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UNIVERSITY OF MINNESOTA HOSPITALS AND CLINICS

BOARD OF GOVERNORS

BOARD OF GOVERNORS' MEETING

AND

GOVE~~ORS' CO~ITTEE MEETINGS

JUNEs 1984

OFFICE OF THE BOARD OF GOVERNORS

B-390 MAYO

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- CON TEN T S -

Agenda •••••••• ~ ••••••••••••••••••••••••••••••••••••••••••••••••••••••••••

Minutes of May 23, 1984 •••••.••••••••••....••.•••.•••••••••••..••...•.•.

Credentials Committee Report &Recommendations 1984-85 •••••••••••••••••••

Committee Chairmen Appointments 1984-85•••••••••••••••••••••••••••••••••••

Clinical Chief Reappointments 1984-85•••••••••••••••••••••••••••••••••••••

Report of Operations 7/1/83 - 5/31/84 ••••••••••••••••••••••••••••••••••••

Statement of Operations 7/1/83 - 5/31/84 ••••••••••••••••••••••••••••••••

Joint Conference Committee Minutes of June 13, 1984 Meeting ••••••••••••••

Finance Committee Minutes of May 23, 1984 •••••••••••••••••••••••••••••••

Minutes of Joint Meeting of Finance Committee and the Planningand Development Committee May 23, 1984 ••••••••••••••••••••••••••••••••••

The Best Medical Specialists in the U.S. {Town &County Magazi~eExclusive Directory, June, 1984 Issue) ••••••••••••••••••••••••••••••••••

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University of Minnesota Hospitals and Clinics

Board of Governors

June 20, 1984

1:30 P.M.

Dale Shepherd Room - Campus Club

Coffman Memorial Union

University of Minnesota Campus

Agenda

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I. Minutes - May 23, 1984

II. Chairman's Report - Mr. David Cost, Board Chair

III. Hospital Director's Report - Mr. C. Edward Schwartz, Hospital Director

IV. Committee Reports

1. Credentials Committee Report & Recommendations 1984-852. Committee Chairmen Appointments 1984-853. Clinical Chief Reappointments 1984-854. Clinical Chiefs Retreat Report5. Nurses Strike Update

1. Renovation Renewal Committee Update2. ~i&C Capital Gifts Planning Study3. Purchasing Update4. Unit J. Progress Report

1. May Year to Date Financial Statements2. Hospital Budget 1984-85 - Operating & Capital

(Approval)

(Information)

(Information)

(Approval)(Approval)(Approval)(Information)(Information)

(Information)(Information)(Information)(Information)

(Information)(Endorsement)

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V• ..,J\djournment

- TOUR OF NEW THERAPEUTIC RADIOLOGY FACILITY I~fEDIATELY FOLLOWING MEETING -

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IMinutes

Board of Governors

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University of Minnesota Hospitals and Clinics

May 23, 1984

Carl DrakeDavid LillyPaul Quie, M.D.

Absent:

Chairman Cost also announced the dates for the Fall Board Retreatand asked that members reserve September 4 - 6, 1984 for the trip toMinnesuing Acres in Wisconsin. Mr. Robert Latz noted his unavailabilityon those dates. Chairman Cost asked that the Board members begin givingthought to the retreat agenda, as they would be asked for input in thenear future.

Chairman Cost noted the May 22nd dedication of the new TheraneuticRadiology facility and acknowledged the nresence of several Boardmembers at that event. President C. Peter Magrath and Vice PresidentNeal A. Vanselow joined Dr. Seymour Levitt and Mr. C. Edward Schwartzin marking the occasion with a brief ribbon cutting ceremony. ChairmanOost asked for a show of interest in a tour of the facility for thoseBoard members who were unable to attend the dedication and asked thatarrangements be made for a tour immediately following the June 20thBoard meeting.

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Chairman David Cost called the May 23, 1984 meeting of the Boardof Governors to order at 1:40 p.m., in Room 555 Diehl Hall.

Chairman David Cost introduced Ms. Sally E. Howard, the newly appointedHealth Sciences Public Relations Director. Mr. Cost highlightedMs. Howard's educational background and experience and welcomed Sallyto the University on behalf of .the Hospitals Board of Governors.

The Board seconded and unanimously passed a motion to annrove theminutes of the April 25, 1984 meeting as written.

Present: David Cost, ChairPhyllis EllisAl FranceRobert Goltz, M.D.Al HanserLynn HornquistRobert LatzJ. E. MeilahnVirgil MolineBarbara O'GradyC. Edward SchwartzNeal A. Vanselow, M.D.

INTRODUCTIONS:

ATTENDANCE:

CALLTOORDER:

CHAIR.\1AN'SREPORT:

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~I APPROVALOFMINUTES:

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Mr. Schwartz presented the fiscal year 1984-85 InstitutionalObjectives for the Board review, noting that both the Planning andDevelopment and the Joint Conference Committees had reviewed and commentedon the document. He highlighted the six categories of objectives forthe Board and indicated that two additional objectives, one on BiomedicalEthics and one on a Clinical Program Development Fund were in the processof being drafted for inclusion. With the understanding that these twoobjectives would be added, the Board seconded and unanimously ?assed amotion to approve the objectives.

Lastly, Mr. Schwartz invited the Board members to attend a receptionin honor of Dr. Eugene Gedgaudas immediately following the Board meeting.He explained that Dr. Gedgaudas t Chairman of Radiology, was being honoredfor his recent election as President-Elect of the American RoentgenRay Society.

Thirdly, Mr. Schwartz apprised the Board of the potential for a JuneMinnesota Nurses Association (MNA) strike. On May 21st, he reported,the MNA had given the employer group, Health Employers Inc., noticeof intent to strike on Friday, June 1st. Mr. Schwartz indicated thatthe University of Minnesota Hospitals and Clinics had been workingwith the Hennepin County Medical Society in the development of a strikecontingency plan and that the objective of the University Hospitalsduring a strike would be ensure the aVailability of services for thosepatients in need of medical care.

Committee Chair Al France introduced three Finance Committee itemsincluding the year to date April financial reports, the 1984-85Budget, and the 1984-85 Employee Compensation Plan and asked Mr. CliffFearing to detail the first of those three items. During the month ofApril, Mr. Fearing reported t total admissions were just 22 below budgetlevels. Further, he indicated, due to a lower overall length of stayfor the month, the patient day total of 14,099 was about 2,000 days belowthe budget level. The average length of stay for April was 8.7 days.'Recapping the year to date inpatient census, Mr. Fearing reported a 2.57negative variance in admissions, a 5.2% negative variance in averagelength of stay and a 6.5% negative variance in ?atient days. Additionally,he reported that the outpatient census year to date remains slightly aboveprojected visits.

Secondly, Mr. Schwartz reviewed for the Board the progress made to dateon the recommendations of the Cost Containment Task Force. In sum,he noted, that a majority of those objectives could be classified ashaving been accomplished, while another substantial portion arecurrently in process. Discussion followed regarding the impact onhospital operations that the implementation of these recommendationshave had. Mr. Latz suggested that it would be useful, if possible,to quantify and document this impact t while Chairman Cost suggested thatthe Cost Containment Task Force members might be interested in knowingof the progress made.

FINANCECOMMITTEEREPORT:

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Mr. Fearing summarized the Hospitals Statement of Operations as showinga total of revenue over expenses of about $8 million. This favorablevariance, he explained, continues to be due to a larger than expectedinvestment income. Turning to accounts receivable, Mr. Fearing reporteda balance of patient accounts receivable as of April 30. 1984 of almost$42 million with an average of 84.9 days of revenue outstanding. Thisincrease in receivables, he explained, occurred primarily in the MedicalAssistance, commercial insurance and HMO categories. Board discussionfollowed regarding hospital industry practices in the handling ofaccounts receivable.

Mr. Al France introduced the second major Finance Committee item, theBudget for the 1984-85 Fiscal Year, noting that the volatility of the1983-84 census and revenue levels necessitated the development of twoseparate operating budgets. The two budgets, he explained, were developedusing two different sets of assumptions regarding utilization levels.The first, or the base budget, assumes the patient day level of 178,861patient days, while the second, or the contingency budget, assumes apatient day level of 163,465. With the background Mr. Cliff Fearingdetailed the two separate budgets for the Board. Highlights of thatbudget review included the fact that both budgets are based on a 7%rate increase, both incorporate the Cost Containment Task Forcerecommendations, both provide the necessarv cash flow to fund thefinancing obligations resulting from the Renewal Project Bondingand both provide, in sum, the capital and operating resources necessaryand essential to fulfill the hospitals mission. Substantial Boarddiscussion followed regarding ~he criteria and methodology that wouldbe applied in determining whether the base or the contingency budgetwould be better utilized. In conclusion, the Board agreed to reconsiderthe Operating Budget at the June 20th meeting.

Per Mr. France's request, Mr. Greg Hart presented proposed CapitalEquipment and Remodeling/Renovation Budget for the fiscal year 1984-85.Mr. Hart detailed the five year capital budget projections, theequipment items of $100,000 or more and the 1984-85 detailed equipmentbudget by department for the Board. Highlights of Mr. Hart's presentationincluded the idea that Diagnostic Radiology, Labs, Operating Rooms,Patient Monitoring and Respiratory Therapy represent the departmentsthat customarily have the larger capital equipment expenditures and thatthe idea that a five year capital equipment plan this year would facilitatethe prudent planning for both recurring capital and Unit J new equipmentneeds. Board discussion followed regarding the idea that budget approvalof a large non-recurring capital expense is not intended, in any way,to eliminate the need for subsequent program analysis to determine thewisdom of purchasing these respective pieces of machinery. Mr. Hartasked that the Board review the Capital Budget over the course of thenext month in anticipation of a second review for approval at the June 20thmeeting.

Mr. Hart also presented the Annual Employeee Compensation Plan, notingthat annual Board approval of the plan is required by the new PersonnelPolicies and Procedures. The basic plans increases, he explained, followthose of the University very closely. The plan included in the followingcomponents: A 4.5% increase salary scales and individual employeeesalaries effective July 1, 1984; an additional 1.0% increase effectiveJanuary 1, 1985; comparable worth adjustments for employees in 35 jobclassifications amounting to approximately $475,000; $900,000 in market

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place related salary adjustments for a number of classifications,two-thirds of which are in nursing related classes. Each of thecomponents :of the plan, Mr. Hart explained, are incorporated intothe 1984-85 budget projections. Following brief discussion theBoard seconded and unanimously passed a motion to approve theAnnual Employee Compensation Plan as written.

2930 NSF6750 NSF1900 NSF

500 NSF200 NSF

1200 NSF

EndoscopyCardiopulmonary LabsNutritionMaterials ManagementTherapeutic RadiologyPediatric Dialysis

The Board seconded and unanimously passed the resolution as written •

2. Detailed planning, department review and constructionshall commence on all spaces listed, total planning andconstruction costs not to exceed $2.4 million.

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1. The allocation of Unit J shell space be accomplishedin accordance with the s.:~.ematic drawing date Mav 8.1984. Approximate assignments of space are as follows:

Thirdly, Mr. Hanser presented background information on the optionsconsidered for the allocation of Unit "J" shell space 'and proposedthe following resolution for the allocation of that unfinished spacein Unit "J".

RESOLUTION

Mr. Hanser reported that 99% of all bid packages for the Unit "J"project had been awarded and that the project remains on schedule forsubstantial completion by March, 1986. Mr. Hanser also apprised theBoard of a current issue regarding the installation of coaxial cablein Unit "J" and whether that cable would most appropriately be installedby the Northwestern Bell Telephone workers or by the Electrical Repairand Construction workers. Although the telephone workers hid was wellbelow that of the electrical workers, he explained, the electrical workers,on the national level, have been disputing the issuance of coaxial cablecontracts to telephone workers.

Committee Chair Al Hanser introduced three items covered at theMay 9th Planning and Development Committee meeting including aRenewal & Renovation Steering Committee Report, the Allocation ofShell Space in Unit J, and a status report on the ExtracorporealLithothripter. He noted that the allocation of shell space itemwould require Board approval and that the scheduled Planning andDevelopment Committee review of the Bentz, Whaley, Flessner & AssociatesCapital Gifts Planning Study had been postponed until the June meeting.

RESOLUTION:

PLANNINGANDDEVELOPMENTCOMMITTEEREPORT:

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JOINTCONFERENCECOMMITTEEREPORT:

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Lastly, Mr. Hanser noted that hospital representatives had met withrepresentatives of the Dornier Corporation, manufacturer of the!Xtracorporeal Lithothripter. He indicated that as FDA approvalof the Llthothripter is not expected until late 1984 or early 1985,that the Domier Corporation is not prepared to develop agreementsfor acquisition of this technology at present. He did note thatthe Dornier representatives are well aware of the continued intereston the part of the University Hospitals in obtaining a Lithothripterand that Dr. Fraley would continue to communicate closely with thecorporation.

Committee Chair Barbara O'Grady reviewed three items from the May 9thJoint Conference Committee meeting for the Board. The first item she

<explained,involved a case study recently reviewed by the Biomedical EthicsCommittee which raised several ethical issues. Following a briefdescription of the case, Mrs. O'Grady indicated that a satisfactoryconclusion had been reached in this difficult case and that theBiomedical Ethics Committee expected that cases such as these wouldlikely become more frequent in the future. In anticipation of theincreased frequency of such cases, the Biomedical Ethics Committee is inthe process of developing guidelines for this consultative role, andMrs. O'Grady indicated that the Joint Conference Committee had askedto review these guidelines.

Secondly, Mrs. O'Grady summarized the Clinical Chiefs Report presentedto the Joint Conference Committee, noting that the Clinical Chiefsare planning a second retreat on June 9, 19~4. The focus of thatRetreat, she reported, will be on program development, volume levelsand marketing. The Chiefs and the Hospitals are also in the processof review the organization and financing of ambulatory care at thehospitals with the assistance of a Seattle based consulting firm.Mrs. O'Grady noted that this study is expected to begin shortly.

Thirdly, Mrs. O'Grady reported that the Joint Conference Committeehad passed a resolution commending Dr. Paul Ollie for his outstandingcontribution over the course of the past five years to the Joint ConferenceCommittee and the Board of Governors in his role as Chief of Staff.Mr. Schwartz assured the Board that there would be ample opportunityto honor Dr. Ollie for his contributions at a formal event being plannedfor the month of July.

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ADJOURNMENT: There being no further business,the meeting of the Hospital Board ofGovernors was adjourned at 4:15 p.m.

Respectfully submitted,

:::;;l:d~~Executive Assistant

to the Board of Governors

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HEAl1H SCIENCES

H8/cf

TO: Board of Governors

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Henry Buchwald, M.D.Chairman, Credentials Committ

Credentials Committee Report &Recommendations 1984/1985

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UNIVERSITY OF MINNESOTA Unlversll)' Hospitals and CliniCSTWIN CITIES 420 Delaware Streel S E

Minneapolis Minnesota 55455

FROM:

May 21, 1984

The Credentials Committee having considered the reappointment of MedicalStaff including the recommendations from the clinical chief of each service,and documentation of the required malpractice insurance, hereby recommendall those included in the Credentials Committee reoort (pages 1 - 25) forreappointment to the Medical/Dental Staff for 1984/1985.

SUBJECT :

Also included are the Credentials Committee's recommendations for RegularMedical/Dental Staff appointments (page 26); change in staff category andaddition of clinical privileges (page 27); Provisional Medical/Dental Staffappointments and requests for clinical privileges (page 28); SpecifiedProfessional Personnel Appointment &Psychology Privileges (page 28);Clinical Chief recommendation for termination of Medical Staff appointment(page 29); and resignations from the Medical/Dental Staff (page 30).

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~IvtRSITY OF ~~~ESOTA HOSPITAlS & ClIKICS

MIDICAl ~~D DEKTAl STAFF RtAPPOI~TMr~TS JVLY I, 1964 JL~r 3D, 1955

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DEPARnI!KT OF ANESTHESIOLOGY

William W. Anderson

Kumar G. Belani

. Joseph C. Belshe

Jon F. Berlauk

Joseph Buckley

James F. Curn=ing

Jorge Estrin

Ian J. Gilmour

John Gordon

Ed...·ard Han iSl.:h

Dou~las Koehnt0?

Russell Larse"

Ji-C~;ia Liao

Jos€j:'hine !\. Lo

Euge;"l€ R. Lucier

l..'en "i. "iue

CATEGORY

Attending

Attending

Cl inical

Attending

Attending

Attending

Attending

Attending

Attendin~

Attending

Attendin;

Attending

Attendin~

Attendin~

Clinical

C1 inical

JOINT APPOIKr~Z~:TS

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UNIVERSITY OF MlNNESOTA HOSPITALS & CLINICS

M!DICAL AND DENTAL STAFF REAPPOINTMENTS JrLY 1, 1984 JL~E 30, 19£5

HOSPITAL DENTISTRY CATEGORY

James L. Baker Cl inical

Carl L. Bandt Clinical

Richard R. Bevis Attending

Gerald D. Cavanaugh Clinical

David Clay Cl inical .:

Richard T. Ford Cl inical

James R. Fricton Attending

Daniel J. Gatto Attending

Richard J. Goodkind Clinical

Robert J. Gorlin Attending

Ja::les L Hinrichs Clinical

Nor::-.a n O. Holte Attending

Mark Jaspers Clinical

Ja::les R. Jensen Attendin;

James R. Jensen, Jr. Clinical

V:ill ia::-. H. Ku."11 r:1ann Clinical

Hak-Joo K...·on Attending

Ronald Eo LaBelle Clinical

Thor..a s D. Larson Clinical

~li chad \.: . Lehnert Attendinf,:

Myer S. Leonard Attending

Andre ...· T. Horstad Clinical

Dale Olson Clinical

Allan D. Petersen Cl inical

Bruce L. Pihl strom Attending

Edgar Rajek C1 inica1

Herbert \oJ. Schul te At tendint,

Mark S. Simmons ClinicLJl

T. J-li chad Spddel Attending

J-lichael J • Till Attending

Robert Vickers AttenMng

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UNl\~RSlTY OF Ml~~ESOTA HOSPITAlS & CLl~lCS

MEDICAl A.~D DE~TAl STAFF JU:.APPOl~rME~TS JL"l"i 1. 198':' - JL~,t 3D, 19E5II~

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HOSPITAl Dr~11SrR"i CO~TI~~LD

Daniel E. Waite

PaulO. Walker

. Carl J. Witkop

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CATEGORY

At tending

Cl inicaI

Attending

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tn\lVIRS1TY OF HlN!'ESOTA HOSP]TALS 6. CL11\lC5

M!~lCAl ~~D DE~!Al STAFF R!APP01l\TME~jS JVLY 1. 1984 JL~r 3D. 19E5II~

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DEPART!'!ETG OF DEF:..'1ATOLOGY

Bruce J. BaTt

Carrett T. Bayrd

Mark V. Dahl

John Fenyk

William Gentry. Jr.

Robe Tt Gol t z

Noel A. Hau~e

Maria Horclinsky

~illarcl C. Pete"son

Steyen E. Pra....e.

H~ro1c G. Rayit5

J. Con.•in Vance

c. GC'rci~;1 \'au;~.:-:

AJYin S. Z~licks~;1

CATEGORY

Clinical

Clinical

Attending

Cl inical

At tendint:

Attendint:

Clinical

Attending

Cl inicaJ

C1 inicaJ

C1 inicaJ

Attencbf

C1 inical

Clinical

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~IVERSITY or MlN~ESOTA HOSPITAlS & CLINICSI

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M!DICAl A~~ DE~TAl STArF R!APPOI~T~Z~TS JtLY 1, 198~

DEPART!1[~T OF r~nLY PRACTlCE CATEGORY& CO:-r-ll~In HEALTH

Sharon Smith Allen Cl inical

'n1omas M. Altemeier Attending

James Canine Attending

Edward Ciriacy Attending

Joseph P. Connolly Attending

~ichael L. Daly Attending

John T. Kelly Attending

John \0.'. J-!cConnell Attending

Jok B. O'Leary Clinical

Share:,: B. Satter:ielc Attending

Harde C. Sei~ Clinical

Leif !. SC'!:,e:-b Clinical

Jol1n r. \" e:-~': A... ! en : i:i t:

JL'~;[ 3D, 1955

JOINT APPOINr-Z~;'7::

Psycr.:iaay

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tmlVERSln' OF MI~~tSOTA HOSPITALS 6. Cllt\ICS

MEDICAl oU\D Dt~TAL STArF JU:APPOlt\TMI:~TS J1"lY 1.1964 Jl'!,E 3D. 1965

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DEPARn:nn OF LABORATORY Mr!'l Cll'i'T6. PATHOl.OGY

Diane C. Art hur

Fritz Bach

Henry Balfour

Bonnie S. Bean

Ellis Benson

Robert J. Bo.~an

G. Mary Bradley

Dayid l-l. Bro\.'11

Richard Bru~ninb

Barbara BurkE

DCI~ald P. Connell,

lClui.s P. De~~er

J. R2fH Edson

R:charc D. I.stensen

Patricia Ferrieri

Gla:.:cC' Frizzera

K. Gajl-Feczalska

Dua~e HaS€fa...·a

Jo:-:n KErsey

larry c. las~:y

Angeline R. Mas:ri

John J. McCullouf:-:

Rebert ~. McKenn~

Ja~e5 J. O'leary

Juan Rosai

Richard K. Sibley

Dale C. Snover

Michael ~. Steffe~

R. -Sorot hy Sundb(-rb

Joo Ho Sung

Lee ~. ~attenb€Tg

JOTS£- J. Yunis

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CATEC,ORY

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Pediatrics

Pediatrics

Pediatric 5

Peciatric!'"

Pecia:rics

Peciatrics

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~l\~RSITi OF Ml~~ESOTA HOSPITALS & CLI~lCS

MEDICAL A~D DE~TAL STAFF REAPPOI~!}EKTS JrLY 1. 1984 J~~E 30. 1985

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* Outstanding Malpractice Information Forms

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DEPARTMEKT OF MEDICI~E

John 1. Allen

Silvia H. Azar

Robert J. Bache

John Bantle

Jose Barbosa

Da"id Bendi tt

Jonathan Bishop

Jose?h R. Bloom~r

Clara Bloo;;.:ield

~alcolr K. Blumenthal

J0h~ n. Bend, Jr.

Jose?h ~. Cardamone

J2:" ~. Cohn

De:1rlis L. Confer

\.\'alter Dornan

Ronald E££ert

Thor7'.as r. Ferr i 5

Patrid: J. Flynn

Benja~i:1 Fuller, Jr.

Joyce 1. Funke

Robert L. Gebhard

Ste?hen Gilberstadt

Richard F. Gillum

Frederick C. Goetz

Dale E. Hammerschmidt

Daniel Ha thal,.'''y

Robert P. Hebhd

~inda L. Hedemark

Marshall I. Hertz

CATEGORY

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Attendin£

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Clini cal

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UNIVERSITY OF MINNESOTA HOSPITALS & CLINICS

MEDICAL AND DENTAL STAFF REAPPOINTMENTS JULY 1, 1984 JUNE 30, 1985

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DEPARTMENT OF MEDICINE CONTINUED:

Charles A. Herzog

David C. Bomans

Bryon J. Hoogwerf

Thomas H. Hostetter

Robert Howe

William Hrushesky

Donald B. Hunninghake

David Hurd

Scott Hutton

Harry S. Jacob

Fran E. Kaiser

Kal1e Kang

Lawrence Kaplan

Joseph R. Kelly

B. J. Kennedy

David T. Kiang

Richard King

Robert G. Knodell

Thomas Eo Kottke

Richard Kronenberg

John W. LaBree

Stuart Lancer

Robert Lasser

Herbert Lauritzen

Wayne F. Leebaw

Irving Lerner

T. Barry Levine

John I. Levitt

F. Bruce Le....is

Constantinos Limas

Michael Lobell

Phillip Wm. Ludwig

Russell V. Leupker

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CATEGORY

Attending

Attending

Attending

Attending

Attending

Attending

Attending

Attending

Attending

Attending

Clinical

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Clinical

Clinical

Attending

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Clinical

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Clinical

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Clinical

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Attending

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MEDICAL AND DENTAl STAFF REAPPOINTMENTS JUlY 1. 1984 JUNE 30. 1985

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DEPARTMENT OF MEDICINE COl-."TINUED:

Sharon D. Luikart

Raymond L. Marecek

Cary N. Mariash

Robert J. McCollister

Philip McGlave

James L. McKenna

Nancy L. Meryhew

Ronald P. Messner

Wesley Miller

Charles Moldo,",

M. J. Murray

William O'Brien

Jack H. Oppenheimer

Mark S. Paller

Bruce Peterson

David Pli.lIlpton

David Plut

Richard A. Pfohl

Claire Pomeroy

Brian H. Rank

Fred Rasp

Frank S. Rhame

Fred A. Rice

Kathryn L. Rice

Stephen C. Riendl

Thomas J. Rose

Joseph M. Ryan

reon D. Sabath

Mark Schmidt

Eric Schned

William Schoenwetter

LaWTence D. Schuster

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CATEGORY

Attending

Clinical

Attending

Attending

Attending

Clinical

Attending

Attending

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Clinical

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Clinical

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Clinical

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Clinical

JOINT APPOINTMENT

Laboratory Medicine & Path.

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~IVERSITY OF MINNESOTA HOSPITALS & CLINICS

MEDICAL ~~D DENTAL STAFF REAPPOINTMENTS JULY 1, 1984 JUNE 30, 19E5

DEPAR~ff~T OF MEDICINE CONTINUED: CATEGORY

Jeffrey S. Schwartz Attending

Peter T. Silberstein Attending

Stephen E. Silvis Clinical

Thomas R. Smith Clinical

Ronald D. Soltis Attending ..,.

* Wesley \0.' • Spink Emeritus

Masanao Takahaski Clinical

Joel D. Taurog Attendin~

Robert J. Tierney Clinical

Louis Tobian Attending

Joserh To::-:bers Clinical

Dace 1. Trenee Clinical

Naip Tuna Attending

NEal A. \' an se10\,' Attending

Jack A. Vermes Clinical

Gregory t-!. Vereell ot t i Attending

Yar1g \..'ang Att end i nt:

John Arnold ~ang:1€'ss Clinical

Dar1iel J. \.,'eisdorf Attending

1. Dodd \o,'il son Attending

C. Paul \o,'inehell Attending

David C. Zosehk(· Attending

* Outstanding Malpractice Information Forms-10-

17

lml\'IRSI TY OF Mlf\"KtSOTA HOSPI TAlS & ClIl;1 CS

MrDICAl A~D Dt~TAl STAFF RtAPP01~TMr~TS JrLY I, 190~ Jt~;I 3D, 19~5

II~

IIIIIII~I

IIIIII

I~

II

DtPARnlr~T OF NEUROLOGY

Cary Birnbaum

Daniel E. Cohen

Miguel E. 1iol

John R. Gates

Robert J. CUDrli t

Ronald 1. Jacobson

~il1ia= R. Kennedy

Arthur C. Klassen

Da\"id KnC'pr1an

~YOU:1~ C. Lee

11C' E. Let';ik

La~rence A. Lock~~~

Ja~es A. M0riarty

Venkat Ra~.ani

Joser:-: A. Resch

Robert 1. Roe10fs

Phyllis L S":"ler

Ste?he~ A. Sr.:ith

Ke~,eth r. S~ai~a:1

rf:rna~d.:' Torres

-11-

CATEGORY

Attending

Attending

C1 inicaJ

At tending

Attending

At tending

Attending

Attending

At tendin£

Attendin£

Atte~dbf

Atte~cb~

Attendinf

Attencin~

Attending

Attending

Attendint:

Cl inical

At tendinf

Attending

JOI~T APP()l~~~~~S

Pediatrics

Peciatrics

Pediatrics

Pediatrics

18

•.~

•II•

IIII!~

IIIIIII•

~~II

"tml\1£RSln' OF M!~'1\ESOTA HOSPlrALS l. Cll~,l CS

Mr'lCAl A~~ DE~jAl STAFF REAPPOl~TMr~TS JrlY 1. 1984 Jl~,L 30. 19E5

DEPARnl!~T OF ~"EtTROStTRGrRY CATEGORY

Shelley N. Chou At tendingDonal d Erickson Attending

Lyle A. Trench Attending

Stephen J. Haines AttendingRobert r. Ma x\"e11 AttendingCaylan L. Rocks....·C'1 d C1 inica1Ed....·ard L. Seljeskog AttendingDennis A. Turner AttendingErich S. \o.'isiC'l Clinical

-12-19

20

JOI~T APPOn::-"~':;

laboratC'ry Medi~inf & Path.

Psychiatry

Laboratory MedicinE &Path.

Attend:in~

Attenc:i71;

Atteildin~

Clinical

Clinical

Clinical

Attendin~

Attending

Attendin~

Attendini:

CJinical

Clinical

At t endi n;

C1inical

Attenciilg

Cli~ical

-13-

ra~~as~i Oka;:aU

Shaila A. Phansev

KC':la} d A. Pre;:,

JC'~:; E. Sa\'af.(

Le-sliE- A. SharpE

Gaiu!'. J. SlC'ssH, ]]

CharlE-s A. StE-~E-~~n

Geor~E- E. Ta~at z

ROgH C. Toffle

L~o B. r""ig!-,s

Preston P. ~illiam~

[rn~sl C. ~ynn(, J))

J oh~ ~~7:".. ~:Q:::"

TheC':i("r", !\a~f-l

~l\~RSITY OF Ml~~£SOTA HOSPITALS , Cll~ICS

MrD1CAl. A.'\D D£~TAl. STAFF RIAPPOI!\T!iE~T5 JLTY 1. 1984

D£PAR~lr~T OF OB~TrTRICS & r.)~rC0L0r.Y CATrr.0F.Y

Leon Adcock Attendin~

Arthur H. Bearon Clinical

Irvin~ C. Bernst ein Clinical

Doris C. Brooker Attending

Julius But leT At tending

Harry F. Farb Clinical

JC'hn D. Fan Clinical

Peter E. Fehr Clinical

}iC"",ard \-:. Fi~her Clinical

lia,ry rC'Te:7;a~ Attendin£

~a,~ly~ S. Joseph Atten~ing

Th::'=.2~ ~~. Jl;lia7'; Atte:lcin;

Be~i Katz Clinical

II~

IIIIIIIcI

IIIIII

I~II

~lvtRS!TY or ~NKESOTA HOSPITALS , CLI~lCS

Mr~:C.~ A~D Dr~TAl STArr R£APP01~T~~~!S JULY 1. 198~ Jt~\E 3D. 19£5

II~

IIIIIII~I

IIIIII

I,II

DrPAR~~T or OPH!li~L~vLOr.Y

J. Douglas Cameron

Herbert L. Cantrill

. Donald Doughman

~illia~ H. Kn~bloch

R~bert LetsC'n

Richard L. LindstrC'IT.

John Da~iel ~elso~

Jonatha~ E. PedersC'n

RC'bert c. Ra~s2Y

Ge;:,r~E:- T. T.3:-::

CATrGORY

Attending

Attending

Attending

Attending

Attending

Attending

Attending

Attencing

Attendin~

Clinica}

Attencinf

JOIN! APPOn,T~t~:'T

. _ .'_·_~"4'__." ' ...._ ........ _ ........... - --~.-.......- -_._..... -~. "-',- -.--, -- ----.--..' ... -- ---.... ..-------.. -

~IVERSITY OF M!~KESOTA HOSPITAlS & CLIKJCS

MrDICAl A~~ DEKTAl STAFF RtAPPOIKTMt~IS J~lY 1, 19S~ Jt~;l 3D, 1955

..

I

i"'"IIIIIIII"IIIIII

I~II

DEPARTH!~1 OF ORTH0PAEDIC St~GERY

Alfred F. Behrens

David Bradford

Edward V. Craig

James H. House

Robert E. Hunter

John Lonstein

John H. Moe

JaT:les l.I'. OSi1 \'ie

Janes D. Priest

Harry J. Robins~n, Jr.

Rob: C. T.~~m~son

Fra~cis J. Trost

Robert l.I·i~ter

-15-

CATEGORY

C1 inica1

Attending

Attending

Attending

Attending

Attendinf,

Emeritus

Attending

C1 inica1

Attending

Attendin~

C1 inical

Attencin~

. - ..._•... _.._ ...... -- •.-, .. - I,,, -... •.•.• -.- ,'~.", _._. ..... '•

22

In\l VI.RSln· OF HlNNESOTA HOSPl!AlS & CLn,l CS

MrD1CAL A~D DE~TAl STAfF R£A?P01~T~~T5 JrlY l, 198~

II~

IIIIIIII~

IIIIII

I~II

D!PART!'1!XT Of OTClLARYNr.OL0GY

George Adams

Norman T. Berlinger

Lawrence R. Boies, Jr.

Arndt J. Duvall

£krern Gozu;r.

Peter A. Hilger

Timothy T. K. Jun~

Severin H. KoC't'

Ste?~en 1. listC'n

RC'bert !'~Qi sel

Kurt PclJa~

-H>-

CATEG0RY

Attending

Attending

Clinical

Attending

Clinical

Attending

Attending

Cl ini cal

At tencbg

Attendinb

At tencing

At ten cin/=

Clin::al

Cl bical

CJ ini cel

Jl~;r 3D, 19E,S

23

~1\~RSITi or ~~~ESOTA HOSPITAlS & Cll~lCS

MEDICAl AKD DE~TAl STAff JU:A.PP01~nZr\TS Jl1."i 1, 1984

I

I.~r

IIIIIII~I

IIIIII

I~II

DEPARn-IPiT or PEDIATRICS

Don P. Azoren

Arnold S. Anderson

Stuart L. Are)'

Sol Austrian

John Bass

Lowell L. Becker

D. Woodro~ Benson, Jr.

T. Blanton Bessinger

Da\"id Bloor.:

RC'be rt ~r::. Bl u."':".

