Case closed

Surgeon William Meyers agrees to resign after butting heads with UMass Memorial, but academic physicians agree his departure is a shocking example of what happens when doctors criticize managed care

by Kristen Lombardi

The official word on liver surgeon William Meyers's decision last week to step down, effective next year, is one of relief and gratitude. But the scandal that circulated through medical centers nationwide provides a chilling example to academic physicians everywhere of what can happen if they speak freely in -- or are critical of -- health-care's increasing corporatization.

For nearly three months, the staff at UMass Memorial Health Care, the UMass Medical School's teaching hospital, had endured the maelstrom that followed after Meyers, the surgery department chairman at UMass Memorial, was fired by UMass Memorial CEO Peter Levine for discussing the tension existing between hospital administrators and doctors (See "Muzzled," January 28).

Meyers refused to leave, prompting Levine to request Aaron Lazare, the UMMS chancellor, initiate a job-evaluation process, consisting of a three-member panel of "external experts," that could have recommended Meyers's dismissal this month.

But by February 9, it was announced that Meyers had reached a "mutually beneficial" agreement with UMass Memorial and UMMS administrators. And Meyers and Levine, along with their warring factions, were quick to put the conflict behind them. In a brief statement released to the Phoenix, Levine and Lazare wrote that "to secure our missions . . . and to initiate healing from any harm, we commit ourselves to closing the dispute in a constructive way and moving forward."

Likewise, Meyers confirmed that he agreed to step down once it became apparent that UMMS wished to end the "harmful consequences of the continued controversy." To repair the damage he helped create by defending himself, Meyers will leave.

The agreement, though, halted the three-member panel investigation. So doctors and observers will never know what was offensive enough to cost the prestigious surgeon his job. Now that Meyers is stepping down, academic physicians are chalking one up to big business: it's hardly surprising, after all, when a critical employee gets tossed in the corporate world. Still, like many observers, David Rothman, a social-medicine professor at Columbia College of Physicians and Surgeons, maintains, "This is one more example of how academic physicians are starting to be treated like employees," not like professionals.

If anything, the Meyers case shows that even academic physicians can lose when they challenge the status quo.

By all accounts, the Levine-Meyers feud escalated into what's been called a "bruising battle" almost as soon as it became public. Since mid-November, the scandal tainted UMass Memorial's image, hindered its fundraising and recruiting efforts, and created an atmosphere of paranoia and anxiety among staff.

It even prompted William Bulger, the president of the state's entire UMass system, to intervene behind the scenes in recent weeks. "All we were hearing in central office was that the sides were fairly entrenched," one UMass official in Boston explains. To stop the debate -- especially the unfavorable publicity -- Bulger and his aides pushed for compromise with attorneys and administrators.

Meanwhile, of course, the three appointed panelists arrived at UMass Memorial on February 3. Members -- Mitchell Rabkin of Beth Israel Hospital, Edward Miller of Johns Hopkins University, and R. Scott Jones of University of Virginia -- conducted two days' worth of hearings to review the case, interviewing not just Meyers and Levine, but also UMass Memorial department chairmen.

Before the panel could finish its work, however, Bulger's attempts at shaping a quiet resolution paid off -- literally. Last week, a mutual agreement was announced: Levine would permit Meyers to complete his current, five-year contract; Meyers would leave when it expires, in January 2001. In addition, Levine and his UMMS counterpart Lazare intend to change institutional by-laws that dictate the hiring and firing of department chairmen.

No doubt, the agreement -- which pays Meyers an undisclosed yet an assumed-to-be hefty severance package -- lets everyone save face. Now Levine isn't forcing Meyers out; the surgeon is walking away with dignity; and the nasty, disruptive scandal is fading.

By settling, though, the very vehicle designed to protect the tenet of academic freedom -- namely, UMass's 90-day, job-evaluation process, which had been enacted only after Meyers refused to leave -- didn't succeed. For while UMass officials consider academic freedom to be preserved because "due process" was upheld, the bottom line is undeniable: the openly critical Meyers, who challenged UMass Memorial's leadership on issues like fundraising and billing, has lost his job.

As one medical professor outside Worcester laments, "It certainly says something about the health, or lack of health, at the academic medical center."

