Patients, Parents Decry Doctor’s Dismissal : Medicine: Childrens Hospital cites financial troubles in decision to let popular physician go. Cystic fibrosis patients and their families say they will miss personalized care.

Though many ill people develop strong bonds with their doctors, not often are the ties as heartfelt as those between Dr. Alan Osher and his patients at Childrens Hospital Los Angeles.

His patients suffer from cystic fibrosis, an illness that strikes young and sentences its sufferers to years of debilitating sickness before certain death at an early age.

Osher offers patients not just medical science, but emotional support. Some of his patients have been with Osher, 55, more than two decades, following him from one hospital to another.

Kim O’Brien, 26, of Oxnard began seeing Osher when she was 11. “Cystic fibrosis is always fatal,” she said. “There is no cure for it. With a chronic disease like that, you want someone who knows you inside and out.”

Thus, when officials at Childrens Hospital decided recently not to renew Osher’s contract, citing financial problems, patients and their families were outraged. They have fought the hospital’s action with letters and phone calls, but so far it has been a losing fight.

Part of the fierce loyalty that Osher commands stems from the experience doctors need to recognize the onset of the disease. Just about every cystic fibrosis family has a story about a child whose ailment was misdiagnosed by a physician who thought the child had asthma or a bad cold.

Cystic fibrosis is the most common fatal genetic disease in America, affecting about 30,000 children and young adults nationally, according to the Cystic Fibrosis Foundation. It clogs the lungs with a thick, sticky mucus and leads to lung damage and infections.

But it attacks under a variety of disguises, posing as severe asthma, bronchitis or pneumonia. Claudia Manuel of Simi Valley said, “My daughter just turned 14 . . . when other doctors told me she would not live past 6, because of Dr. Osher.”

Her daughter, Jamie, burst into tears when she opened the letter from Childrens Hospital announcing that Osher was being let go. Osher has been her doctor since she was 2. “I couldn’t imagine another doctor helping me through cystic fibrosis the way Dr. Osher could,” Jamie said.

Osher’s patients also said that he takes a personal interest in their health and their lives, which they deem critically important to their overall well-being. He remembers gifts on his patients’ birthdays, attends weddings for some who survive into adulthood, and shows up at funerals.

Carmen Miller of Monrovia has two children, 8 and 11, with cystic fibrosis. She, her husband, their two daughters and a healthy son recently returned from Disney World where her younger daughter, Christina, was a guest of the Make-A-Wish Foundation, a program that grants wishes to terminally ill children.

Miller said Osher was especially important to her younger daughter. “He lets her have her anger, her attitude,” Miller said. “My daughter is very spirited, very angry at the unfairness of the disease. There have been times when she’s kicked Dr. Osher. He understands, and she loves him for it.”

Another patient is Stacy Sewell, who made medical history earlier this year when her parents gave her part of their lungs, enabling her to became the first cystic fibrosis patient to receive a double lung transplant from living donors.

Sewell had been a patient of Osher’s for 21 of her 22 years, and her mother, Barbara Sewell, credits him with saving her daughter’s life.

Though relatively few Southern Californians suffer from cystic fibrosis, the dispute has broader implications than those faced by Osher and his patients.

Childrens Hospital, in explaining its action, cited deficits running into the millions that are threatening its financial well-being. At Childrens, a teaching hospital affiliated with the USC School of Medicine, doctors are responsible for generating enough money to pay part of the cost of their salaries and overhead.

That means that in addition to a bustling clinical practice, physicians like Osher are also expected to secure grants and contracts related to their academic endeavors. The hospital says Osher has not been pulling his weight, even though he has more than 150 patients.

Osher himself is an uncomfortable figure in the fight. All he will say for the record is, “I’ve been relieved of my duties. This is what I do. I don’t know what I’ll do in the future or where I’ll do it.”

The average appointment in Osher’s cystic fibrosis unit is about 20 minutes, according to the hospital. Osher’s patients say he routinely spends twice that amount of time with them, if not longer.

While this is the very thing that endears Osher to his patients, it is a significant aggravation to hospital officials.

Osher’s immediate supervisor, Dr. C. Michael Bowman, director of the cystic fibrosis center, calls Osher’s case a “tragedy,” but nevertheless is critical of the way Osher practices. “I see as many as 2 1/2 times the number of patients in the clinic as Dr. Osher does,” he said.

Health experts say that more doctor-patient relationships are going to be upset as the medical system moves increasingly into managed-care programs that place a premium on controlling costs--in part by limiting the choices patients have in choosing their doctors.

Most of Osher’s patients are being treated under publicly financed health programs, such as Medi-Cal, that do not cover all of the costs. With a disease like cystic fibrosis, it is next to impossible for many of the patients to get private health insurance coverage.

Of those children who are covered by private health plans, through one of their parents, many have exceeded the benefit limits because of the expense of treating cystic fibrosis.

Bowman, Osher’s supervisor, said of the physician’s layoff: “It is a major problem when someone who is a long-term, trusted care-giver loses his job. That is a tragedy, and it’s a tragedy for everyone.”