EMPIRE BUILDING Jeffrey Romoff and the ascent of the University of Pittsburgh Medical Center Lake Fong, Post-Gazette
	Jeffrey A. Romoff, 60, has spent 32 years with the University of Pittsburgh Medical Center, the past 13 as president. Under his guidance, the sprawling health system has become Western Pennsylvania's biggest employer with 2005 revenues of $5.1 billion. ALSO TODAY Who will succeed Jeffrey Romoff? THE SERIES Part One: How a stagnant psychiatric institution led to UPMC's growth Part Two: Organ transplants put UPMC on the map, confirm growth strategy Part Three: Consolidation and controversy at UPMC Part Four: Clash of the Titans Today: Join an online chat with author Steve Levin about the series
	Online Graphic: UPMC's Hospitals and Facilities
	Lake Fong, Post-Gazette
	Rebecca Kaul, left, Jeffrey Romoff and wife, Stefania, and oldest daughter, Jennifer Gilstrap, at the 2003 American Ireland Fund dinner.
	A TIMELINE 2003 UPMC total employees reach 36,500. UPMC recruits nation's leading bioterrorism policy experts to create Center for Biosecurity. 2004 Jeffrey Romoff's salary now $2.4 million. UPMC transplant facility opens in Palermo, Sicily. 2005 UPMC creates Strategic Business Initiatives to manage its existing portfolio of about two dozen for-profit companies involved in health-related endeavors. Joint UPMC-IBM partnership worth more than $400 million to expand health system's electronic health record project. UPMC has 40,000 employees. By comparison, at the steel industry's peak in the late 1940s, it had 80,000 employees in the Mon Valley.
	John Heller, Post-Gazette
	Pitt Chancellor Mark Nordenberg and Jeffrey Romoff, right, at the 2004 Hillman Cancer Center benefit.

In fall 2002 Jeffrey A. Romoff was 57 and unquestionably one of the region's most powerful executives.

He was paid $1.95 million a year as president of the University of Pittsburgh Medical Center, an empire that included the just-opened Hillman Cancer Center, a 10-year contract with the region's largest health insurer, Highmark Inc., and the financing to move Children's Hospital into $250 million digs in Lawrenceville.

During his 29-year career with UPMC, he'd risen from an anonymous program director at Western Psychiatric Institute and Clinic to head a health system that had 35,000 employees and more than $3.5 billion in assets. Mentored for a quarter century by the now-retired Dr. Thomas Detre, Mr. Romoff had evolved into a tough, driven leader.

Socially, however, he was a recluse. He had been married more times -- three -- than the number of close friends he could count. His two daughters were grown and gone from his Hampton home. He did not participate in Pittsburgh's cultural life. Dinners with business associates were timed to last 90 minutes, no longer.

"He's only going to let you get so close," said a former co-worker, one of many people interviewed for this series who refused to let their names be used because they fear Mr. Romoff's clout. "Not many people wanted to get that close."

For 29 years, UPMC had been the dominant relationship in his life. His work ethic, drive and commanding presence had attracted a core group of fiercely loyal acolytes.

Years earlier, Mr. Romoff had begun Wednesday evening meetings with senior executives in his conference room. People attending recall Mr. Romoff as focused, quick-witted and lacking humility. They also said he had a curious way of addressing people so that they were never sure whether they were being complimented or denigrated.

The key to dealing with Mr. Romoff is getting to the point, said Dr. Freddie Fu, one of those who has been able to build a professional relationship with Mr. Romoff that has evolved into a boon for UPMC.

Beginning in the mid-to-late 1980s, he met with Mr. Romoff and Dr. Detre to talk about sports medicine. "In the beginning, we all didn't understand each other," Dr. Fu recalled. "I was able somehow in my own way to convince them to support it."

In 2000 UPMC opened its state-of-the-art Sports Performance Complex on the South Side. It houses the UPMC Center for Sports Medicine and practice facilities for the Pittsburgh Steelers and the University of Pittsburgh football team.

"What he can do and not do is quite clear to me," said Dr. Fu, who is chairman of orthopedic surgery, which includes sports medicine. "He's not going to play two sides to me. If you can work within the [UPMC] system and understand how the system works, you can work with Jeff and be successful."

Dr. Fu certainly has been. UPMC is now considered a national leader in sports medicine and is planning a 100,000-square-foot sports medicine facility on the South Side.

