Save UTMC

Note: this editorial was published in the April 19, 2020 edition of the Toledo Blade.

When the merger of the former Medical College of Ohio with the University of Toledo was proposed it was sold to the Greater Toledo Community as a win-win proposition.

We were told the Medical College would lift up the University of Toledo and benefit the university financially. In turn, the Medical College would gain the support of an entire university and enjoy various organizational synergies.

Hindsight is 20/​20. But it is quite clear, in retrospect, that the merger was a mistake. The medical school has been degraded, and its custom-built campus has been significantly depopulated.

Similarly, when the university struck a partnership with ProMedica back in 2015, we were told that the medical college and its hospital would be augmented by Toledo Hospital and subsidized by ProMedica.

Hindsight makes clear that this too was a mistake. The subsidy never came, and the university hospital was not augmented but superseded and marginalized.

Why did these two steps, announced with such optimism and fanfare, go so wrong?

There is no one explanation. Market forces played a role and some would argue bad faith did. But without question the merger (with the University) and the partnership (with ProMedica) went wrong because of a lack of interest, expertise, and management skill on the part of the UT administration and Board of Trustees.

In short, no one in charge or doing oversight looked out for the medical college and its hospital, at least after Lloyd Jacobs, who ran the medical college and then the university, left the scene.

No one in authority made it his or her business to take care of the medical college campus, its faculty, or medical research.

And no one cared that the university hospital was being abandoned and dismantled.

Now the hospital is for sale, and the president of the university and the board of trustees have made a final decision to sell it without a public process of deliberation or even disclosure, forgetting what the medical college means to the community and how its hospital serves the community, particularly South Toledo.

The whole story is one of indifference and unforgivable incompetence.

What has also been forgotten is that the medical school and its hospital actually belong to the state of Ohio.

So Gov. Mike DeWine has something to say here.

The governor should move to re-establish an independent board for the medical college, even if it stays subservient to the UT board. This board would include people with knowledge of medical education and health care and with a commitment to UTMC. Depending on the breadth and depth of its authority, action by the General Assembly might be required to create the board. It would be worth the effort.

The state must obviously take great interest in who buys the UTMC hospital and under what conditions. But the greatest need now is to establish decent governance and an umbrella of independence and protection for Toledo’s crown jewel.

by Mike D’eramo, Chief Administrative Office of the Toledo Clinic

Note: this essay was published in the April 18, 2020 edition of the Toledo Blade.

Toledo is fortunate to have a large academic medical center; the University of Toledo College of Medicine and Life Sciences (COMLS). However, the Toledo area requires a physician practice model that better supports the growth of medical talent in Greater Toledo; including skilled practitioners of clinical medicine, clinical educators, and clinical researchers. And in light of recent events, with the pending change in disposition of the University’s Medical Center (UTMC), the sense of urgency to preserve highly-trained physician and research staff has become imperative.

To address this need, I recommend that the University allow for the creation and deployment of an expanded community faculty model. Having helped to develop multiple different health care models around the country, I believe that an expanded community faculty model is ideal for this region.

According to this construct, physicians belong to one or more independent physician groups. In a city with an academic medical center, members from each of these groups are then provided the opportunity to practice medicine, teach, write, and/or perform research, according to their interests, abilities, and community needs. In return, the academic medical center leadership is expected to coordinate with all available physician groups to recruit and provide faculty appointments for those members who are aligned with and support the academic initiatives and priorities; without facilitating a segregated, competing dynamic. Further, according to this model, members of each the independent physician groups will be welcome to practice in all University of Toledo COMLS teaching hospitals, including UTMC, St. Luke’s, Wood County, and ProMedica hospitals.

The Toledo Clinic is a strong, successful independent physician group that aggressively supports the preservation of physician talent in Greater Toledo. Many Toledo Clinic members are talented, enthusiastic teachers and clinical investigators and eager to support the UT COMLS academic mission, including training and retention of physicians in Toledo. Further, the Toledo Clinic independent physicians’ group is strongly committed to the success of UTMC as an essential part of its community support and its goal to create an effective market alternative for patients and employers.

There are a number of modern reasons to keep the UTMC vibrant, including the pressing need for health care access imposed by the current COVID-19 pandemic. Over the last 30 years the prevailing health care business model has been to reduce costs by caring for patients with chronic, long-term health problems such as congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD) in a non-hospital setting. Fast forward to 2020. We have shrunk the number of available hospital beds, ICU beds, ventilators, and other resources that would make the surge of COVID-19 patients easier to manage. In this context, I can safely say, this would be no time to close a hospital.

Secondly, UTMC offers the opportunity for unbiased, academic, and research-based medicine to thrive and progressively improve. Active participation of The Toledo Clinic in the expanded community faculty model will allow COMLS to partner and conjoin with multiple facilities and numerous physicians, and thereby open the door to expanded opportunities for students and residents to stay in NW Ohio.

A medical school represents the pinnacle of higher learning as it shepherds the careers of numerous MD’s and Ph.D.’s. into the market-place. Patients, consumers, spiritual leaders and tax-collectors all gain from the presence of science and medicine in their midst.

A community with a medical school is exceptional, unique, and blessed to have an asset of this caliber in their backyard. The presence of an academic medical center is a major incentive to businesses considering relocation. Which begs the question, should we be doing more to protect and grow the University of Toledo College of Medicine and Life Sciences, and the physicians and scientists who are aligned with this institution?

