An acclaimed Boston transplant surgeon, upset with his lot after a difficult merger between two teaching hospitals, has become the poster physician for the dark side of consolidation and competition in medical Mecca.
The surgeon's pending move from the merged medical center to a new liver transplant program has spawned a court fight, turned allies into adversaries and produced a public example of how a merger with high hopes can trigger personnel and financial losses instead.
Roger Jenkins, M.D., and his transplant team at 656-bed Beth Israel Deaconess Medical Center in Boston burst into national prominence last December by performing the first adult-to-adult transplant in New England by using part of a living donor's liver.
Two weeks later, the Boston Globe reported Jenkins' resolve to bolt Beth Israel Deaconess, citing conflicts springing from the 1996 merger of surgical staffs from the former Deaconess Hospital -- where Jenkins had directed a liver transplantation program since 1983 -- and the former Beth Israel Hospital.
In an interview, Jenkins, 47, summarized the problems guardedly, saying the situation involved "obviously an extraordinarily complex series of events." But he concluded that the continuation of his pioneering work "was going to become increasingly difficult" under conditions created by the merger. "I've dedicated my life to patients. And that's something I don't want to abrogate," he said.
Jenkins subsequently accepted an offer to move his whole team, including three other top-tier physicians, to 298-bed Lahey Clinic in suburban Burlington, Mass., which petitioned successfully for a state determination of need to start a liver transplantation program.
But that approval sparked a court battle between the state Department of Public Health and Beth Israel Deaconess (March 22, p. 16). A state Superior Court judge denied the hospital's request to block Lahey from starting a new program, but Beth Israel Deaconess President Herbert Kressel, M.D., plans to appeal.
Among other objections, Beth Israel Deaconess protested the state agency's decision to accommodate the doctors and expedite the DON request rather than require them to navigate the review channels, which usually takes about a year.
"I think it's an error to make policy around an individual in terms of allocating resources for a state or geography," Kressel said.
Lahey Chief Executive Officer John Libertino, M.D., said the urgency was warranted. The team of three surgeons, a hepatologist and about two dozen support staffers wanted to stay intact in Boston, preserving their expertise with cutting-edge techniques. But they would have been forced to break up or leave the state rather than wait through the standard review, he said (See related story, p. 29).
Libertino said Jenkins had been concerned that other liver transplant programs in Boston had support teams in place and could not accept the Jenkins team as a unit.
Libertino said Lahey could take them in; it had no liver transplant program but had anesthesiology and other support functions in place from kidney, bone marrow and heart transplant programs.
Judge Linda Giles sided with Lahey, writing in her decision: "Given the human cost of liver disease . . . this court finds, as did (the Department of Public Health), that the public interest weighs in favor of keeping a world-class transplant team . . . intact and in the Commonwealth (of Massachusetts)."
Kressel said the policy debate doesn't end there. "There are currently five hospitals in Massachusetts that are performing liver transplants and fulfilling the needs of the residents of the state," he said. "The need for additional services has not been proven, nor have the effects that an additional center would have on the existing services."
Beth Israel Deaconess said the state requires transplant centers to demonstrate the ability to perform at least 15 procedures per year and also prove the program won't cause the volume at facilities with established transplant programs to drop below that minimum. Between 110 and 120 livers become available annually to the five existing transplant centers.
In pointing out potential volume decreases, the hospital could have been describing the effects of Lahey's DON on its own center, which would have to find a new team to replace the one preparing to depart for Lahey. Jenkins' team has a backlog of 250 patients waiting for a liver, Libertino said.
Kressel declined to speculate on the aftermath of the team's departure, saying the change wasn't official, and therefore it was premature to comment.
Other departures from the surgery department in the past year include 12 of 16 anesthesiologists and several surgeons.
Meanwhile, the merged hospital reported an operating loss of $71 million in fiscal 1998 ended Sept. 30. The net loss dropped to $29 million after investment and other income was included.
The hospital's parent organization, CareGroup, and Lahey launched a partnership last September to combine their clout and negotiate unified managed-care contracts.
Asked whether the court fight would affect the alliance, Kressel said, "This is a fight about Lahey, but it's not a fight with Lahey." But reflecting on the recent ruling against Beth Israel, he said the ties with Lahey might be "re-evaluated in light of these events."