Changes in life and style
Mr. Romoff's marriage to Michele M. McKenney -- his third -- ended in divorce in 2001. The two had met while planning UPMC's development of the $58 million Mediterranean Institute for Transplantation and Advanced Specialized Therapies center in Sicily. Ms. McKenney claimed in court filings that the 5¹/₂-year marriage was "irretrievably broken." She sold her share in their $399,900 Hampton home back to him for $1.

Now remarried, Ms. McKenney until recently was UPMC's president of diversified services, a job that included oversight of the Sicilian transplant center. She is retiring from UPMC Saturday.

To facilitate his work with the Sicilians, Mr. Romoff had begun taking Italian lessons from an Italian native, Stefania Ferrarese, then 35, who lived in Squirrel Hill. They married Dec. 26, 2002, in an intimate ceremony at Mr. Romoff's home. It was his fourth marriage. She was 22 years his junior.

Through exercise during the next two years, he lost 80 pounds -- he had weighed as much as 250. A year-round tan, nourished by trips to Florida and days on a 70-foot yacht he owned at the time, was accentuated by a more stylish off-the-rack wardrobe. The couple began attending Friday night theater, symphony and opera performances, where he would sometimes introduce his wife to stunned acquaintances with, "Have you met my daughter?"

While Mr. Romoff's physical makeover may have been due to his new wife, the transformation of his professional attitude can be traced to mid-2003, when it was announced that John Paul, the hospital system's executive vice president and chief financial officer, would be taking a six-month sabbatical.

Mr. Paul, a smart, tough negotiator, also had been chairman of UPMC's health insurance subsidiary. The social antithesis of the reclusive and aloof Mr. Romoff, he was gregarious and hands-on, often doing business on the golf course.

That's why the announcement three months later that he would not be returning was so shocking. Mr. Romoff said in a terse statement that Mr. Paul's return "would not serve his best interests or those of the UPMC." Mr. Paul declined to be interviewed for this story.

His departure meant that Mr. Romoff would take over many of Mr. Paul's responsibilities. That was "an eye opener," he said. "I hadn't appreciated the impact of the intangible issues of style, for lack of a better word."

He altered the way he related to co-workers, trying to be more personable. He remained direct to the point of being tactless, but, said a former associate, "You knew where he was coming from. He didn't get caught up in personalities [and] he was generally always true to his word. There was never any wondering."

More importantly, perhaps, Mr. Romoff saw that he didn't always have to be right. He claims nothing pleases him more now than to be among people "who are actually better than me."

He drives himself to the office. Once home, he continues working, using his BlackBerry and a PC to keep hospital projects flowing.

Mr. Romoff doesn't shy from unilateral decisions. One that created a stir was switching UPMC's multimillion-dollar advertising contract to the New York firm of his brother, Douglas. While the switch wasn't a complete surprise -- Douglas Romoff had worked for eight years as a sound and music subcontractor for other ad agencies that held the UPMC account -- it bothered many Pittsburghers, who inveighed in letters to the editor against "Mr. Romoff and his cronies at UPMC" running the health-care system "as their own private fiefdom." Douglas Romoff has since moved his office to Pittsburgh.

A subcommittee of the 61-member UPMC board vetted the decision to change ad agencies and approved it. In any $5 billion business, "the CEO is going to make multimillion-dollar decisions,'' said Mark J. Laskow, a member of the board's executive committee.

Other decisions from Mr. Romoff's office have been calculated to keep UPMC growing. In April 2003, it partnered with Highmark to acquire control of a Virginia-based biotechnology firm whose parent company was involved in producing the cloned sheep Dolly.

Five months later, UPMC hired the entire 20-person biosecurity team from Johns Hopkins University. That established the health system as an international leader in the field and guaranteed that it would continue to be among the leading recipients of National Institutes of Health grants. Last year, UPMC ranked eighth nationally, with about $347 million in NIH funds.

Other decisions have had unintended consequences. He hired Dr. Stanley Marks and his large and profitable oncology practice away from Allegheny General Hospital in 2000. He also made Dr. Marks director of clinical investigation at Pitt's Cancer Institute. That led to the departure, two years later, of Dr. Donald L. Trump, a prostate cancer expert who, as deputy director of clinical investigation, was passed over. Dr. Trump declined to comment for this story.