MIKE D’ERAMO
Chief Administrative Officer, The Toledo Clinic

by Dr. James C. Willey

Note: this essay appeared in the April 8, 2020 edition of the Toledo Blade.

A recent article by Brooks Sutherland in The Blade provided a perfect example of the benefits a region receives when it supports NIH-funded health care research through strategic planning, funding, and public recognition.

The article reported that the University of Toledo Medical Center, the former Medical College of Ohio Hospital, Pathology molecular diagnostics lab worked quickly and expertly to provide rapid coronavirus testing to the citizens of northwest Ohio. This was indeed uplifting news for our region, stressed by the worst pandemic in 100 years.

The key scientists at UTMC Pathology who drove development of the COVID-19 test, Jiyoun Yeo, PhD, and Heather Kvale, M.D., acquired their molecular genetic skills in NIH-funded laboratories on the Health Sciences Campus in South Toledo. Further, Dr. Thomas Blomquist, the pathologist who helped develop the molecular diagnostics lab and hired the key personnel, received his M.D./​PhD in an NIH-funded lab on the health sciences campus.

At UTMC, for more than 50 years, the citizens of South Toledo have benefited from access to the high-quality care that only a teaching hospital provides. Moreover, funding from the National Institutes of Health to the University of Toledo College of Medicine and Life Sciences, and UTMC on the Health Sciences campus has been a major source of support for high-tech jobs in our region.

Further, vibrant clinical and research activities in South Toledo is an important source of commercial activity that supports regional property values.

Unfortunately, in the 15 years since the merger between UT and the Medical College of Ohio, NIH-funding has declined nearly by half and UTMC is facing financial insolvency.

In the face of this decline, one can only conclude that key political, financial, and health-care leaders in Toledo have failed to recognize the important role NIH funding plays in the generation of high-tech jobs as well as the overall health and welfare of a region.

The affiliation agreement signed between COMLS and ProMedica five years ago promised to change things for the better. It was stated explicitly in the agreement that a goal was to increase the ranking of COMLS among U.S. medical schools. After nearly five years it is fair to ask: Where is the plan agreed to by both ProMedica and the COMLS that provides a clear pathway to achieving either of these goals?

Dr. Cooper, dean of COMLS and one of the signers of the affiliation agreement, was and clearly is, genuine in his belief that the affiliation will lead to a significantly increased NIH funding, and that this will be a key element in improved ranking.

To his credit, Dr. Cooper has directed as much money as possible to hire talented faculty capable of submitting grant applications worthy of NIH funding. In contrast, while ProMedica has many strengths, including a well-regarded and well-executed business plan, high-quality medical care delivery, and commitment to the education of health-care learners, it has no track record for supporting NIH-funded research. In this context, five years after signing the agreement, ProMedica and the COLMS have been unable to agree to a master research agreement that will facilitate NIH-funded research in ProMedica clinical facilities, including ProMedica Toledo and Flower hospitals.

Thus, a sufficient amount of time has passed, and there is abundant direct experience to conclude that UT and South Toledo must seek additional support, independent of the COMLS-ProMedica Affiliation, to sustain and grow UTMC as a regional research hospital, and COMLS as a strong NIH-funded academic medical center.

Recently, strong potential source of support for NIH-funded research in the COMLS and UTMC on the health sciences campus is developing. This opportunity comes in the form of the Toledo Clinic, an independent physician group. There is a cadre of physicians at Toledo Clinic with well-established commitment to the role of research in advancement of health care in Toledo. As one example, when Dr. John Nemunaitis brought his expertise as an investigational oncologist to the Dana Cancer Center on the health sciences campus, nearly all of the patients who entered his Phase 1 and 2 clinical trials of cutting-edge cancer medicines were referred by Toledo Clinic physicians, including Drs. Rex Mowat and Richard Phinney. Importantly, this TTC commitment is now recognized by UT leadership. Specifically, UT is now working closely with Toledo Clinic to develop closer relationships in the areas of research, education, and clinical activity at the Dana Cancer Center and UTMC.

An affiliation between UT and Toledo Clinic could introduce our region to an academic physician practice successfully implemented at Brown University in Providence, Rhode Island. Brown Physicians Inc. is a community-based, not-for-profit, multispecialty practice group. Members in BPI populate the teaching and research faculty at The Warren Alpert Medical School of Brown University. BPI members have a choice in the amount of effort they commit to teaching, research, and clinical practice. In addition, BPI members provide clinical service at a wide variety of hospitals in the Providence region. This level of physician autonomy leads to a vibrant, healthy, and innovative health-care environment.

An affiliation between the UT and Toledo Clinic will be synergistic with the COMLS-ProMedica affiliation. This step will optimize education of COMLS learners at all hospitals in Toledo, support NIH-funded research, and ensure a high level of clinical activity at UTMC and the Dana Cancer Center on the UT health sciences campus. Furthermore, it will enhance the ability of UT COMLS and ProMedica to recruit top faculty to our region who can compete for NIH grants, conduct clinical trials, and increase the ranking of our UT academic medical center. All of these activities will bring new job opportunities and advance health care in our region.

Dr. Willey, M.D., professor of medicine, George Isaac Endowed Chair for Cancer Research, UTMC, is a member of Save the UTMC Citizens Group, with former Toledo Mayor Carty Finkbeiner, state Sen. Theresa Fedor, and Randy Desposito, president of AFSCME Local 2415. Dr. Willey’s views do not necessarily reflect those of the University of Toledo.