To the Editor:
"Fast-Growth Strategy Has Its Costs at U. of Miami" is a shocking example of irresponsible and lazy reporting (The Chronicle, June 19). Most of its conclusions are unsupported and inaccurate, and in the many cases where public information was readily available, the reporter failed to do his research.
For more than 50 years the University of Miami has stood side by side with our partner Jackson Memorial Hospital in our primary mission of providing a single standard of care for everyone regardless of their ability to pay. The reporter's statement that by buying Cedars Medical Center in 2007 we "greatly expanded the university's ability to direct many of the area's most profitable patients and procedures to the new facility and to other university-owned hospitals, further worsening Jackson's own considerable budget woes," is completely false. Actual data on volumes and revenues produced by Jackson Memorial Hospital's management absolutely contradict The Chronicle's statement.
A grand jury report on Jackson's finances raised no concerns about the University of Miami Hospital or its physician practice. If the reporter had reviewed the public record from the Miami-Dade County Commission, he would have learned that Jackson's leadership has repeatedly said it has no evidence that patients are being moved from Jackson to University of Miami Hospital.
In reference to the suggestion that the university has moved cardiology from Jackson to the University of Miami Hospital, it must be noted that before the university's purchase of Cedars, Marvin O'Quinn, then Jackson's chief executive, decided to bring in an outside cardiology group to practice at Jackson. Even so, University of Miami physicians continue to staff Jackson clinics, wards, and the coronary-care unit. We also provide some of our premier services, such as heart transplant and implantation of left-ventricular-assist devices, only at Jackson.
Additionally, the University of Miami stroke service at Jackson is nationally acclaimed, and University of Miami/Jackson Memorial Hospital was recently named the No. 1 hospital in the Miami-Fort Lauderdale metropolitan area by U.S. News & World Report. If the reporter had done his homework, he would have found that the worst loss in patient volume at Jackson is in obstetrics and related pediatric services (neonatal intensive care), two services not offered at the new University of Miami Hospital.
A section of the article about two federal agencies investigating possible clinical-research billing-compliance issues is based on documents that are more than five years old. The problems were cleared up long ago as Jackson and the University of Miami invested in system changes and process improvements.
The article also suggests that the University's rise in U.S. News & World Report's "America's Best Colleges" survey was due largely to our expansion of the medical school. As The Chronicle certainly knows, those rankings are based almost entirely on undergraduate data, which show that improvements in the quality of the undergraduate student body, freshmen retention rates, six-year graduation rates, and alumni giving were the primary contributing factors to the university's rise in this ranking.
As for the reference to my membership on the UnitedHealth board, the public record shows that the company's stock-options problem preceded my service and that I participated in the company's new strategy which ended in the chief executive's replacement. Furthermore, if the reporter had bothered to check the public record, he would have learned I resigned from the board when the university bought the hospital to avoid a conflict. Likewise, the dean of the Miller School of Medicine, Pascal J. Goldschmidt, has reported his outside-of-university activities and compensation flawlessly.
I could cite many more examples of inaccurate, unsubstantiated conclusions in this article. Suffice it to say that it is reprehensible that The Chronicle would publish such a story without carefully checking publicly available facts.
Donna E. Shalala
University of Miami
The Chronicle stands by its reporting of this article. Our research relied on public documents and data, and on-the-record interviews.
The response from President Shalala contains a series of complaints that I feel compelled to address.
President Shalala rejects The Chronicle's characterization of Jackson's financial troubles as "completely false" and writes that a "grand jury report on Jackson's finances raised no concerns about the University of Miami Hospital or its physician practice." But indeed, as the article points out, the grand-jury investigation described Jackson as "a colossal mess" running at "near-financial collapse." The article makes clear the grand jury did not explore the question of whether and how the University of Miami may have contributed to that situation. The article, however, contains on-the-record comments from involved parties, including the most recent head of Jackson Health System, describing what they see as deliberate actions by the university to shift profitable medical services from Jackson to the University of Miami Hospital.
President Shalala raises a series of points that are not disputed in the article, including comments about the link between U.S. News rankings and undergraduate performance, comments about patient volume in obstetrics and pediatric services at Jackson, and comments about the quality of medical care provided by university doctors. The article does cite an outside evaluation of Jackson Hospital that shows it faring increasingly poorly in the years since the university purchased its competing hospital across the street.
The rating cited in the Chronicle article is based on solely on patient outcomes and survival, whereas the U.S. News rating cited by Ms. Shalala is based largely on a combination of reputational rankings and "other care factors" such as nurse staffing levels and technology.
President Shalala contends that the allegations involving university doctors bringing patients into Jackson without Jackson's knowledge are based on documents that are more than five years old and that the problems "were cleared up long ago." The article does note there are some documents describing this situation that date back to 2006, but it also describes more recent documents. The article also quotes the current director of compliance at Jackson Health System as stating that these matters remain under active investigation by two federal agencies.
President Shalala states that the stock-options problem UnitedHealth preceded her service on the company's board and that she participated in a strategy that ended in the CEO's replacement. She also states that she resigned from the board when the university bought its hospital. The article does not state otherwise on any of these points.
Finally, Ms. Shalala states that the university's medical school dean, Pascal J. Goldschmidt, "has reported his outside-of-university activities and compensation flawlessly." But a study we reported on this year ("Failure by Deans of Academic Medical Centers to Disclose Outside Income") concludes that the faculty-disclosure Web site overseen by Dr. Goldschmidt underreported the income he received for two outside directorships by 39 percent and 82 percent. The university's faculty-disclosure Web site also failed entirely to mention additional compensation in the form of stock options that Dr. Goldschmidt held but had not exercised. That existence of those stock options was noted on the site only after Dr. Goldschmidt was queried repeatedly by the authors of that study, and the Web site still does not list any dollar value for those options.
Jeffrey J. Selingo
Editor, The Chronicle of Higher Education