Is there a doctor in the house?

UPMC does God's work, but someone needs to rein in its rapaciousness

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You know you've got an image problem when even your best deeds make people suspicious. That's where the University of Pittsburgh Medical Center finds itself, and the health care giant has no one to blame but itself.

We already know that UPMC has a split personality. It cares for the sick, conducts important research, employs workers, attracts talent and contributes megabucks to charities such as the Pittsburgh Promise college fund for city school graduates.

It also ruthlessly pursues a monopolistic empire, gobbling up once-independent health centers, building new hospitals near competitors to drive them out of business, amassing a fortune while providing less free care than it could, branching out to other countries and still refusing to pay its fair share for city services.

This bipolar disorder helps explain how UPMC could jump to send medical assistance to disaster-stricken Haiti more than 1,000 miles away and bring back a planeload of adoptive children, while simultaneously closing the only hospital in one of the poorest communities in the county just a few miles from its Downtown headquarters.

Good thing none of those Haitian kids was headed to Braddock. Today, the town's sole medical center is scheduled to be officially shuttered by its multi-billion-dollar corporate owner. No wonder folks in and around Braddock think the Haiti mission was more self-promotional than humanitarian.

Maybe that's not fair and this is a case of no good deed going unpunished. UPMC couldn't sustain itself if all its hospitals lost money at the rate of Braddock. But the fact is, they don't. They make money -- scads of it. Otherwise, the "nonprofit" couldn't afford CEO Jeffrey Romoff's Wall Street-style paychecks.

Rising to a crisis abroad is a good thing, but it won't paper over deserting thousands of folks at home -- especially when UPMC is sinking millions into a new hospital in Monroeville, a wealthier community that already has one (at least for now).

Headquarters did offer jobs elsewhere in the UPMC system to displaced Braddock workers deemed qualified, which beats the heck out of laying everybody off. But it still drains the lifeblood out of a place with little to spare. It also leaves the hospital's 100-year-old building empty, another kick in the gut to a scrappy town that's already absorbed more than its share of blows.

UPMC officials say the hospital was underutilized, and it probably was. But with their charitable obligation and fat bottom line, they could have downsized it, established an urgent care center in its place or at least given the community a fighting chance to find another operator. Instead, they pulled the plug.

They insist they are not abandoning the town, that clinical operations will be available at other locations. That's a bit like Dad telling the kids that he's moving away and if they break an ankle they can go see their uncle in McKeesport. It's better than nothing, but where's the love?

Love, of course, has nothing to do with it. For UPMC management, it's business, not personal. But if there's anything patients take personally, it's medical treatment that makes the difference between life and death.

I don't claim to fully understand health care economics in this country. It's clear, though, that health care monopolies are bad for the public health. They drive up costs, dictate practices, threaten would-be competitors, bully workers, intimidate suppliers and leave professionals who might object with no place else to go. And once they have the market all to themselves, they can pull out of the least-profitable operations with few consequences beyond bad PR.

We're not quite there yet -- the West Penn-Allegheny system still operates seven facilities in this corner of the state -- but UPMC is so much bigger and more profitable, we are marching inexorably in that direction.

UPMC doctors, presumably committed to a healthy populace, understand the perils of a monopoly as well as anyone. And if anyone could grab the moral high ground, they could. Why aren't they coming out in droves to protest UPMC's predatory side?

Probably because it would be professional suicide. UPMC controls so much of the market, wields so much influence and rakes in so many government grants, those who make a stink risk writing their own doom. That's the beauty of bigness -- it is its own best defense. On the other hand, if a whole army of doctors stood together on this, well, the corporation couldn't fire everybody. Could it?

It's no accident that most criticism of the way Braddock was closed is coming from citizens with nothing left to lose. In 2008, they managed to shame UPMC into reversing the closing of House of Hope, a tiny program in Braddock that reduced infant mortality by taking in homeless, drug-addicted pregnant women and new mothers. That was small potatoes compared to a money-losing hospital, and public fury hasn't worked this time.

Criticism is also coming from officials and medical staff outside the UPMC system, who can always be accused of ulterior motives no matter how right they may be.

The medical side of UPMC is doing God's work; I and countless others are living testament to that. But the corporate side sometimes seems to have made a deal with the devil.

If this is the only way they can operate, it's time to change the equation. Get the feds in here for some old-fashioned trust-busting, and let a level field compete for the public's health care dollars and good will.

Corporatized health care is a ship that sailed long ago, but it doesn't have to be steered by megalomania.

Sally Kalson is a staff writer and columnist for the Post-Gazette ( , 412 263-1610).


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