Page 2 of 2
"Physician support [will total] $20.5 million in fiscal year 1998-99, ranging from $148,000 at UCSF to $290,000 at Stanford per primary care clinical employee," the audit states.
The Hunter Group is recommending that the average support -- including salaries and other research expenses -- for physicians at UCSF be reduced to $140,000 in fiscal year 1998-99, $125,000 in fiscal year 1999-2000, and $100,000 in 2000-2001. During the same period, the consultants recommend reducing the average support for Stanford doctors to $200,000, $150,000, and then $125,000.
Adding insult to injury, doctors and department chiefs all describe having been left out of the loop with regard to structure and cost-cutting, particularly on the question of closing all or part of Mount Zion.
"I'm saying to you that the savings [from closing Mount Zion] will not happen because faculty will leave," Dr. Laurel Hodgson, medical director of emergency services at Mount Zion, warned at the legislative hearing. "You are destining UCSF to no growth and if you have no growth, you die."
Dr. Laura Esserman, one of UCSF's top cancer specialists, echoed those feelings. Esserman is a key player in the new federally designated cancer center connected to Mount Zion.
"The idea is to have all the services [together] there," she told legislators. "If I had to run lab activities, administer the grants, see patients, and run up and down to Parnassus [UCSF's other hospital] ... I don't think I could tolerate that kind of atmosphere."
Of course, cuts to the academic side of things are also likely to further anger the faculty doctors. The corporation's turnaround plan includes a $12 million (up to 10 percent to each university) cut in support to the university medical schools.
The presidents of both universities are set to review the merged entities' structure and make a recommendation on its future Oct. 1.
In the meantime, corporate heads and their consultants continue to run the four hospitals under the USHC umbrella and try to stem their losses. The effort has led to some downright strange activity, the aforementioned laundry saga being a case in point.
Before the merger, UCSF had its own laundry facility at Oyster Point, a facility that had been created about a decade before, to wash the tons of sheets, robes, and other linens that hospitals require every year. The Stanford hospitals, meanwhile, contracted with an outside vendor for their laundry services. One of the first acts of the merged UCSF Stanford Health Care was to combine the laundry services of all four hospitals into the Oyster Point facility.
"By simply using UCSF's existing in-house laundry service, the merged organization expects to save $288,500 annually," Lou Saksen, head of general services for UCSF Stanford, said at the time. In fact, the corporation was so proud of how things were working at Oyster Point that it offered tours of the facility.
Strangely, by early this summer, everything had apparently changed. UCSF Stanford Health Care closed down the Oyster Point laundry operation and laid off the 90 or so workers who ran it. Instead, USHC contracted with Sodexho Marriott Corp. in Gilroy, again saying the move would save money. This time, Saksen said that contracting the laundry to Sodexho Marriott would save $1.9 million a year.
By mid-August, rumors began circulating that some sheets were coming back from the laundry -- headed for patient beds -- still stained with feces and blood. USHC managers flatly denied any such thing was occurring. But an Aug. 19 internal memo contradicts the official denials.
"At a Medical Surgical nursing division meeting held on August 12, there were several reports of linen noted to have fecal smears, blood, hair, dirt and tape," says the memo, which was written by infection control officers to Nick Gaich, a USHC administrator.
Questions have also arisen about whether Marriott is washing linens used on patient beds along with dirty laundry from animal research labs. (As research facilities, both UCSF and Stanford have facilities where diseased animals are studied.)
Asked about the mingling of human and animal laundry, a hospital spokeswoman said it has always been done that way. "We do not separate the linens used for animal care and patient care and we never have," says USHC spokesperson Laurie Itow. "All medical centers follow the same procedure."
But at least two former laundry employees told SF Weekly that -- before the laundry service was contracted out -- human and animal linens were always separated. State regulations don't specifically spell out what is required in this area, other than to say "soiled linen shall be handled, stored and processed in a safe manner that will prevent the spread of infection."
In the Aug. 19 memo, the infection control officers stated "there is the concern regarding separation of linen that may have had contact with animal care procedures especially with respect to Q fever [a flulike sickness with which some animals at UCSF are infected]."
The infection control officers recommended that the linen from animal care and patient care be segregated.
When the laundry service was contracted out, Speier's office had asked that UCSF at least keep all the laundry equipment it owned at Oyster Point until the merger's future is resolved -- in case UCSF winds up doing its own laundry again.
But eyewitnesses say Sodexho Marriott has already taken small equipment, such as folding machines, sewing machines, and laundry carts, from Oyster Point. The equipment may well have been a part of the deal to contract out the linen, which would be perfectly legal. Except that, the laundry equipment belonged to the University of California and, under the merger agreement, was leased to USHC.
Underneath all the fray over management and contracting and service lines, the mess at UCSF Stanford Health Care is a tragic metaphor for the state of public health care. The suits that run the hospitals are trying to cut costs. The folks wearing the lab coats are trying to find out what causes cancer. The patients want clean sheets.