Ste;-l1en J. B=,:"os

Robert H. Bugenstein

Ed~in C. Burklu~=

Blancl1e ~. Chavers

Joh:1 A. Cich

C. Carlyle Cla~sC'n

Richard T. Cus~ing

k:Jos Deinard

Stanley tinzig

Grebor)' R. Ell iott

Donnell D. Eu..·iler

AJexandra Til ipo'dch

Robert O. Tisch

AJ fr~d J. fish

Lloyd Tish

Deborah K. Freese

Endl ey Tuhrman

C. Scott Giebink

Thomas P. Green

J. Margaret Horrobin

Margaret K. Hostetter

Dana Johnson

Edward L. Kaplan

Robert Kri~l

CATEGORY

Cl inical

Clinical

Clinical

Cl inical

Attending

Cl inical

Attending

Cl inical

Cl ini cal

Attending

Cl ini cal

Clinical

Clinical

Attending

Cl inica1

At tending

Cl inical

Attendin£

Attending

Attending

Cl inica1

Attending

Attending

Attending

Cl inical

Attending

Attending

At tending

At tending

Clinical

Attending

At tending

Attending

Clinical

-17-

JL~E 3D, 1955

MoO,:i c inr

Neurolob\'

24

WIVIRSITY OF KIf\"l\£SOTA HOSPITAlS 6. Cllt'lCS

M!~1CAl. A.~D DE~TAl STAff JU:APPOlt'TME~TS JrLY I, 198.:. JL~;E 3D, 1985

I

I"IIIIIIII~

IIIIII

I,II

DEFARTI-lrt'r Of PEDlATR1CS C0KTlKl"ED:

Younf:ki Kim

Williarr. Krivit

Stanley A. Leonard

Carolyn J. Levitt

James Lock

Russell t. Lucas

Richard ~. Matus

S. Michael MaUEr

Kenne~h L. McClain

Car0lyn J. !'1cKa)"

A!fre~ F. ~icha~}

Bernard L. ~irkin

Ric~ar: f. ~t:S0~

Mark Eo ~ t? S ~ :i t

Th"7..as ~E\"i:lS

RC':>Ht O'Dea

Kare:" t\. 01 ness

Art:'ur R. Paf~

~ar, Ella Pierpont

Charles E. Pitzel~

John R. Priest

Pa:J] G. Qd t-

~O!'~2 ~. C. Ra~say

~arren E. R~g~lmann

Thomas f. Role.:i cz

Richard r. Sand

Sylvester Sanfilippn

Le-on Satran

Steven A. SHl ig

Harvey L. Sharp

Le is Sher

La rence J. Sholler

Alan R. Sinaiko

-18-

CATEr.OF~Y

Attending

Attending

Clinical

Clinical

Att end ins

Attending

Clinical

Attending

Attending

Clinical

Atte:1din~

Attencinf

At tE:1din~

Clinicc.l

Attencing

Atten:ing

A~ten:inf

Clinical

Attendint:

Attendin/=.

Clinical

Clinical

Attencinr

Attendin~

Attendin£

Clinical

Clinical

Clinical

Attending

Attending

AttendinJ:,

Clinical

Clinical

Attending

2"5

tn\lVIRSITY or Mlf\1;£SOTA HOSPITALS Eo C1It\lCS

ME:>! CAl A.~D DE~TAL STATr UAPPO!t\TM!:~TS J1'1.), I, 1984

II~

IIIIIII~I

IIIIII

IeII

DEPAR~~t\T or PEDIATRICS COKT!t\t~D

Amarjit Singh

Lawrence J. S1ngher

. Clark M. Smith, 11

Theodore S. Smith

Joseph J. Sockalosky

Frederic M. Stone

Ed••ard 1. Strerc

Robert ~. ten Bensel

Theod~re R. Tn~r.?50n

R0be"t A. r15tro~

R. Ja~es Vaccarella

H~~er D. Venters

Robert L. Verni~r

~a"re~ J. ~ar~ick

Ja:':1es G. \,'hite

~alt€r L. ~iJd€r

~illia;.. \o,'oods

-19-

CATEGORY

Cl inicaJ

Clinical

Attendin£

Clinical

Clinical

C1 inical

Clinical

Attendin£.

Attendin~

At tending

Clinical

Clinical

At tendb~

Clinical

Attencin~

At tendin~

Clinical

Attendin~

J1;,E 3D, 1985

26

U1'H'ERSIn or MlJl.1;ESOTA HOSPITAlS 6. nlt\lCS

MrJICAl A.'\:J DE!\TAl STArr R!A!'POH,nn:XTS Jl:lY I, 1984 Jl~;E 3D, 19~5

II,IIIIIIII"IIIIII

I~II

DEPARPtEl\T or PHYSICAl MtDICIY\"E & RDiABllITATIO~;

James Agre

Thomas P. Anderson

Alan S. Bensman

Jeffrey S. Cameron

Dennis D. Dykstra

Glenn Gullickson, Jr.

Miland Knapp

Frederic Kottke

John 1. ~:a~nes~

Hark A. Moret

* ~:ary ~:. Price

Keith B. S?erlin~

* Outstanding Malpractic~ Information Forms

-20-

CATEGORY

Attending

Attending

Clinical

Attending

Attending

Attending

C1 ini cal

At tending

Attencin~

Attencbt:

C1inica]

Attendi;:f

27

~l\~RSITY or ~~~£SOTA HOSPITALS & Cll~lCS

28

JOIt\T APPOl~~:r~::

Medicine

Clinical

At tencinf

Attencinj:,

At tending

At tendin;

Cl inical

C1 inical

Attending

Clinical

Attending

CATrGORY

Attending

At tencH:1g

Clinical

Attending

At tending

At tending

Atterl:::ir.f;

Attending

Attending

Clinical

Attendin£

Clinical

At tending

Attending

Attending

Attencinf;

Clinical

-21-

Michael K. Popkin

Richard 1. Pyle

George ~~ . RealT:':uto

ThOT:1as R. Stapleton

MyTon R. Stocking

Charles t-l. Van ValkenbuTg

Joseph J. WesteTmf'yer

Ronald C. Young

Richard ~:iner

Richar d ~:e i s ch

Joa:1ne ~. Pearson

t-:ichaeJ C. ~:oC're

Janes r. ~itchell

All an J05et'~S:':J

Richarc D. le:1:z

Tho~as B. Mackenzie

La~rence Greenberg

Ronald Groat

Jonatha~ B. Je:1sen

\,;'illia!:l Hausrr.a:1

leonard Heston

Jorj~ R. Hu~he5

DrPARTm:~j" or PS)'CHIATRY

Faruk S. Abuzzahab

Paula J. Clayton

David W. Cline

Ilke Eckert

I

I~

IIIIIIIIe

IIIIII

Ie;II

MI:~lCAL Ale) Dtt\TAl. STArr llAPPO!!;nn:XTS Jl:lY I, 198':'

UNlVIRSl!Y or ~N~tSOTA HOSPITALS & ClI~ICS

29

CATEGORY

Attending

Attending

Attending

Attending

Attending

Clinical

At tending

At tending

Attending

Attencin~

At ten dint:

Attendin£

-22-

DtPART~\"T or RADIOLOGY

Kurt Amplatz

Wilfrido R. Castaneda

Jeffrey R. Crass

Deborah l. Day

Samuel B. Feinberg

Leroy A. Forstro~

JoI.athis Frick

tuge~e Gedgaudas

La~rence H. A. Gold

JoI...a~dn E. GcJdberg

t-'.rrJe Loke;")

narry C. \..·alker

IIIII"IIIIII

1(;II

~I\~RSI!Y OF ~~~ESOTA HOSPITALS & ClI~lCS

MIDICAl ~~D DE~;Al STAFF RtAPPOl~!~~TS JDl~ 1. 1984

J

I!

~I

IIIIIIII~

IIIIII.,II

DEPARTHr~T or SURGERY

David H. Ahrenholz

Robert W. Anderson

Nancy t. Ascher

Ralph M. Bolman. III

Henry Buch..-al d

Frank B. Cerra

Bruce L. Cunnin~ha~

John P. Delaney

JDhr. E. Toker

VictDr A. Gilbertsen

Sta:-.le:' Go] d:>er~

Robert L. Goodale

TheocD:- B. Grage

H~valc ~. Helseth

Arnold S. leD~a:-d

FElix A. McFarlane

J. ErnestD ~Dlina

Richard Moore

Johr. S. ~ajariaT1

Santhat ~iVatvD~gs

~illia~ D. Payne

":. SteVES Rin~

Alan R. ShC'ns

Richarc l. Si~~ons

~. Albert Sullivan

David E. R. Sutherland

-23-

CATEGORY

Clinical

Attending

At tending

Attending

At tending

Attending

Cl inical

Attendinr;

Attending

At tending

C] inical

Attendint:

Attendbg

Clinical

Attencint:

Clinical

Attencinf

At tending

Attencin~

At tendint;

Cl inical

Attencin~

At tending

Attendinf,

Attending

At tendint:

JL~~r 30. 1955

30

m;IVt:RSln or Kl.~1\rSOTA HOSPITAlS & CLn~ICS

MEDICAL A~D Dr~TAl SlArr Rr:APPDl~TME~TS JrLY 1. 1984

I

~.

IIIIIIII"IIIIII

I~II

DEPART!'!r!\T or THERArrPTI C RADIOL0GY

Taeh""an Kim

Chun& Kyu Kim Lee

Seymour Levi tt

Rober A. Potish

-24-

CATEGORY

Attendin&

Attending

Attending

At tending

31

~I\~RSITY or ~~~ESOTA HOSPITALS & CLI~lCS

MEDICAl A~~ DE~TAl STArr RtAPPOIXTX:~TS JrlY I, 198~

I' .. "~~.''-I'

IIIIIII~....

1'-'

IIIIII

IeII

DEPAJ\nrEt\T or UROLOGY

Ralph V. Cla)~n

Elwin E. Fraley

k1chardo Gonzalez

Paul lange

Pratap J\.Reddy

-25-

CATEGORY

Cl inical

Attending

Attending

Cl inical

At tending

JL~,E 3D, 19E5

32

~IVERSl1i OF MINNESOTA HOSPITALS & CLI~ICS

RECO~E~~ATIONS FOR REGULAR M!DICAl/DE~TAL STAFF APPOI~~E~~S

Attending March 28, 19&.:.

Attending 1-1.3 r eh 28, 190.:.

Attending l-:.a r ch 2 E., 190':'

Attending ~·1arch 28, 198.:.

Attending ~~arch 28, 198.:.

At tending 1-1areh 28, 19&.:.

Attendins:; ~1a rc~ 28, 195.:.

At tend in; l-1arch 28, 198.:.

At tencin S l".arch 2 8, 198..

Attendin~ March 28, 198.:.

Attending l-1arch 2 S, 198.:.

At tencin~ Nareh 28, 19 f.':'

At tendin~ !·la r ch 28, 195.:.

33

l-1arch 2 S, 19S':'

March 2B, 19R':'

Marcl1 28, 196':'

DATE nIGIBU

March 28, 1984

}1arch 28, 198!.

Nareh 28, 19&.:.

Attendinr,

Attending

Clinical

At tending

CATEGORY

At tending

Attending

JV~:E 30. 1985

-26-

DrPAF.r-:r:T OF UROLOCY

Timothy D. Moon

Marcos H. Pinto

TnC'::J.2s J. Kulik

JULY 1, 19B':'

Da\'id i-,'. Hunter

Charles \.:. Maile

Steven A. Sirr

Antony T. YOU:1/;

Sally A. ~eisd~rf

D!:?;:::7'~!:~:T OF R.;:'J OLO::Y

De~orah S. A1~in

Robert J. Boudreau

Monte E. Go1ditch

Sandra Cole

Bonnie G. LandruL

DEF'A.'l\~tE~T OF PEDIATRI CS

Elizabeth A. Braulin

Ann C. Dunnigan

T. Bruce Ferrara

DEPAR~lE.';T OF A~T£SreESIOLOr,y

Michael D. }Sontgomery

Michael F. Sweeney

HOSPITAL DE~TISTRY

II_~

IIIIIIII~

IIIIII

I"II

UNIVERSITY OF MINKESOTA HOSPITALS & CLINICS

RECOMME~~ATIONS FOR ADDITIONAL CLINICAL PRIVILEGES

RECO~~:~~Cl.nIO~ FOR CHA..~GE I~ STAFF CATEGORY

34

Rr('o~r-1I\'"DI~ CA:rc:0:::~'

Emeritus

CATEGORY

Attending

Attending

-27-

PRISI~T CATIGORY

AttendinbC. Paul \o:inchell

DrPARTr.I~T OF SrRGERY

Robert L. Goodale

DEPARTMENT OF OTOLARYNGOLOGY

Arndt Duvall

II~

IIIIIIII~

IIIIIII,II

Caryl Eo BoenneTt Cl ini cal

-28-

-.

35

CATEGORY

Attendin;

tmJVERSlJi OF Ml~~:ESOTA HOSPJTAl.S & CLl~1CS

DEP.;:.r.·:E~T or R..b:~~ C'lL0CY

Jo::r: F. Card€J la Attencin£

RECO~~:D:DATlO~S FOR PRO\'lSlO~ tlED1 CAl./DE!'IAL STAFF APPOlJ,n:r!'!S

DEP.~.'r.'rr:~: or PEDIATRI CS

Susan A. Berry Attendin£

DEPARD!E!\"T OF LABORATORY ~1EDJ C1 NE& PATIiO::'OGY

Joan L. Bundtzen

II~

IIIIIII~I

IIIIII

I~II


CLINICAL CHIEF RECOMMENDATION FOR NON-RENEWAL OF MEDICAL STAFF APPOINTMENT

II~

IIIIIIII~

IIIIII

Ie.II

DEPARTMENT OF OPHTHALMOLOGY

Howard David Gilbert

-29-

CATEGORY

Clinical

36

II~

IIIIIIIIeIllllIiQlI


RESIGNATIONS FROM THE MEDICAL/DENTAL STAFF

DEPARTMENT OF HOSPITAL DENTISTRY

Timothy A. Peterson

DEPARTMENT OF MEDICINE

John G. Bergstrom

Ivan D. Frantz

Peter D. Kenyon

James L. Reinertsen

Bruce A. Schwartz

DEPARTMENT OF OBSTETRICS & G\~ECOLOGY

Paul L. Ogburn, Jr.

DEPARTMENT OF OPHTHALMOLOGY

James Allen

Robert C. Campbell

Richard Carroll

DEPARTMENT OF PEDIATRICS

Jon 1. Scheinman

DEPARTMENT OF PHYSICAL MEDICINE& REHABILITATION

Dennis J. Matthews

DEPARTMENT OF PSYCHIATRY

William Erickson

DEPARTMENT OF ORTHOPEDICS

E. Harvey O'Phelan

-30- 37

"AM! ,(tAJmfF.NT PACUL'I!-RANI(tNTF.RN~HtP, REStDEIfCT ,

Ff.LLOW~HtP-CUtWLF.T'ON DATF.S LA"POSITIOR

------~rrt.lr.ANTS TO"""'HF.DT~F.NTI\~f1l' -_.- .. - ---. --

.JIIN_H4

~rF._~t_A.'.I_1! HF.~T~~r.lf_oo.TcC_OHPJ~F.n~N---.!!A_T!:

---CAnr.ORT----

----LABO~TORY ~~F.DICINE~~IH0I.0£o.!.

Joan L. Bundtzen Attending, Instructor ChemicalI'alhnlo~y

Unlvl'rsltv of TennesseeMemphis. ll'nnl'ssN'

1'J7S J!'_t~!.!1!,hil'-.Lmedlcine).

IInlverslty of Wisconsin Hospital~Idlson. Wisconsin1976-] 977

~~!'J~~!'~I-JLaboratoryMedicine~_nj_.!'~_t~~~l

University of Minnesota Hospitals]978-1982

J.{~~~arch Fellows!!!p""":'UnLverslty of WisconsinMLddleton V.A. HospitalMadison. Wisconsin1979-1980

FeJl~w~hlp - Health Computer SciencesiI.n_d-.9lemistryUniversity of Minnesota Hospitals1982-]983

DEPAR~NT OF PEDIATRICS

Susan A. Berry At tending Instructor Genet ICB IInlvprsl ty of KansasKansas City, KS

]978 !..L-~2~nter!!..sJ1}p.Reslde~University of Minnesota Hospitals1978-]981

fellowship (Medical Genetics)University of Minnesota Hospitals1981-present

DEPARn1ENT OF RADIOLOGY

John F. Cardella Attending Instructor Dial:nost Ic University of Michiganf, Interventlon;11 Ann Arhor, MIRadiology

