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This Merger Is Malpractice

Bad Deal Imperils UConn Facility's Mission

By FRED HYDE

January 11, 2009

Legislators have been treated to a rosy exposition of this proposal: "Why don't we give the state's only teaching hospital (the John Dempsey Hospital in Farmington, part of the University of Connecticut Health Center) to Hartford Hospital, a private facility? Oh, and let's send along a new $500 million building at the taxpayers' expense, to boot."

Stated this way, of course, the proposition appears absurd. The alternative, "Hartford to merge with John Dempsey," is no less absurd, once examined.

First, John Dempsey Hospital is the state's only public academic health center hospital, the clinical home for department chairmen of UConn's schools of medicine and dentistry, a focal point for medical education and a source of great pride.

Dempsey regrettably has suffered from management with divided loyalties for nearly all of its modern history. Management has been shared at times with Hartford Hospital; it has been part-time or itinerant. One of the smallest teaching hospitals in the nation, Dempsey has been blocked at every expansion move by the politically influential Hartford Hospital monopoly.

Despite the obstacles, Dempsey does unique work. Its case mix index (a common measure of the complexity and difficulty of medical care delivered in hospitals) was the highest in the state — higher than Yale-New Haven Hospital, higher than Hartford, higher than that of any other hospital — for 2007, the latest year for which such numbers have been published.

The professionals at Dempsey have exemplified public service for the acutely ill, have cared for those with unusual diseases and have assumed responsibility for educating the next generation of health professionals.

Second, the impropriety of privatizing a public asset — without recompense, and with a confused notion of mission — should be clear. Leaders of the University of Connecticut have apparently decided that resistance to Hartford Hospital is futile, and that an exit from the hospital business will save political conflict. Of course it will save conflict — if they give in to the main source of that conflict, namely the protests of powerful private-sector competitors.

Quite aside from the differing missions of public and private organizations, there is also the question of governance of academic health centers. The department chairman in an academic health center controls the use of clinical resources and positions. Is the Hartford Hospital medical staff ready to have the chairman of the department of medicine of UConn named to be their chief of service?

If not, will the resulting facility be a teaching institution? Will it give primacy to advancing knowledge, to training the next generation, to the conduct of clinical research? Or will that primacy be sacrificed in the service of the private medical practitioner, the mainstay of the Hartford Hospital medical staff?

Finally, we have troubling precedent for these public-private combinations. In 1996, the leaders of the University of California at San Francisco tried to combine their clinical facilities with those of Stanford University. Within three years, the "merger" fell apart, with a $100 million repair bill. The same (a public-private merger) was tried by Penn State and the Geisinger Health System, at about the same time, and with the same results.

Neither of these examples has been presented to Connecticut legislators. But anyone paying attention in the health field has noted that public-private combinations of academic organizations don't work, to say nothing of attempting to combine an academic hospital with a community hospital.

A merger of Hartford and Dempsey hospitals will promote further price-busting consolidation in the hospital field — eliminating any remnant of price competition. It will turn a state-owned and developed asset over to a private corporation. Most of all, it will deny the nature and mission of UConn's Health Center.

These are reasons enough for state lawmakers to take a hard look at this proposed transaction, and to give it the public scrutiny it deserves.

• Fred Hyde, M.D., of Ridgefield is an adviser to six unions representing more than 3,000 employees at the University of Connecticut Health Center.