Dr. John Fung, who worked with Dr. Thomas E. Starzl and was UPMC's longtime chief of transplantation, left in 2004. Many others -- Dr. Bartley Griffith, former chief of cardiothoracic surgery; Dr. Jorge Reyes, a pediatric transplant surgeon; Dr. Arthur Feldman, chief of cardiology; Dr. Richard Baron, president of the University of Pittsburgh Physicians Practice Plan; and Dr. Peter Jannetta, chairman emeritus of neurosurgery -- also left.

"When you're an employee of the medical center, you take on the corporate mentality of the corporate entity," said Dr. Fung, who now is chairman of the department of general surgery at the Cleveland Clinic. "It's the building of a big empire versus what's good for the school of medicine. It didn't happen overnight. Slowly, the faculty's rights were taken away."

Dr. Griffith spent more than 20 years establishing a special heart and lung surgery unit and the McGowan Center for Artificial Organ Development, now known as the McGowan Institute for Regenerative Medicine. Though he left in 2001 to become chief of cardiac surgery at the University of Maryland Medical School, he would have preferred to stay at UPMC.

"I had spent a lot of effort trying to build something special," said Dr. Griffith, a Pittsburgh native. "I had hoped for a more balanced partnership between the hospital and the medical school.

"Jeff is an amazing person . . . I regret that I was unable to have him consider a view contrary to his own."

Some non-faculty employees expressed similar sentiments. While the health system's pay and benefits are considered excellent, the personal price is considerable. Former employees speak of a "sink-or-swim" mentality. "Nobody really wants to sink," said one long-time employee, who claimed she worked 70-hour weeks at the expense of missing her children's early childhood. "You would work your rear end off."

Jackie Scoglietti was let go from her position as director of accounts payable in June 2004 after more than 19 years. "To us, it always was a business as opposed to a health-care business. How the culture changed is that more was expected, to work harder, to take on more responsibility. Positions weren't filled. New facilities were added but not people. Working 40 hours [a week] was like working part-time."

Mr. Romoff dismisses such talk with the wave of a hand. UPMC's annual employee turnover rate averages 10 percent -- about 4,000 people. Not everyone will be happy, he said.

Technology ventures
His ambition to continually remake UPMC by integrating for-profit and not-for-profit business capabilities has led to the health system's foray into information technology and the commercialization of intellectual property. In addition, UPMC either owns or is associated with more than 100 partnerships and joint ventures. These include pre- and post-acute care facilities, international businesses, health plans, information technology companies and the transplant center in Sicily that opened in April 2004.

The importance of these efforts to Mr. Romoff is clear: He has described the push as "mini-Manhattan projects," referring to the feverish U.S. effort during World War II to build the first atomic bomb. It's part of a constant search to develop new products and new sources of revenue for UPMC by melding medical center breakthroughs with large technology vendors.

The hospital's first venture turned up roses: UPMC earned $36 million through the 2005 sale of Stentor Inc., a California company it helped to create. Stentor technology allows X-rays and other radiology images to be viewed over personal computer networks. And earlier this year, UPMC reached a $402 million agreement with IBM to integrate digitalized information for better patient care and lower costs.

The health system is consistently ranked among the nation's most innovative users of advanced information technology. That success, Mr. Romoff says, is a result of his being able to "sustain the vision" to pick "tomorrow things," ideas and possibilities that provide new opportunities for UPMC. He judges the success -- or failure -- of his choices only by their impact on the health system. Success and failure are not absolutes, he says, only relative concepts.

Just a few years ago, many people both inside and outside of UPMC wondered whether Mr. Romoff would become restless after the intense building cycle of the 1990s. But he merely continued building through his "mini-Manhattan projects."

It was not a revolution that brought UPMC to dominance, Mr. Romoff says, just logical steps in a process dictated by public policy or economic realities.

Mr. Romoff says the fact that some of the most critical of those steps have been counter-intuitive -- melding academic physicians and community physicians; incorporating a university hospital and community hospitals into a health system; pairing an insurance arm with a provider -- has everything to do with consistency of focus and management mien.

"I have always had a sense of what needed to be done," Mr. Romoff says. "I have not been driven by how I will fare in doing it. And that isn't a sense of false modesty. I'm not even putting a value on it. It just happens to be true."