]978 lnte!ns~.!I' (Dept. of Fam!!L..!'..r~ctlce)UnIversity of Minnesota Hospitals] 9 78-19 79

~~~)dency - (Dept. of RadloloBILMayo ClinicRichester, HN1979-1982

Private Practice:Loraine. Ohio1982-1983

w00

.r

MEDICAL STAFF-HOSPITAL COUNCIL COMMITTEE CHAIRMEN APPOINTMENTS

1984/1985

UNIVERSITY OF MINNESOTA HOSPITALS &CLINICS

6. Disaster Committee

2. Bylaws Committee

39

Bradley Fuhrman, M.D.

Robert Maxwell, M.D.

Product Evaluation &StandardizationCommittee

Pharmacy &Therapeutics Committee

Russell Lucas, M.D.

Quality Assurance Steering Committee

James Moller, M.D.

Utilization Management Committee

Donald Doughman, M.D.

Jeffrey McCullough, M.D.

Tissue &Procedure Review Committee

Transfusion Therapeutics Committee

9. Operating Room Committee

Roby Thompson, M.D.

10. Outpatient Committee

Amos Deinard, M.D.

11.

16.

12.

14.

13.

15.

Michael Daly, M.D.

Henry Buchwald, M.D.

Frank Rhame, M.D.

Credentials Committee

Russell H. Larsen, M.D.

David Hurd, M.D.

Glenn Gullickson, M.D.

Theodore Thompson,· M.D.Diane Bartels, R.N., Co Chair

Seymour Levitt, M.D.

7. Emergency Department Committee

8. Infection Control Committee

1. Bed Allocation Committee

4. Cardio-Respiratory Advisory Committee

3. Biomedical Ethics Committee

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June 5, 1984

The Bylaws of the Board of Governors - University of Minnesota Hospitalsand Clinics were amended in November, 1982, requiring the following:

The Hospital Director in consultation with the Chief of Staff hereby recommendsthe reappointment of the following Clinical Chiefs for 1984-85.

The following persons are subject to re-appointment;

Article V. Section 5 (B)

40

DEPARTMENT

laboratory Medicine &PathologyAnesthesiologyNeurosurgeryFami ly Practi cePsychiatryOphthalmology

HEALTH SCIENCES

Annual Reappointments of Chief of Clinical Services

C. Edward Schwartz, Hospital Director~~~e~~Paul G. Qui e, M. D., Chi ef of Staff ~~,.!;. .(1. _*=

Board of Governors

NAME

Dr. Ellis BensonDr. Joseph BuckleyDr. Shelley ChouDr. Edward CiriacyDr. Paula ClaytonDr. Donald Doughman

UNIVERSITY OF MINNESOTA University Hospitals and ClinicsTWIN CITIES 420 Delaware Street S E

Minneapolis. Minnesota 55455

After consultation with the Joint Conference Comnittee, at its Junemeeting each year, the Board of Governors shall appoint the chief ofeach clinical service of the Medical Staff to serve at the discretionof the Board for an initial term of three years, execept in the caseof a chief of a clinical service who is an individual other than theHead of the corresponding medical or dental school clinical department,in which case the initial appointment shall be for one year. Reappointment thereafter by the Board of Governors shall be yearly. Vacanciesin the office of the chief of a clinical service may be filled at anytime by the Board. In the event that a chief of a clinical service isappointed at some time other than the June meeting, and if the appointment is made no later than December, for purposes of determining thetime of reappointment the appointment shall be deemed to have commencedthe preceding June. In the event that the appointment is made afterDecember, for purposes of determining the time of reappointment thecomputation of time shall be deemed to commence at the next succeedingJune.

RE:

FROM:

TO:

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Joint Conference CommitteeJune 5, 1984Page 2

NAME

Dr. Thomas FerrisDr. Elwin FraleyDr. Eugene GedgaudasDr. Robert GoltzDr. Glenn GullicksonDr. Arthur KlassenDr. William KrivitDr. Seymour LevittDr. John NajarianDr. Michael PaparellaDr. Konald PremDr. Roby ThompsonDr. Daniel Waite

CES/sdsEnclosure

DEPARTMENT

MedicineUrologyRadiologyDennatologyPhysical Medicine &RehabilitationNeurologyPediatricsTherapeutic RadiologySurgeryOtolaryngologyObstetrics &GynecologyOrthopedic SurgeryDentistry

41

I

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FUNCTION OF CLINICAL CHIEFS*

1. Be accountable for all professional and administrative activitieswithin his or her service.

2. Be a member of the Council of Chiefs of Clinical Services givingguidance on the overall medical policies of the hospital and makingspecific recommendations and suggestions regarding his or her own :service in order to assure a high quality of patient care.

3. Maintain continuing review of the professional performance of allindividuals with clinical privileges in his or her service and reportthereon on the Credentials Committee as necessary.

4. Be responsible for enforcement within his or her service of the hospitalbylaws, policies and directives and of these medical staff bylaws, rulesand regulations.

5. Be responsible for implementation within his or her service of actionstaken and policies set by the Board, the Council of Chiefs of ClinicalServices and the Medical Staff-Hospital Council.

6. Transmit to the Credentials Committee his or her recommendations concerning the appointment, reappointment, and delineation of clinical privilegesfor all individuals in and applicants to his or her service.

7. Participate in every phase of administration of his or her service withthe hospital management in matters affecting patient care, includingpersonnel, supplies, special regulations, standing orders and techniques.

8. Assist in the preparation of such annual reports, including budgetaryplanning, pertaining to his or her service as may be required by the Chiefof Staff or the Board.

*Article 3, Section 5 of the Bylaws

42

It..

2.

3.

6.

43

\..

Medical School: Yale VniversityInternship: Osler Service, John Hopkins HospitalResidency: Yale-New Haven HospitalCertified: American Board Of Internal Medicine

Medical School: University of Utah Medical SchoolInternship: Providence Hospital, Detroit, MichiganResidency: University of Minnesota Hospitals, Minneapolis, MinneostaCertified: American Board of Neurosurgery

Medical School: University of Io~a College of MedicineInternShip: Los Angeles County Ceneral Hospital. Los Angeles, Calif~rnia

Residency: University Hospital, Iowa City, 10~a

Certified: American Board of Ophthalmology

Medical School: Ne~ York Medical CollegeInternship: U.S. Laval Hospita, Chelsea (Boston), MassachussettsResidency: University of Minnesota Medical SchoolCertified: American Board of Anesthesiology

Medical School: Temple University Medical SchoolInternship: Frankford HospitalResidency: Frankford Hospital and Temple HospitalCertified: American Board of Family Physicians

CLINICAL CHIEFS BIOGRAPHICAL SUMMARIES

Hedical School: University of Minnesota Medical SchoolInternship: Cincinnati Ceneral HospitalResidency: Veterans Administration Hospital, Minneapolis, MInnesotaCertified: American Board of Pathologists

Donald J. Doughman. M.D.Professor and ~ead

Department of Ophthalmology

£d~ard ~. Ciriacy. M.D.Professor and HeadFamily Practice & Community Health

Thomas F• Ferris , M.D.'rofessor and HeadDepartment of Medicine

Shelley Chou, M.D., M.S., ~HD

Professor and HeadDepartment of Neurosurgery

Jospeh J. Buckley, M.D.Professor and HeadDepartment of Anesthesiology

Ellis S. Jenson, M.D.'rofessor & HeadLaboratory Medicine & Pathology

5.

1.

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IIIII,,"'."f·....I

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9.

8.

11.

12,

4~...

'.

Hassachuset-tsMassachusetts

Medical School: University of Munich, GermanyInternship: St. Boniface General Hospital, CanadaResidency: St. Boniface General Hospital, CanadaCertified: The American Board of Radiology

Medical School: Harvard Medical SchoolInternship: Massachus~tts General Hospital, Boston,Residency: ~ssachusetts General Hospital, Boston,Certified: American Board of Urology

Medical School: Tulane University Medical SchoolInternship: Charity Hospital, New OrleansResidency: Utah School of MedicineCertified: Diplomat of the American Board of P~diatrics

Medical School: University of MinnesotaInternship: Gallinger Municipal HospitalResidency: University of MinnesotaCertified: American Board of Physical Medicine and Rehabilitation

Glenn Gullickson, Jr., M.D.Professor and Interim Head,Department of Physical Medicine and Rehabilitati~n

Medical School: University of Manitoba Medical SchoolInternship: Winnipeg General Hospital, Winnipeg, CanadaResidency: University of MinnesotaCertified: American Board of Psychiatry and Neurology

Arthur C. Klassen, M.D.Professor and Acting Head.Department of Neurology

Medical School: University of MinnesotaInternship: Ancker Hospital, St Paul, MinnesotaResidency: University of Minnesota, Minneapolis, MN, School of MedicineCertified: American Board of Dermatology

William Krivit, M.D. Ph.D~ro~essor and HeadDepartment of Pediatrics

Elwin E. Fral~y, M.D.Professor and HeadDepartment of Urologic Surgery

Eugene Gediaudas. M.D.Professor and HeadDepartment of Diagnostic Radiology

Jobert W. Goltz. M.D.Professor and HeadDepartment of Dermatology

I·~ ~ 7.

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16.

15.

17.

18.

45

Mecical School: University of MichiganInternship: Emanuel Hospital, Portland. OhioResidency: Henry Ford Hospital. Detroit. MichiganCertified: American Board of Otolaryngology

Medical School: University of California. San FranciscoInternship: University of California Medical SchoolResidency: University of California Medical SchoolCertified: American Board of Surgery Diplomate

Medical School: University of Virginia School of MedicineInternship: Columbia Presbyterian Medical Center, New YorkResidency: Columbia Presbyterian Medical Center, Ne~ YorkCertified: American Board of Orthopaedic Surgeons

Dental School: State College of University of IowaResidency Certificate: State University of IowaCertified: American Board of Oral Maxillofacial Surlery

Medical School: University of MinnesotaInternship: Minneapolis General Hospital. Minneapolis, MinnesotaResidency: University of Minnesota Medical SchoolCertified: American Board of Obstetrics and Gynecolo~'

"Medical School: University of ColoradoInternship: Philadelphia General HospitalResidency: University of CaliforniaCertified: American Board of Radiology

Konald A. Pre~, M.D.Professor and HeadDepartment of Obstetrics and Gynecology

Robv C. Thompson. Jr .• M.D.Professor and HeadDepartment of Orthopaedic Surgery

Seymour H. Levitt, M.D.Professor and HeadDepartment of Therapeutic Radiology

Michael M. Paparella, M.D.Professor and HeadDepartment of Otolaryngology

John S. Najariap. M.D.Professor and HeadDepartment of Surgery

Daniel E. Waite, D.D.S .• M.S.Professor and Hhad~epartment of Oral and Maxillofacial Surgery. School of Denistry

~3.II~ ~

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19. Paula J. Clayton, M.D.Professor and HeadDepartment of Psychiatry

Medical School: Washington University, St. Louis, MissouriInternship: St. Luke'. Hospital, St. Louis, MissouriResidency: lames and Rehard HospitalsCertified: American College of NeuropsychophaTm8cology

46

HEAL TH SCIENCES

47

June 13, 1984

The Hospitals' operating position for the month of May continues to reflectlower than anticipated inpatient census levels and further reductions in theaverage inpatient ancillary service revenue per admission. To highlight ourpos it ion:

Board of Governors Finance Committee

Report of Operations for the period July 1, 1983through May 31, 1984

Clifford FearingSenior Associate Director

UNIVERSITY OF MINNESOTA UnIverSIty Hospitals and ClinicSTWIN cITIes 420 Delawa re Street S E.

: Minneapolis. Minnesota 55455l5i1

To recap our year-to-date inpatient census:

1982-83 %Ac tua 1 Budget Actual Variance Variance

Admissions 19,208 18,691 18,219 (472) (2.5)Avg. Length of Stay 9.5 9.6 9.1 (0.5) (5.2)Patient Days 182,635 179,443 166,897 (12,546) (7.0)Percent Occupancy 74.0 72.5 67.5 (5.0) (6.9)Avg. Daily Census 545.2 534.1 496.7 (37.4) (7.0)

SUBJECT:

TO:

FROM:

Inpatient Census: During the month of May, admissions totaled 1,670 or55 below projected admissions of 1,725. Admissions this month were at orabove budgeted levels in all areas except Surgery, Obstetrics, Rehabilitation,and the Intensive Care Units. Due to a lower overall length of stay for themonth, the patient day total of 14,514 was 1,919 days below the budgetedlevel of 16,433. The overall length of stay for the month of May was 8.7days compared to the year-to-date average through April of 9.1 days.

O~teatient Census: May clinic census totaled 18,692 compared to projectedV1Slts of 17,969. Our year-to-date clinic census total of 191,471 visits is1409 visits, or 0.7% above projected visits of 190,062. However, the cliniccensus through May of this fiscal year is 412 visits over our total of ayear ago.

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Report of OperationsJune 13, 1984Page 2

Financial Operations: The Hospitals' Statement of Operations shows totalrevenues over expenses of $ 8,589,378, a favorable variance of $ 320,284. Thisfavorable variance continues to be due to our investment income being higherthan projected by approximately $ 2,578,000. The net revenue from operationsthrough May shows a net loss of $ 9,049,753, which is nearly $ 2,255,000 greaterthan the budgeted loss of $ 6,794,284.

Patient care charges through May totaled $ 164,967,706 and are $ 7,527,768(4.4~) below budgeted levels. Routine revenue is 6.5% below budget and reflects t

the overall patient day variance. Ancillary revenue levels declined duringthe month of May reflecting a lower average acuity level. Inpatient ancillarycharges per admission declined from the April year-to-date average of $ 4,754to an average of $ 4,546 for the month of May.

Operating expenditures through May totaled $ 145,585,352, and are approximately$ 3,526,000 (2.4%) below budget. Overall spending levels during May continueto reflect reduced personnel costs, and supply and expense costs associated withour lower census levels and with the actions taken by management in November.

Accounts Receivable: The balance in patient accounts receivable as of M?y 31,1984 totaled $ 40,410,868 and represents 83.4 days of revenue outstanding.Total receivables decreased $ 1,421,488 during the month of May with the decreaseoccurring primarily in the Medical Assistance and commercial insurance categories.Receivables are still reflecting backlogs in Medicare, Blue- Cross, and out-of-stateMedicaid programs. The length of time to collect third party receivables continuesto be a problem in this region.

Conclusion: The Hospitals' overall financial position through the end of Maycontinues to remain within the fiscal plan implemented in November. We continueto assess changes in acuity level and ancillary service utilization and makenecessary and appropriate changes consistent with this fiscal plan.

48

1II

Je,lJJ VJIvtlSITT or MIJRESotA 10SPItAlS • CLINICS

ITATEMINl or OPERATIONS

roa TIE PEIIOP JVlT I, 1983 TO KAl 31, 1914

I

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III

Croll Patient Cbarlel

Deduction. from Cbarle,

Otber Operatiaa levenue

TOtAl llVEIiOE nOM OPElATIONS

bpendituru5alariuPrinle InditaContract CompenlationMedical Suppliel, Dru&I, IloodCl&puI.Ad~lniltrationbpenleDeprecullonCeneral Suppliel • tspenle

total bprnditvrel

let le~enue fro- Operatiool

lon-oprrat~o&.le~rnveAPfroprlatlonlIn .rrll Income on lelervelSband SrTViceInveltm.nt Income 00 trvlter

ReId Allet,

total Joo-Operatiaa levenue

'ar~antrOur -Onder

lud&rud 'ctval lud&et 'ariance S--------- -------- ------------ ---------

$172.495,474 5164, '67.706 S-7,~27,768 -4.4%

33,121,083 31,621,007 -l,~00,076 -4.5

2,942,283 3,188,900 246,617 1.4---------- ---------- --------- --------S142,316,674 SU6,5H,599 $-5,711,075 -4.n

$ 71,788,028 $ 70,226,871 S-l,~61,157 -2.2%13,333,954 14,079,889 45,935 5.66,861,234 7 352 740 491,506 7.2

Z3 ,437 ,865 22:394:004 -1,043,161 -4.54,797,638 4,797,638 ° 0.05,949,700 5 576,869 -372,131 -6.3

22,94~,539 21 :157,341 -1,785,198 -7.8----------- ------------- ----------- ----------$149,110,958 $145,515,352 $-3,525,606 -2.4%---------- ------------ ------------ ---------S -6,794,214 $ -9,049,753 S-2,255,469 -33.2%

S 11,402,380 $ 11,402,380 °1,687,891 4,265,946 $ 2,578,055338,9ElO 336,658 -2,302 -0.7%

1,634,147 1,634,147 0----------- ------------- ---------- ----------S 15,063,378 $ 17 ,639,131 S 2,575,753 17.n----------- ------------- ------------ -----------$ 1,269,094 $ 1,589,378 $ 320,214 (1)

---------- ------------- -------------------- ----------- ----------

III

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(1) 'ariaoer rquall 0.21 of total bud&.ted rrvenur.

49

NURSINGSTRIKEUPDATE:

APPROVALOFMINUTES:

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III ATTENDANCE:

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MINUTESJOINT CONFERENCE COMMITTEE

BOARD OF GOVERNORS

June, 13, 1984

Present: Barbara O'Grady, ChairPaula Clayton, M.D.Phy11 is Ell isGlenn Gullickson, M.D.Robert Howe, M.D., (for Paul Quie, M.D.)Robert LatzRobert Maxwell, M.D.C. Edward Schwartz

Absent: Paul Quie, M.D.

Staff: Jan HalversonGreg HartNancy JandaBarbara Tebbitt

Guests: Jan BrockwayDavid GawaluckKim Werner

The minutes of the May 9, 1984 meeting of the Joint ConferenceCommittee were approved as submitted.

Ms. Tebbitt reported on the status of the nursing strike in thecommunity and its impact on University Hospitals. She indicatedthat University Hospitals has seen a moderate increase in censusas a result of the strike and is making internal accommodationsto respond to this increase in activity. She indicated that thelargest impact is being felt in Pediatrics, the Neonatal IntensiveCare Unit, and the other ICUs. Staffing levels in these areasin particular have been tight, and as a result some temporaryhiring has been done to meet increased patient care needs.

Ms. Tebbitt also reported on the status of the negotiations betweenMNA and the community hospitals. The Committee discussed thepolicy implications of the strike, particularly its impact onthe nursing profession and the future availability of nursingrna npower.

50

2

r·1EDI CALSTAFFHOSPITAL/COUNCILREPORT:

CREDENTIALS

I······,MITTEEORT1\1 0RECOMMENDATIONS:

Dr. Howe reported on the June 12 meeting of the Medical Staff HospitalCouncil. He indicated that the Council approved the appointmentof the chairs of the medical staff committees at this meeting.Dr. Howe presented the committee chair recommendations for theJoint Conference Committee's endorsement. He indicated thattwo new chairs are recommended for the coming year; Dr. SeymourLevitt will become chair of the Bed Allocation Committee andDr. Robert Maxwell will become chair of the Tissue and ProcedureReview Committee. The Joint Conference Committee endorsed therecommendations for Medical Staff Hospital Council chair appointments.

Dr. Howe also indicated that the Medical Staff Hospital Councilreviewed a study performed by the Tissue and Procedure ReviewCommittee on ORG 354, non-radical hysterectomies. Ms. Brockway andMs. Werner reported on the results of this study. The findingsrelative to quality of care, appropriateness, cost, and reimbursementwere reviewed, as were the recommendations from the study.

51

,.In discussion of the reappointments, it was noted that a numberof the medical staff have not yet submitted full informationrelative to malpractice information as required. It was also notedthat one member of the medical staff is being recommended foremeritus status without clinical privileges given that thisindividual no longer maintains malpractice insurance coverage.

After discussion the Joint Conference Committee acted to endorsethe recommendations of the Medical Staff Hospital Council andthe Credentials Committee, with the stipulation that the reappointmentof those staff members who have not yet submitted malpracticeinsurance information be made pending receipt of such informationby August 31, 1984.

The Committee also discussed the future role of the clinical medicalstaff and its use of University Hospitals, and the use of facilitiesother than University Hospitals by attending members of the medicalsta ff.

Dr. Howe presented the report and recommendations of the CredentialsCommittee. The recommendations include annual medical staffreappointments, regular medical staff appointments, changes instaff category and addition of clinical privileges, provisionalmedical staff appointments and request for clinical privileges,specified professional personnel and Psychology privilegerecommendations, Clinical Chief recommendation for non-renewalof medical staff appointment, and resignations from the medicalstaff. Dr. Howe also described the Credentials Committee processused for appointments and reappointments to the medical staff.

1111131II ~

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CLINICAL~IEFS

WTREATREPORT:

CLINICALCHIEFREAPPOINTMENTS:

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3

Dr. Clayton reported on the Clinical Chiefs Retreat held on June 9.She indicated that the Chiefs had held a retreat in January focusedon cost containment; the June retreat was oriented toward planningand marketing issues. The early sections of the retreat revolvedaround a review of financial and volume trends and reports fromseveral groups who had made site visits to other universities tolook at HMO and PPO programs. One of the outcomes of the retreatwas the endorsement of the establishment of a clinical prograMdevelopment fund, targeted at enabling increased volumes to occurat University Hospitals. Dr. Clayton also noted that the Chiefshad acted to appoint a task force to develop specific recommendationsfor the creation of an executive body of the Clinical Chiefs.

This executive body will be charged with the responsibility torepresent the clinical departments in HMO/PPO planning andnegotiations, joint venture and joint billing arrangements,coordinating outreach efforts, and developing publicity programs.Ms. O'Grady indicated that the Regents, at their most recentmeeting, had expressed interest in and support of these kinds ofactions.

Mr. Schwartz drew the Committee's attention to the letter ofrecommendation for the annual reappointments of the Chief ofClinical Services. The Joint Conference COmMittee acted toendorse the recommendations for reappointment, after brieflyreviewing the function and background of the Clinical Chiefs.

There being no further business the meeting adjourned atapproximately 8:45 p.m.


~/~~Greg Hart

52

1

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IMEMBERSI PRESENT:

I MEMBERSI ABSENT:

STAFF:

I

I GUESTS:

I~I CALL TO

ORDER:

I MINUTESAPPROVED:

IAPRIL YTDFINANCIAL

I STATEMENTS(INFORMATION) :

III

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MinutesFinance Committee

University of Minnesota Hospitals &ClinicsMay 23, 1984

A1 France, Cha i rShelley Chou, M.D.Clifford FearingJerry Mei1ahnC. Edward Schwartz

Ma ry Des Roc hesCa r1 Ora keRichard Kronenberg, M.D.

Greg HartNancy JandaNels LarsonJane MorrisBarbara Tebbitt

Da vi d CostLynn HornquistVirgil MolineBarbara O'Grady

The meeting of the Finance Committee was chaired by Mr.Al France and was called to order at 9:45 a.m. in Room 608of the Campus Club.

The minutes of the April 25, 1984 meeting of the FinanceCommittee were approved.

Mr. Fearing reviewed the Report of Operations for the periodJuly 1, 1983 through April 30, 1984. He stated that themonth of April showed some improvement in census levelsover the month of March. Inpatient admissions for Aprilwere only 22 below the projected level of 1,718, howeverthe average length of stay was 8.7 days compared to the yearto date average through March of 9.2 days. The outpatientclinic census is fairly stable for the year to dateat 172,779.

Total revenues over expense are $8,104,094, a favorablevariance of $525,392, and this variance continues to bedue in most part to investment income. The net revenue.from operations through April showed a net loss of $7.840.500compared to the budgeted loss of $6.098.655.

53

MinutesFinance CommitteePage 2May 23, 1984

i~

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II OPERATING

BUDGET1984-85II (ENDORSEMENT):

II

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I~III

Patient care charges are 4% below budget, routine revenueis 6% below budget and ancillary revenue is down 2.8%from budgeted levels, Data from the first 20 days ofMay shows a slight increase in routine revenue over Aprillevels. Ancillary utilization has declined since Januaryand is now down to an -average charge of $4,299 per admissionthrough April.

Expenses remain below budget by 2.1% reflecting the declinein census levels and reduction in personnel costs.

Accounts Receivable continue to be above the expectedlevel of 80 days of revenue outstanding at 84.9 days.Mr. Fearing stated that the original year end target of78 days is optimistic and the 80 day level will be usedas a base for projecting the 1984-85 budget.

Mr. Fearing gave a review of the Statement of Operationswith explanations of areas showing the most variation frombudgeted levels. The large variance in physicians compensation is mostly due to over-budgeting for Medicare Part Bcharges and under-budgeting Part A charges in Lab Medicineand Pathology.

The Operating Cash Flow statement shows negative cashavailable of $572,295 after transfers to Renewal Projectof $3,333,333, transfers to debt retirement of $2,333,333,and transfers to Plant of $3,129,614. Mr. Fearing addedthat the negative cash available is being offset by $3.8million that is being held by the University for intereston reserves.

Mr. Fearing gave a compl~te review of the 1984-85 operatingbudget being proposed for the Hospitals and outlined theobjectives and variables used to develop the budget.He explained that the volatility of the recent census andrevenue levels has necessitated the development of acontingency budget that would assume this current trendto continue into 1984-85. A 7% price increase is assumedfor both the contingency and base budget. Mr. Fearingnoted that since FTEs generated the primary area of expense,the current FTE count of 3,460 would be reduced to 3,476.4in the base budget and to 3,286.4 in the contingency budget.He suggested that the 1984-85 operating budget as outlinedbe presented to the full Board of Governors for theirinformation.

A motion was made and passed by the Committee to endorsethis budget and submit it to the full Board of Governorsfor their information now and seek final Board approvalat their June meeting.

54

JMinutesFinance CommitteePage 3May 23, 1984

55

~IH/~/~Ja ne Morri sRecording Secretary

Because of the time restriction, it was decided to deferthe remaining agenda items to the full Board of Governorsmeeting later this day. The meeting of the Finance Committeewas adjourned at approximately 12:15 p.m.


A motion was made and passed by the Committee to endorsethe 1984-85 Employee Compensation Plan and recommendit for approval to the full Board of Governors.

Mr. Hart outlined a proposed annual employee compensationplan for fiscal year 1984-85. This plan recommends a4.5% salary increase effective July 1, 1984 and anadditional 1.0% increase on January 1, 1985. He notedthat some comparable worth adjustments will be implementedas well effecting 35 job classifications with increasesranging from 2.7% to 7.7%. Adjustments will also benecessary for a number of Nursing-related classifications,and $600,000 has been budgeted for these adjustments.Another $300,000 has been budgeted for salary adjustmentsto non-nursing personnel.

XI

J .84-85EMPLOYEECOMPENSATIONPLAN(ENDORSEMENT) :

JJJJJ ADJOURNMENT:

J31 5

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I~

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IIMEMBERS

PRESENT:

III STAFF AND

GUESTS:

II CALL TOOW:I

CAPITAL

I BUDGET(ENDORSEMENT):

IIIII~DJOURNMENT:

I~II

MinutesJoint Meeting of the Finance Committee

and the Planning and Development CommitteeUniversity of Minnesota Hospitals &Clinics

May 23, 1984

A1 FranceShelley Chou, M.D.Clifford FearingClinton HewittWilliam Krivit, M.D.Jerry Meil ahnVirgil MolineBa rba ra 0' GradyC. Edward Schwartz

David CostGreg HartLynn HornquistNancy JandaMark KoenigNels LarsonJane Morris

