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The Unhealthy Dispute at Children’s Hospital

The details of the dispute at Children’s Hospital of Orange County are disturbing enough. A nationally prominent physician on the forefront of treatment of cancer in children has a falling out with the hospital. It results in his being stripped of several key posts, and he is forced to step down as chairman of a medical group he led that is responsible for much of the hospital’s revenue. Meanwhile, a messy medical peer review is underway.

Wherever the truth lies in the dispute between Dr. Mitchell S. Cairo and CHOC, this embroilment is not good news for the delivery of health care in Orange County, and in particular, for the treatment of children. Beyond the details lies a simple truth: no institution that serves a great public need can indulge egos over mission. The situation at CHOC is complicated, but the basic solution seems simple enough. Put the children first.

Already, the landscape is littered with casualties, and the task for the hospital is to find its bearings. The former chief executive officer, Thomas Penn Jones, resigned abruptly. A recent federal audit criticized the hospital and Cairo for putting patients on government-supported research studies and then taking them off inappropriately. It also noted lapses in obtaining consent for experimental treatments.

There are other problems. The hospital estimates it will post a loss of about $13 million for the fiscal year ending June 30. Department heads have been asked to make drastic cuts in budgets, and there has been talk about what is described as “a close affiliation” with neighboring St. Joseph Hospital. CHOC has closed its oncology intensive care unit.

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The battle has alienated donors, riven the staff and cost business. All of this while the facility has been trying to conduct an important mission, taking care of youngsters with rare life-threatening diseases. Some say this is a result of a failure to manage properly changes that are going on industrywide. Whatever lies at the root of the controversy, the combined problems have affected morale, slowed the search for a new chief executive officer and raised questions about health care for children in Orange County. The conflict between the hospital and the medical group came at a time when the hospital well might have been focusing its energies on more productive enterprise--navigating the transfer of local children on MediCal into managed care.

The problems appear to illustrate what happens when personalities and egos are not subordinated to a larger sense of shared mission. With staff demoralized and said to be leaving, and while the medical group is left with legal bills, the hospital should regroup to recollect its larger purpose.

There is no doubt that the hospital has benefited from having Dr. Cairo as its resident star, and it is clear that he has done celebrated work despite the criticism that he can be difficult. The important point for the hospital and the community at large is that when one person becomes critical to its operation, a sense of balance and perspective may be sacrificed. There has been plenty of high drama in the good times--the bringing of celebrity and status to an important local institution. But often the important work just as likely can be found in the trenches, in the day-to-day work of those who do unheralded things.

The hospital recently seems to be trying to draw attention to the important work of the many instead of the few. Now the hospital must make clear to donors and others that it is intent on rising above who is right or wrong in any particular dispute. It needs to get beyond the intramural politics, to avoid finger pointing and assigning of blame, and to focus on the great goal of doing good.

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This will be the challenge for new hospital leadership in the years ahead.


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