UC Accused of Plan to Control Patient Care

In an unusual showdown between giants of the state’s medical industry, the California Medical Assn. today is expected to sue the UC system over an alleged scheme to wrest control of patient care from doctors in the West Los Angeles area.

The lawsuit essentially accuses UCLA Medical Center administrators of taking over the practices of community physicians and shifting control of patient care to UCLA Medical Enterprises. The plaintiffs say this constitutes the “corporate practice of medicine,” which, with few exceptions, is illegal in California.

The university has long employed physicians to teach and perform research; CMA officials say that is perfectly legal and ethical. What they object to is the alleged push to employ community doctors who have little or no academic responsibilities with the aim of capturing patients and dollars.

The CMA also objects to the university giving these doctors the title “professors of medicine,” suggesting they have superior qualifications to those not affiliated with UCLA.

Although the CMA “emphatically supports” UCLA’s efforts to keep academic medicine afloat financially, “they are choosing to solve this problem in a manner that is deplorable,” said Jack Lewin, chief executive officer of the association, which represents 30,000 California physicians.

“If UCLA succeeds, there’s no reason why any other corporation shouldn’t be able to hire doctors and direct them. We will fight this to the bitter end.”

A UC attorney said Wednesday that UCLA is simply fulfilling its academic mission and adapting to the changes in medicine by spreading its research and educational activities out into the community. The rebuilding and downsizing of the main hospital as a result of the Northridge earthquake has given impetus to the community expansion, said deputy general counsel John Lundberg.

“We have students in physicians’ offices who are learning from the mentoring and proctoring going on there,” he said.

“We have research going on [away from the main site]. This notion that somehow we are doing this to make money and be competitive is just not true. We are simply trying to survive like everybody else.”

In particular, Lundberg said, UCLA is planning to bring such academic programs as orthopedics and general surgery to Santa Monica-UCLA Medical Center, a community hospital it purchased a few years ago.

The lawsuit was initiated by a group of anesthesiologists at Santa Monica-UCLA. Lewin said the CMA joined as a plaintiff “reluctantly,” only after repeated efforts to negotiate with the university stalled. The anesthesiologists say in the lawsuit that they are being forced out of their practices at the hospital and replaced with UC employees.

But the problem is much bigger than one department at a UCLA-owned community hospital, said Dr. Thomas D. Bohlmann, one of the Santa Monica-UCLA anesthesiologists, who says he refused to become a UCLA employee.

“It’s [affecting] primary care, cardiology, general surgery,” he said. “It unfairly puts the community practitioner at a disadvantage compared to the university system, which has tax dollars to back it up. . . . And it’s important for patients to know that they won’t be siphoned into this system whether it’s appropriate or not.”

According to the suit, UCLA is setting up a situation in which it can, for instance, require that referrals to specialists be made to UCLA physicians whether or not it is medically appropriate; exert control over the medical services provided by its physicians; require that the employed physicians pay, in effect, referral fees to the university; and interfere with physician judgment.

The danger, the suit states, is that physicians will be required to demonstrate “greater loyalty to UCLA Medical Enterprises than to their patients by placing financial needs of UCLA . . . ahead of the medical needs of patients.”

At the same time, some community doctors say that physicians who don’t work for UCLA or refuse to join UCLA’s payroll are effectively locked out of the university’s referral network.

That, some doctors say, amounts to unfair competition by a publicly supported university.

One community cardiologist and former UCLA faculty member, Dr. Daniel Wohlgelernter, said he has had patients come to him in tears because their UCLA primary care doctors, who make referrals, are telling them they can’t see Wohlgelernter any more.

“That rises to the level of being unethical,” said Wohlgelernter, who turned down an offer by UCLA to become an employee because he wanted to remain independent.

According to the suit, UCLA Medical Center officials have offered primary care doctors--such as general practitioners--above-market value for their practices to ensure that UCLA obtains referrals from these doctors. At the same time, the suit states, specialists, who depend on referrals, are allegedly compensated at lower rates because UCLA takes a portion of their fees as a condition of making referrals.