The joint meeting of the Finance Committee and the Planningand Development Committee was chaired by Mr. Al France andwas called to order in Room 608 of the Campus Club.

Mr. Koenig introduced the Proposed Capital Equipmentand Remodeling/Renovation budget for fiscal year 1984-85and gave a detailed rev1ew of a schedule showing five yearcapital budget projections. For 1984-85, recurring andUnit J requests total $5,102,365. Mr. Hart reviewedthe schedules showing the proposed equipment budget(totaling $3,875,808) and remodeling/renovation budgetof $578,427. He stated that since Nursing is assignedthe majority of space, it has the most repairs and remodelingneeded. Remodeling of the Mayo Building will occur onlywhere absolutely necessary and where nursing stationsneed to be merged. A laboratory replacement computerwas the only capital equipment item requiring certificateof need.

A motion was made and passed by the committee to endorsethe proposed 1984-85 capital equipment and remodeling/renovation budget and to recommend it to the full Boardof Governors for their approval.

There being no further business, the joint meeting of theFinance Committee and the Planning and Development Committeewas adjourned at approximately 1 :15 p.m.


ytf4u- /II~/oJane MorrisRecording Secretary

56

I Six years ago. Town & County published what became one of our most requested features-a guide to the best medicalspecialists and specialty treatment centers across the country. Since then, new treatments have been developed and

I new medical stars have arisen, In May we published Part One of our revised list; its completion is in this issue,

~

IIIIII

T&C'5 EXCLUSIVE DIRECTORY

THE BESTMEDICAL SPECIALISTS

IN THE U.S.PART TWO

IIG

IY JOHN PEKKANEN

I

I

I

PrIlFssor nflnll'rna! mf'd/I"Hlf. hrad. dll"$1(>'/. 0/ ~ndornno!ogy and ml'foboilS7I/.

DA!'oOIEL D. FEDERMAN

Ma"~achu,,f'ttsGenera! HospitalBoston. MA 022J4Pro.r.·.~~or of rnl'dlnnl'. Han'(lrd.

JAM&" FIELD

Baylor Colltc'ge of M..dll:aneHouston. TX ";'';'030Pro.li'.~~or of medIC,,"r; IlI'ad. dll'LfIon ofrndocnnology and mt'labo!I.~m.

LAWRENCE FISHMAN

l:nivt'rsity of Miami Mt'dlcal SchoolMiami. FL 3:3101Profl'.~~or of ml'din nl'.

Boy FR."ME

Z7~9 West Grand Boule\'ardDt-troit. MI 4820:!ClIIIIC'al pf'Ofl'Mor of mt'dann~. C'nll't'mt~

of ,l'lrlrigan..NORBERT FIu:INKEL

Northwe.tem UniversityMt'diC'al SchoolChiraKo. IL 60611l>Jrl'rtor of ('f'TItn' for Eradol""no!ogy,."f'fabolJ$f1I ~ ,....IlI,.,tIOn..

f'RANt.'I!I S. GREENSPAN

l'ni\'tc'rsity of CalifomiaM,',hral C',('nterSan FranclliC'o. CA 94143

Rr"<l\..h·n. ~y J 1:!1I9Pro/t'.,.,·or of "tcd"'"I''' Dou·/I:;Inl .. Jffdlcn/('.. II/rr

Et'GESE P. CLERK.S

Lahey ClinicBurlinj.!ton. MA 0I!o'O:!('hnirl/lQn of mrd""II'.

PHIL.lP CRYER

4!J~9 Barn..~ Hospital PlazaSt. Louis. MO f;:1110As,~ol"iale prldi ..~~or of mrd,rll'l'.WlI3hlll9'on C·7Il1·rTSlly.

WILLIAM DAUGHADAY

Harm's Hospital PlazaSt. Louis, MO n:H 10Pro/.. ·.~.~or of m,.d,Mnr, Wa.,hp'glonC'n lI'I'rSI I y.

LESLIE J, DEGROOT

Uni~·tc'rsity of Chl('a~o HospitalsChica~o, IL 6Of;'1';'Profl'Sl/or of mrdan n~. rh ,,.r ofrndomno[ogy

PHIUP R. EATON

Univer~ity of l\:pw M.. ,icoMedical SchoolAlbuqut'rque. /10M ~";'131

Profl'!Uor of mrdln,,~.STEFAN FA.JAN!'l

UnJvt'rsity of MIchij.!an M..di,'al C'f'nltc'rAnn Arhor. MI 4klll~

This ~.. ('tJOn i:; devok'u to "pet'Jalist,,; whotreat a wide ran~e of endocrine problems.from thyroid j.!land probl.·ms to diseases ofthe adrt-nal j.!lands, such as Cushing's dis·ea;,.. or Addison'" disease.Lot'lS A \'IOU

JeWIsh Hospit.al of St. LouisSt. Louis, MO 6.1J 10PrOfl'!;sor of medlC'ine. Ui.l.sh, '/glonC:n lI'er,'lty

KE~~ETH BECKER

Geor~e Washington t.:niversityHospit.alWal;hington. DC 2003';'

Chll'f of I'ndorrin%gy.EDV'ARD BIGUERI

l:niversity of CaliforniaMedical CenterSan Franci.co. CA 94143

I Profe...or of ml'dinne; rlrief of I'ndorrino/,ogy. San Frann.ro Gl'nrrfl! Hm pIta/.

~ERT RICHARD CHRISTUEB

W'joslin ClinicBoston, MA 02215Auonatl' profl's..or of ml'dln nr. Ha n'O rd.

NWHOLAS P. CHRISTY

Hrooklyn VA Medical Ctc'nter

I

II

I

I Jilne. 198,4 57

ANlZl' GOL.t>B

S2:i Southdl&lf' Mf'dle.al Buildlnl'MinnealtOhs, M!' 5.'>4:~:,

Clrrnralprofcuor ~rSll.rgcr/i

f MIt/lI .

Do"'4L.t> G4UAGHER

~ Callforni.. Strt'f'1San Frl&nci"co. CA 941 1~

""""riat, rh,,"ra! proufn~or of"Ii r.QrI'.1Il'nll't'~lly of Ca ltfo nila

J. B. GATHRIGHT, JR.

Ochsner ChnicNew Orlunf'. LA 70121

If r r.uor of6lJ r,QI'ry Tulnllr

BARTO'" HOEXTER

6U Cuttt'r MIII RoadGr~at l'f'ck. l'Y 11021A,,-n~lanl rllniral profes.,,}T (){.~lirpn!l.

Cern,.11JOH'" MADDEl'

12:i Eli!'1 6~th Slret'lNf'w York. !'Y 10021Pro.ft!...~ur of rhmrn! su ry"'71 .\f" ltd.Mrrirro I Cul/ry'

GERAUl M "RI\.!-

111 Soulh Eip\t'nlt. Str..,·]prllladl·I!.I.i". J'A 1!·ljO:Profts,,,, 0'- ...urgrry. JfJ"rrn,.' ,H· :.:,rtl·COl/Cpf

NORMA .... D. NIGRO

~ll Great.n Mad A\,'nu,St. Clair Stl',rl'~, Ml 4.... ' .. ·,C"meal prv'r.,.,nr o.t,."ry' r." H"j,I;,Slolf

BERTRAM A. PORn ....

161(; }\t'n~inj!t.or A\·f'nu.Buffalu. NY 1421;)ChOrrT7l0', ~r rolor. aTiC T"t'rln/ .1,,. 'Pi r,~

Sta~e l'IlI1.t'~:f1 c!{ Sf"lI }'.ri.STL'ART H. Q. QI A!\o

17/00 Ea!'! End ..henut'}l;f'''' York. 1'Y )i1(12"rillc/ of t;" rrrtu! rI/lilr. Ro",s, " .Ho.JSVI~1

JOH .... R",Och"l,!'r CllmcSew (Irkar,~ LA ;(1121

EtIGE!liE P. SAn'AT!

10)(1 PO..rk AVt'nu(Piamflt'ld N.T 07("-,(1r1l1ll:0 I "ro.'e".<or uf SIJ r.Q' ,-!> l.' I, 'C" ,..

THEO{lORL SCHIHX·t\

t:nl\·er~lt~· of Cahforni.,M~dl('al CenlerSal' Francisco. CA 9414:,""...~ona It pro/r.s.,,}r 0.( SIJ rprr./i

El'GE>;£ SllUJ\"4N. JR.

Portlal,d Mt·dleal Cenl~'r

Portland. OJ{ ~72U;,

FaA"... TH£l'ERt\AlIF, JR.

8~16 Statt· Slrt'f'tErlt-. PA 16[,(lf'

G. BRueI: TH<n\

Carlt- Clinic6U2 Wet;t Uni"PMlit)' A...enUt'Urbana. lL 61~(lJ

Ht'ad. drporlnlrtll o.f rt,for. and rertnl.urgel'}'. Corle CIITllr. rlrl/iral a.~wnnlfprv,f,..,or ~r ,urge'11. ('TlII"''''''II}! 0.( /lhllOls

MAJ..r()L.M C. VEJD£NHElM£Jl

Lahey CliniCBurhnj.!t(lTl, MA 01AA:i

TImoDOaa B. SCHw4RTZ

RUlh-Presbyt.erian-Sl. Luke'j;Medical CenterChicago, IL 606f,(lPY-of-.or OM clt4innaft, dtpartmrnt ofwaedil:'lrt.t. BtUh lIedl(:al C.olltgr

PamDJCK 8INDa

Loa Angel. County-USCMedical CenterLoa Angeles. CA 90033PY-ofeucr of rw.dlnnr

PENN 8JW.J..K1lNCJpveland ClinicCI~veland, OH "106Cl&iLf of nt.d«-rin.ology

Pnat J. 8HYDU

Univenity of PennlylvanlaMedical SchoolPhiladelphia, PA 19104Auonatr profusor of rrudlC'1nc

DA\'lD H. SoLOMON

UCLA Medical CenterLoF Angeles. CA 90024Clt4irm4ll, Mpartmt'JIl ofmedlri.,/(

Ro"'AL.t> S. S""ERDLOFTHubor-UCLA Medical CenterTorrance. CA 9O~

Profusor ofmrdtritu. UCLA"'lU.J.uI THOMAS

Veterans Administratior. HOSlJi:.a1G~ne8\'illt:, FL 32610PY-ofeuor ~r lIUdinnc, Unll'f"1Titv 0/ Fiondo lIedlral Collegr.

RoBERT UTIGER

University of North CarohnaMt-dIC&J SchoolChapp) Hil!. Ne 27514PY-ofeuor of medlC'1T1r

&~QLON & REcTAL ' ..-'';~ SURGEONS - ~-.-..:~ -: ..~-- ---

Colon and reelaJ C&ncer is thf' third mo~:

common cancer and if; ont' of lht tnl('~ ofC&ncer that i8 increasini' in mcidenct· Lik.many cancen;. if it i8 detected early, tht' out·come can be very favorable. Beside~ cancer,colon and rectalsu'rgery involvef' oppratlonsfor ulcerative eolitit; and Crohn'f' dll'eal't:. aFwellu hemorrhoidr. (perhaps thf' most Nlm·

mon prOCt'durel,H..a.AND ABCAAIA'"

160'7 NOM AvenueRiver Forest, lL 6030;:'

ROBERT "'. BLUrT, JILMayo ClinicRodtest.er. MN 559UlHrod ofcolon and rerro! ,urgt'TJ/

H. "'HrTHEY BoGGs1634 EIi:r.abPth PlaceShrev~port. LA 71101

A.1..LJAHDRO C4IITRO

1112.'; Rockevillt' PiktoRockville. MD 20852AMociAtr prof-or of ftlrprl'}'

~MPttoll'7L

VlcroR W. FAZIOClf'veland ClinicCleveland, OH "lor.Clt4i""4'l, deportmenl of colon andnlt'W ftI~

DA"1Ll ]'I;. ORTH

\'and~rbii~ Medical CenterS~h\'ill(', T1' 3723~

Pru/r.s.sor 0/ Prl£tiIn 11cJOH!'oo T. Pcrrrs. Ja.

Milssachusettl- General HospitalBoston, MA 02114Profeuor ofmrolC'1M. Han'tJrd.

THADDEU& E. PROUT

Gru~r Baillmort Mf'dlcal CenterBaltimor~. MI I 212(14"""onalr profeMor of medlC'1ntJo;'n.< Hophrv.

ERIC'REl.<t....

Uni\'ersity of Miami Medical SchoolMIami. FL 33101Profeuor and rlt4lrm4l1 of rrudlrillr

LAWRENCE RIGG8

Mayo Clinic'Rochester. MN 55901Cltirf ofrndorrino~

ALA'" RoBINSONPrt<sLyt.erian Univenity HoapilalPitUburg;h. PA 15213

N4GUIJI A. S411AAN

IrS I) Anderson Hospilal and~Tumor Institulf-.,Houl;ton, TX 77030

Chief, Hrtion on end.orriflology: proff»Orof me41(:inc. l'"il'tTWit~ of Tenu s,-u-mCollrn' Cnrtrr, II.D. AJIdroraon.I

IIII

II

CirniealproftaDr ofrw.dln·rt.t; d~fof

IUtyroid rll"ic

.JOHN H4RE.Jollin ClinicBoston, MA 02215

IDoROTHl' T. KJuZlGEil

. 1\.... Ml. Sinai School of Medirinp• Nf'w York. NY 10028

ProfU6CW ofrw.dirine.ANJli M. LA.·Il&NCIE

I Loyola Universit), Schoolof MedicineMa)·wood. IL 60153PY-ofCS8or of medieiM.

I .JAMIlS C. Mn.BvUnivenit)· HospitalBOlton. MA 02118

IPY-ofr.uor ofmedlnlle. BOlton U"il.,.mt~

THOMAS MERJME£

llni\'ersity of FloridaMedical SchoolGaineF\·ille. FL 32610

I Chll,/ 0/ rndomn:>logy (nul mrtobolinnRoBERT Nn

Johm Hopkim HospitalBalun,orE. Mil 21205

I 1'ro/r.5.'0r of mrdlC'1nr, dirrrtor of ",dON""01091- olld .",rI4bolisT7l

CH4RU:S A. NlIGD-"J. Ja.

Il'niversity of ArizonaH~IoJlh Sciences CenterTuc.roor.. AZ 85724Profr4l;or of mrdlnnf

Wlll.I4M D. O'DIJ..l..

I lin/versity of l:tah Medical GenterSl:ilt LakE- Cily, UT 84132Prc,rr....' ,r tid rMlnnat; of mrdlMTI€CA PP£Po;H£IM£Jl

I tn/versity of Mmnesou. Hospital~Mmnlapolib MI 5.'>4;,5

J.fe-&~()'" r mrdt

I

11-. ------ 58

:::- 59

lIedical CenterDenyer, CO 80262Prof""- au cMi......1I, dqartflWflt ofaedieiM.

B~INOB. 8cIWIHalUniversity ot Waahini'f,OnSeauJe. WA 98196Prof"'" of.....ieiu.

DoNALD W. 8I:LD1NUniversity ot TexaaSouthwest.em lIedicaI SchoolDallaa. TX 76235Prof"'" au c\oinull of illtrrwGJMftiin...

JI'UD L SJIAPIBOHennepin CountyMedieal CenterlIinneapolia, liN 56'15Pro,/eDDr ofMftiinJU,

l.'"itllrT'fttr of .1(1"1IaOtA.WADI N. SUK!

Methodiat H~pitalHoWlton, TX 77030Clew! P'f'IIA/ a.ctiOtl; FOfeaar oflfUdin1llC,Barlcw,

SAMUa. O. TImraYale L'nivenitySchool ot MedicineNew Haven, CT 06510Prof"'" au o\4lrmoll ofill~llU'diclu.

In 1983, the Food and Drur Adminiatratioaapproved the lIM ot the d.ruc CycloaporiD A.whicb tranapllLllt IW1reona around Uteworld believe is the ma.t import&Zlt drul'breakthroui'h in tranaplantation ill the putmyean. This drur ia dramatically incTe...inr the chaMa for keepinl' a tranaplantedkidney, liver or panc:reu.CLYDI: BABJUCIlH~pitaJ of the Univeraity otPennsylvlLlliaPhiladelphia, PA 19104H«Ml of trafllJllGlIl~' e.laI flDtMJ forpGlIt'f'lIlIhc IraupIiJIIt.atiOl1.

FOL&alT Ba..DaUnivenity ot Wiaeonaill lIedical SchoolMadiaoD, WI 53'706Prof..,.. au cA4inu. of"'~,

BoIialT Co_TUniversity H~pita1l

Iowa City. 1A 6220UClewf of,"uupl.II'~UlliWf"ftt, t¥1-.

AaNoLD o. DDnauIUnivel"lity of Alabama lIedical CaterBinninrha.., AL 16184ProJ-t¥...~.BoNALDD.G~

Royal Vinoria HoapitaJ aDdIIcGiII UDivel"litylIonU"n1, Quebec:Can.da HIA lAlCl~oft,.aqlall~

Torrance, CA 9OS09Pro!euor aU cuinu. of~'"UCLA.

RoBERT GBOII8I1AN

H05pital of the Univenityof PennsylvaniaPhiladelphia, PA 19104Proftaor olllWldit"iu.

PJuu.IP M. HAu.Cleveland ClinicCleveland. OH 44106

.JOHN P. HAV81Z1T

Yale-New Haven H~pital

New Haven, CT 06510CARL K.rI:1.UlTRAND

Hennepin County Medical CenterMmneapolia, liN 55455Cluef of "rJlltrolon·

SAl'W KLAHR

Barnes HOlpital Plaz.aSt, Louis, !dO 63110Profeaor of rudinfle,Kashlngt01l ['''I_tr

JA..Dl KNOCHR.

Univel"!lity of TexaaSouthwestern Medical SchoolDallas, TX 75235

NEIL Kl'RTZMAN

l'nivenity of Illinois H~pit&J

Chicago, IL 60612Chll!! n'Phrologr .cllOtL

JACOB LDlA....N. JL

Mt!dical CoOlJege of WisconainMilwaukee, WI 53226Proftwor of JMdiri~.

MANUEL MARnNEZ-M.u.DoNADO

Univenity of Puerto RicoSchool o( MedicineSan Juan, PR 00931Profew:rr of M~an·ru.

SHAUL G. MAssavUSC School of MedicineLoa Angeles, CA 90033Cllle! dltoi.noJl ofvpJtT'OU:1n; /krward J,Hanl~ profeaM' ofm«iinJU.

KAflL D. NOU>H

L'nivenity of MiaaouriMedical CenterColumbia, MO 65210Profu.or of rudirifle, dif"fl('tor, diNiml ofneph rology.

VICTOR POu.All

Univenity ot CincinnatiCollei'e of lIedicineCincinnati, OH 452167Dirutor, dilViow ofrwpltrol.4n·

AUGUST R. RDi...... JL

Univenity of TexaaMedical BranchGalveston, TX 77550Prof- of iJlUruJ ...tiei...

EDWIN RUTIIIlV

University of AlabamaMedical CenterBirmingham. AL~Prof_ of ffI«liri...

GIDOReE Eo ScHB.Il:INal

Georltetown Univenity HoapitaJWaahini'ton. DC 2OOCY7Prof_ of lIWdin...

RoBERT W. ScHBJD

University ot Cokwado

, . FERRI~

L:nl\' .. rs:ty of MlI1ne~oLa HospitalsM II1n~a(Xllis, ~f N 5;"H.j5PT,;;, .'i.~or 1)( mea,,..,

DA\'to S. BALO"'IS

~o E.."t rll!th Str....-t.~t>w \".lrk. ?\Y 1(1021

PTO/(','>S(Jr vi rncdl(,;'it~ SrI< }or{[·nlre~t!l.

CHRlSTOPHER BLAGG

~orthwpst Kidney Ct'r.ll'r7(,1) Brll:luwaySeanle, w.-\ ~~122

A"~o("'ljtl' prtJ/c,;,wr oJ nll'c'ln7/f, l'lIl1'f'T'S1tyof 1I'n.,r1l ng/071.

CECIL C.()(,CISS

Ma.",oach1l3('tt.~ Gt'n<'ral HospitalBf,ston, ~A 0:2114P'"-"',.\.\,,r o( ,,/c':lell,,·. Hnnard.

-

NEPHROLOGISTSApprol<imat",ly 1;0,000 Americans are on kid

~ey dialysi" today. Many Ilre on hemo<halyWis, which usually requires (our to six houn

a day, three days a week. but a growingnumht!r are on perlton!:!al dialysis, a moreportable (orm o( liialysis, and which offerskidney patienUi more (reedom and (ormany, a more energetic life. Ont! nephrolergist warned that patienUi must always seekout a nephrologil't who at least offen pati",nts peritoneal dialysis.

!\ephrologists orten perform a second(unction (or their patients· e\-aluating them(or kidney transplant. The physician's expertise is \-ital bfocause he must ilelect the"ur!O:'t'on alld the c('nter which has the ilk illand the rt'SIlUfl'PS to offer the patient thebest chance "f ha\"ln~ a successful transplant. .Plt'ase sO'e Kidnl'Y, Liver and Pancreas Transplant SpeCialists (or importantLreakthroul!hs in tran;;plantallon.)TOM ASOREOU

l"nlversity of Tt'xas~f,·dlcal :,,'h,),)!Hduston. TX 770:10

Prll/fS'''ur (~." mt-\ilrlni'.

AllEN ARIEFF

-11.-,0 Cit>m..nt ~trE'l't

San Franc!"co, CA !q:~1

_'hIO,'WI,' pro/i.'!,sor 0/ rnrdL"1n~, l"'III~ rsll/lof (a/j.r~)MlJQ.

I

WII.l..IAM. !'lIGAN

I:niversity of Arkansas for MedicalSCienl't'6Little Rock, AR ;2'205PTofessur of "",dlnnt'; dlrt'rwr, departrra"",tof dlnilln., and transpla IIwtlon.

RIC'JlARD B. FREiMAN

L:niver!lity of RocheSll:!r~<,dical Cent.t!rRochester, NY 146~2

Htad ofn'PhrologYI4n1l; a.uOMau

I P""off'uor of lrIedanne.~ A. FRIEDMAN

Wnwnstate Mt-dieal CenterBronklyn, NY 11:lO3Profeuor of lrItdinne, StDU l"nil'""l1tlf of.\'nt' Yorle.

RICHARD J. GussOc:K

Harbor-UCLA Mt'tlll~al Center

I J1411e, /9&4

IIIIIIIIII

I

II

I

II

I 60

Lo~ Anl!ell·!>. CA 90024ChId of urolag./I. IIprnalllltl'1'Y'l'! IToinro~t;·nrnr(. N'Tlo/llQJtru/ar .... rgrry.

""ARRE" W. KOONTZ. Jk.

M('dlC<l1 CoJle!!t' of \'JrjZiniliRichmond. VA 23~/'

Profr.&.nr Gnd rhrrf of II rO/09.1IROBERT KRANE

University HospitlilBoston. MA 021 IE<Auonol,r p"o.fesso" o.f ur%g.1I Bo.<IoliLJn"'t'rstt,lf. .pl'no!lnu-r(',Jlf II, nru"ogrnirb/addrr dL~ord(,71i

BERNARD LY'M'O"Yalt- l'niversity Mf'dlci:1! Scho(,1~('... Ha\"en. CT ()(j:,J(1

Pro.fc.,.~u.. and ('hl('f of uru/og./JJOH" H. M{'GO\,ER..

53 East 70th Strpl't)l;pw York. ~y ]OO:!1Pro.frssoT o.f uroI09.11 COM,fi!

EDWARD McGl'IRF

l'ni\"erFlty of MlChil!"r. Medlea: :;'c;'r.(,'

Ann Arbor. MI 4~1O!-'

Clio 1r771n I, 0'" ro!o,C./;01. WILLlA"" McRoBERT!'

l·nJ·'l'rl'lt:, of J\entuck~

Collt'l't, of Mt-dlC'lncLe>dnl:"\(.r•. J\Y 4(1.',0('

Pr(Jff"'~UT orcd rhfn~.,.,.a I, c( I. ro!".c."RICHARD G. MmDLETO'"

l'n1\'er~lt~ of l't4hMedlc,,1 C-er.h'T

S,,11 u.k.- (ny. 1'1 N13:::Pro/rs"(lT a7d: r',OlnrIOl o.'" .."IOP.L

TERRF."'C[ R. M4LLO\

Pl'nn,yh·an'll HOFplt4:Philadf'I~'hli:1 PA ]!<107{hH""! a.' /1"01001:

VIl\CE",T J. OT.o'WR, JR.

~ orthwl'l',t-T1: t'n1\'t'r~ll~

M...dlc"i !'\'l,(IOJChll·Ai-"'. IL 6(1(;J 1Pro/t·....... ,-,., 0./ ~ rl'.'c,p.l.'

C4Rt 01-"'''0"'C'olu mbi,,· Prt'l'I'ylt'Tlcl.Mt-dlC'.. ' (-tor-U'T

~t'w Y0rl-. ~Y ](I(1~;;,'

Prufrs"vT or.d rhclMIl07;. drJ,n-:II,n . c'urv/c'.C,li Sl"rw! 17,frre.': 17, ran·-"T

D4\'JD F. P4t·U'O'

Ilul-.,' l 'ni\E'r~ity· ~h'dlca' ('f'nt"Tflurh"n .. ~C 27j](lPro.fe.',<u T a.' ur%{:/ro.' surg,'ry "J'I ~1C:'

"ltrrc.~r H. ra'lrr,LE.<:TER PER!"";l'

l'nl\'er~il~ Hpl'l'ital,Cll'\"eland. OH 44){1(;

Pro.f(·",<o' a.' u rolo,O.L COM Hi'slrM, J(r.,r'"1'(PAI'l C. PE.'TER"

l'ni\'f'rslty of TexasScouthw('!'lA.'rt1 Mt-dlcal 5ch"oJlJaJlR!'. TX 752:~:.

Pro/('.,~.nr and rhalmla?l. dll"~I071 0.(

IIro/ngli. 'lorna/ iflt,"sl in pro.~tCI(

VIC"TOR A. POUTANO

JaC'hon Mt'morial HOl'lJit41Miami, FL 3:i131;Pro.fr.~~n .. Gnd rhnlmlQn of urology.1'1II7'f'nnty o.fMIOn/1

JEROME P. RIl'HIF

RTli!ham and Wumen'" Ho!\pit.al

Mf'dical Cen~rRochel;lA.'r. ~Y ]4f>42Profe.uor G"d rha7rn1an o.f uroloUY

ROl' 01. CoRREA, JR.

MaI'on CliniC'Seattle. WA 91']]]

KENNETH CUMMINGI'

University of Wiscon!'inClinical Sciencf' CenlA.'rMadison, Wl 53792Pro.fr&~nro.f m"dln·1Ie. chlrf of uro/o.o."

JOHN DoNOHUE

Indiana Uni\'ersity MedIcal CenlA.'rIndianapoli~. l~ 46202Pro/u.~o"Gnd chairman of uroIOP./I.

GEORGE \\'. DRACH

1501 North Campbell AvenueTucson, AZ 852';4Chrrfofurology Unil't'rS'ity of Arizona.Ipf'Clal intrre.~f In ,I07/(~'

"'ILU4M FAIR

Washin~ton Univer!\ityMedical School5t Loui~. MCl 6..11]0Pro.fr.•.•(JT and rhalrTI/ari. d'l"lsim, ofurology 5pr60: Ir.ffrr.;' 171 771.(prflon'

\\'IUJAM L Fl'RLO"

M,,~'o CliniCRoche!\ter. M~ 55~(I]

Pro/e.sS(.T ofu ..olog.II .~prno:' ITIfrr('s~ III

lmpofrnr( olld I1Iront'"('Ilr(ROBERT GIBIIOl'i~

Ma"on Chnl('Spanlf-. WA 9~1 11

J. \'. GILLI:"~4TER

l'nl\ersity of VJr~Ini" Medica) C-enterCharlottt'<\'ilit', VA 22"1I~

Chl(f o.,ru ..olo,OpRI'BE" F. GITT&"

Brll'ham and Womfn's Ho,plt.alBo~ton, MA 0211;,PrO/""'M o.'Ur,,!oplra.' .•ur,Orry. Har"ord"J.,.r,o,· I1IlrTe.~f H' SIOT,C.,. ronrf'·.

JOH' T. GR4YHAC"

~orthwest~rr. MemOrli:11 HOFplt41ChiC'a!!(" IL 60(,1 JPro.frssor and rholrmo1l, drpCTtn/rnr ofurology..~·orthu'('sfrML, sp(nn! Infrrrsr H,

pro.,louDOl'iAUI GRIFFITH

Baylor CoJle~f' of Medlclnt·Houston. TX ii03PPro.fr.....o.. o.f wrology. sprno! IIllrrcs- In

stonr'ROBERT HACKLl:R

Mt'dlC'aJ Collt:j:!t' of Vlrl!ini"Richmond. VA 2a2!l1'A""onat, 'Pro.fr.~.or o.f mrd/r1f1r. sJwrra!lnl'·Tr.~I iT' "rurogr71lr bloddr-r prob!n/l.,lI'hld, arr rau...('d b.lIl/plna! rOTd In)"ry

THOM4!" R. HAK4L4

l'ni\'f'r~ity of PltL~hurl'h

Pitt;;ourl!h, PA 152(,,1Pro.fcs.,or Gnd rh7cj d"100rlmr7l1 0/Ilro/ogiral .... rg,,'7/

FRANK HINMAN, JR.

Uni\"prsily of CalifurniaMpdical CenlA.'rSan FJ'Ilncisco. CA 94]4~

Cllniral 'Prof",Jl.~o" o.f IIrologyJOSEPH 01. KA\!F'MA'"

VC'LA Mpdlcal CenLPr

Hl\ AJARIAN

University of Minnesota HospitaJ~

Manneapolis, M~ 554;,:'Profellor G"d chairn,07' of surgr'rll Majnrerntn for lil'f'r and ponrrrQ.'troM lonlollok

•' uroloi!iclol ~y!\tt'rr, includt-> th,· urmary

t. kidney!\ and bl"ddcT. pr('~t4tt' I-'I",.dand malt- genJt41 "ystt-m Alth'Juj:!h mOF!uroloi!ist.< oJ.*ralk 01; all th,· lJ"rl, of th.urinary syHeITl. the~' m,,~ haH ilit .. rt'-t, ir,fl.,eC'iflc art:lo~. sud. a, kldl'''~ F\(,n,·~, lJru'"~t.€ sur~er~ . mfectJom or U ..ddt·r C<lnct-TTERRY D. Al.L£",

linl\'er"ll~ of Tex ..-~uth ..... e!\U'rTi ME-die,,] Scl."n 1

Dalla~, TX i52:;:.~I( prlJff:.sOT 0/ Uruiugj.

SAMt·£!. S. AMBROSE, JR.

EmoT) l'nl\t:rsity ChnlcAtlllntot. GA 3!J::l2'LProfrNoor 0.( urolo.oy

JOH"" BARRY

Ore~or. HealthSciencto!' 1: niversityPortland, OR 9i2u1Profruor o.f u rolug!,

WIU-IAM H. BoVCE

Bowman Gnly' School of Medlcm,Wml'lon-Salf'm; ~C 2i]o:,Profe.uor GlIdrnalrmoT,. urolog.1I srrtlol,.qJtr14/ i"tnuf in ,to1lr"

W,U-IAM BRANNAN

Ochsner ChnlcNe,.,· Orleans. 70]2]

C. EuOENE CARLTON, JR.

~~'Ior CoJle~f' of Medlcim·

~f::a~'a~ ~Z~~OTI o.f urology, 1pt'M01i"'truf in ronrer.

ABRAHAM T. K. CocKETT

UniversJt~· of RochesU'r

R, MYIlON KAUFFMAN, JR.

Ih'dical Collei!f' of WisconsinMiJ""aukee, Wl 53226Brad of traupla71 f M'n,r(

R.M. LEE~edical CoJleve of \'irvinia~ichmond,VA 232]fI

Profusor of,urgrryTHOMAJI L MARCHIORO

Universjt~· of WashinvtonSchool of Medicint'Seattle. WA 98]9;.Nnw 0 traMplo n f 'u rprry

l:liCAR AL\'ATIERRA, JR.

Uni\'ersity of California MedlC'a! Centt'rSan FrancisC'o. CA 94]4:~

Pro.fn.~(lr o.f su"prrll •THOMAS E. STARZL

Vni\"ersity of Pltu.bur~~, MedlC'Ai Sd,oo]Pitu<t.ur~l:. PA ]['2GlHrad oflra71.~piar.t<Jt/(ll, n/O)OT rl'7ifp'fnr111,(," a1ld palir..rQ.' tr071.'jJ!onlollC!7I

G. M£!.vILLE WlLUAM"

Johm HopkmF H('Spll"'!BaltimorE:. 1.1 D 2] 20;,Brad of tran.•].·107/T SI; rgtry.

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JOHN L DECKERNational Institutes of HealthBt>thesda, MD 21)814Like all carr al Ihe ...../H. il 18 free. HOk'n'er,patients must fw reftrred and must fitlIilhln Ihe rt,~l'arch protocols tfJ qWlhfy forIrratmrnl.

Rl.'SSELL DD. TOROAshford Medical CenterSan Juan, Puert.o Rico 009iJ7Chief, dt'par~1rItnt of medlnne. San JlI.anOfll Hospital.

HERBERT DIAMOSD •Lon~ Island JeWish Hosplt.al~~w Hyde P..lrk. ~Y 110.10

EDMl'SD Dl'BOIS4:3.'" ~orth Bedford Dri\'eBeverly Hills. CA :1(1201ClinIcal profcssor of "It'd/nne dlrec~or ofLII.pll.~ ClinIC. CnlferSII!; of S01o:ht'"MlCafl/onlla .~fl'd/('al School.

GEORGE E. EHRUCHHahnerr.ann Medical C01Jei:'''and Hospit.alPhJlade-lphia. PA 19102Professor of ml'dlnne dr Tl'r'or. 01, !'Sl''1 or'r17plI. mr.lology.

EPHR .... ,M P. ESGLEMA'l'ni\'HSlty of Cai:fi)rnlaMedical ('~nt~r

San Francisco. CA 9-1, 4:~

Chnlcal professor of mfdr!":n/'

J ....M~ FRIESSt.anford l'niverslty Medica!CenterStanford. CA 94:~05

ASSOCIate profrssor of mrdln,.,e.EsTHER GoSZALE!',PARES

l'nlversity Hospit.alSan Jt;an. Puerto Rico 00905DIrector 0/ rhell.matlc dl.Sea.sp sa:lOn.C,.,II·ers/ly of PII.t'rto RICO.

NORTIS !\II, HADLERl'niversity of ~ orth CarolinaMedical SchoolChapel Hill. ~C 27514Profes.sor 0/ mrdlnne.

BEVRA H. HAHSlTL\ M..dlcaJ CenterLos Anlleles. CA ~:24

lhlrf 0.( rhclI. ma folngy .~prtlOn

DAVID HAMERMANMontefiore Hosplt.alBronx. SY 10467Chalrma1l, drpa rtmrnt 0/ gt>natnr.s

ED"'ARD D. HARRIS. JR.St>w Jersey Collt'lZ'e of Medicint'Piscataway, SJ 0s.".'>4(,h lef of 1rIrd,n 'I".

Lons A. HuLEY, JR.ROBERT F. Wlu..KENSKESNETH WILSKE

l'nivenity of Washin~nM..dical SchoolSeattle, WA 98195All art on thl' 1rIl'dieal f-It) at thl'l.",.,II'f'7"S1t~ of KiuhJngtu1L

EVELYN V. HDISUniverllity of Cincinnati Medical C-enterCincinnati. OH 45267.VrDoPlaid profl'MOr of 1rIl'diriM, dirl'("for,dilvlo?l ofl1rl1rluPlology.

WIl.BlR J. BLECHMAN909 ~orth Miami Beach BlvdSorth MiamI Bearh. FL :3:31t>2Clmlcal a.ssonate pro/cssor of medlnne.l:nil'f'rs/ly o/J!larrll.

RODSEY BLl'ESTOSE!'6.11 West Third Stre~t

Los AnJl",les. CA 9I1()-ti"P?o.(r.<sor a." mediC-PIt'. [·('LA.

GIL£." BOLE. JR.'-'nl\'er~Jty •.If ~tichigan

}t..dlcal CenterAnn Arbc'r. MI -Il'109

KESSETH BRASDTl"ni\'erslty of Jndiana \t ..dlcaJCenterIndianapolis. I~ 46223Pro.fcssor of mn!Jrlnf. chuf. flrthntlSdu'IS1or..

JOHS J. CALABROSt. Vincent Hosplt.alWorc..ster. MA 01f,O-lPro,r.'ssor o/mpri,nnp flnd prdUl~""CS.

l'nll'prslly of .'.fa.~sachII.sc/ts.

JACQt'ES R. CALDWELL71uti SW 11th PlaC'eGain~,;\·ille. FL :3260.,.,ClInlral a.ssonate pro/pssor lJ,fmedrnne.l'nu'/'rslty 0/ F!onda

ANDREI CALINStanford l'nl\'ersity M..dlC'al CenterStanford. CA 94JO!).4ssonutl· proff's.~or 0.( mfdlnne.

CHARLES L CHRISTIASHospital for Special Sur~er}'

}IOew York, z.,:Y 10021PhYSlnfl n-In·ch,ef

ALAN S. CoHENThorndike Memorial LaboratoOryBoston City Hosplt.alBoswn, MA OZ11~

Proftssor of mtd,nne, director of thl'Thornd,kt lAb and tltt Arthntu Ct?ltn- of80.•to,., l.''''"'f'mty School of .'.ftd,n,.,e.

Wlu.JAM A. D'ANGELOCatholic Medical CenterJamaica. NY 114:32Chll'f of rheu1rlalology.

JOHN S. DAVl8University of VirginulMt'dical CenterCharlott.esville. VA 2290RProft.'l..or of tntt'rn.al mtd,n,.,e; rhll'f,arthntu &I PII I.

I Rheumat.o)o~ist." could accurately be calledarthritis sp~clahsts ~cause that is the vastshare of their medical practice and r~search.

ArthrItis is in fact a catch·all term for any

l one of a number of dIfferent bone and jointdisord~rs such as llout. infectiOUs arthritiS.ankylosjn~ spondyhtis and rh~umawld ar·thrltls, usually the most crlpplJnR form of

I this dis~ase. Other diseases treated by rheu·mat.olo~ists include lupus. more formallyknown as Systemic Lupus Eryth~matosus

ISLE). a dis~ase of the immune system

I which usually strikes young ,,·omen.

RA~~~~~~~\fiami"dical School

I Miami. FL 33101Auoriall' profl'.".or of 1rIl'dinne.

GENEV. BAll.University of Alabama Medical

I Center

Jknl'.191U

Boston, MA 02115 Binnin~ham, AL 35294AISCX'ialt prO/l'ssor of urology. Han·ard.: Professor ofmt'dlrine: head ofrperialllllere.~t I,., cancer. rht'Umalology sectlo'n.

DoSALD G. SKISSER JOHN BAUM~s Anlleles County·esc Monroe Community HospitalWM..dicaJ Center Rochester. NY 1460a

Los Angeles. CA 900:33 Prolrssor of1rlt'dln'nr and pedIatrics, andChalrma,., 0/ urology, .,penal interl'.sl i,., p1'f!1,(,71l/roe. family, a,.,d rehabiWatlO'"ranrl'r, r,.ron.~tructil'l' surgrry. 1rIrdinne. C"i''f'nrify of Rochester.

THOMAS A. STAMEY GERSON BERSHARDStanford Medical Ct>ntt>r Medical College of WisC'onsinStanford. CA 94305 Milwaukee. WI 5.1:.!26Professor of,.urgt>ry, chaIrman. d!l-1.S1on of ('lIniral rnfr.ssor 0 mrd,r'ne.urology. SpenoI Inltresf 111 I n.fectlons. ""~A~t~·tL1t'~I~.K~·A:-iiii----~~ ,

RALPH A. STRAFFON 62 South ~inth StreetCleveland Clmic Minneapolis. M~ 55402Cleveland. OH 4-1lC16 ClinIcal .fJro./rssor 0/ medlnnr l"n/!'erslfyHm4. drparlrlll'ni 0/ urO/O.9,1I ,. ~ /I '.

DAVID l'TZ~tayo CliniC'Rochester. ;\t~ .}5~1

Spl'nal l1Itprrsl in ca nrl'rE. DARRACO'M' V Al·GH .... S. JR.~ew York Hi)~plt.aH:-ornejJ

M~dlcal Cent..r~e ..... York. ~Y 11)()21Pro.';·.....nr r:nd rhrll...,:,] n o.~' i. r0!0.QY

PATRICK WALSHBrady l'r(,;r;~1C'3! Jr,:'::t:..:!",Johns Hopkin!' Hospl:"'!Baltimore \tD ~l:2t).'"

Professcr and (';,,] I ..." '1 n 'J" II. N):09Y. .;pFna IJnrrrfS~ In pros'arr Sll. rg"'"!1

A1.As J. WEIN.nl\'~r!'llY of Penns:,!\'anlaWni:ad"lphla. PA !!iJ04

Professor and chaIrman 0." 11. rO!09Y. spenalIntt'resr I,., nnlrogrnlr bladder dlSfJrdprs.

WILLET F. WHITEMORE, JR.~ft'morlaJ Sloa!1-Kett<'rlng CancerCenter~ew York. ~Y If)C121Professor 0/ su rgt'ry. ('orne[1. spenalInler•.• t In carlcer.

LEONARD Z"MA....Lahey CliniCBurhnl'ton, ~fA 01803

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DA\'ID S. H01n:u.lIni\'l'rsity of Miami Ml'dical SchoolMllimi, FL 8.'ilOlPrCJIl'~or of mtdinllf'.

GENE G. HlINDER

Mayo ClinicRocht'lI~r, M?' 55~]

THoMAS G. KA~Rl'l'W York UniversityMl'di('al CentE'rNew York, NY 100]6J)ifTrtcr, Rhrumatlr lJI.~ra..( Study Group,('hic.'••('ctioll 011 cllmra! thrrop.'t

STEPHDi R. KAPU'"

Ro~er Wilhams Gl'neral Hospit.aJPro\'iden('l', RI 0290~

Assonat( pro.fcs.~oro/m,d,nnc. Brou'1i£. CA."·I1.£ LERO\'

Medi('al l'ni\'l'rsily ofSouth CarohnaCharleston, SC ~~2:;

Pru/i,ss(Ir o.f m,d,C"/7Il'. dirl'rtor.rl,climalo!ogH and ,m muno!o[l!l

D ... SIEI. J. McCARn. JR,

M..d.('a) Collt'j!" of Wl,,('onsmM:l"'·auket'. WI [,;j~2t~

Prq!tS'l'· Olio' rJ,olrmc1l • drpcrrn,r';f £Jfnt' dl('ill'

ALF"OSSE MAl'I

t'lJl\er"lt~ of Ilhnol""h·tilt" I ::;do()(ojhUrl... IL 6]6(lt;

Prc.(('~.'o~ and rhOI"'7/1or: d('jJorrlltr'lr ~r

'11 ( d~~Pd

THo!'ol,'" A. MWS<.ER. JR,l'n!\'E'rslty of PItl-"burghJ'ltul.ur.,.r. Penmy·)n.nJ" ]5::?t~]

PTv" ,"I.,.~,.,.. (If 11/idl'· l'

RoLA'o;lJ 0';1\0

:!fl";:; A b:!,~tvr, k"itdell \t-J"nc OH 44]0;,rrt/f ........ U·· oJ n,rd:-l1". d1T{'rl(lr £.!I'rjd-unla~lr d",'t('a.c;{ ",rtl!. Ca..\( U,~\tcrJj

k'.\I''i'f

DA\'JlJ SElSTADT

::lz.... MtcdlC&1 Tu",eT"o Soulhu .... i;:\'II,t·. J\Y 40;!1I:':

('ipltCO,' }Ir(jf~.'i.\()·,- (!In,rdl"',-r" l·ro,'rr.r.:1f."

c.( Lvu ~St'1/ir

\\'a.uA110I O'BllI E"l' ,,1\ erslt,\' of \'Ifj.."JnJ;'

Mt-dl~·..1(~nlt'r

Charlvttt-~\'i)It., VA 2;!!-f(1]

Prof, ....,or 0/ mrd,r;1I(J, D. O'OnTl

MilYU Chnlc,kocht'~~r....M!I: :.;,~IJ

HAkOU> E. PAl'LL'S

VCLA Medlc..1 Cent..,Lo~ Anttt-lel-. CA 9h(J24hut.:....,,,,. of n",d,nnl

ROBERT H. PEIL<;EU..JI'

2(Jj E ..q E\'er~rt'en

e.SIiI. Ant()niu. TX 7tl212WAl'U>I!\;G PH~

lkll P"rt. A\'t'nutPorlilind. ME 04102

CHAIlLD' M. PLOTZDO\l,onIlt.8u' M,'d,clil c..n~rBrooklyn, KY 1120:jPrO/tllSor 0.' ",('dlrlt/l'

GUAU> P. ROD"'A'"

Uni\'l'rsit) of PitLSburj1'hMt'dlcal SchoulPitu:bur~h, f'A 1St!;]Profl's,sor of mpd,rml

8ANPORlJ ROTH

Sl Luke's HosJ'it.aJPhOE'nix. AZ l\;l(llll;

NAOIlolI Fox ROTHnELu

Uni\o'l'rsit) of C.onne('tirutHl'altll C~ntl'r

Farming-lon, CT o{iO:~.:

PrO/f's.~or 0/ mFdlnlll, rnlt:f. dU'l$ior, o.fr"l'lIma/ir d,sra,<c;,

