CHOC Drops 17-Year UCI Pact in Rift Over Control

A major rift has developed between Childrens Hospital of Orange County and UC Irvine’s College of Medicine, resulting in the hospital dropping its 17-year-old agreement to help train the medical school’s new doctors specializing in pediatrics, officials said Thursday.

CHOC officials charged that the university wants to assume control over the nonprofit children’s medical center to keep tabs on growing hospital competition in the county.

“They wanted to run Childrens Hospital, and we didn’t want them to,” said Kenneth Heuler, a CHOC board member who chaired the negotiating committee.

UCI College of Medicine authorities denied having any desire to take over the hospital but said they must have some representation on the board if students and residents are being trained there. This was especially needed in light of CHOC’s “capricious” notice three months ago that it intended to sever its affiliation with the university when the current contract expires June 30, 1986, they said.

Insisted on 3 Seats

The two sides then attempted to negotiate a new agreement but abandoned those efforts this week. CHOC officials said UCI insisted on holding three seats on its 16-member board.

“It gets down to who is going to run Childrens Hospital. . . . The board is jealous of its own prerogative,” said Charles Hester, president of CHOC’s board.

But Dr. Thomas Nelson, associate dean of the medical school for academic affairs, said there was no attempt to take over the independent hospital. “We were asking only for security and protection if we have a significant part of our program there,” he said, adding that the UCI chancellor currently has an ex officio seat on the board. He said that if CHOC wanted a “looser” affiliation, with fewer residents, the university would not insist on board membership.

There are now 20 residents (medical school graduates taking extra training in a specialty) in a three-year program, and five students and five fellows (post-residents studying in subspecialties) assigned to CHOC, which in exchange pays the university about $1 million a year. The residents, fellows and students will continue working and training at CHOC through June 30, 1986.

However, dropping the CHOC affiliation throws into question not only how UCI will train next year’s residents, but also how Childrens Hospital will fill the vacant residents’ positions, especially the middle-of-the night staffing, a task that usually falls to the doctors-in-training.

Dr. Beverly Morgan, chairman of UCI’s pediatrics department, said the rift is a loss to both the students and the community. The medical students and residents will lose the opportunity to learn from CHOC, which treats some of the county’s most severely ill children, she said. The community will lose, she said, because the hospital will no longer benefit from exposure to a teaching institution. Noting that all major children’s hospitals across the country have medical school affiliations, she said she hopes a new affiliation can be worked out for subsequent years.

Possibly Another Affiliation

“I think the children of Orange County have a great deal to benefit by an affiliation,” she said.

CHOC officials said they will now look for ways to round out their medical staff and possibly will attempt to affiliate with another medical school.

“Childrens Hospital is still going to be the eminent facility in Southern California. This hospital was successful before there was even a medical school here” and it will continue to be successful without UCI, said Dr. Harriett Opfell, CHOC medical director.

The UCI medical school has a number of affiliations with hospitals other than CHOC, including Miller Children’s Hospital, part of Memorial Medical Center of Long Beach. However, most of UCI’s 600 residents are trained at UCI Medical Center in Orange, about two miles away from CHOC.

CHOC officials said hospital economics and competition for patients in the county played a part in UCI’s demand that it hold seats on CHOC’s board.

AMI Negotiations

UCI Medical Center is negotiating with American Medical International to have the for-profit hospital network manage the debt-plagued UCI Medical Center. Additionally, AMI plans to build a hospital in Irvine, complete with women’s and children’s health services, and the university will be affiliated with the medical complex.

“We have felt these two things present a threat to our program,” CHOC board member Heuler said. If UCI held seats on the CHOC board, it would be able to keep tabs on CHOC’s responses to AMI’s moves, he said.

“When they’re going into (an agreement) with AMI, and with medicine as it is now (with) hospitals vying against each other, we couldn’t afford to have that,” Heuler said. CHOC, he said, bristled at UCI’s contention that the university needed the “security” of positions on the board.

“They made an issue of security,” said CHOC Administrator Harold Wade. Yet, the university is courting AMI, which is a threat to Childrens Hospital’s security, he said, adding: “It wasn’t a two-way street.”

UCI’s Morgan and Nelson contend that the CHOC officials’ fears are groundless.

Competitive Plan Issue

“I can understand why they feel threatened, but I can honestly say the university is not threatening them. There’s an unknown situation there” with AMI, Nelson said.

Morgan said UCI never planned to develop a big pediatric center at the yet-to-be-built Irvine Medical Center. “There are no plans to build a competing unit at IMC,” she said.

In addition to their concern over AMI, CHOC officials said they had longstanding grievances about how UCI assigned residents to the children’s hospital. The university has reassigned and removed residents without consideration for Childrens Hospital’s needs, and hospital officials wanted to renegotiate an affiliation that would grant the hospital more say in the medical school’s plans, as they affected the hospital, Opfell said.

CHOC had proposed that the hospital and UCI set up a liaison committee, to satisfy CHOC’s concerns, said Dr. Mitchell Cairo, who oversees the residents at CHOC. The proposal was rejected by UCI, hospital officials said.

One-Year Notice

“We wanted input and they wanted control,” said Wade of UCI’s response.

The negotiations apparently got off to a rocky start.

On June 25, CHOC sent a letter to UCI giving one-year’s notice--in accordance with the current contract--that the children’s hospital planned to sever its affiliation. The second paragraph stated the hospital would negotiate for a renewed agreement.

“It came as a bolt out of the blue,” UCI’s Nelson said of CHOC’s “curt” letter. “It left us in a precarious position.”

There had been no hint of long-standing grievances, Dr. Morgan said. UCI has had a liaison committee with CHOC which is supposed to meet quarterly, but CHOC has regularly called off meetings, she said. Furthermore, she said, she is at CHOC every other Wednesday for “rounds”--tours of patients under residents’ care--and she regularly meets with hospital officials. “There’s been not one word of any problems,” she said.