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City of Hope Rift with Physicians Threatens Both—and Scares Patients

Cheryl Clark, for HealthLeaders Media, May 26, 2010

An ugly and very public fight between the prestigious City of Hope Medical Center and its 187-member group of cancer specialists threatens the reputations and stability of both as it has frightened many of the patients in their care.

The way leaders of the NCI designated cancer center tell it, all they want is to create a non-profit medical foundation that serves as a model of integration with their physicians. They say the foundation will streamline and improve cancer care, teaching, and research in the cost-effective, high-quality spirit of healthcare reform.

The foundation would serve as the kind of entity seen in many other hospital-physician relationships throughout California, where the ban on the corporate practice of medicine prohibits hospitals from directly hiring doctors, hospital officials maintain.

But the way leaders of the California Cancer Specialists Medical Group see it, the hospital is trying "to force" its doctors "to participate in an illegal scheme" to violate the state's prohibition against the corporate practice of medicine and control the way doctors treat patients. These are the doctors who serve as principal investigators or lead researchers in many of the 250 research projects and clinical trials now underway at City of Hope.

"We're not blind to healthcare reform, and we want to partner more closely with the hospital," says CCSMG President Lawrence Weiss, MD. "But we're against the medical center conception of the foundation, which looks like a hospital takeover of a physician organization."

Early this month, the disagreement resulted in the doctors filing a lawsuit against City of Hope, saying that the foundation would illegally end a financial relationship through which the hospital pays the doctors substantial amounts of money for teaching, administrative, and research services.

The hospital filed a cross complaint, saying CCSMG simply wants "to force City of Hope to continue to pay it millions of dollars after CCSMG's contract with the hospital runs out at the end of January, 2011."

The California Hospital Association sides with City of Hope, and the California Medical Association sides with the doctors. Both groups have weighed in.

City of Hope "is abandoning the medical group entirely to create a model giving it control over crucial decisions made by physicians about medical care," said CMA president Brennan Cassidy, MD. CHA President and CEO Duane Dauner countered that City of Hope is "searching to find a way to survive and thrive under the new environment and to do [so] in such a way that brings greater accountability."

But the litigation wasn't the only issue that turned this fight into such a publicly embarrassing one.

On April 27, CCSMG leaders wrote a letter to thousands of City of Hope's cancer patients complaining that the medical center "will not renew its relationship with all physicians currently providing clinical research and physician oversight of its clinical programs," implying that cancer patients would have to go elsewhere for care in just nine months, or if they stay at City of Hope, will all have new doctors.

The letter said the City of Hope's "new Medical Foundation seeks to change the balance of decision-making within the institution from physicians to non-physicians . . . [which] would fundamentally alter what has made City of Hope so successful—an integrated faculty of physicians who are fully responsible for the care of our patients."

The letter also said, "It will fund research only to doctors that join its Medical Foundation," and that most of the doctors had voted no.

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