EIIoIIIoIA"t'EL Rl'DlJ

Husplt.a! for SII('('ial Sur~HY53::' Ea~t 70lh Slrt-t'lNf'''' Y(lrk Jl:Y ]flO::?]

FRAI\;); R. S('HIIoI II I

North""eHern l;ni\,ersltyMt-diral Sdlo(,)Ctllcaj.."C>. IL 6(w~ JPr%sur CJ.fmr,-!ln'tf. rni('< .~ccll(>r. 0',arth":l., and rO/";t'('III~ Il."-'u( dl.'l·jl."

GOR[)()!10 C, SHAHP

linl\'t'r~i!~ of ttl ,''',our.M ..di('a! Sdl(olJ~

CoJumloi" M() (;~,:!lIJ

Pr(~(('~",,,,o'" 0/ m('(f,r/1ff

JOH" SIGLER

Ht'nn F,.rd H""I'll"'!IIE'lrun. MJ 41-~I'':

('11lr.' 0/ rllf'U7Jd: t u.'Up!,M.'Rl Brrn SlT\'F""

Goocl Samarito.l. Ho!'.J'it:. 1

Baltlnwrt-, MIl 2]::.;~'

lJ1 rrr:OT. rJ,rumc Itl/UPH d, 11....·j 0': as.SfJrIG Ir

profr~.' :,r ~f ",rdirnd. ,h.'I>,' HUl'l:lIl.'ROIU:RT SI'EZFl

Arthrill' 6: Ihd 1'-.. 11. eot-I.kr Inl22(10,' S;,nw, Mur.,,·;, h, '''It'' ardSilnw. M"!;IC'a. CA ~14'1.:

[:nT( r/(/" u/ {It' ((". (('r, rl"lIra,' pTv.frs.\op «

mrd,rl/" ['CLA.CHARLDo TOl'RT£LUlTt

Tt'mJ,It, l' nl\·t'r~n~ H 0;-,,,1:.0.1

Pt.il"Jdl,hl". I'A l!JJ 4(1Pru/r......\{Ir of n,rC;('1'I1I ('J,G ,'-",U 1..

,./11 Ii molulu::._ .,ul,,,,.PETEII l'TSI"C;ER

1'1'1;", Gt rn;:.ntA'WI, An·nu ..J'hjlilddl'~ll". f'A ]\1]1"

81 ASI.F.l' WAU.An.

]fF. ClJnLur, Strnllirlloklr'l, 11:'1 ]]~(IJ

/Jr(!fi.......\I,.,. of 71lrd,n1It, [)uu·.".(.;.,tlJft

JOH", R. WARIIllm\,('rsny (If t'u,l, M..dlf'.. 1 C.pnlt·rSail Lloh Cnr. l:T "~l~;:

hufl's...," of ",,,dln ''', rhld. or/h .-,tl!

dlt'1.<ionHOl"ARH J. "'EJI\;Bt:RGEIl

loli.H Wt'st Ttllrd ~tr"f'l

Lo... AnJ!.,Jl·S. CA ~14"

CoWl\; WIU«J.... Jk.Emory llm\·pr...n) HnspiwlA thmt.a. G.~ 3();j;!~

Profr.'1..\u" o,f ""d,n I"

oJACIl ZtJC""'£IlSt. Louil- Ilni\'l'r'IIity Medical SchoulSt LoUIS. MO 6::lJ~l

Dtr('rtor. arthrd",' .('r/io,." professor 0/e1miro! ml'd,n,,,

ROBERT Zl'RIEIl

HOfo;J>iLlol of the Uni\'t'rsny ofP.'nnl'yl\'linlliPhilildt-Jphia, PA ]9](4

NATHAN Z\AIn..Ek

t!ni\'l'rsity Hospit.alSan Dtel'o. CA 91](J:!Pro/t'''''o'' of 'rI,l'd,n7ll. l!lIl,ormly ofCalifonilQ

- ORTHOPEDIC"""~ SURGEONS - -

LikE' many ollot'r mt'dlcal sJ./·cialtit'S, orth,.,JM'di r· surf..r) hac bt'r(Jn.t' an art-;, of SJ.o<'Ciili('ollf'entrilllOJ, Wllhll, lbl fIde ar", thes,spt:('iflt· i,.lt're, I ~

JOlrrl rC'}Jlo,.,.nr('l,! Thl' in\'oh't'- t(j~J rt-·pl:il't-rrwn: of J(lll~I" \o\'n~, n,t'to.' and "Ia<litpar!.... lind !'(on" !'~'/'Cl .. jl't; cunc,-ntrilh' emon.. )lOlt;t r"tI,t-r lha!, &l.(ol!,,·~

Fmeurt Inal'""/,I M(J .. ~ hr·,hl·r, bont"('al. u., Sf't r(\UlJnt·!y a; mu'l I.o·j,;t .... !;.. but inc.... t',. (If ('(,IlII,I.·) or nor.·h(·;,:.:,~ fr;,rtur.-;.lht- loro(,t'dur.- l,t'c'umt'c f .. ~ IT,. ,n dlffwull

51'1', r:.' ."try ""'." In(') Uti.-' I.,,! l ned. al.abad ,pir.,,) sur~.'ry

lip,,, cud .\{~ ..: rl.~.::;.J1 fl1n:(,; .~u T~II "'J, Ttlt- rtrTH"'"J of tht':o<t r:art.- tU~Jur~ rt"':..pJirt-'~ \-t-r~

spt-rializ!'d eXJoE'rtl"A,·.lit.,t/~ SUrfJf 'r}.t ~ur~t'r~ t. retl~lr d~rr,

Iif:' ('au,,/'d I.:. llnhrill-WAl'SF" H. Au:so,

l' ni\f'rsi!y Htp.. tJ1td:~"r. 11j('~\' CA \42)(1?-rt fr • "~lJl « ortl,(,)"1':'" ,f:'i?',C·... -r-:w "'ii, ('ry.'j"~

((- (C: Ifl1 ""'7i 1;,

H ... HI.A" AIIoI;:n'T7

1TLA M to·il,·" I-~r,t<·~

I,., An~,;... , ('..\ !tl"',,,:~

PrCJJ;',\Sl' O),r! (1,1(.··0' (1"':I'l;'(:~"'· .~li."".or~'

b'P(i"IQ' Z7;:rrr~... ~ H, .lOIJi' TtJ ;[~r(",.t·11;

l..£"'I,. D. ASDEIlSO",

liTl:\"t"rsity of Southt'rn Aj~l'~'1n,~

M..dlC'aJ Srh"c,jM"Io;I •. AI. :-!ti(;J7Pr".'n"...;pr one' rn"j"nIl(J. P, c( (1'-1', Ji't a'-,(114'"'pr ...."_ ~p("r,a: pdf·r"('.'" 17, /'"IlC','ld't'

Ruu'I;n Ii. B1."I."Ort'cur. H";jltr, Snen('," l'nl\.-r.. ,TyPlIrtland. (Jk 9";~1.]

Pru/; ......... :17· 0/ orll'Pjlf'd,,: ~'" '.L,II -~

CARL T. BRIGHTO'l;

HO'I"t..1 of ll" t:nl\l·r,..n,\ ofPt'nn~)·lnlni••f'hlladdphill PA ]!lJ(I~

('1,oln'lali o,f or/hQJ"'d,r iS1I r,Q"ry, I<}'('no!inlcrl'.~t III "U'''''1I101: frO"I/. r,..,

RICHARI! BII\'AlIi

May'o ChiliI'}<o('ht'I-lt-r. M!\ '':,~'I

S'I('('JII!lIltrT/.\: II: ),,"1/ rCI,!occn,,.,,:Rocco CAl.ANIlRl'('(,"IO

Camplo,.J) C1mi(')h·mplll,... T!\ a"-lO;;Prv.ft·.~~"r and rhnlrlllan 0.: ortlro}/cdlC

• . _ 62_.e.....----...----------

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63

OB\' THOMP~)." R.

l'nJ\'er!llty of M:nnesoUi Hll~~ltals

\1mneapolJs. ~f:\ ');;4,j5

Pro.';·.<",ur arrd ,hnl M7111 " ofu"';'rJ,I"'d:r'''''4r:'1, '·n'·f~l,;.' It~'r''f.,,' 1'; .. ;1"11." ··,"4 r " .,..

VBUlT TOCIMS

Camph..11 Clinic"",mph/s, T:\ :l~10:i

"/'f'tlQllnt""'st Hi arthnl .., .-1, r9"'"Al'Gl:STliS A. WHITE III

Beth Isra(>! HO!lpltalBoston. ~:\ O~~l.')

Pro/i'ssoT %r!h')Jlf'dlr s",r9rry. Han·flrd..'pFf'lal ''''f'rrslln sp'IIal :Wrgfry.

THOMAS WHIT£.~IDE

Emory l'niH'rslty HospitalAtlanta. GA :ln322Pr(~,"'s..or vf orthnprdlC !Ii< rgr'7t. "1)/',lalH,trrt'."I" spInal S/Jrgf'T!l nnc.'rQrluP'f·s.

ALAN WILDE

C1t'\'t'land Clini~

Cle\'eland, OH 44106ChOl rma 11 of urthopt'dlc "'" rgf'ry, sprn'alintrrest ill )Olllt "plaumrnt.

LEON WILTRE

~ Long BeaL'h Boult'\'ardL(ma- Beach, CA 9Ol'OfiSpenal I"t,rest III llimbar gplnr.

PHIUP D. WIUKJN, JR.

HospiUlJ for Spt'clal SurJCer)'Ne~' Yurk, NY 1{)(J;!1Su rgt'on·ln·d",;; qwnall1ltrrr3t III hiprrplaC'rmnaL

Prn,f"ssor of orfhopedic~urgery..~penal/n'err,~' I" jUlnt rl'plarf'fTlpnt,

CHARLES A. ROCKWOOD, JR.

Uni\'t'rsity of Texas Medical SchoolSan Anltmio, TX 782/;4PrOj"....wr find rhalrmnn uf orthoprdlcs,"penal if/tf'rt>st '" fraetu r"s. shoulderprob!t'm',

RIL'HARD ROTHMAN

Huspital of the university ofPto nnsy l\ am3Philadelphia, PA 19104 •Pro.fl'IL'or of orfhopf'd,,' .• ,. r9t>ry siJC!"1fllIntf'rrst in lu mflO r ·~P11lr, hlj> ,', r9' '!I

Al:Gl'STO S"R"'IESTO

Lo!l AnlJe1t's County,l'Se \f"d"'alCentl'rLos Anj!eks, CA OOO;~;j

rhnlmlan %rthop"d,rs, 'P''("'IO/ ,nln~sl

In fmr! Ii res.CU:"'E->;T B, SL£D<;E

Brl~t:am and Worn"n'" H"~I.)/!.<11

B";;LOn. M.~ 0211')Chlf:'u.rvr~hop,'dir surrl"'ryJ. \'./,,.,-,"]. i'J.f,·n:..... ~

''')G1Y!! rpp/arC7III·r,f.

W.-\\'SE O. SOl'THWICK

)'a!l":\""" Ha\, .. n Hc'~p.taJ

~t'''''' Haven. CT 1\#:;;,10( 'h 1r/ ._~" vrrrlfJp, dlr~1.J rgr '7! "T-'f'rl t! / ; 1/tr- 7",$ ~

In rrrt"l("O; :';~ll nr

LEE RAl""'''A\' STR..H'B

H');;~lta! [>lr :'I'",r I ..1 :'ur;:t'r:-'~t'''''' Yorio(, :\Y Ifk);,!1Spt"lullllll'r,.,.~ In ./OInl rr!,'!Jam,"":.ar~h,,!1S 'lrId hand ~I,rglry

LLOYD T ..VLOR

4141 Gl'ary BoulevardSan Francl:>co. CA 9411'""'ufia/ lntt'rr.'it In /r(l(",'un's

S!Wc-ial i,,"""'~' i" k",t> rf'plar,.mt>nt.Au.AS E. INGUS

HO!lpiUlI for SPf'cial SurgeryNf'~: York, SY 10021Spf'nal intrrr.~t In arthn',s ,'",rgrry

JOHS INSAU-

HOf.pitaJ for SJlt-rial SurgeryNe..... York. :\Y 10,,21Sprnal i"t,.rrst in hlt''' rrpla'Tmt'nl

PATRICK KEU-Y

Mayo ClinicRochestt!r, M:-'; ;'·;""1Sp,'n'al illtrrrst 1/1 bun.. ",jutlOl/.'.

DoNAlD B. KETTl..£K.""'P

Indiana l'nIH'r~ity \f .. dlcal ('t'nt~r

Indianapolis, 1:-'; 41;2u2Profes-.or and rhalrman 0" or/hopt'd,r

,~urg"ry..'p"n'allrrlt're,~( 111 arlhntis

su rg"",.JOSEPH LASE

Hospll.41 for ~pt'clal Sur~l'ry

:-';ew York, :-iY lUO~l

Ch 'rf of 60 'Ie Iu mo r .'rr'lonGERALD LAROS

t:ni\'t'f'sity of ChlcagcJ HospitalsChicl1j!'o. IL ;j(lt);I'7

Sp,.rialln!"T(s! ;11 ··r,).t.~u.."t"s.

HE~RY J. :\fA:-'I\I~

~fa;;,,,('husf'tL" Gt'nera! H'J"~>ItaJ

Boston. M.-\ ;)~1 14EdIth .J!, Asf;/'1! prr, ..;··.·...... ()'r o/(},.'hn!J~'rf:r

surgr,..", Hnn'()ra.<I"r;n: Inr,'r",,1 111 b"ne~u."'lorr;; and n~i'(tJIJ(,;,r l'U1(f di.... '·flSf

DA~A MEARS

~ti(ll FIfth A\'f'nu ..PitL.;nurllh, P.-\ 1.'j2I:~

Proj;'.'<scr of·)r,huj>,·d,r .~1IrQ""71. ['n'I'r"lli1of P,ft,SbUTgh, "p."al Inlr)·p.</ l1I.:rnC(",TPS.

El'GESE R. ~J~[)E:l..l.

4fi2 Grider A\'enuf'Buffalo. :\Y 1-l::1'')Pro/rssvr and hl'flrl or oJr,h0po'a;r 1>11 rqo'ry.S [',\T. spt'('lQl I nlrr".,t '" bu 'u' II' ",or~.

WU.UAM R. Ml:RR .."l.·ni\'t'rslty of Ca;lfornla ~1t'dl('al ('..nt-·rSan Francl~co, CA ~·H4:J

Profn'sor oj f)rrhop,'d,r .'U rq"·Y.';/JprmlInter""t In jOlrr' r"plnel nll"rll.

CHARLES S. NEER II161 F'Jrt Wa:>hin~wn A\, .. nue~ew York. :\Y WO:12Profes.mr of rllniral 'Jrlhoprd,r'ru rg"ry.Col", mbla..'p"nal /"trr"st In ,'lho",ldnr"palr nnd r,.plarrmt>nL

CARL NELSON

Unj\'erslt.r of Arkansas for Mt·rlicalSciencesLittl .. RUl'k, AR 72:!O,-)ProfF.•sor and rhalrmlH/ ofurlhnpf'dlrIIU rg"ry; sJH>rlal Intl're,.t In a rlh "tl,~

,."rg"711D()l'lilAl'l J. PRITCHARD

Mayo ClmicRochester. MN :';,9(11Spt'natillt,rrst In bn", '",mo",.

CHfTRAN,IAN S. RANAWAT

HOllpiUlJ for Spf'cial Sura-eryNew York, NY lOU~l

SJWnal i"t,.rr.' In jOint r"pla ..,.m'llt.LEE H. Ru.EY. JR.

Johns Hnl'kmM H"~plt.al

Baltimore. MD 21:ID5

ntrgrT1J, ['"irormtll o.r Trnf/rf,.'t>r; SfWnali" trrr.,t i" fractures.

TERRY CASALE

Campbell ClinicM~mphili, TN 38103

~AC"K 1.. CLAYTON

... Denn'r OrthoPE'dic ClinicDenver, CO 8O:.!Ofi.-lssonatr dl",ral profi'.~sorof orthoprdirSIl'1lI'11l, l""il'f'mty a/Colorado, sprnaii"tl'rrst i1l )OI1lt rl'placf'1IIrnt and orth"tis

$'/I. rgr""REGISAlD CooPER

t.:nl\'f'rsit)' HospitalsIowa City. IA 5.')240PrfJ.'"s"or al1d chai"man 0/ oJr'hoJprdlr'''' rg,,'1I, l'''"'t'T5ity of lou'n: ,'p"nallntrrrslIn nr"romu,~C"Ular disordt''n;.

ROSALD DEWALD

Ru,h·Presoytertan·St. Luke's Mt'dicalCt'nt.. rChK:,~'), IL t~Jt)l:.!

PrO"',-ur oJ." .)r~"(lp"d,,- 5i< l'gP~. Rush.I/'.d"',,1 Coli"gr: "pr'"1o.' "rr, r"SI ''I splT/alP"Vfl.'rrn~.

WILLI."'" F, E"SEJO"'G

l"nJ\t'r~i!y of FI"nd.. 'f~dlt'al C..nlerGam.... \·dle. FL ;l:'?i;:uPr: -; ,.,._;" of ur?If).LJ,,'d,,' ~u rQf"1l. "p"nalIn~r~'~~ ,." DfJnf' rU"mors.

CH,..RLES H. EPps, JR.

H,i .... ard l'nl\erslty H()~;'dtal

W,"~h:q..·t.1n. [lC ~lklt.O

Pr0';·",,)r and ,-hai,.mnn ur" "r'h"I" 71r,~I' rgrr:.J, "p"nnll1lterl',1 In .'rrul" res,

~~l('()LUSTER EVARTS

j nl':ero'ay o~ ~ocht'stt'r \f .. Jical ~ch,,,)1

('l·n.. -tt!r,]I;) 14627Chc;;,.man 0.( orthopedic .~u rg07l. ,~p"Mal

1n:, rp .... • :n }Oll'lt rrplocf'mr1il.

ALBERT B. FERGl'SOS, JR.

l'r"\'H~Jty of Pltt.sbur~h Medical SchoolPItL,t·.Jrj!'h. PA 1521JDfJ:,J S/:,'rr pro/e!i.<ur %r'h"p"dlesurr;'·"'.J.<peMcl,nterpsl In -,o'nt

I

J. WILLI"'" FIELDfSG

1(';; L.L:il 65th Strt-etSO"' .... )"'rk. :\ Y 111()~ 1Ch!,,; of 'Jrthop"dirs, s~ L",;"r:~ Ho.<Jlllnl._'p"r/'ll /I"rre.~1 In ,'plnal"urgl'ry

F. JA"'ES F'l:SK, JR.

I10,; ('nllll'r Road, :-':WAt!"nl.4. GA :30:i09

JOR(;E O. GALANTE

Rush MI·dlcal Collt'lI:eChicaj!'(), IL MG12Pr'Jj;·.->sor and rha'rman of ur'hop,'d,cS/Jrg"ry. ,<p"nallnt,rellt In )OIntr"p!run"rnt,

IBRt't:E HAPPENSTAU-

HusPIUlI of the Vnivt.'l"!lity ofPtmnl>ylvaniaPhlladeJlJhla. PA 19104

ISpenal ,nlrrut I1If~tu,.,..f,

WILUAM H. HARRIS

P1~achll!'..tUl Gt'neral Hf)~piUlI

.on, MA 02114

ISpr>nal int,rrst 1'1 hip rt>plaumrnt.

DAVID Hl:NGERFORD

John~ Hopkins HOKpitalBaltimure. MD 21~5

t"n" J98.4

IIII

IIIIIII

II

h(I/' ........ PT c'.r.' rt.n/rt/;cl to d, -',,~', u.e.t.$}Hill1:' 7J;t('rt.~; H. /""'!1(]' ,,:f, r.', ,',.'

ROllER! E. JORD""t·nl\, ... r;.!t~ of 1.·:1. .., M..dll;" :o'er" ,,":Htlu!'lflr., TX ';';11:-;"

Pro/('.....sor e1t d (';1 i.; """te:), n." r.', -,),:~. '. ,Jp.",,.'},rru; I lTitrrr,t.t n. 1))/11.",7,,1: I,';i 'I~

d1.I.;,'ITa"f'''.,

WILLIAM P. JORDA', JRM...dlral Coll,·j.'" of \'Irj.":r,::.Rlrhrr.....nd, \'A ~;{2:1'

1)r(~fn.. ,',..JT l?1-drrl'l:"":!('!C1.ct. (},t rj;~: j';~f r,'.":U, r071fnr.1 n',~r":n"':L"_ tr:r" ::

C'lflll('all'rofr",,,OT 0/ d~ntlalolo,Q,II, 1'1Iil'f'r,/f11,11 of .4flcJ"ym,. 6prrlQll1Ilr,.,..,' Hi fungo/'111/,.,.11011.'

oJUH" HASERKJ\Pmf'hur"t Mt'd,c.. l CenLl'rPJnt'hur~t. ~c Z":{i4rhlllro! prof('.~.'M (J/drrma!%.c~ lJuJ.:r

J. 1'ERE'o;CE Hl.ADISGTOS (dl'rmatr>path(.!o~y)

Vnl\'en:dty of Mlrhi"an MedICa) C-t'ntf'TAnn Arbor, MI 4i']~

Pro/r.\,~nr 0/ dt'T""Ololog,~ and pn 'h"I,,(J~

oJ, B. HOWEll "3f>On Ga!'ton At'enut-Dalla~, TX 75:24(;

CIIlIlra! pTa/cli,'oT o.f d/'nlia :olog." r "I11'rr.BlI,/I c( Tua.'

HARRY J. Ht'Rl.EY. JR3fl CO/,)('y Ro..dUP/'t'T I1arb~. PA ]!filio.;,;Pro.(n"rll 0/ drrm(J/oiop" l',,, "'''.;; I." fJ f

Prr. Ti.<.".' "0 n1(1

G. THOMA!' JA'\'SE~l"ni\'er!'il.\ of Arkan~l1< fp~ ~l,·,j,ra:

Srier'l ..."Lilli.. Rod.. Ai·: ';;2!1I."

Profl·~· ....(lr n"r! (IIC, Mllti I, (I· n',,..,, .:","'.~'4#

sprrlfJ.1 H. {rrn;;' H, a'rrnl,... /"·(L...· .1 _,/:1'

ra1;('("'

MICH-\El T. JARIl"nlO:~(I~ R'-'T.j.' Hill elrellA u~tlr, TX i~-:-;)~4

SI.n-(']{J: iTt :r'·(.I,,·~ n. ~"Ii,/,-,n...... "

WAISE C. JOH"\~O' Idt-·rTl""'J':'·.~ .. ;",::-,Skul and Ci:LJJf"t'!" Ht''';f:W1;Pr,ilad.·II'r.... , PA ];ll~ll

Pr(~{(,"'·.";IT (:' drrn,c'II;'O.::,l. Tt ".l

HE"R\ W. JOl.U. JR1-Q' Mf>d,ca' Schou:b .. :tlT: Ruq" LA ,;,,;::.:Hmd 0; drrlliO~";v.o/'

Hr:"\R' Jo",£'''Eni(lr~ r r!j\·er~ 1t~ S~·h\.l(': Co; ~1 ,.J;(' d J'

A~br........ GA :{O:tL:

STF\'£:' J, KAT:I~"II('Tl;': )n~lJtUl'" of H,'ailibuddl"/: 10Bt,tht-~da, MIl 20~1~

S,,,,n/l/ltl',·rr.,' ", I""'U.'/"/P.o_ 1/1" (;""'JH ('or!. 1/ L' /rrr. Ill" l'alll ... 1.' "11,,<7,filthr n',<ra Trh I,r%('oi.,

oJOH"" A. KE""SE\·. JJ(Hoy.'aTd t'ni\'er"rt~' H""l'!t..o.lW..~hll1l::t"rl, I,e 2'"111(,Profr,~"nT and ('ha,..,nol, (I'drr",er"l(lg,~

6l,rn/l! 1tI1/'rr,,' 11/ 1".Q",r,,~a111lr; dl."·os""

af blad 1'1'01'"JOH'" K ...o)(

baylor ('.oll.. j:" of Medtrmt'

otlt:Jll W. GUl.T:I (d,·rm'''''I'"thlll ..~·\ )t'nl\'er:,ay of Mmnl';;(lt~, H""l'it",h,Mmn('apolJ" M~ ;1;>4;.;,

)7"O(,·......,(1r oJld rJ,nfr'n.IO 1, (l'df'rll10fulo

J: ;('/IoAJlll ARIII.1i

('.olumbi,,·f'rt'sl,ylf>rilln Medlc-al Cent.E'r}\f"Vo' "forI., ~y 11"1:{~

hfl"''''\t1~ (",d r!UJ/rmar; nfdrntlolologysp/'rlOllnlrrr.~1 i" p,\orr/l.'1'\. Ilghl

ICf"'.<11l "'./1E. RIl'HARJ' HARRELL. JJ(

a~;',(1 Plymouth HoadAnn Arbor, MI 4/,:W;,

WILLIAM Cu:SOE!\l""I!'IiGMar~' Hlldll'(><,k MemOria! Ho!'pil.liJHano\'er, I'H o:r;;,;,Cllr"ral pro.fr,...~nT o.f mrd,rl1l/

DorlmoutJ"DA\'JJ) L CRAM

Vni\'er!'it~ of California Mt'dicaJ Ct'nterSan Franc-i!'co, CA 94]4:~

Ch,'.f of drrmalulogll r/,nIC: sprnal '"In·r,~1 'To psona.'i.< ar,d drrmal'Tasioll

Ll;r~ DIA7l'ni\'ersity of Mirhi~an Mt-dlc,,1 CfonterAnn Arbor. MJ 4~](t~

Pra,frs,<nr of drrmalology ~1>rr'lal illlrrf',s1'11 sku/ imm/JlIolagp dl.<ordrr.\

RICHARD DORSOl\.'Mt-dtc"l rni\'E'r!,jt~ of South C"rohnaCharJe~ton, SC 2!-l~~;,

Pro/rssoT ond rhalr71la" o.fdrrmaloloP!Isprnal ''1lrrr.<t i'i dl'nltaflll.\

ERns H, Ep~TEI". SR411(1 :illt!. StTt-etOakl..nd, CA !-l4()l);l

JOHS EPl'TElS4;'(1 ~uttt'T ~trt-t'l

Sar, rr.m(,I~(,", CA ~~}(I-

S}u rIO! u;:rT(." p. sku· rrll,(( '. hg~"

.~( n~,,'f:t·1t.41

MARK Al.J...Es EVERETTt'ni\'t'rsl:~ (of OJ..i"h(.n,aHealth SCll-r,('e, C'of'nlt'r0J..I.. homc. C'Jt~. OJ\ ';:11!-l(,pro.';·SS(JT end rha,nld:>: or drrmolc,fog,~s},rriC:' '1i.'f rt·.,,·~ HI s;'," 17, rO'i(('1

El'GE"\r M, FARBERSt4nfurd ~11'dll:al renlt'~

SUl r.f(ord CA 94 :~(,;,

PrO/l'SSlI T U"c' rnr.: Y"'''''O 1/ (j(n'rru,O'o!og:lI

,f:l'rfiQ/ ,n(frrs" 11: 1J,"unas1...

ROBERT 1'1'\'£4i'7 WJn~, Wa~

II"ca~ur, (;.-\ :{III);{('

('illllca;' J'rt~f( ~"ur of Cr"'-u.nf(J,l op,,,, £"',(Jr.lITHOMA" FITZPATRlC...

M.... ;... Cr.U~i·tI- Gent-ra: H"'j'lt.;".:B"qon M.-\ (1~1]4

Ed", itnC H·i.Q.'l,·( ...·wprff, I'rl~,f'·.....·,,",. (~( a'fr·

mnlu!og,lo. Harl'/lrd Sp'('IO: ",I"~rg p,

p,-o"n.<I.\

ROBERT G, FREE\1-\'-' (rit'rnJ.. v..../'a~h,,)(I~~,14:,f,(1 hdtVo'a~ I'rl\'IlalJ.. , TX i;,~{~

{inilre: pTofr.",or (/l'alh[.!op... and d,T·nw:,,/o,Q4I 1'nl;'f·""II.~' of Tr,o.'

LoRE' GOLITZt'ni\'("r;;ll~ of C{.J"rad" Ht-alth Su..lI('t-Cot'ntl'rD.. II\·t'r. CO "'\I~;;;';

r

DERMATOLOGISTSDcrm..tt.lo~l~t.- trt'at skill dIM'aS('~ andman)' of them all"o han- special intRrt'!'t in

~lain ('ondjtion~, suC'h a~ pl"oria!'il', IIkin

> C'er Imcludm,:! melanoma), hair di!'orderl.,C'ne, fun~al inft'rtionl', Ii~ht sensitivity,

pi~menlationd.I"t'a!'e;., and ('onlart dermatj·tj" and Kuma Some dermatoloj:!'i!'ts Slit'·

('iallZ(> in dermatopatholo~~'. which im'ol\'e~

the anaIY!'I~ of "klTo t1s~ut' to detRrmint' thensturt' of tht' le!'ion Dermatopatholoj:!'i~L~

dtl muct. of their work in tht' laborator)·. butthe~' do set' ()('ca!'iona! plitienL... and art' sodt'!'ij:'nated in thl' Ii!'tjn~" Somt' dt'rmllw)o,gl!:L- do dermabra!'ion, or ('osmeti(' derma·talon. which remo\'t', supt'rflcial bCJel!!'rarrin~

BERSARD A, ACKERMA .... (dermatopa~hol,OJ:!'~'1

1\\T Medical C-enter}\ew York, ~y lfl(i] ()

Profrs.<(\T of drrmafolog!, and pall,olog,,,

PHILIP B-\ILJ'Ci.. \ .. 1011,:1 CJllll'Cit'\(J;..nr. On 44l (II

Sp(('UJ: lr.frrt' .... 4 P 71/C/::1;(H1in

WILMA BERGF'EUICIH.. lanrJ Cllld'CIHt'I..llc, OH 44](1(, •Splnn' :'ntrr('.C'~ n, hair dls0r-drr.....

ntrla',(Jmr.DA\'!D R, BWKER.

l'r.!\erslty Hl'Si·; ...... i, of CJe\'<·I.. ndC1t'\t-land, OH 44101:

~r{)ft·,'''(l'rGllc' r;/C}1rnir:? Of drrnlnt(I/OQlJ

_a.I.:l.Jf(S~rr1tR(,··if''''it s)Jcr-ia,' l1i(,'ru..',f J1i

Iig'.: ,<n,.<, tll'lll'

DO"ALD BIRMISGHA\1\\'"\'r,, S...... ~.- !'cIH.t,J of ~l ..dlrlr,tVetTuit MI 4~~"]

PTv/(,~,"~'''' v.fa'(rll,(J'(.,'Dp~ "")Irrtc' Hiff'r(,"

p, r(l"ittJ~r drr.,,:r.~lfl.·

HAR\'EY BI.A'"t'ni't'T-lt\ of ~l.;,r.'. ~lt·dl('a: ~ch('(JJ

M,;"", rL a:,j"]I'Tol;",,,' ane rt;01rll.nl, '" drn'/n'olu!?p.c:.JIf·r;r;" 17ir("r(.~.' 17~ HI,fi r1tflu.l" Skl',

dl.\u~ci,·r."IR"'I" M. BRAVER\IA'

y ..I, ..~ ...... Ha\(·T. H'''l''!';':~e\t Ha\t-I.. ('1 (I,:",]"

PTIJI; "-,, 0' drn"'1,'IJ!I.g,,, SP/ rlolpdr'Tr,t'11, P-'''''O-'I.',

THOMA" K. Bl·R .... HAMHenr) Joord Ho,plt,,!Dt'lroll. MJ 4~~":

(,1"'''''111 a.t;~(Jn'G~( Ptl~((,,,,,.l.."?' u.f d('n)dJt(~/u,flY l-'lI"Y'~lIy pf M,rl"g'JI" "/"'('101 "drr·

I1'.,1 '" ('OllTlfrfi'iv Ii.<,'ur dl.'UlM',- 0/ (/"shr.

WILLIAM A. CARO1\ nrthwest.ern l'ni\t-r~Jly

Mt-dl(',,1 Srh<t<tl

I Chtcar(,. JL til"i] I

~CJlf ,,,"'OT of d,'m,o lulog.~

... CE H. CUR'" (dl'rm"lO"atl,oloj:!'~'1

Ini\'ersity .Of Pt'r.n~~'I\·ani"

School of Mt'UICIIH'Phil"dt-Jphla, PA 1!-l104Profes.,oT of df'rma lolu.QY. pa tho/ogy

II

IIIIIII

I·

I

II

I 64

I

II

There lire two different areas of plastic surgery. One is rt'construC'ti\'e surjCt'ry ..... hlC'hinvo!\'es the repair of Injuries. bums. con·genital defects and rppair of sears aft",r cancer surgery. The second is aesthetic plasticsurgery. which invol\'ps the beauufylnlr offeatures. Most all of the plastic sur~eons

listed here do both. but some concentrate onone &n!a more than thp other.THOMAS J. BAKER. JR.

1501 South Miami AvenueMiami. FL 33129An ru'.,thl'tir plastir rurpeoYl.

MILTON T. EDGERTON

l:ni\'enllty of Virginia Medical CenterCharlottelville. VA 22908Pro/usor and clll2,""a" 0/ plestlr .rur·

San Francisco. CA 94108C'liniral professor ofdermalology. ['1/I1'f'r,sily of California: ~nal iT/tereol ;nimmunology.

EVGESE VAN SCO'M'Skin and Cancer HospitalPhiladelphia. PA 19140Professor 0/ dermatology. Tem",le. spenalin/t'"s/ i71 ,kin ~an,,". psonasls

JOHN J. VOOHREES

1:niversity of Michigan MedIcal CenterAnn Arbor. MJ 48109Professor and ~hairman ofdprmafo!ry9Y:spenal interf!l$t ;71 pson~"'1S

MORRlS WALSMAN

220 Madison StreetTampa. FL 33602Clilllcal pro/es.,or' of dl'rmafnl"gy findpha,..",~olog?l. Cnl1·l'r.<nty 'of Sou:hFlor'lda.

PEYTON WEARY

Lniversity of Virginia M..dlcal r ..ntt.>rCharlott.es\'jlle. VA 2:..>9114Projessor' a"ld ('hai,.man of d,·,...r;c.·0iuQ,if

HARR\' WECHSLER

502 .')th A\'enueMC'Keesport. PA 15132Clinical Pr'ryfFssor of d('rmato!·Jqy. !'n I :'('r'.sity 0/ P7.:tMlJ. r'gn.

GERALD D. WEiSSTE1~l"nj\'ersity of California MedlC'al :::l'.~fJ'JI

In·jne. fA 92"i1'7ProjpSSOT and rhalrman of dn....r:a:,j ..oqy.spena/lnlerest in psona..on..•. skIn ('a';,('r'

WILUAM WESTOS

l"njverslty of Colorado Medical C-enterDenver. CO 80220ChaIrman 0/ derma/olo!l!l: I!penai In'e".,..':17/ ,mmu nolo!l!l.

CLAYTOS WHEELER. JR.Sorth Carolina l"niversity MemorialHospitalChapEl Hill. SC 2'7514Professor and ~hal""all 0/ d,·mlafo!0!l!l."pen'af ",Ieresl l1/ infertlons.

isAAC WILUS

Sorthwest Medical Cent.er3280 Howell Mill Road. SWAtlanta. GA 3032"iProfe-ssor of dermalology. £mory:.ppnalinlerest l7/ lighl Sl'l'I$ltll,ty. skl7/ ra nrer

Boston. MA 02118Profusor ofderma/ology. Bos/on C:nil'er,8ily: spenal intnotst in arne.

THOMAS PROVOST

Johns Hopkins HospitalBaltimore. MD 21205Professor of dermatology; spenol interestin immunology.

PERRY ROBlss

NYU Medical C-enterNew York. NY 10016Professor 0/ dermotologll. spena{ infl'res/in skl1l rane'er.

HL"'IRY H. ROL""IGK. JR.~orthwestern l"ni\'ersity Mt.>dicalSchoolChicago. IL 60611Professor of dermatology: spen'a! Interestm PS0."flSLS.

W. MIT1:HELL SAMS. JR.

l'niverslty of Alabama Medical CenterBirmin~ham. AL 35294Professor and chaIrman 0/ dermatology:spena! Interest In Irghl .•en-stlll,ly. lupus.bu Ilous dlsea..es.

GORDON C, SAl'ER

~400 Pro~pt.'ct AvenueKans~ City. ~IO t).t::3:!ClInzral professor o/dermatology. C·nll'f'r·,\,111 of Ka"sa..~.

WIL.uAM F. ScHORR

~farshfield CliniC~arshfield. WI 54449Chnl~al pr'ofessor of dermatology. L"nl!'f"rsily of WIS(,On.~,,-

WALTER B, SHELLEY

l"nlverslty of Illinois Medical SchoolPeoria. IL 61631Prof"SSOT 0/ derma 10logy

EDGAR B. SMITH

l'ni\'ersity of Texas Medical BranchGalveston. TX 7'7550Chal'rman of de-rm a tolo!l!l: spenal Inlt"7'u!In fu ngal mfertlOns.

SAM STEGMA."'I

350 Parnassus AxenueSan FranCISco. CA 94 J17Spl'nalmlerc.•t in sliln .~urgery.

RICHARD STOl:GHTON

l"ni\'ersity Hospi141San DlelOt0. CA 92103Professor of medinne. Cm~TS2ty0/ Cali·forma; spenal Interut in psorJtJ8U.

JOHN S. STRAl:8S

University HospitalsIowa City. IA 52"242Professor alld rhalrman of dermatology,L"nll't'T!'lty of J01i'G.. spt'nal mterest 111

arne.JAMES S. TAYLOR

Cleveland ClinicCleveland. OH 44106Spenal infl'f"f!6t 111 ~ont4ct dt'rmatltis.

THEODORE A. 1'ROMOVITCH

350 Pamassus AvenueSan Francisco. CA 94117Clmical profl'uor ofdt'Ml'la tology. U?lil,"'"t~ of Calijo",ia; spenal inte~st in skinconrer. ~air tral'Uplanta. cosmetl~

dermatology.DENNY Tl,;VPANELU

..50 Sutter Street

I

Houston. TX 77030Pro/essor alld ~hairman 0/ tkrmatology:q1t'C'ial ;lI~re$1 ;71 sklTl ~an~er.

ALFRED W. KOPF

NYl: Skin and Cancer HospitalNew York. NY 10016

~essor 0/ rkrmatology: spenal ;ntereslWi~~kin ~n~er.

EDwARD KRl·U.

Hen')' Ford HospitalDetroit. ~I 48202ChaIrman 0/ drrmalology. ~nal intert'.,tin skin ruP'f/~.

AARON B. LERNERYale-New Ha\'en HospitalNew Haven. C1' 06,')10Dirt>rlor 0/dt'Ml'lalology. spena! Inll'rl'st

I in pigmelltation disor'ders.JAMES J. LF:vD£:';

Hospital of the l'ni\'ersity ofPennsyh'aniaPhiladelphia, PA 19104Spenal intl'rest In aC'1le.

AU-AN L LoR!~C'Z

Il"nh'ersit)' of Chicago HospitalsChicago. IL 6063'7Professor 0/ dermatology.

PETER J. LVSCH

l'ni\,ersity of Arizuna ~ft;·dJcaJ CenterTucson. AZ 85'724ChIef ofdermatolo!l!l Sp('('7Q i In leresl zngl'1IIta: skin dLSorders.

HO"'ARD MAlBACH

I l"ni\'erslty of California ~edlcal Cent.erSan Francisco. CA 94143Professor' of derm a Inlo!l!l: spena! interes!"'nt~t dermalllLS.

h~CK MALKINSON

I Rush·Presbyterian,St. Luke'sMedical Cent.erChicalit0. IL 60612

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Chairman ofcUrmaUilo!l!l.£:,;0 MICHEL

l"ni\'erslty Hospitals of ClevelandCle\'eland, OH 44100

1,4s.~onale ~!,ni~al professor' of d.orm.atolo!l!I. Case- Up"I~rn Reser'l'f': spel"1.al InUres!I7l Immunology problem3.

l"RTIN C. MIHM, JR. (dermatopathology)Massachusetts General HospltaiBoston. MA 02114Chief of dermatopathology; spmal znter--

test In melanoma.l'n Mosctu:J..l.A

Lahey ClinicBurlington. MA 01803

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penal In/nut in skin ranrer.SK PARKER

regon Health Sciences LnJversityPortland. OR 97201

f.0fusor and chai,.man 0/ dermatologyPAJUUSH

assachusettA General HospitalBoston. MA 02114call1ltnut ill ptoria.su, light

Io~tlt'lt~.

~:C~~~:~ ~901tofusOf' and luad of dermatology.~ Eo POCK!oniversity Hoapital

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Medical CenterADn Arbor. M1 41110e~ aflll"-...... ~""tria oflllJr"M'OUw

.. JAN ......MAN

W'l1liam Beaumont H_pkaIRoyal Oak. M' .,,2Prof~ of.~trict oflll~.

IV.....,. S&Ate,.. JIIPPUY CIIAHo

UCLA Medic:al School1M AnCelea. CA~Prof-.or ff!.-utnc. oflll WJWtIO"'nc.D.~

UDiveraity of AriaoMMedical CenterTucson, AZ 85724Prof-.m- oflll .i"'loll71 ff!_tetria oflll~.

IbLvuo It.. CoHDiFertilit), lutitute LuI.133 Eut Superior StreetChicago, IL 60611DirctM ofiutih.te.. 1'"'f~ of.~t,

rict oflll gpeeolo,r, NorlJa_flrT...VAL. DAVoYAH

Lo6 Angeles County·USCMedical Center1M AnCelea, CA 100008Profa«rr of .~tril:a owl nu«'ton

A1.AH n.c::HD.NnYale-Nev.' Haven HoapitalNev.' Haven, CT 06510

Wu.LLUf J. DIGI'lAJ(

UCLA Medical CenterLoI A.ncele&, CA 90024Profeacr ofot.tnria Gad n-oLon

~ILuIONO....ClA

HoapitAl of the UDiverait)·of PennsylvaniaPhiladelphia.. PA 191004WiJlaafl/l S SAIppt'fl.. Jr~ J1"O/-... 0/ rr'",.odwtiOft, director. dirVioPl ofhmall~lU'tion.

ca..w, _ B, ILuoIOND

Duk£' Unh'ersit)' ..edical CenterDurham, NC ml0E. c. Hcfflblnt fMJ/- ofc*tttrit8 ondWftIJCO"'n eAGinu" of W dLportMnlL

lLouaT JAPftUniversity of CaliforniaMedical CenterSan Franciaeo. CA SNagProfeaor o/obItl'tria Gad 1W"I~~Wgy.

HowAaD L JUDD

UCLA Medical CenterLoI Angeles, CA 10024Profr:uor of.trtria ... gp«oQl1_it! dirVicnl of rqrode-rhwftd«ri-.olOlfll

NA'nIANG........"L Sinai ..edJcal CenterNew York. NY 10029Prof-.or ff! .tl'tria 011II n-lOlfll

llOON II. KIMUniveraity HoapitaJColumbus. OH '32)0ProftJDCr "fol»Utria nd wueoiOlfll,(Mws..~.

WILUAJII I...aM.AIUUiliveraity 01 ....miMeodacal School

RoNALD R1:I:PIlORLDukt' UDiveraity Medical CeDt.erDurham. NC 27710S",C'iGI iRUTat i.. ..tAetic h,,",.

.JAa H. 8HUN1201 SUMet BoulevardLo& Angele., CA 10069Auocic~ cli"icol J1T'O/-.o'" "fplutic hr,~, UCU."eci41 i"lna! i.. ..tAe~,h"Pt")'. IIOIeI oflll ¥luu.

IlELVlN8p.....Baylor CoHere of MediciJIeHOUlton, TX 77030Profeaor oflll I&Ad of ,la.Jtic h7p")'; .,w.ftlll i 71 t.t-rut i71 jaw' oflll f7IOI£th.

IlJCKARD 8TAIlX115 East 67th StreetNew York. NY 10021Profeaor of eli7lic.oJ h"Pt")', Col.,mb!4;qecial i"UTat ift oaINt", eklt polcte.

BUGH 'l'HOIllP8ON

HOlpital for Sick ChildrenToronto, OntarioCanada M5G lX8Spenal i7ltl'rat ift rqcirr ofeo~itAldLft.rts, apeC'iGl/tk~

LV18 V A800NEZ

University of California Medical CenterSan Fl'ancisco, CA 904143Diredor 0/ plo.stiJ: hrp"')

JOHN E. W0006

Mayo ClinicRochester, MS 55901SptC1al ifttnul 1ft ItnJ.d OM 11«1reconslT'kl'tioT~

HUVE\' A. ZAILEMUCLA Medical CenterLos Angeles, CA 90024Pro/euor Ofh"Pt")', dtitfofpla.Jtic nr·grt") dlrvion

- :::;The specialty of reproductivt' endoc:rinolo~deals mostly with the problems of infertilityamong women,

What defines infertilit)·~ If • couple at·tempu. to havE' a child for a period of a yearand ~hf' female d0e5 not becomt' pre~nt,physician~ eonsider thiF • li~ that theremay bE' II problem with eonct'ption. In themajority of t:a5e1' the problem is with thewoman; howe\'er irl 30 t.o *' pereent of thec:&5es, thE' problem iF "..ith thE' male. Unfo!"tuna~l)'. the,., is generally Ie" that ean bedone to correct the problem with the malE'.Urologist.s generally tnat malE' infertilit),probl£'mf,

When reprodurtiv£' endocrinologistl' arenot dealing with problems of infertility. tht')'also ronsult on menatrual problema andproblemli luch a.5 hair gTowth on women...well &f' other I)'neeological probleln5.SEZER AIuIn.

Universit)' of SouthernAlabama Mt'dical SchoolMobile, AL 866)7Profu.sor o/obItet"a OM WftrrolOlfll

ALAN BEER

University of Michigan

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~;~ l"UTat ift ml"W ofill foriGlf'llCOMtra.etlOll

NICHOl-U G. GmRGIADE

DukE' Universit)' Medical Center

I Durham, NC 27710~ CAoimIDlI OM prof-O'" of,la.Jt~ fflGZil·., wf~l ond 0'"f11 h"Pt")',~ iftt.t-rut

ift oatMtic, f~1 OM bf-eGItrecq7l8t~tlO1l.

V. IIJCHAEL. HOGAN

799 Park AvenueNt'\I' York. NY l002JAuMctl' prof_or of,lo.stlc h'l'f"'l',NYC

.JOHN E. HOOPES

Johns Hopkins HospitalBaltimore. MD 21205P,'OfCS80r o7ld I&e4d of plastic hrp~.

NORMAN E. HllGO

Columbili·Presbyterian Medical CenterNe..... York, NY 10032CAulof plastiC h rgn"1l

M, J. JlTJlKIn'lCZ

Emory Affihatf'd HospitalsAtlanu. GA 3030i-Chir.' of plastlr ond 'Tccmst~t1f1(hr,

gt'1"}. 11~rta! 1r. tl'rc.(! 11, Ittad and neckhrgf''1I

JOHS R. l..E1\'lS. JR.3316 Pit-amont Road. N[Atlanta, GA 3030;,Spcrto.' mttres! 1" QUlnt/ic IUrgNJ/

\\'I~AM K. LINDSAY

Hospital for SIck ChildrenToronto, Ontario

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Canada M5G 1Xt-<. Spt'na! inltrcst In rrpal"ng birth IUferu

OSEPH McCARTHY

NYl' Medical CenlRrNt''''' York, l'Y 10021S~Ma! Intl're..st In ('TOma! rtconstT'kl'llon

D. RALPH Mlu.ARD

1444 SW 14tJ-. A\'enuI:Miami. FL 331z.',

CJlIC," a..' }Jla.Mu su r gr"1l. Ullll'f'rslt~ ofM,cml

T'IMOTH' Mll~.ER

lTL'" Mt"dICbI CenterLo~ Ani!f'If:,.. CA 90024PrCJ.'r.ssar a/pla.sllc IIJrge7, wptnal intl'r·ut '" lllmphcdrmo. a lymphatiC rondillonCQUS'/7ig UU'.""l'( leg SI/'(/llng

