally, Jai Chabria, positioned or encouraged the Trustees to favor ProMedica over UTMC.

Still, Cavanaugh’s April 8, 2014, application for the appointment raises red flags. He checked the NO box when asked, “Do you have, or have you had, any personal, financial or business interest or dealings that might pose a conflict of interest with your proposed state appointment?’’

As early as 2012, however, HRC ManorCare and ProMedica had agreed to partner on a nursing home and rehab center, meaning that Cavanaugh was compromised the day he became a Trustee.

Although Gov. Kasich also appointed Pisanelli as a Trustee, the archivist handling his gubernatorial records could find no application from Pisanelli for her appointment.

Please let us know at your earliest convenience when you plan to begin these audits and who you have tasked to conduct them.

Sincerely,

Senator Teresa Fedor Representative Paula Hicks-Hudson
Ohio Senate District 11 Ohio House District 44
Representative Lisa Sobecki Representative Mike Sheehy
Ohio House District 45 Ohio House District 46

CC:
Randy Gardner, Chancellor of Higher Education
Save UTMC Coalition