And, despite its "mutually satisfactory" conditions, the agreement does little to address the reason behind the squabble. People will probably never know what made up the 22 charges amounting to "institutional disloyalty," which Levine issued one month after he fired Meyers. Nor will the panelists issue their expected report, which was to recommend how such conflict should be resolved in the future.

As a result, says Andrew Warshaw, chairman of the surgery department at Massachusetts General Hospital, "People still don't know where the truth lies." He adds, "the agreement is an expedient decision, not one arrived at based on issues."

Neither can the settlement erase the damage done. Though it remains to be seen whether the surgery department finds an equally qualified replacement, there's little question that Meyers's successor will enter a beleaguered department, and this hardly makes recruitment easy. The financially struggling UMass Memorial may also be criticized for spending what insiders suspect is millions of dollars on Meyers's severance pay, as well as on lawyers, experts, and even a private investigator -- rather than on patient care and research.

So if anyone looks badly in this debate, it's Levine. After all, the hospital CEO set off the controversy with his shocking, precipitate action, then heightened the alarm by working to ensure the surgeon's dismissal. Since he's backed down, letting Meyers resign on his own time, some UMMS insiders argue that Levine appears defeated.

Others, though, aren't so certain. Levine wanted Meyers gone and, in the end, he's going. The UMass Memorial CEO can also be assured that Meyers, as a lame-duck chairman, will be less vocal this year: any department chairman will likely think twice before expressing different views.

What's so ironic about this debate is that Levine, like Meyers, has a habit of speaking out too. Just weeks after he fired Meyers for talking about the tensions aggravated by managed care, Levine and hospital administrators statewide staged a Statehouse press conference to decry the fiscal crisis facing health care in Massachusetts. He then published an op-ed piece in the T&G, lamenting the financial pressures placed upon hospitals because of managed care. What ostensibly cost Meyers his job -- commenting on managed care problems -- isn't actually a topic on which the two men disagree.

Even when they did disagree, Meyers's criticisms often were justified. Take his push for the UMass Memorial leadership to reconsider how it collects money from insurance companies; his unremitting pressure led to a task force that's about to implement his ideas. Then there were Meyers's efforts to carry out "his own plans" for fundraising -- plans that helped him raise more money than other departments could.

In the weeks leading up to the panel investigation everyone from UMMS officials to Meyers's supporters agreed the 22 charges would turn out to be "specious," and hardly grounds for dismissal, but sources close to Meyers admit he capitulated because he lacked support from his medical-school colleagues. During the hearings, which took place the first week of February, department chairmen failed to stand behind Meyers -- partly because they disliked his rough, demanding style, and partly because they disliked his public fight, although Meyers was left with no other choice than to defend himself.

To UMMS colleagues, the Levine-Meyers clash was rooted more in personality than in principle. What is remarkable is that Levine's and Meyers's detractors tend to use the same words to describe them -- words like "control freak," "hard ass," and "relentless." In essence, the Levine-Meyers feud might not have been so harmful had these men not proven to be equally matched.

What mattered most to UMMS officials looks to be preserving the institutions -- specifically, their partnership, finalized in March 1998. And this thought dismays those who view the debate as emblematic of the inevitable friction between corporate and academic influences. For what happened to Meyers simply reinforces, one local doctor says, "the corporate side of UMass is winning over academic medicine."

That said, it's true the battle might not be over yet. In spite of Lazare's reputation for mending fences, he's kept a low profile throughout the three-month flap, fostering the general perception that he's had his head in the sand.

But sources close to Lazare offer another, very different portrait, describing him as "devastated" and "concerned" by the ordeal -- so much so he risked his desire for fairness by circulating a faculty memo, in which he confirmed the dispute's detrimental effects. The January 19 memo was subsequently (and predictably) leaked to the T&G.

If Lazare is as hurt as friends claim, it's likely to surface when he and Levine haggle over the UMMS and UMass Memorial governance documents. Indeed, both men are expected to recommend by-law changes on policies regarding department chairmen, prompting observers to predict the next battlefield: Levine will do all he can to retain control over faculty hiring and firing, but so will Lazare.

Ultimately, time -- or, more aptly, these changes -- will tell how willing UMass leaders are to guard academic freedom.

Kristen Lombardi can be reached at klombardi[a]phx.com.