JOSEPH E. MI'RRAY

Brl~hlim and Women's HosJ.lit.il1Boston, MA 0211;,Pro,fr....(or 0/ IIJrgt''1I Ha,,'Ord Sptrtal intl'rt'./1r in htad and nt'd hrgc7

REX PrrERso"252;-, East Arizonls Bil~more C,reltPhoenix. AZ ~H;Sptnol inU'¥est In authrllr Il'Ori.

PETER RANOAu..

Hospital of the Unlverslt)· ofPenns)'lvania

IPhih.d~lphla, PA 19104ChiC.' oj plo.shr Ilirpn"1I, wptnallntnut in

., btrth tkf('cu" rlr.n IIp and palal-l'WtOM~ D. REE!i

17(; EIL~t 72nd Slref'tNew York, l'Y )002JPro/user of r/I"lcai plastIC hrpt'1l. N)l:;'Ptrial Intrre.(t 171 tul.~thf'lir .wrprTf.

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FRmERIC D. FRlGOlZ'M'O, Ja.Brigham and Women's HospitalBoston. MA 02115ProftaOr of obltttnca and ~cology,HanlQrd.

STEVEN G. GABBE

Hospital of the Universityof PennsylvaniaPhiladelphia. PA 19104DirertoT. Jerrold R. Golding dll"lSlDn offetal mtdin,.,.

GUY M. HARBERT. Ja.Vniversity of VirginiaMedical Cen~rCharlo~svi1le. VA 22901Prof~&10r of obstetrics and gynteology.

JOHN HOBBISS

Yale l'ni\'erslty !dedical SchoolNew Haven. C'T 06510ProlessoT %bstnncs and gynrco!ogy

CALVIN HOBEl..

UCL" !dedica! ('enterLos Ani!'eles, CA 900:2~

Pro/essor 0/obs/rtnc3 and !l1f'Il'CoIDgJIJOHN 'Ii. C. JOHNSOS

UniversIty of FlondaMedical ('~nter

Games\'ille, FL 32610Proje,'iSur 0/ obst<,tnc3 a n.d gynecology

WlLUAM J. LEDGER

Se ..... York Hospital-CornellMedIcal CenterNew York. NY 10021Pro/e.ssor and chaIrman. d~rtment0/obst,tnu alld gy,.,cology, Cornt'n· ~r1.a1in/t1'('3t ill gynerologlc rnfection.s.

WILUAM A. 1.rM'u:University of Miami Medical SchoolMiami. FL 33152Proft$3()r aM chairmall of obs/ttrics andgynecolvgy.

JOHN MORRISON

University of MississippiMedical CenterJachon, MS 3~Z16

ProfeS3oT oj obst,/rics aM gynuologyJE.,,"NIFER NIEBYL

Johns Hopkins HospitalBaltimort'. !dD 2L!05ASS0C'1ate prof~OT of ob.~/e/ncs a J'ldgynecology.

M. L PER!'iOLL

Tulane l'nh'ersity Schoolof M...dicrneNe..... Orlelins, L-. 70112Proft'S3or and chaIrman of obstt'tncs andgyllecology

Roy M. PITKIN

l'niversity HospitalIowa City, IA 5~~Z

Profeuor arid rhalrma?l of obslt'tnC'8 alldgynrcolOflt. l"nll't"mt~ of /011'0.

JACK A. PIUTCHARD

University of TexasSouthwestern Medil'al Sl'hoo1Dallas, TX 'j!)~5

Gillettr prolr....or of obitrt rie. 1I11dgyrr"ologr

JOHN QL'EENAN

Georlletown t1niver.<ity HospitalWaahinl('tOn, DC' :!0007Prof'4lIOr alld rhairma", obItdni2 11M

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HIGH-RISK PREGNANCY_", '_ .-:~ECIALlS~ __

=Profusor of obltttrie. aJVJ yynet'OI;;>LtiTHER t A.LBbt

University of North CarolinaMedical SchoolChapel Hill. NC 27514Profellor of ol»utncs and gynecology.

EDWARD E. WAu.ACH

HOlpital of the University ofPennsylvaniaPhiladelphIa, PA 19104ProfeuoT ofob,utria and gynn-ology.

JAIID C. WARREN

4911 Barnes Hospital PlazaSt. Louis. MO 63110Cha,rm.DlI of obltttnr. a7td gynecology,WQ3hrngton L·7tit~ty.

SAMUEL S.C. YEN

University of CaliforniaMedical SchoolLa Jolla. CA 92093Chairman of rtprod~tit'tm,dlri7te.

Over the past several years. advances in thiSspecialty ha\'e permitted more and morewomen to have healthy babil!s. while at thesame time increasing their chances of r~

maininl!' healthy Such problems as toxerr.ia.diabe~s, early labor, and hemolytic diS'eases (RH disease) no longer prl!\'ent women from bearmg children.TOM BARDEN

Uni\'ersity of CincinnatiMedical CenterCincinnati, OH ~526'j

Profeuo r of obstttnt:'S alld gynecology.WATSON A. BoWES. JR.

University of North CarolinaMedical SchoolChapel Hill, NC 27514ProfrS3or of ob$utnu and gynecology

MARlON CARLYLE CR.E....SHAW. JR.University of !daryland HospitalBaltimore, !dD 21201ProfruoT and rhalrman ofobstefnc3 andgynecology.

THOMAS DILLON

St. Luke's-RooseveltHospital Cen~rNew York, NY 10019ProfruoT of obstetnc3 aM gynrcology,Columbl4.

PRDrroN DILTS. Ja.University of TennesseeCollege of MediCineMemphis, TN 38163ProleuoT and chairmall of ol»trtncI and!11I?lrcology.

ROGER K. FRIZIIAN

University of c.lifornia atIrvine Medical Cen~rOrange. CA 92668Prof'lIoT of oblt,trics arid gynecology

EMANUEL FRIEDMAN

Beth Israel Ho.pitalBOlton. MA O~15

ProfeaoT of o#Mtetncs and !11IYln'·ulogy.HanJOrd.: 'J)rMal intt1"Ut irl IIbnormalI4bor

EDRGE TAGAT'Z

University of Minnesota HOlpital.Minneapolis. MN 55455

J~,.,. 19~I

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.tttriC'8 Q1Id gylltrology, .ttcGill.PAUL C. MACDoNAU>

University of TexasSouthwes~rnMedical SchoolDallas. TX i5235Profe6lJ()r ofobltttria alld WnU'ology.

JOHN MARBHAU..

Harbor·UCLA Medical Cen~rTOrTance, CA 9O;;Q9Chairman ofobsutnc3 and gyllecology.

LUIGI MAsTROIANNI. Ja.Hospital of the ljniversityof PennsylvaniaPhiladelphia. PA 19104Professor alld chairman. departmtnt ofobstetrlC'8 and gynuology.

PAl"L G. McDoNOl:GH

M",di.:al C~lIe~e of GeorgIaAugusta. GA 30902Profes.~or of obstetncs and gyllecology

DASIEl.. R. MISHEJ..L. Ja.Lo~ Angel~~ lounty-L"SCMedical CenterLos Angeles. CA 90033ProJ;.ssor and chairman of obs/etncs andgynecofO!1!l

K.~MRA." S. MOGHISSI

Wayne StateSchool of MedicineDetroit. MI 48201ProfeS3or of obstetncs and gynecology:chief dll"lSlon 01 reprodl.l.clll·C elldor-nnol,ogy and Infer~iiJ/y

ROBERT N'ACHTIGAU

490 Post StreetSan Francisco. CA 94102

FREDERICK NAF"TOUN

Ylile l'niversity !dedica! SchoolNe'" Hli\'en, CT 06510Proft'.~SlJr and chaIrman olobs/e'ncs andg!lll~cology.

KE."'iSETH RYAN

Bngham and Women·s HospitalBo~ton, !dA 0211.5Profes30r olobstttncs and gyntrology.Han'ard.

ANTONIO ScOMMEGNA

MIchael Reese Hospital andMedical Cen~rChicaa-o, IL 60616ProleS3or af obltelnes and gynecology.l"III'trmtV of ChICago

LEoN SPEROl"FCast',V"l!s~m ReserveCle\·eland. OH 44106Proltuor and chairmall of gynecology.

SERGIO C. STONE

I ... University of California at""', Irvine Medical C~n~r !

W Orange, CA 92668

IDirector, d'pGrtment of reprod~ctil" l'7I-

I ,nfprtility.

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Miami. FL 33101Profeuor ofobstetriu and gynero/on·

A. BRlAo"" 1.rM'u:

I .... .Royal Victoria Hospital

. Montreal, Quebec~ Canada H3A lA1

Auonatt profusor and chairmall ofob-

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Hospitals

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. OUTSTANDINGHOSPITALS & CLINICS----------~ - - - -

Althoullh it is ~enerall:i agreed that thechoice of a phyaician is probabl)' more im.portant than your choice of hoepitAl, Ifoodhoepita1i provide the depth of etAff in allareas, from nuraine to dietar)', that improveyour chanc:ea for 1000 care It is widel)'agreed that teac:hing h05pjtal~ offer auperi·or medical care. Here are 80me ,uidelines,• They ehould have at least 400 beds bf..cauae this willlikel~'mean a wealth of ltAffpeopl(' 't\'ho may be needed to consult onyour problem.• The hospital ahould be affiliated 't\'ith amedical school.• The hospital should be accredited by theJoint Committee on HospItal Accredlt.ation(JCHA), This is 8 minimum requirement.

BARNES HOSPITAL

St. Louis. MOA/filiat.eall,tt. Mashillgtor. r'1Il1'f'mt.!l

BETH IsIlAEl.. HOSPITAL

Boston. MAA/fil,at~d "'th Hart'Ord.

BRIGHAM AND WO~~s HOSPIT...L

Boston. MAAffiitat~d Il'tfh Hart'c.,.d

COl.l..'MBI... ·PRESB\'TERl...S

MEDIC...L CENTERNew York, l"YAffiilaUd Il"tth Columbta,

Dl..'KE UHl\'ERSIT'\' MEDIC...L C!:sTER

Durham. NCAffiiJaud trit1l l>kkr l'71ilormt],

HosPIT... l. OF THE: UNJVERSIT'\'

OF PENNSYl.V...NI...

Philadt>Jphia, PATht ma.lor tf'Grhlnp hosp:'ta! lOT t1Ir C'n1'torm't.!l of FTnnsllltocr.lc

JOHNS HOPKIN8 HOSPIT...L

Baltlmore, MIlA/fiilattd Il"tth John.< Hophn.c r'nll't"f"rtl/>

MABS...cHlJSE'l'Tf; GENEIl...L HOSPITAL

BoslOn. MAThr maJoT U~hlng hosplro: i?l thr Har.mrd sy~tt'm

MT. SINAl MEDICAL CENTERl"e"" York, 1\"1Th, mojor UadllnG hospital fOT M: SInalMrdlt'al SrAool .

Nn.. YORK HosPIT...L-COIlNEU.

MEDICAL CD."TI:Rl"e"" York, l"YCorntU, mojor tI~hln9 1J00011a:

ST...NPORD MEDICAL CENTERStanford. CAAffiltatld ritlJ SUJnford l'"irrmtll

STRONG MEMORIAL HOSPIT...L

Rochester. NYA/filioUd .oitlJ Unitormtll of Rorhrstn

UCLA MEDICAL CD.'TERLos An,ele•. CAUCLA, mojor tladlng hOlpita!.

UNIVDBITY OP CAU?ORNIA

MEDICAL CDln:R

STEVJ:N F. BREN'"Emor)' hin Control CenterAllanUl. GA 90322

CH...Rla Bt'RTON

CHuLD R ...ySister Kenn)' InltitutRMInneapolis. MI' 5.......0i

H ...ROLD CAARON

hin ClinicUniverail)' of Virginia Medical CenterCharlottelville, VA 22903

BENJAMTN CRUL JaNew Hope hin Center100 South Raymond Avenut>Alhambra, CA ,91801

EDITH KEP~

NORM"'N M ...RClIS

Pain Treatment CenterMontefiore Hospitaland Medical Cen~rBronx. 1\\' 1046i

DoNUN LoNG

Pain Treatment CenterJohns Hopkins HospitalBaltimore. MD 2120,:'

TOSHI M"'Rl'T'"Pain Managemen~ CenterMayo ClinicRochester, M~ 55901AlI Inpattt"1l1 cllntc

RICH...RD MORSE

Pain Control Ct>nterTouro HospItall"e ..... OrJean~. LA i0115

TERE.'I;CI:. Mt:RPHY

Pain Chmel'nive~ity of Washinl:'lOnMt>dlca) CenterSeattlf. WA 98]K,

Iv..." G. PODOBSIK...R

OhIO Pain &: Stres. Center14(1) W Lane AvenuE'Columbus, OH 43:!21An ou tpo tlrn! ('t1'/ tn

Hl'BERT L ROSOMOFF

Comprehensi\'t' Pain Centerl'niversity of Miami Medical SchoolMiami, FL 33]3f>

JOEL. SERES

l"orthwest Pam CenterlOCI;' SE Cherry Blo!'.som Dri\'tPortland, OR 97216

FR"'NK SKt'l.TET'l'

BR...DLn' BERM ... "

l"t>braskll Pam Mlona~ementCenterUni\,ersity of l"et.r~sk"

Colle1e of MedicineOmaha. 1\B 6810:'

RICHARD STERNB...rH

Ploin Trutment CenterScripps Clini('La Jolla, CA 9203;

JOSEF K ...·...NG

Pain ClinicMay'o ClinicRorhester, MI' 55901An outpat't'nf cltn"

AWN P. WINNIE

Pain ClinicUni\'ersit)' of lIlinoisCollel?:f' of MedicinE'Chicago, IL 60612

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fY"tcology, ip('nal ,,,tnat in RHdurQllt.!,

Eoll·...RD J. Ql'IUJG"'N

IUniversity of Wi"consin

~1~~IC:~n~~~ln~7~~n~r~ft~orand chairman of obltrtr;c,( and

IfY"trology, Unitormtw of W"ron.rin

ROBERT RESNIK

University of CaliforniaMedical Cen~rSan Diego. CA 92103Pro,frMor aftd chairman of obstttnes andW"'rcology

dOHN d. 8cHRl.."EFER

Geori!'etown Uni\'ersity HospitalWashington. DC 20007Proft&((lr of ob~trtnc.\ and g]/nrrology

RICHARD H, SCl"'.....RZ

Down~tate Medical CenterBrookl~·n. NY 1123(1Pro.frs.(OT and rhalrmar. of obstrtn'rs andgynuolO!l1'

IJ "'M~ SCon

l'niversity of t'tahMedIcal Cente~

Sal: Lakt City, l'T B413~

Pro/r&(C'· and rhalrmar. 0/ obs:rtn('~ ondfn/Tlrrology

9t"IUJ...M SPEJ..J..AC"'l

Vni\,ersity of IlimoisMedIcal CenterChica~o, IL 60(·1~

Pro/r.(.(':)r and rt.al:-maTi 0.( ob.<lrtnc.< and

•TlC~OIOP!o

, " ,,9t"EI"GOLD

'. • t>or~E- WashinrtoT' l'nl\'ersltyME-dlea) CenterWa!'hiTl~lOn, DC 20(l0'7Pro.fr.ssoT and cholrmol< o.f ob.(Il'lnc.\ andgyT,rro;opy

FREDERICJo: P. Zt:sP... "Ln;\erslty HospItalCo{\h;rnbu" OH 4:'1210Pro/r~,'o· end rhnlrrnOT. D.' ob~trrnc,\ andY!f"lrrolog]" OhIO Stale, sprna! I1Itntsl 111

to;rrmlQ

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Pa:r. center~ art a rE-lati\t'ly ne..... addition lOmt>dlcal cart', largely becausE' pain has al·way!' bH-n considered a symptom of a prot-·k>m, not tht- problem it-st-ll. That ha. nowchan~t'd and the!'.E- cente~ lreal pain with Ii

variety of t.f'chniques includml: nervebloch. bioft"edback, elt'('tri(' current. hypn(>-sis and steroid injections TheSE- c:enter~ alsobrin~ a multi-disciplinary approach to dll.~·

nosi!' and tTeatmt>nt by includm~ nt-urohgist-so aneslhesiolol?:ist.'-, nE-urosurl!:t-ons,psychiatrist." and other spt'ciahst.sJOH'" AD"'MS

I YOSHIO HOSOBllCHI

~.in Clini('Wniversity of California Hospital

Sar, Fr..nciseo, CA !f4122GER...LD ARONOFF

BObton Pain UnitMlossachu!'E'lt-< Rehabilitation HospitalBoston. MA 021]4

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interest in one specialty over the other willbe so designated. However, most all practiceboth of these areas. treating non-cancerblood diseases as well as prescribing chem~therapy for cancer patients.

Rtuii4titrtl OncologUt8 specialize in radia·tion treatment of cancer.

Su'i"flltal Ortcologuu specialize in canceraurgery. Many have special interest in cer·tain cancers, .uch as melanoma or breastcancer. Also, .urgeons in other speCIaltiesao~times have interesta in certain types ofcancers and they are so designated.

GY'I~co/ogtcal Callttr Sp,nalisls concentrate on cancen of the female reproductive.ystem.

Adult Hematologists &Oncologists

RAYMOND AJ...EXANIAN (on{'ology I

M.D. Anderson Hospital andTumor InstItuteHouston, TX 7702.'5Pro/tssor 0/ mtdinllt!. CT/II'!"m!jI of Te.rasGrtuiuat~ SthooL spt'nal IT/(tres! In

m!ltloma.TOM ASD£RSOS (oncologyl

Medical C-ollege of WIsconsinMilwaukee. WI 5.1226Htad, Stct,Oll 01/ hematoloflY oT/('OloflY.M,llt'auku en/eral HOlrpltai

JOHN AntEN8 (hematology)University of l'tah Medical CenterSalt Lake Cit)·. UT 84112ChIt/ of hnnatology-<J1lcology

DA.I'\fIEl. BERGSAGEl. (oncology)Ontario Cancer InstitutePrincess Margaret HospitalToronto. OntarioCanada M4X lK9Chitf 0/ mtdin7lt, ['71it~t!l of TorOllto.ill~t ill mllt107rUJ aT/d lymphomaoS.

JOSEPH R. BERTI!'IlO (oncology 1

Yale University Medical SchoolNew Haven. CT 06510Pro/rUM 0/ mtdlnllr: qJtnallTltt'rt'SI IT/lrukmua.. lymphoma.s, brta.st., alld ht'adalld "t'ck tall"trs.

JOHN BERn.D (hematology)St. Luke's Hospital CenterNew York. NY 10025Pro/tssor 0/ mtdil'illt'. Colu mbla. ....·oledlor ltilltl()T/c It'itlt ab1lormal hnnogloblllolld ""kit ull allnnia.

ERNarr Bn'Tl.l:ll (hematology)Scripps Clinic and ResearchFoundationLa Jolla. CA 92037

k M'ith

hANKUN UNN ematololY)Brieham and Women's HospitalBo.ton, MA 02115Di"ctor. lI_atology reltarch; pro/e»or0/ rrtnJil'ifU., HO"'OrrL

GIlORCK P. CANau.oe (oncololY)Sidney Farber Caneer Institute

~LA_ DIER8ER BLooMFIELD (oncology I

University of Minnesota HospitalsMinneapolia, MN 5S455Pro/taor o/JrVdil'irae; qwn4J 11Itnut ira~ia orad Ipphoma.a.

Cancer and blood diaeue. are linked becau.e hematoloci.tI oft.!n speocialize in oncolon. which involve. cancer chemotherapy. Becau.e of the type of diseue it ia,cancer often requires the help of leveral dif·terent .peocialiatl. from aurreona to radiation therapiatl. Thia aection includes thedifferent types of cancer speocisliatl

Ht'JJf4tologYu OM OrtcologVu who have an

Clinics

ISleep centers seek to diagnose and treat themore seriou••Ieep disorders, from chronicinsomnia, niehtmareB. restless leg syndrome, sleep apnea to night terron. These

Icenters also treat ~ple who've become dependent 011 sleepine pills-which usuallyworsen insomnia-and offer a wide ranee oftherapies for different sleep problems.

IR,CHAJU) P. Au..I:N. PHD.Pinup C. SMITH. M.D.

Sleep Disorders CenterBaltimore City HOIpital

IBaltimore, Mf) 21224

RoGER BROUGHTONOttawa General HOIpitalOttawa, Ontario KIH 81.6

IRoeAUND CAJl~aHT.PHD.

Sleep Disorders Clinic

*... sh-Presbyterian-8L Luke'..

ical Centericaro, IL 60612

IMARnN CoHNSleep Diaorder UnitMt. Sinai Hoepital

IMiami Beach, FL 88140

JMfU., JIU

II

CLEvELAND CuNICCleveland. OH

EMORY UNTVDSITY CuNICAtlanta, GA

LAHEY CuHtcBurlington, MA

MAYoCu?ocRochester, MN

I~ pr1rote clinic IDh~h 11011' ha.s iu 011'11

Wradua~ IChool o/medinnt.OcHsNER euslC

New Orleans, LAScRIPPS CuNIC

La Jolla, CAA ""'all clillic bl.t~d unllnat.

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San Francisco, CA WI1LLUI DEMENT7Ttt 'lrUJjot- teacIli71g 4oqita/ lor tAe Un;· Sleep Disorder ClinicIIrI7itr 0/C4Jifomi4. Stanford University Medical Center

IVNTVERSIn' or ClDCAOO HOSPITAL8 Stanford, CA 94305

Chicago,lL MILTON G. EM'tNGER~ 771t major teodi71g 1I00000t.4I/or Uniflem'- Sleep Disorders Center., t¥ 0/Clticago. Hennepin County Medical Center

VNrvJ:RSITY OP MICHIGAN Minneapolis. MN 55-USMa)lcAL CI:NTat Prn:R HA URI. PH.D.

Ann Arbor, MI Sleep Disorders Center7Ttt 'lrUJjot-leochi71g 401'pit4J lor UnittnYi- Dartmouth Medical School

14- tro/lliclaigofL :J Hanover, NH 03756l'!'fTVD8IT\' or MINN'aoTA HoePlTAIJI MILTON KaAMER .

Minneapolis, MN Sleep Disorders Center1le 'IrUJjor t«Je4i71g 4oqii4U/or tk Uni- University of Mississippi

t- W'I"Iitr o/lIiflUMJI4. Medical CenterUNIVDUUTY or WA8H1NGTON Jackson. MS 39216MEDICAL CI:NTat DAVID KUPFER

Seattle, WA Western Psychiatric InstituteThe major te~hillg ltoqnt.4l/or l!lIil'l"7'7l' 3811 O'Hara Streetty 0/ Wa.shmgton. Pittsburgh. PA 15261

YAL£Nrw HA\"EN HOSPITAL HELlO 1.EMMI~ew Haven, cr BMH Sleep Disorders C~nter

Tht major te~hi71g h06pital/or Yalt. Baptist Memorial HospitalMemphis. TN 38146

MERRJJ.J.. MJTLERSleep Disorders CenterScripps ClinicLa Jolla. CA 92307

WIU-lAM ORA. PHD.Sleep Disorders CenterPresbyterian HospitalOklahoma City, OK ;3104

EuJO'M' PHIU-lPSSleep Disorders CenterHoly Cross HospitalMission Hills, CA 91345

CHARU!:8 POu.AXSJee~WakeDisorder CenterNew York Hospital-CornellMedical CenterWhite Plains, NY 10605

GERAU> B. RICHSleep Disorders ProgramGood Samaritan HospitalPortland. OR 97210

THOMA8 ROTHSleep Disorden and Research CenterHenry Ford HospitalDetroit, MI 48202

HELMUT S. ScHMID'TSleep Disorders CenterOhio State University HospitalColumbus, OH 43210

MICHAZL J. THORPYSlee~Wake Diaorder UnitMontefiore HospitalBronx, NY 10467

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mneapolis. MK 55455"JIOAonir profrNlOr of "",di('l1lc. ~rto! ,n,tnal in mtJ6t and latirklar canN'''' andkukrmiaBERT n.E (oncology)Mavo Clinic~hes~r, M?' 65901Notrd fOT Au intrrut In mvrloma tJ.6 \loe/!tJ6 9/'n"ol hrntatologirol problrm.~

BvaTON La: III (oneolog)')Memorial Sloan·Kt't~rinl:

Cancer Cen~rNew York. NY 10021S~rial intnut in m~rloma

LAWRENCE S. LasIN (hematologylGeorge WlLShington UniversityHospitalW8£hinvton, DC 20037Profe&8oT of mt'd,nnf and po~holog1J qJf·

nal intrrest in a1lrmIQVIRGIL LoEB, JR loncology I

498!1 Barne~ HOl'pital Plaz;,St Louis, MO 63110Profr-ssor oj clin iro I mrdlnnc, Ha.~hl'lg.

tern UnlJoemty s}H'nall7ltere,~~ IT, irukf'mia and lympJrom(J..~

CRA,JU.»; MENGEl (hematoJo~yI

Univerl<ity of MIssouriMedical Cen~rColun.bla. MCI 65~12

A .fH'('lollnt,rr...s1 in anrmlcEu.1O'M F. OssUMA" (oncology I

Health Sciences Cen~r

701 VVest 1~Lh StreetNev. York, ~Y 100:3::Pro.fe3S0r ojmrdlnnf. Columbia S}Jfrla!intrrest 111 mytloT1UJ.

JOH" C, P ARKER (hematoJol"~"

l;ni\'ersity of North Carolin;,Mf:'dical SchoolChapt>1 Hill. ~ C' 27514Pro.rl's..~oT o.f 1IUdlnllf and blorhl'rt,l-'lTJi

HAROUJ ROBERn; (hpmatolon I

Vnrversi~y of l'orth Carohn&Mtodlcal St'hoolChapt'J Hl!l ~C' Zi514A'nolo, for hI... iii UTe..' ITo roa9"'!o ~lVl,

dl..~()rcirr:;

SAl'L A. ROSE.It/BERG (oncoloj:Y \Stanford Uni\"E'r~ity MpdlcaJ C'.entc-rStanford. r:.~ 943(Jf,

Pro.rl's..~(lT of fIlrdlMnC and ra.dl.,!().o~ Sl"na! Intcre$t IT< lymphon,a..< one" H(ldr;~'pi:'

dlSrosc Re••ra ..rhrr.< 01 St(JTi/ord die" nllJrh7Jlonrcnn9 \I'ork in t"a/menl (lr Hori.okin s dlSt'tJ.Sl' and iymphom(J.',. bolt. 11; (In·t'ology and radlOlogJ;

"'£NDELl ROSSE (hE'matolo~·)

Vuh Vniversity ME'dicaJ Centt'rDurham. NC Zi7}(1Chte.' a.' hnraalology.•prnol!7llerr.. ~ ,nimmuno/ugtrol problrms

S\'DN£\' SAUlO,," (ont'olo~ I

Vni\"en;ity of Arizona HealthScit'nceF CentRrTucson. AZ 85724DtrrrtoT of tIlr COTlr'f'r Crlltrr, ~r(";a! in·"rr'~1 I7l mllrlomo

PHIUP SCHEIN (ont'ology)VancE'nt Lombardi Cant'er Cot>ntt'rGeor~t'toYo"n University Ho!\pitalWashinirton. DC 20007

ARRY , 400B (hE'matuloIrY)Uni\'en;ity of Mmnel<ota Hospit£uMinneapolis, Ml' 55455Projr.$,~or of rnrdl('lnr, Ipfrio/lnl,rest in

nf'mia

. J. KENNEll" (onco ogy)Univenity of Mmnesota Hospital!'

MANllEL E. K4PLAN ematologylUni\'ersity of Mmnesota HospitalsMinneapolis. Mf\; 55455Professor of medlC"ine, ,peC"iol intnut in

mlO and immli1lohrmatol

"'4u.Al'E , ENS£,. (ht>matology)Albany Mtodlt'OiI Collel:f'AltJany, NY 1220tlProfrssor Gnd rhalMlUl1l, drpartmrnt of

f' I a I In ,,"AI in a Ul.

HOUlton. TX 77025ProftMor oj m~iC"ine, U",t'f'fYitt oj TerM,.,wrial ifttnat ift ~io ondlymphomtJ.S.

EuGENE P. FaENIlEL (hematology)University of Tex8l'Southwestern Medical SchoolDallas, TX 75235ProfU60r ofl,,~l "",dlM'lr, 'PfC"ial in·tnul in I'"'!iriolU annnia.

.JOHN GUCK (oncology)Univen;ity' of PennsylvaniaMt'dical SchoolPhiladelphia, PA 19104.talOt'iotr projt8S0r ojmedln1le

EzaA GREENSP4N (oncology)1045 Fifth AvenueNt'Yo' York, NY 100~

Chirj oj cmrology Ihnno.tology. ilL S!7la'Jlrdlcal Cmtrr, cltnic4! profe&8or of medr,nne, ilL SInai Mediral School

DoNA.l.D H4RKNDf; (hematology)Clinical Science Cenl-erMadison, WI 53792ProfessoT oj mrdlrinr, L'nilOf'TSlly 0.' Ifl.\con.~n. ~na! intrresl in onnnia

9t'ILUAM J. HARRINGTOl\i (hematology)Vni\'ersity of Miami Medical SchoolMiami, FL 33101Proje&$OT and rholrmon. drportmnll ojmedlnne, 'Ptna1 i1ltrrr'...s1 in immunedisordrrs

RoBERT C, IlABTIllANN (hematology)Uni\'ersit) of South Florid&Tampa FL 3..%2(.Projr8Sor 0.( mtdl('lnr. ,prnallntrrr:s/ !7lOllt'77lla DlrerloT of till' serllOIO on hnno·tology and onrology

PAL'L HEU.ER (hematology)University of 1Ilinoi~ Medic.J Schoo~

Chicago, IL 6OtJ12Profus(lT of mt'dlM 7lC, lfH'nai in tnT.3! Inonl'mia

ED,,·A.JlD HEsDERSOl\i (oncology)66& Elm StreetBuffalo. KY 14263Resrarrh pro!rs...oT ojmtdlnnl. Statf C'lllvem/y oj"'ft; }ork: Ipf'na! InUres! Inltkkrntla

JAJlIb> F. HOu.A,.D loncolog~')

Ml Sinal MedIca! CE'nt..erKev. York. KY 100~

Dtrrr/(J'T of til. Canr!'T Cm/.rr: lfH'nal in·terest in Intkfl'71Ia. COTnIlOmlM alld

IDTrOmCl>

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I If1 a7iemiaRICHARD CooPER (oncology I

85 H lj:h SlreetBuffalo. ~Y 14203

I"'¥c,nal( cllnlral professOT o.f'TFU'dln7i[,~/.t C'17Illfrnt.- o!!';n }OTk. S'penall7l

trrrs~ In brw.sl canceT.RICHARD A. CooPER (hematoJog"yl

t:nJ\"t'rsity of Pennsyh'anlaMf:'dlC4l SdwolPhiladf:'lphia PA l!1HI';Proff'.I;..~o'" of rnr-dln nc, noted fOT }u..~ G"}Jf

I na' Inlr1"'(:.1>.' Hi rrd rrli probll'm.;JANE F. Dn;FORGE.<: (hf:'matulvgy I

Tuft.<·~e ..... En~land Medical CenLt'rBO~LOn, MA O~lll

I Pro.fC&OT oj mtCH'l1<f

THOMAS Dl'Fn' (hematology)Y&Jf- t:ni\erslty MedIca: Schoul~ew Haven, CT 06::illl

I PrO/eMUT ojmedlnnl'JOH" DURANT loncu:ogyl

University of AlaLlt.m;, Mt'dlcill CenlRrBlrmmgham, AL 35294

I Dtrerto,. of tIlr Comprthr1lsil0f' ConrrTCrntrr

Ros£ RUTH EJ..usoN (oncolog~)

Columbill,Presb~·Lt'rian

MedIcal CenwNew York, NY 10032ProfUl;O'T of medinne, chir! oncology dm·,ion. 'PUia1 i"trresl In lrkkrmla

I EMIL FREl III (oncology)Sidnt'y Farber Cancer Inl<titutRBosum,MA 02115

~fu..~or of mrdln1u, Han'Ord, fpc-nolln·

I.~, in lekkrntla and lvmphoma.:;.

EMIL J. FRElREJCH (oncology)M.D. Anderson Hospitaland Tumor Instilutt-

I, Bolton, MA 02115AuOt'iat~ proftMor of mediri"t, HantOrd:.,wC"ial i"tnut in cllronir hlcrntio, Iym'pltomQl and brr'tJ.S / ranrt'r.

1Pnu CAJlSl1ZnI (ont'ology)University of Pennsyl\'ania

Qit~I:~~~~A19104

1 Proftuor of "",dsr'l1U'. ~C'ial inU'rt:sl ,nIntlcrntlO

S4JlWEL CH4RACH£ (hematology,Johns Hopkins HospitalBaltimore, MD 21205Prof_or ofrMdin'ru, ,~C"iol int~1 inIIrntoplobtn duortin's. ,nclauJl7Ig 81rklf ce/lont'77lw

I P4l'L CHER\"ENICK (hematology)UnJ\'ersit~· of PittsburghMedical SchoolPitUiburgh, PA 15213

I Profr.$8()T olmrdlnne. noted for his voor/;in v'hilf cd! protlrm..~

BA"ARD CuRKSO" (ont'olo~y)

Memoria! Sloan·Ket~ring

Uincfr CenlRrf\;e ..... York. ~Y 10021Spena;' In/.rrr:s~ ITo o.rlJl~ lrukrmla

MARCEL E. eo!'"RAD. JR (hematul0J::'yll'nJ\'ersit~ of Ala.bam;, MedIcal Cen~rB,rminj:ham, AL 3529':Pro.fr$,w.,. 0/ "",dlnru d,rfCI<lr, dll-iston ofItrmolologJ; and OTU'olo~" 8pfnallntrres/

II

Surgical Oncologists

St. Louis. MO 63110Profe3S0r of radiolOW. H~hingt01l

l/nil~ty.

RVHERJ PERrz..TAMAYO

Loyola University HospitalMaywood, IL 60153ProfU6or and thairman 0/ radiolOW.

LEsTER PrrERsM.D. Anderson Hospital andTumor InstituteHouston. TX 77030Head 0/ TfJdiotiolt ~ology.

TKroDOU L PHu.uPs •University of California Medical CenterSan Francisco, CA 94143Head of radiation ontology.

MARVIN RO'nlANDownstate Medical CenterBrooklyn. NY 11203Pro/usor and I'halrmon of radiology

PHILIP Rl'BIN

Strong Memorial HospitalRochester, NY 14642Chal'rman of radlotl071 O7I.C%gy [irll1't"T·$ltv of Rochester.

GLENN F. SHEUNI!:

University of California MedIcal (-enterSan Francisco. CA 94143Pro/usor of radiology.

J. ROBERT STEWART

University of Utah Medical CenterSalt Lake City,'CT 84132D1N'l'tor of radlatwn tht'raplI·

HERMAN SUIT

Massachusetts General HospItalBoston, MA 02114Cn Irf of radiatlo1l medlnne.

JEROME VA£TH

St. Mary's Hospital and MedIcal Centt'rSan Francisco. CA 94117Chief of radiati01l O7I.Co/ogy

C.C. WANG

Massachusetts General HospitalBoston. MA 02114Profusor of radiology, HoJ'1)Qrri.

HAJlVEY W. BUER2222 NW Lo\'ejoy StreetPortland. OR 97210Clinical prof_or of6lJ.TgrrJ/. C.·1/I1'tT'S'ltvo/OFrgoll.

R. RoBINSON BAKERJohns Hopkins HospitalBaltimore, MD 21205D1'rt'cttJr of tit, bTt'/Ut til 11 II': pro/usor of6lJ.TgrrJ/ and oJICologv.

BLAKE CADY

Lahey ClinicBurlini'ton. MA 01803SIWtial i,,~t ilt brea.t t'a7l.Cer.

A VlLAM CooPII:IUI.UI

18 E..t 82nd St.l'eetNew York, NY 10028Profeuor of6lJ, rpt'7'), A'n,· York MrditalCollege.

T. K. DAsGUPTA

Univenity of IllinoisOncolol')' ClinicChicago. IL 60612HIGd of 6lJ, rgacoJ IJ'JICOlow·

Moua LEvrrrUnivel"lity of Minnesota HospitalsMinneapolis, MIlO 55455PrOfU6or and tlaGirmo.JI 0/ tAt'Tape'ktit

Radiation Oncologists

RoDNEY MJu..lON

Univel"lity of Florida Medical CenterGainesville. FL 32610ProfU6or OM t'laGirman of radlO/ogJ

WILUAJI MoesOregon Health Sciences UniversityPortland. OR 97201Prof_or OM claGirmo." of radiO/OW·

STAN~ OllDal

Johna Hopkina HoepitalBaltimore. )(D 21205Prv/eaor Olt'i t'laGi""""" of radiati01l~olow·

Ro8UT G. PA.IUl.II:IlUCLA Medical CenterLoa Ani'elea, CA 900~

F'ro/euoor olrodiolO(W.CAm..08 A. Paa

Mallinc:krodt lnatitute of RadioloiY

IIALooLli A. BA08llAw

Stanford Medial CenterStanford. CA 94305PrvfrMor afld tAairman of radiolow

LL'THEIl W. BRADY. JR.Hahnemann Medical CollegePhiladelphia, PA 19102PrvfU60r and t'laGirmo.n of radiAllonoraeology.

RAVIIOND BVSH

Ontario Cancer InstitutePrincess Margaret HospitalToronto. OntarioCanada M4X lK9

CHv H. CHANG

Columbia-Presbyterian Medical C~nter

New York. NY 10032DiretttJr ofradlotu". therapy.

DoN GoFFINnStanford University HospitalStanford. CA 94305.AMonate proft.$&CT 0/ radiology

tin-YIN L GaJEML'niversit)- of Chicago HospitalsChicago. IL 60637ProfaMJr of radwlogv

SAJlL'EL HI:U.KAN

Memorial Sloan-KetteringCancer CenterNew York. NY 10021Ch~f of staff

hANK HENDRICKSON

Rush-Presbytenan-St. Luke'sMedical C~nter

Chicago, IL 60612ProfU6or of radiation tAerapy, RU3h Jledico.l College. '

HENBY S. KAPLANStanford University HospitalStanford. CA 94305Profu:wr of rod,O/{,gy; did plonur k'Orki" radiotion tFratJrW1lt for callLt'T.

SOlON KaAMuThomas Jefferson University HospitalPhil.del hia, PA 19107

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Sp«iol i.~t iJi CGlIet"'I of till di~.tittr.,.tnrLaoURTS~ (hematology)

NYU Meclic:al Center

I New York, NY 10016

,~~~:=:=':~~~~Ology.Duke University Medial C~nter

Durham. NC 27710Prvf-.or ofrrudit:iv.

MAaVDI oJ. SToNE (oncology)Baylor Univel"lity Medical CenterDan.., TX 75246CAW!of11AC01on, rliflicoJ pro/r6llOr 0/ iflIeruJ JIIftIiciM, l/Jaivrrrntw of Tt'nI.I.

oJOHN Eo ULTIlAHN (oncology)Vnivel"lity of Chiago HospitalsChicago. IL 60057Di1?tttJr of tlu Cantt'r Ct'fftn-: .~rial in·lnat iJi Hodglcin:' dWOM and/papA011l4&

Wu..UAII VAl.OITINE (hematology)UCLA Medial CenterLos Angeles, CA 900"4!4F'rofe.or of JMdinne.

EDWA.&D VJNJ:Il (oncolol)')Pennsylvania H06pitaJPhiladelphia. PA 19107CliJlitOl proftaor ofmrdinllL, ["nllorTB1l~

0/ AoItMJlvIJlu:a; ~noJ I"terr.t 171

Ipplurrruu..RAutH O. W.u..r...EIL!ITE (hematology)

3838 California StreetSan Franciaco, CA 94118Cli"icG/ profe.or ofWU!dit:illL, l'nil~tll

IQ~C~~~~:~:n anemllL

86S5 Weat Third Streetto. Ani'eles, CA 90048Clinical profeaor ofJMdit1nr. UCU

HAIlvn Waaa (hematology)St. Luke's-Roosevelt HospitalNew York, NY 10019F'rofUMlr of1lUdit:i1W. CollI.mbia., ~noJifttnat i fI tOGgll./ati01l problrnu..

WILUAli oJ. WIU IOU IhematololO')State University of New YorkSyracuae, NY 13210Ed/l.lfJrd c. Rnfrn.stein proft'MOT andtUI""""" offIWditiru; ~tial Interut intoagII. /atioJl p roblenu.

h8E1lT C. YOt!NG

Eu GlAD8TEl....National Cancer lnatituteSuildini'10National InatitutA!'S of HealthBethesda. MD 2001.Notedfor olllJrU1n tantt'T. lympllOma andHodglc1" ~ dw_ tre4tmmL Lllcr all !I/a·tiou/ lutiiWu.. of HUJ/tJa t'OFr, tlteFr Y110 cJao7JC. H()Wt'W'r, ifl~ ttJ W Gt't'rpt·H for treot","t, roll. ",~t k re/rrrrd ~a pApit:io" au roll. m~t flWt't till utab-IUW NotUmttJ lrutit.da 0/HraltA 1?-I 8eCTtA JWOloeDli.

~~~7~~=~:~:~w York, NY 10008

CAW/. diviNnt ofAnruJttJlon/~olon;profeaor ojrudiciflt., ilL SiratJl IIrdital&ItDoL

I

71

Charf ofo7lcolog'// 1t7"IIiet.HO'fo·...RD JONI:I8 m

Vanderbilt Medical Cent.t'rNashville. 11' 87232Head ofw nrco1ogiC41 oncology

Lao D. LAGASSE:

UCLA Medical CenterLos An~eles. CA 90024Director ofgyn~cologiCQIoflcology ,rrzojee

'GEORGE: C. 1.z1I"lS, JR

Jefferson Medical Collegt'Philadelphia. PA 19107Dlrrctor ofW'U!cological O7lcologll

"'IU..IAM LUCAS

University HospitalSan Diego. CA 92103Herui o.fgyrlrcologrcal oncology

RICHARD MArnNGLY

Medical College of WisconsinMilwaukee. WI 5322('.H~ad 0.( gynreologIca,' oncolog1'

JOHS MIKt'TA

Hospi~ of thE- l'ni\'erslt~ ofJ'ennsyl\'amaPhjhid~lphi.. PA 191(1"DzTrrto,. 0/gyTlrrologlra,' o."ro!op!-

GEORGE W, MOR1...£'·

l'nj\,ersit:- of Michiglor, Medlcl:.~ Cente~

Ann Arbor. MI 481~Profes...o .. 0.( obstrt"c; and gyncrol·oy./,

C. PAL"!. MORROW

USC Medical SchoolLos Angele:., CA 9003::lPro.(t'-ssor of obst.el"c.' and gy'n(,(,O/O!l!t

JAMn' H. NELSON. JR.Massachusetts General Ho~pjLlil

Boston. MA 02114Pro.fes...nr o.,r V!f11.rrolog}i. Har'/'C"c

M. STEVE.' PI\'"ERRo!'''''ell Park Memorial InstJtuttBuffalo. J\Y 14263

FEux JI,j. R t'Tl.EDGE

M.D Anderl'or. Hospita: llndTumor Instltut.t.-HouSl-or.. TX 700::l('ChId l:(r p.II'/(r%p,/'

PETER E. ScH"ARTZYalt'·!\t>Yo' Ha\'er, H('Spl'.a:J\pw Haver.. C'T 06~H'

Asson'al( pro.(rs.'(l" c( ob~tr~.,r~ o',c'gy."rrolop!-

Jl'UAS P. SMITH

Waynt' StatESchoo! of Mt'dlcintDetroit. MI 4S2(l1Pro.'rs..or o.f obs!r/"r.< ane' gY'I(,~L':Og./'

RICHARD E. S\'MMONDli

Ma~'" ChnicRochel'uor. M~ 55901

PAUL B. USDERWOOP. JRUnJ\'t'rslt~· of Vl1'~mia Mt'dlc:al(.enterCharlottes\'illt'. VA 22901Chari 0.(gynrrologiral onrol<Jg1;

JOHN R. \'A"; NAGELL.JR

Uni\'ersity of Kentucky Medica! CenterLexin~n, ..Y .0536Pro/r-s.,or 0.( obstrtrics find gyrlrro!ogy

J. TAYLOR WHARTON

M.D. Andt'rson Hospit,al andTumor InstitutE'Houston. TX 77030 =

lJIrertor,Lombordr CClnct'" RurarenC~tt>r.

£[nl'ARD F. ScANLON

E\'&nston Hospit,alE\'anston, IL 60201Chai""on o.flll'P~, qJeCtol tfl~rut ,."masl C.a'lCI'T.

HARRl' Sot'TH""JCIIRush-Presbyterian-St. Luke'sMedical CenterChicago. IL 606]2Professor a'ld cnairman of IIIrgrry. Ru..hMrdlral Coll~gr: qwCtal i."trrul 111 heruiand nrrk ronrrr

JOH"; STEHU"; , JR

777 St. Joseph Professional BuildingHoul'ton, TX 77002Dlrertor 0/ the Su-hll1l Fou7ltiallon forCanerr Rr.sraTch A plont'rr in neal trrol·mrnl lor cancrr. Spenal i."tf"l"eSt.,. f1Ir1udcmrla"oma, ,0rC01710. bTt'Q8t. and III'rrranrrT/j

JOSE J. 'I'ERzCJt~ of HoJ,lt' Mt'dlcaJ CenterDuart.€, CA 9101(1Hrac o.fgrt/rral arid onrologlcal surgr'1l

JEROME URBAS

Mt-mom.J Sloan·KetterlngCancer CoE'nter}l;eYo' York. !\Y ]0021Lhrrrtor 0/ thr brras~ rancrr $rrz.,cc. Sp("riali;;('~ In brea..' conrrr SIJT.QrT']{ only

GynecologicalCancer Specialists

HER\")' E. A\"ERE'TTE

Jachor, Memorial HOl'lJiLli!Miami. FL 33136Profr.ssor 0.( obslr/"c.., and gynrrology.l'lIIl'f'TS·it." a.' MiamI

Hl:CR R. K. BARBER

Leno:\ Hill Hospa.aJ1\ ey. Y0rk. !\y lOO~l

D1rrrlor %bs/('I"c..' and gynrrulog1'RICH"RD BoROSO"

160(1 !\. SLlitt· Strt'etJachol', M~ 3920~

CIIlIIra: pro.frssoT 0.( obsu/"r.< and gy1i('colog." l'1II1'f'TSIty of MlSSlSSlPPZ

CARMEL ('-oH£.'

M\ Sm... i Mt-dicaJ C-enter!\t-\Io York. !\Y 100Z~

Pro.(rswr o.f obslrr"c..' a"d gynrrolo!JYPHILLIP J. DISAlA

t'nr\'ersit~ of CllhfornraIr\'lnt- Mt-d,c"l C-enu-rOranj!e. CA 926C';"Pro/r••.•('r and chairman of ob.•lrl"r,' andg!,,,rcolog,1I

LEo Dl'NS

Ml'dlcaJ COlJf'l!'t' of Virl'iniaRichmond. VA 2329~

Chalrmotl %bstrrzr,' a."d w."erolog.1ICREWHTOS ED"'ARIJS

M.D. Anderson HUl'piUiJand Tumor InstituteHouston, TX 77030

ARTHl'R HERBST

t:nivt'rl'lty of Chic:a~o Hospital~

Chica~(), IL 6OG.1i

122

IIIIIII

~ -M;;;oriaiSi:~-k~tteringCancer Cent.t'rN~,,' York, NY J002]C40i""an of ''''PM')'61Jf!nal ifltnul in GJ «'OncrT.

hEDERICII Eu.BERUCLA Medical Cent.t'rLos Angeles. CA 90024ProfU$oT oflll'P"ll,qwnal i."t~?'UI i.".a rn>m Q8

Dos,o.U) FERGUSON

Uni\'ersit~' of Chicago Hospit,al!'Chicago. IL 60637ProfuaOT oflll'PrTJI: Iptnal i."Irre...1 i."breasl ca."r~T.

WlU.lAM S. Fu:"rcKER

Oregon Health SClenet.!' UniversityPortland, OR 97201Pro/usor of ,urgrry. ,pre-ial i."l~rr"1 inbrra.. I ca."e-rr.

FREDERICK M, GoLOMB

910 Fifth Avenue}l;pYo' York. KY 10021Pro/r&or 0.( elmira! su rge-'1I .\Tl". sprria!i"'lrrc.<~ in mrla'ioma

ROBERT HERMAS'"

Clt-\'eland CliniCCle\'~land, OH 441()(iHrrui 0/ grnrra! su rgrry', sprna.' I1'llrrrstin brra..t and Gl ranrrn;

A1.FR£D KE."TCHAM

t'nJ\'ersity of MIl.mi Mt'dlcaJ SchoolMiamI. FL SSW1Pro.(c-s.~(l" 0/ su"glra,' onroloy1'

EDwARD KR£ME...TZ

Tulane l'niverslty Mt'dlca1 C-enter}l;eYo' Orl~ ..n~, LA 70112

I Q' Pro/rs.<or o/surgrT'}l. sprna( I11lrrr." Hi

, mrlano171a.

"'ALTEIl LA"'RESCL JR

Medica! ('.olit-~t- of \'lr~ima

Richmond. VA 23~'

PrO/f'SsO" of SIJrpr'1l, d;r(rlor a.' 0" ra'"rrr crnlrr.

LASAU-E L£FTALL. JR

Hu....ard l'niH'Tl'lly HO~Pl'.al

W"shmg-ton, DC' 2("'til l

PrCJ,frs.<or arid rholrmor, a.' "/i"gf'r,iIWILLIAM A. MADOOX

l'nl\'ersity of Alal,am"Birmjn~hanl. AL 3:'2\1~

Pru/t'..~o" 0.( surgf'T'}ICHAIU..£." McBRlDl.

M.II Andt-r!'(m Hosl.Jlt.a 1

and Tumor InstltUkHouston. TX iiO:·l(jSpeno/ Inll'rrsl IT, brca..t cat/r('T ar,dmrloT/omo.

Dol'ALD L MORTO~

VCLA Mt'dICIoJ Cenu-rLos An~~Jt'~. CA 90024Professor OJsu rgrry: '1,rna / 111 I rrr., ~ Hi

fPIrlanomo and Iiorroma."'YOSET PILCH

Uni\'ersit~ HosJ,it.a1Sar, Vi~~f>. CA 1f21OaSlH'rio/ Inlt>rrsl in brf·a..t conrrr.

JOHS F. POTTER

r~.G~or~f'LoWn t:ni\'t'rsity Hospit.aJ....., W...shinl'ton. DC 2000i

I

IIIIII

I~I

'---_----------..----------~7-..:;....2

II

II


BOARD OF GOVERNORS

IIIIe;.,IIIIII

I~III

~

BOARD OF GOVE~~ORS' MEETING

AND

GOVE~~ORS' CO~ITTEE MEETINGS

MAY 1984

OFFICE OF THE BOARD OF GOVERNORS

B-390 MAYO

IIe;,

IIIIIIII~

IIIIIII"I

I

CONTENTS

Agenda ••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••

Minutes of April 25, 1984 •••••••••••••••••••••••••••••••••••••••••••••

University Hospitals & Clinics Institutional Objectives •••••••••••••

Cost Containment Task Force Response ••••••••••••••••••••••••••••••••

Report of Operations 7/1/83 through 4/30/84 •••••••••••••••••••••••••••

Statement of Operations 7/1/83 through 4/30/84 ••••••••••••••••••••••••

Budget 1984-85 ••••••••••••••••••••••••••••••••••••••••••••••••••••••••

1984-85 Employee Compensation Plan••••••••••••••••••••••••••••••••••••

Re:solution - Allocation of Unit "J" Shell Space ••••••••••••••••••••••••

Appointment of Chief of Staff •••••••••••••••••••••••••••••••••••••••••

Minutes - Finance Committee April 25, 1984••••••••••••••••••••••••••••

Minutes - Planning & Development Committee May 9, 1984 ••••••••••••••••

Minutes - Joint Conference Committee May 9, 1984 ••• o ••• o •• o •• ~ ••••••••

News Clips & Articles ••••••••••••••••••••••••••••••••••••• O •••• O.Q ••••

1

2-6

7-22

23-26

27-28

29

30-58

59-60

61

62

63-65

66-68

69-71

72-79

Board of Governors

IV. Committee Reports

A. Fi~a.!!.c~ C0!!!.ffi.!.t.!.e~,_M!.._Al !.r~nE.e...!.. ~o.:::m2:.t.£e~ ~h~iE.

I G,iii

1I

JJ~

JJJJJJ

I.

II.

III.

V.

May 23, 1984

1:30 P.M.

555 Diehl Hall

University of Minnesota Campus

Agenda

Minutes - April 25, 1984

Chairman's Report - Mr. David Cost, Board Chair

Hospital Director's Report - Mr. C. Edward Schwartz, Hosp. Director

A. University Hospitals & Clinics Institutional ObjectivesB. Cost Containment Task Force ResponseC. Other

1. April YTD Financial Statements2. Budget 1984-853. 1984-85 Employee Compensation Plan

1. Renewal & Renovation Steering Committee Report2. Allocation of Unit "J" Shell Space

1. JCAH Review2. Medical Staff/Hospital Council Report

a. Appointment of Chief of Staff

Other

(Approval)

(Information)

(Approval)(Information)

(Information)(Discussion)(Approval)

(Information)(Endorsement)

(Information)

(Approval)

J VI. Adjournment

~

J] 1

II~

II

CALLTOORDER:

MinutesBoard of Governors

University of Minnesota Hospitals and ClinicsApril 25, 1984

Chairman David Cost called the April 25, 1984 meeting of the Boardof Governors to order at 1:40 p.m., in Room 555 Diehl Hall

IIII

ATTENDANCE: Present: David Cost, ChairMary DesRoches (for David Lilly)Phyllis EllisAl FranceRobert Goltz, M.D.Al HanserLynn HornquistJ. E. MeilahnVi rgi 1 liol ineBarbara O'GradyPaul Quie, M.D.C. Edward Schwartz

The Board seconded and unanimously passed a motion to approvethe minutes of the March 28th meeting as written.

II~

. APPROVAl.OFI MINUTES:

Absent: Carl DrakeRobert LatzDavid LillyNeal Vanselow, M.D.

II 2

Secondly, Chairman Cost asked that the members of the Board reservethe afternoon of May 22, 1984 for the dedication of the new RadiationTherapy facility. He noted that formal invitations would be sentout in mid-May.

Chairman David Cost announced the appointments of Mrs. Phyllis Ellis,Mr. Robert Latz, Dr. Paul Quie, and Mr. C. Edward Schwartz to theBoard of Governors Bylaws Committee. He indicated that ~ir. Latzhad agreed to chair that committee and that Mr. Jan Halverson hadagreed to act as staff to the committee.

The Board of Governors paused to recognize Mr. David R. Prestonfor his seventeen years of dedicated service to the Universityof Minnesota Hospitals and Clinics and to the Health Sciences.Mr. Preston will be assuming the position as Vice President forCorporate Affairs at Allegheny Health Services, Inc., Pittsburgh,Pennsylvania on May 1, 1984.

Chairman David Cost welcomed Ms. Margaret Kelly, a second yearPharmacy Administr~tion student, and Ms. Dee Ryan, a first yearPharmacy Administration student as observers to the Board ofGovernors meeting.

I~TRODUCTIO~S:

CHAIRMAN'SREPORT:

IIIII ,SPECIAL

~PRESENTATION:

I

~

• ~~I•,,'I

",,,..,•,•.. ,J

~

,•J

J

,•

HOSPITALDIRECTOR'SREPORT:

2

Mr. C. Edward Schwartz apprised the Board of progress made insearches for the Medical School Dean, the Dean of the Schoolof Public Health, the Hospitals' Senior Associate Director forPlanning and Marketing and the Health Sciences Public RelationsDirector. tiro Schwartz reported that the Medical School DeanshipSearch Committee had narrowed its consideration to two c~~ljidates

and was in the process of conducting final intervie~~.

Secondly, Mr. Schwartz reported that the Public Health Deanshipwas in the process of being finalized and that an announcementwould be' forthcoming. Thirdly, in reference to the Hospitals'Senior Associate Director for Planning and Marketing Search sMr. Schwartz reported that the qualified candidate pool had beennarrowed to 40 and that a review of those candidates was inprogress. Lastly, Mr. Schwartz announced that Ms. Sally Howardhad accepted the Health Sciences Public Relations Director positionsnoting that Ms. Howard is expected to begin her work at the Universityon May 1st.

Mr. Schwartz indicated that budgeting for the 1984-85 fiscal yearwas well underway, noting that Mr. France would be elaborating onthe development of that budget under the Finance Comnittee Report.Mr. Schwartz did note that a series of institutional objectiveshad been developed for the next fiscal year and that follo~ing

review and comment by a variety of t1edica1 Staff and Manage~ent

groupss these objectives would be presented to the Board of Governors.

Under the heading of marketing, Mr. Schwartz overviewed severalcurrent efforts. Those efforts included the Minnesota Associationof Public Teaching Hospitals (MAPTH) marketing study being conductedwith the assistance of Mr. Eric Berkowitz, a service assessment beingconducted by the Clinical Chiefs under the leadership of Dr. RobertGoltz s and, to go hand-in-hand with that service assessments anassessment by the administrative staff of the hospitals internalenvironment. On June 9th a Clinical Chiefs Retreat will be heldto review the findings of those assessments.

Mr. Schwartz also reported on two separate studies s one bein~

conducted bv the }~PTH group on the costs of graduate medicaleducation, and one being conducted by the Council on Teaching Hos?itals(COTH) examining capital reimbursement. The MAPTH graduate educationstudy, Mr. Schwartz, explained is similar to a national study bein~

conducted for the Health Care Financing Administration (HeFA) byArthur Young & Company. Both the Arthur Young and MAPTH studies she indicated, will assist the University of Minnesota Hospitals andClinics in formulating their position on the best methodology forfunding of graduate medical education. Secondly, Mr. Srhwartz notedthat he and Mr. Cliff Fearing continue to participate on the COTHstudy on capital reimbursement, noting that the next sub-committeemeeting would be held on May 7th.

Mr. Schwartz turned to Dr. Paul Quie for an update on the Chief ofStaff election process. Dr. Quie reported that a committee consistingof Dr~., Doughman, French, Ferrari, Heston and Wilson had nominatedDr. James Moeller, of the Department of Pediatrics, as the next Chief 01

Staff. Dr. Quie also indicated that three positions on the MedicalStaff/Hospital Council were up for re-election. Per the Bylaws, amail ballot of the medical staff at large will be conducted. Dr. Quieindicated that the results of that mail ballot would be presented

....- ,,-- -.•. ,_ , , .--- -. ~ .. .3

~

,~

JOINTCO!\'TERE~CE

COH~1ITTEE

REPORT:

PLA.\~ING

At-."DDEVELOPMENTCml)lITTEEREPORT:

3

at the May Medical Staff/Hospital Council meeting.

Mr. Schwartz announced the election of Ms. Barbara Tebbitt as thePresident of the Midwest Alliance of Nursing, a professionalnursing organization composed of nursing administrators, educationsand researchers in thirteen Midwest states. There are approximately330 agencies who belong to the organization, Mr. Schwartz added,whose purpose is to improve health care in the Midwest as well asto facilitate communication and cooperation between nursing administrators, educators and researchers.

Lastly, Mr. Schwartz indicated that Board members would be contactedfor potential dates for a Fall 1984 Board of Governors Retreat andthat a synoposis of the progress made in response to the Cost Containment Task Force Reco~endations would be presented to the Board in May.

Committee Chair, Barbara O'Grady explained that the Joint ConferenceCommittee did not meet in the month of April but did ask that theBoard as a whole consider the recommendations of the Medical Staff!Hospital Council Credentials Co~ittee for clinical privileges ofseveral physicians and dentists. Per Mrs. O'Grady's request,Dr. Quie summarized the application ~equests as listed in theBoard packet. The Board seconded and unanimously passed a m~tion

to approve the recommendations of the Credentials Committee aswritten.

Committee Chairman Al Hanser summarized five items considered atthe April 11th Planning and Development Committee meeting. Thefirst of those items was a presentation by Dr. Elwin Fraley,Chairman of the Deparment of Urology, on a new piece of equipmentdeveloped in Munich, Germany called the extracorporeal lithothripter,which provides a non-invasive method for the treatment of stonesin the kidney. Mr. Hanser explained that treatment of stones usingthe lithotripter, involves immersing the patient in a waterbath anddirecting sound waves as the stone, causing it to disintegrate.Mr. Hanser did note that FDA approval of the lithothripter is expectedin late 1984 or early in 1985 and that the question of reimbursementfor this procedure would be further investigated. The Planning andDevelopment Committee, he added,would be further exploring thisissue at their }~y meeting.

Secondly, Mr. Hanser reported the review by the committee of theallocation of shell space in Unit "J". The report by Mr. Mark Koenigoutlined the available shell space and current considerationfor utilization of that space. The committee will be reviewingfinal recommendations for endorsement at their May meeting.

Thirdly, Mr. Hanser highli~hted three aspects of the HospitalDevelopment Report preRented to the committee. Resp~nse tothe distribution of the Annual Report, he indicated, had beenvery positive. Mr. Hanser also reported that Development Officeexperience with patient solicitation had led them t~ concludethat solicitation of patients who are younger had not proven tobe cost effective and that the Development Office, would therefore

4,.....-..., .. ' .... " ~,

II ~ FOUNDAT ION

PROPOSAL

IENDORSEMENT:

IIII FINA.~CE

CmmITTEE

I REPORT:

II~

IIIIII

I

4

be concentrating its efforts on those persons who were born before1940. Mr. Hanser also presented a foundation proposal for Boardendorsement. The proposal seeks funding in the amount of $11,400for continuing education for Nursing Assistants in in rural healthcare settings. The progra~s, as projected, will involve a seriesof four sessions in 4-6 pilot communities where such an opportu~ity

has been requested. The Board seconded and unanimously passed amotion to endorse that proposal as written.

Lastly, Mr. Hanser reported that the Planning and Development COmffiitteereceived a Quarterly Purchasing Report presented by Mr. R. Edward Howel]and an update on Unit "3" Construction presented by Mr. Mark Koenig.Mr. Hanser also announced that the Certificate of Need for NuclearNagnetic Resonance had been approved by the Commissioner of theState Board of Health and that the area to house the equipment wasunder construction.

Committee Chairman Al France began the Finance Comnittee reportwith an overview of the March and the March year-to-date financialstatements, noting that the Hospitals operating position for themonth of March reflected a decline in both in-patient and out-patientactivity levels. Mr. Cliff Fearing detailed the March activitiesfor the Board. He indicated that admissions during March were do~~

in all areas except Obstetrics and Newborn and that due to a lo~er

overall length of stay, the patient days for March were 2.6~ belo~

budget. In recaping the year-to-date in-patient census, Mr. Fearingreported that patient days, per cent occupancy and average dailycensus were all 5.8% below budgeted levels. Mr. Fearing also reportedthat nearly all clinic areas experienced activitv levels that werebelow budget in March, but that year-to-date, we remain slightly abovebudget. The financial state~ents, Mr. Fearing explained, reflecta percipitious decline in revenues during the month of March resultingin a year-to-date revenue figure that is 3.2% below budget. Expenses,he noted, are also under budget (1.8%). The Hospitals Statementof Operations does continue to show a favorable variance of revenueover expenses of just above $1 million, due largely, as in the past,to investment income earnings.

Mr. Fearing also explained that the global census indicators projectedfor the 1984-85 fiscal year, which serve as a guideline for development of the budget, will be re-evaluated given the recent decline inactivity levels. He indicated that the finance department haddeveloped a tentative year-end projection based on March year-to-datedata. This model produced a net total cash available from operationsof about $15 million, which is below the $16.4 million budgetedlevel.

Mr. France indicated that the Finance Committee had been reviewingpreliminary data for the 1984-85 budget an~ noted that the Committeewould be reviewing the entire budget at their May meeting. Mr. Francespecifically asked that members of the Board who do not sit on theFinance Committee feel free to attend the May Finance Committee meetingto participate in this review.

Lastly, Mr. France reviewed the third quarter bad debt statistics,noting a net bad debt of $520,000. The Board seconded and unani~ously

5

UNIVERSITY OF MINNESOTATWIN CITIES

Unlve rS'1', Hosp.1als anc C,'nICS

420 Delaware Stree~ S EMinneapolis M,n'leSola 55455

TO:

FRO~1:

DATE:

SrBJECT:

Board of Governors

C. Ed":ard Sch1..1artz. Hospital Director c:."':?~ .. rMay 15, 1984

Vniversity Hospitals and Clinics Institutional Obiectives

During your next meeting 1..1e will be revie~ing the proposed Instituti0~21

Objectives for our Hospital and Clinics relative to our next fiscal vear.Attached you will find the most recent draft of those ob;ectives ~hich ~ere

prepared by our Ad~inistrative Staff and reviewed by several different ~~a~2~e~~~t

anc ~edical Staff groups.

Iou ~ill note in the background state~ent that this is our first effortin recent years at establishin~ Institutional Ob1ectives. Last vear o~r effortsin this area served only to aid manage~ent in coordinating its efforts. T~i8

year we hODe to institutionalize our objectives by involving the ~ledical Staffand the Board of Governors. In future years '-'e plan to enhance the involvement of these and other groups in the actual develop~ent of the objectives viaa more formal strategic planning process.

I a7:". fon.:ardint: these Institutional Ohjectives to vou in ad\'ance 0: ('",meeting 1..1ith the request that you review the document and be nre?arec to s~~~e~t

changes or additions.

Than~·. you.

CES/ s lk

Enclosure

HEAL TH SCIENCES7

I;,ifUNIVERSITY OF MINNESOTA HOSPITALS

INSTITUTIONAL OBJECTIVES

DRAFT 115May 17, 1984

I,JIIIII

fISCAL YEAR 1984-85

I. Background

During the mid .tages of the fiscal 1983-84 budget ~roceS5. a series

of ~nagement objectives were prepared to aid in the aett1ng of ad~inistrative

priorities during that period. Because thes~ objectives were developed later

in the budget cycle. they were not ~resented to the ~edic.l Staff or to the

Board of Governors. As su.:h. they represented ''management ob1ectives" a:-:: not

"institutional objectives". ~ese management ob1ectives for 1983-84 are enclosee

as attachment "A".

The rniversity of Minnes~ta Hospitals and Clinics' stat~~e~· ~~ ~iss:~~

anc Goals are enclosed as attachment "B". This docuTTlent was a=::'Ptec by t~e

Boare of Govern~rs and Board of Regents in 1978 and has not been uncate: sin::e

that ti~e. The Board of Governors is anticipatin~ a revie~ of that state~ent

in the co~ing year.

For 1984-85 it is intended that ob1ectives for the institution be esta~li5~ec

as a part of the budget ~rocess. The ob~ect1ves are intended to ~uide t~e devel-

opment of the annual budget or financial nlan and to represent the desire: accc~-

pli&hments on the part of the Hospital. 1ncludin~ its Governance ane Medical

Staff.

The proposed Institutional Ob1ectives for fiscal 1984-85 are nresented in

the second section of this paper. It 1& intended that these ob1ectives will be

reviewed broadly by the ManaRement Staff and the Medical Starr before bein~

presented to the Board of Covernors.

9

II~

JIIII,I,~

II

IIi,,I~,

II. Institutional Objectives

A. Medical Staff and Programmatic D~velop~ent Objectives

1. Implement ne~ program initiatives endorsed by KanaRem(nt an~ the.~

Medical Staff Budget Advisory Comr.1ttee and approved by the Hosnital's

Board of Governors.

2. Work with the Council of Chiefs to finalize a ~lan to ~axir.~zf thr

operational efficiency and revenue flow in Ambulatory Services an:

implement that plan during the fiscal year.

3. Organize ad~inistrative efforts and Hospital resources availa~:f to

support to Dean of the ~ecical School in the recruit~ent of Depa~t7.€~~21

Chair~a~ anc Departmental Chair=.an in the recruit~ent of Clinica~ ra:~lty,

to fill kn~~~ vacancies.

~. Work ~ith the Lniversity to finalize a site selection for a ne~

pa~ient parking structure. Cor.plete archit~ctural. operational anc

financial plans to assure the availability of that facility by Dece~~er 1get.

5. Complete discussions with the Management of the ne~ rniversitv Racisson

Hotel to provide adequate lo~ cost rooms for University Hospital.

6. In cooperation with the Clinical Chiefs. establish a ~cond site to

house outpatients and their families who are receiv1n~ care at the University

Hospi tals.

,...

_ LO_ ,. _. ; .... _...~, ... ~,.... :......._.... __ ;_. "'_~. _ ~ ,.,. •.... ::.,,.,.... ', "V-:'~' . .~ ...,,~.- f·

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7. Develop alternate organizational models directed at enhancing

continuity of care. Emphasis should be given to cooperative relation-

ships wi th other providers as well as to enhanced communication with

referring physicians, discharge planning, delivery of services in the

outpatient clinics and through home health care.

8. Work with Hospital and Clinical Departments to implement a hospital

wide patient care management information system ~hich provides the Hcs?ital

and Medical Staff with timely information about the quality, safety anc

appropriateness of patient care.

9. Expand the role of the HosDital Auxiliarv to incorporate ne~

areas that involve a greater nu~ber of support activities.

!. External ~rket Share Ob1ectives..

1. Co:plete plann1n~ for a ~rjvate ~avor .pon.ored Vn1ver.1ty FI=u~ty

an~ Staff Preferred Provider Or~anization and make recomoendations tc

the Board of Governors and/or University Executive Officers re~ar~1~~

1mplementation by December of 1984.

2. Negotiate at least ten service arrangements resul~inb fro~ Me:iCeJ

Staff/Hospital joint ventures to realize new referral anclor inL~e s~urtes.

3. Finalize plannin~ grant applications to the Commonwealth F~nd

1nvolv1ng UHBC and five out-state hos~itals and their medical staffs,

preparatory to the 1mp]ernentat1on of referral. cont1nuing education an:

apecialty aerv1ce arran~ernents by October of 19B~.

, ,

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4. Facilitate the rapid successful integration of the Senior Associate

Director for Planning and Marketing into the Hospital and Medical Staff

organizations by September of 1984.

5. Implement a long range strategic planning process by June of 1985

that includes a thorough assessment of the internal and external environments.

6. Evaluate and strengthen the UMH&C Marketing and Public Relations efforts

in accordance with the findings of the Brum and Anderson study.

Financial Objectives

1. Finalize the preparation for the Medicare Prospective Pa~~ent

Systec, including the establishment of a subprovider for Rehabilitaticn

d P h · t b S t ber 1 198' Continue planning to..·ard the "C:-,:lcrensan syc 1a ry y ep em , ....

Hospi tal" pro\'ider concept, targeted to..·ard Uni t J opening date in 198f.

,. Monitor thr institutional advantages and disadvantages of partici-

pat ion in the Blue Cross Blue Shield of Minnesota AWARE progran: anc

make recomnendations to the Board of Governors in December of 198~ re~ar:in~

the continuation of participation after December 31, 1984.

3. Budget and manage hospital finances to assure an excess of revenue

over expenses sufficient to assure the pa~~ent of Hosoital obli~ations

that come due during 1964-85 relative to abandonM<>nt coc;t an~ e"'Jit'· CC''''-

tributions for the Unit "J" Project.

4. Maintain a high level of Hana~ement and Medical Staff accountability

for the achievement of Cost Containment Task Force objectives. Ouarterlv

status reports will be made to the Hospital Board of Governors.

12

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Monitor the Bond Market and maintain an onDoinc stat ~~ ~ us o. ~renaredness

to refinance the Unit "J" Bond issue when interest costs are sufficientlv

r~duced to accomplish deht savin~s ob1ectives.

6. Develop an institutional long range financial plan that is cong1gtent

~ith the mission, role and institutional objectives of the Hospitals.

I 7. Workins throu~h the University, establish relationshins ~it~ ke.

IIII~

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state legislators to make them more directly a~are of significant r~-

~bursement issues of major teachin~ hospitals that ~ill arise as a res~lt

of the prospective pa)~ent syste~ and co~?etitive enviro~ent.

8. Continue the development of federal congressional linka2es tc a~v1sf

and represent the interest of t~MC on general anc rei~burse~ent ~a~ter5 as

the prospective pa~~ent syste~ ~~lementation continues. Special e~~~asis

in this area for fiscal 84-85 ~ill center on reimbursement for ca~~ta1 COStS,

severity indexing, graduate medical education fundin~ anc the maintenan~e

of quality clinical care.

1 .

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D. Operating and Activity Objectives

1. Work to strengthen Hospital employee relations consistent

with the ne~ly established Hospital Personnel policies, particularly

in the areas of compensation policy and labor relations.

2. Work to strengthen the Hospitals' Purchasing system, consistent

with the newly developed Hospital Purchasing Policies, particularly

in the areas of accounts payable and storehouse distribution; to include

exploration of strengthening the Hospitals purchasing position thTOU~\

group purchasing agreements with similar institutions.

3. Manage an ongoing bed complement consistent ~ith projectec de~a~:

anc occupancy standards established for L'M'HC as a part of the l'ni t "J"

Certificate of ~eed and impleoent required organizational cha~~es

consistent ",-i th patient Uni t configuration once t'ni t "J" is operatiC':;alize:.

4. Finalize the Uni t "J" activation plan and begin departmental nairdn>:

anc orientation activities to assure a smooth transition to the ne~ facility

~ith a mininu~ of service interruption.

5. Assure the successful integration of the Health Sciences Director 0f

Public Relations with the Hospital Administrative structure and finalize

the Hospital Public Relations organization, includin~ recruitment, as

appropriate.

6. Re-evaluate the Hospital Administrative structure to assure that it

continues to be sufficient to meet organizational needs.

7. Continue the Hospitals annual giving program and secure $),250,000

in gifts during the fiscal year.

1I,11

i1

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8. Establish a capital giving campaign to assure funds to acquire

equipment for the public and patient areas of Unit "J".

E. Construction and Renovation Object~ves

1. Manage th~ Unit "J" construction activi ties, 1nclu~ing rE'ce~.t:y

approved facility upgrades and shell apace completion, to assure tha~

the project 15 completed on t1~e and within budget.

2. Co~~lete the construction of the Nuclear Magnetic Resonan:e S~a:e

on schedwle to ~eet the Au~ust 19S~ delivery schecule of e~~i~:e~:.

3. Co~plete the Mayo/Heart Hospital renovations Plannin~ Project bv

Dece~~er of 1984 anc work with the Board of Covernors, the Boare o! Rege~:s

in dete~ining the appropriateness of planned renovations directed at

patient care delivery efficiency and cost.

L. Establish a plan by December of l~BL relativ~ to the co~~let~~~ c!

the fourth and sixth level of building B/c shell space that is inte~ral t~ th~

t'ni t "J" construction and Mayo/Heart renovation pro.;ects.

5. Renovate physical facilities in accordance with the Ku1de11nes Set

forth in the Mayo/Heart Renovation Plan and the 19R4-8~ Capital Buc~et

only.

J

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MANAGEMENT OBJECTIVES

fISCAL TEAl 1983 - 84

1. aefinance aer1el 1982 londl in a .anner whtch aax1m1&el potential .avinJsrelultina from lover interelt COltl and areater equity contribution. Suchrefinanc1U1 1. to be conlummated at the .Olt opportune tlae per the bondaarket, ..suminS there 11 a reduction In interelt ratel before the end ofthe current ~ilcal yea~.

2. Continue to closely aanale the Unit J bid procel. and construction .cheduleto a.sure that Unit J will be completed 1n 1986, within the certified con.truction price. As a continuation of this .anasement effort, identify theappropriate admint.trative perlon re.ponlibile for the creation of a move-inplan and indenti!y and leek approval for the aajor elements of thAt planprior to the end of the current fllcal year.

3. Continue plann1ns relative to the renovation of .acated facilities that villbe utilized by the Hospitals after Unit J occupancy. Complete a facilitiesplan and obtain the Hospital Director'l approval of that plan by March 1,198k. Seek approval of that plan by the Board of Governors and Board ofRegents by June I, 1984.

4. Establish a three year .ajor capital acquistition plan by May I, 195~. Thismajor capital acquisition plan should give particular attention to the priorization in timing, .ajor technological advances, and the manner in vhich nevmajor equipment and technology is incorporated into the operations of theHospitals.

S. Obtain approval for a Unit J capital contributions development progra: byJanuary 1, 1984 and initiate that program vithin 90 days of approval. Thi.capital development program vill lolicit contributions over a three yearperiod. Proceeds from that effort will be uled to purcha.e equipment andfurnishings for programs and functions located in Unit J.

6. Obtain annual eiving contributions to the hospital in the amount of onemillion dollars for the period beginninJ July I, 1983 and ending June 3D, 198~.

7. Develop, by January I, 1984, a list of prime candidates to luggest to themedical Itaff regarding the election of the nev Chief of Staff. Providelufficient lead time for the newly elected Chief of Staff to be acclimatedto the office prior to July I, 1984.

8. Influence the .election of key Univerlity officiall by obtaining lufficient andauccinct 1npDt on the part of University Ho.pitall and by provid1nJ that inputto those relponsible for the lelection process of .uch individual•• The Ipecificarea. vhere learche. are underway that effect Univer.ity Ho.pital. are the Deanof the Medical School, Vice President for Finance and the Pean of the Schoolof Public Health.

9. Facilitate .anasement and medical ataf! adaptation to prolpective payment throuJhthe development of the necel.ary data base, ay.tem. and tooll for case mix&anagement, clinical deci.ion .akins, budget management and reimbur.ement~ximizatton, CODlt.tent with the completion datel outlined 1n the July 1983Prolpective 'ayment Manasement Program document. Support the conclu.lon of the

Hi

17

Achieve a full complement of administrative leadership by July 1. 1984 by allurin:the .ucceslful integration of the Ho.pital Attorney with current Ho.pital and Medical .taff, recruiting and hiring a Senior A••ociate Director for Planningand Marketing, and by recruiting and hiring a Marketing Manager and a PublicRelation. Hanager.

Improve the capacity of the institution to respond effectively to the demandsof its environment through the development of a stratelic planning processby July I, 1984 and the development of a comphrensive .trategic plan by July 1.1985.

Monitor the ongoing development of Preferred Provider Organizations and theBlue Crols AWARE Program in the community. Evaluate the consequences to theinstitution of AWARE participation by January I, 1984.

Strengthen the po.ture of University of Minnesota Hospital. and Clinics infiscal year 1983-84 as an influential body in the formulation of local ••tate.and national health policy through active admini.trative interface with other~rovider organization., third-party payor•• law makers. and community groups.

Provide the capital and operating resources in fiscal year 1983-84 that arenecessary to fulfill the Hospitals mission and to fund the financial obligationsresulting from renewal project bonding. consiltent with the targets establi.hedin the financial feasibility .tudy and legal obligations contained within theBond Identure.

effort. of the Cost Containment rask Force study and integrate therecommendation. vhere appropriate, into the.e Ho.pital activitie•.

Reinforce and .trengthen the communication link be~een Univer.tiy Ho.pital.and the .chools and college. within the Health Sciences. This exchange ofinforaation viII be aimed at enhancing the integration of decision makingproce••e. throughout the Health Sciences.

Gain approval from the Board of Regent. for the delegation of the Per.onnelfunction to the Board of Covernors by September of 1983 and implement theaction. detailed in the June 1983 plan. con.i.tent with the time frame inthat document.

Cain approval from the loard of Regents for the delegation of the Purcha.in~

function to the Board of Governors by September of 1983 and implement theaction. detailed in the June 1983 plan. con.i.tent with the time frame inthat document.

Assure a .ucces.fuI acclimation of the loard of Covernor. to the HOlpitals and itsoperations 1n 1983. Foster an environment for po.itive interaction betveen theloard and it. re.pective con.tituencfes through the cooper.tion and .upport of theMedical and Adm1nf.trative .taff on an onloiD& ba.i••

Develop. utilize and monitor a performance planning. evaluation and compensation system for the Hospital Director. Senior Associate Directors. Associate Director•• and Aa.i.tant Directors for fi.cal year 1983-84 that enhancesthe clear identification and a.sessment of individual performance objectives.

Develop a comphrehenlive three to five year plan during the current fi.cal year.for institutional information .ystems development and computer hardware inve.tment.

20.

19.

16.

18.

15.

14.

13.

17.

10.

12.

11.

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..... -_.. ~ ----.'~a-Re-.lVr--o-•

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~ission and Goals of University Hospital

In 1975, University Hospitals acquired its own Board of Governors.

This Board is res~onsible for the policy-related issues which are

resolved at the hospital level within the U~iversity structure. In

1978, the Board revised the Statement of Mission and Goals for

University of Minnesota Hospitals and Clinics. Follo~ing is this

revised mission and goal statement as adopted by the Board of Regerts

of the University of ~innesota.

18

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UNIVERSITY OF MINNESOTA HOSPITALS AND. CLINICS

STATEMENT OF MISSION AND GOALS

PREAMBLE

The University of Minnesota Hospitals and Clinics has many differe~t

responsibilities and goals. The primary mission of the institutionis rooted in the early recognition by the University of MinnesotaMedical Srhool of a need for a clinical teaching environment. In theearly 1900's. the Minnesota Legislature determined that this need bemet by the University of Minnesota Hospitals and Clinics. (As providfcin laws of Minnesota. 1907. Chapter BO. and as perpetuated in ~;nnesn~a

Statute. Chapter 15B. first enacted in 1921.)

The Legislature mandate underlies the Hospitals' role in providinghealth care services. programs of education and research, and referralrelationships with other health care providers and institutions in theState of Minnesota. In this role. University of Minnesota Hospitals an:Clinics serves various constituent groups by making health care ser~ices

available to all residents of Minnesota. to those of the upper Midwestregion, and in the case of some more specialized service programs. byserving as a national resource. Its programs of education. develore:in conjunction with the units of the University of Min~~sota HealthSciences (the Medical School, School of Nursing, College of Pharmacy,School of De~tistry. and School of Public Health), serve students,faculty. it own medical and professional staff. ~any other practirin;health care deliverers. and the general oublic. Further. the researchconducted in association with University Hosp:tals benefits bothproviders and recipients of health care services nationally and internationally.

The University of Minne~ota Hospitals and Clinics ;s o~ligated to thepeople of Minnes~ta to fulfill its special role as a health care resourcefor the state. Thus. the Board of Governors of the University Of Minnes0taHospitals and Clinics, on behalf of the Board of Regents. representingthe people of t1innesota, set forth this statement of mission andcorresponding goals which h~s been developed to meet the uniQue ~esp~nsi

bilities of this institution.

10

The responsibilitie~ of the University of Minnesota Hospitals andClinics require that its mission be uniquely broad. allowing it toserve as a principal medical and health care resource for the Stateof Minnesota. Elements of its mission must also per~m;t the institution to provide a wide range of specialized health care deliveryprograms designed to advance quality health care.

In this pursuit:

MISSION

GOALS

University of Minnesota Hospitals and ClinicsStatement of Missions and Goals

Page 2

A. To offer sensitive. ~ lality patient care programs at thelowest possible cost.

- University Hospitals and Clinics is an integral part ofthe Health Sciences Center of the University of Minnes~ta.

Throu;~ its multiple health care programs. UniversityHDspitals and Clinics will prDvide an environ~ent for t~f

clinical education of Health Sciences students; cont~nuin:

education for its medical staff and other health practitioners; and. in the course of patient care. healtheducation in the areas of preventive care. ~r~ in personalmanagement of patients' own heal/h.

- University Hospitals and Clinics providps a distinctiveenvironment for the advancement of bio-medical researchand technological development. dS we'l as innovations inthe- delivery of medical care and health services.

- University Hospitals and Clinics provices patier.t careservices which respond to local. state. and in so~e

instances. national needs.

University Hospitals and Clinics also fulfills a role ineducation for health services mal')agel'1lent. 'n this role.it will serve as a statewide and national resource for themanagement of the health delivery syste~:.

pti][rn CAP,r: Services for the sick and convillescinn to givecomfort. assist in recovery. and maintain heesltll. .

1.

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C. To support continuing education programs for health careprofe~~ional~ both within the Hospital and throughout theState of r.innesota.

E. To assure quality health care delivery 24 hours a day. 7 daysa wee~ thrcJg~ a hig~ly specialized medical and professionalstaff.

C. To participate in the di~semination of community healt~

education information to health professionals throughoutthe State.

D. To provide programs of home health care and other outreachservices as alternative and less costly methods for providir;me:ical care.

21

Pagf 3

E. To expose students to a wide variety of management experirncesbott. in internal Hospital operations and external healthpolity.

B. To provide innovative primary and preventive care programsand models, both within the University setting and at othErsites and to provide well functioning, specialized andadvanced or tertiary care for patients of referring physicia~s.

C. To provide well organized modern medical care services forambulatory patients not requiring hospitalization, thuspro~oting the appropriate use of health care resources, a~d

to provide eMergency medical services consistent with thedeveloping regional referral emergency medical servicescare network and the educational needs of the institution.

11. EC~CA710~; progra~s for students. faculty. staff, practitionersarc ot~ers interestfd in learning. teaching. practicing. maintairir;and ~sin; health skills.

A. 10 participate in and develop health care progra~s in supportof the educational objectives of the Health Sciences Units.

B. 10 pro~ide patient education programs as a means of helringpatients becomf involved in the process of impro~ing theirhealth status.

University of Minnesota Hospitals and ClinicsStatement of ~issions and Goals

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111. RESEARCH: projects and programs which support the con~'itnlent

of the University Health Sciences as a major research resourc~

for the State and nation in biD-medical and clinical researc~.

A. To encoura~e and support the medical staff and other healt~

professionals in research inquiries and investigations.

B. To recognize the relationship between a variety ofinvestigative programs so that research findings can beused for patient care.

In pursuit of all these goals, University of ~innesDta Hos~itals ar~

Clinics strives to provide leadership through the de.'elopi"',er,t cf r:::'programs. These model programs serve as exanlples for indiv,d;.Jcls or:institutions in the health care system. Excellence, therefore, issought in these patient care, education and research models so t~=~

they may be shared with confidence. Thus, University of Minnes~ta

Hospitals and Clinics att~pts to provide a health care servicesenvironment for Health Sciences studer.ts, practitioners, al;d cl,~~:='

investigators which will be of benefit to all other health care pr:,:.-,~ ~

in Minnesota. In respect to this, University of Minnesot~ Hos~ita~s

and eli nics wi 11 serve as a resource to pub 1i c grOUQS S tud:'i n9 he.:; ~,

issues and policy and will participate fully ir. local, state. ar.~

national health systems planning. University of Minr,esota Hcs;-ita'sand Clinics will continue to provide a g()vet-,IC~ni( model whic~ ref1e:~s

the public accountability of a statewide nealti', care resource.

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University of Minnesota Hospitals and ClinicsStatement of Missions and Goals

Page 4

??

I II II,,·ft

HI'l"IImm"I"I:lIII1Il'; Ilf Ih.· IIIl~;"II;1I Cl1sl ClIlllalnmf'nl Task Ffln'l'

• ~ - -f'

- - - _ "_'I"_"I"'_I"'I_~"S~' _ - - May - 16, 198e-,

Rpcommt>nd:'It Ions

I. Starr In.&.

"_{'_"_flmp,'-'~;!'_f·-,I_ Tn Process Future

I. Opvelop a rlO1n for rhaspd In slaff n·dllctllln~; thrllll",hlllli 11l1splt;1I

2. Tar~et stOlP' rt,(trlrtlons "t an';,s IIf most Inlf'ns,' {'(I~" r-IImrwl il Ionto allow Jlosrltals III rllmrwtl' wllhllllt ('list ~;hlfl 1IlI~

J. Future Staffln~ IncrNlses shl1l1ld hp offst'l hy I'I1s1 rl'.hll' I I"ns

4. Create standln~ Ht>dlcal St.,ff Cllmmlttf'l' til a,Ivlsl' "dmlnlslrill IflnIn the prioritization of npw rro,~rilms, miljol- ;f("/lllslll"ns, pl .. ntrenovation <lnd staffln~ Inrrp.1st's

II. Physician Usp of Rpsourcrs

I. F:ducate physicians ;m<l hOllsr st:tff rl'gilr,f1n,~ "ffpl'ls IIf IlHC hilsl',Ipayment (New House Staff each July I)

2. F:ducate physicians <lnd house stOlff n'r.i1r,lIl1l~ cnsts of 11";ls,procedures, drugs, prt. (Npw Housp Staff £'.1d, .lilly I)

J & 4. Provide physlcl.,ns with dally IIpdatt' of total t'hiln~p~; Int'lIrrpti.arp 11 cab Ie cha rs~(' 11 mit S and up t £I tfa t t' t' (Imp;, r lsi lIn "f l'l'~; I~; (I f 1111' i rpat lents verses pat 'ents of Ill'fors

5. Continue present pnllcy of mlnlml:dng I('n,~th of ~;Iav whPIll'vt'1'possible

6. Impose ct>llln~ nn r,rnwth flf H,'splr,'lory 'n"'filllV and Pill 1('111Honltorln~ sprv'crs

7. Ol'velop onp,oJnp, utll"::ttlfln rf'vlpw prll""s'; f"r fllIlI'r ",'p;ll'Iml'l1lsan.1Ior,ous to lhat prpsf'ntly WH'" In HI";plrill"rv Call'. ",1111'111Hnnltorln~ and I'h:trm.1(·y

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

- --------R••....!1itlV7.P "ltprn.1t'Vt· mO"t"~; for rJ!;k/'nn'nl'v,' ~;"ar_.Vsplt<ll!'; and Mt'ltlC;J' SI;II f '.J

[)l'~rtmt'nt R£tcomml'nd:H "'ons__'·:I1_"_".r_~'_"_f' hy...II"., T;I~;k FII r ....

A. Respi r<ltory TIlt'rap1.

- -1"'1 WI"'n

.....·_"!'~!I~:..ll_,.11 ~'I'S~

x

"WIlef' -

1. Modify ch<lr,:~p to C<lrcf'o-Ht'splr.llory Adv'sory Commltft.p IIIInclud£t dt'velopmpnt of pollrll's <I'ml'e1 ilt rf'str'ct'nr, r"Sllllrrf'S

2. F.xpand Rpspfr<ltory r..1rp ml'llIr<ll cf'rprtors' ro'p III IIll'I ... I..responsibility for dPtt'rminat'on of ilppro!lrLJI"nt'ss IIf sf'rv'ef'

3. Give Rt'splratory C<lre m('llIral e1irl'rtors alll"orilv tn rl'vl(.w .1n"d Iscont Inue Jn<lppropr latl' t I,,">rapy

8. P"tit'nt Monltor~

1. Involve ICU mpdlcal dlrf'clllrs In """till,: ",row," ,Ill" ":O:P.II,';jon IIfP<ltlt'nt Hnnltorlng sl'rvlcl's

2. Merge dep"rtmt'nts of Rpsplriltory lllprapy alld 1';I11"IIt ~llInitnrln,~

C. Ph~rm;:H·1.

1. Expand ch"rge to Ph<1rm.1ry <1n" ll1f'ril!lf'lItll's Commlttl'f' til Inl'1 ... lf'consideration of Cost efff'cllvf'nf'ss IIf dnl':s

x

x

x

x

x

x

N.c-.

2. Establlc;h smi'tll work grollps In P I. T Cllmmitll'f' til rf'('lImmf'IlIl W.1YSto control costs of p".. rman'lIt 11'i11 t"f'LIPY

J. Oppartmen't of Ph"rmary will wllrk t"rnu,~h 1',. T Cllmmltlf'" 10develop mt'chanlsms for contro" Inr, ro~;ls nf ~;('rvll'f's

4. Delt'te ('lpven posit Inns In I'h;lrm;Il'Y uplln mow' tn IInlt .I

(j. N.!,J_r_~I_nB

I. IJPVf""f' plan tn r(·vl,·w followl ll ,: ,·i"."1 ;I"';I~; IlIr .. ".111",'''; "''';111111,,:In Incn·.1st.'e1 work .. fl'ch'ney:

x

x

x

x

x x

2. Or~anization of Work

-Communication Sy~t~mf\.- - - - - - -

f'- - Ac~llmlP(i--------- ~ Process - -~

x

-l'"

2.

J. Administrative and orientation hours

4. Leadership re~pon~ihf]ltJps

5. Educat ion

6. Nursin~ Utilization Management Information SYstem

7. Assi~nment of Nursing P~r~onnel

8. Linen and Nutrition services

Develop plan to delete two assistant dIrectors 'lnrl el~ht he.,dnurse positions

x X

X X

X X

X X

X

X X

X X

3.Review and determine futurc role of Clinical nurs" srwc 1.'11 1stpositions

X X

III. Program <'lnd Patient Schl'eflllps

4.

5.

6.

7.

8.

1.

2.

3.

Review number of office staff fol lowin~ Instal1.,t Ion of f'omputprterminal

Explore computerized schcchd Ing to dccreasC' planning timp

Evaluate workload of assistants anel .1dmfnlstrators followfngestablishment of autonomous flurchaslng rractll'('s

Evaluate role of Resource office to explorp streamlinIng Inscheduling to reduce hOllrs worked

Cease transportation of research maU'rials to rhvsldans' rrlv.1tplabs

Address annu<'ll lossE's In rat Ipnt ran' cost l'I'nfprs sllch asObstetrics, Physical M('(lfclnc, I'sYl'hl;lIry

Renegotiate Indian "eiJlth Servin' program rclmhursempnt rah'.

Continue diSCUSSions with CIty of Mlnnp;II>oI Is rpr,iJreflng futurpof Commllnfr-v rrnfvprc;fr-v II,..;"th C:lrl' (~('n""r

X

X

X

x

x

X

x

x

x

v

x

f' ~4. The task force strongly lIrgl'R that In the flltllrp. prIor to

implementation of any univendtv wId£' p(llf('lp~ .. ff('ctfngUMlI&C. the hospital adminfRtratlon anrtly7.£' and Inform theBoard of Regents and Cpntral Admfnlstratfon of th£' Immpdlatefinancial effc>ct of such policie~ on UMII&C a~ 101('11 a~ thl'pot£>ntial effect on its futurE' ahiJity to n'mafn compl'titlvein the market place of health care d£'liv£'ry.

Hospital Administration willemploy this perspective beforethose considering institutionalwide policies

N

'"

- - - - - - - - - - - - - - - - -fit -

The Hospitals' operating posltlon for the month of April continues to reflectlo~er than anticipated inpatient census levels and further reductions in theaverage inpatient ancillary service revenue per admission. To highlight ourposition:

Outpatient Census: April clinic census totaled 18,523 compared to projectedvisits of 18,585. Our year-to-date clinic census total of 172,779 visits is686 visits, or 0.4% above projected visits of 172,093. However, th~ cliniccensus through April of this fiscal year is 157 visits below our total ofa year ago.

Inpatient Census: During the month of April, admissions totaled 1,696 or22 below projected admissions of 1,718. Admissions this month were at orabove budgeted levels in all areas except Surgery, Obstetrics and theIntensive Care Units. Due to a lower overall length of stay for the month,the patient day total of 14,099 was 2,059 days below the budgeted level ofof 16,158. The overall length of stay for the month of April was 8.7 dayscompared to the year-to-date average through March of 9.2 days.

To recap our year-to-date inpatient census:

1982-83 .I ..

Actual Budget Actual Variance Variance

Admissions 17,414 16,966 16,549 (417) (2.5)Avg. Length of Stay 9.5 9.6 9.1 (0.5) (5.2)Patient Days 165,902 163,010 152,383 (10,627) (6.5)Percent Occupancy 74.1 72 .5 67.9 (4.6) (6.3)Avg. Daily Census 545.7 53~ .5 499.6 (34.9) (6.5)

University Hospitals and CllrileS

420 Delaware Street SEMinneapolis. Minnesota 55455

Report of Operations for the period July I, 1983through April 3D, 1984.

Board of Governors Finance Committee

Clifford FearingSenior Associate Director

UNIVERSITY OF MINNESOTATWIN CITIES

May 23, 198~

FRO~l:

TO:

SrBJECT:

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Report of OperationsHay 23, 1984Page two

Financial Operations: The Hospitals' Statement of Operations shows totalrevenues over expense of $8,104,094, a favorable variance of $525,392. Thisfavorable variance continues to be due to our investment income being higherthan projected by approximately $2,265,000. The net revenue from operationsthrough April shows a net loss of $7,840,500 which is nearly $1,742,000 greaterthan the budgeted loss of $6,098,655.

Patient care charges through April totaled $150,314,837 and are $6,216,000(4.0%) below budgeted levels. Routine revenue is 6.0% below budget and reflectsthe overall patient day variance. Ancillary revenue levels declined duringthe month of April reflecting a lower average acuity level. Inpatientancillary charges per admission declined from the March year-to-date averageof $4,806 to an average of $4,299 for the month of April.

Operating expenditures through April totaled $132,419,546 and are approximatel:$2,866,000 (2.l~) belo~ budget. Overall spending levels during April cor.tir.~~ toreflect reduced personnel costs, and supply and expense costs associated ~ith

our lower census levels and with the actions taken by management in Kove~ber.

Accounts Receivable: The balance in patient accounts receivable as of April 30,1984 totaled $41,832,356 and represents 84.9 days of revenue outstanding. Totalreceivables increased nearly $872,000 during the month of April with the increaseoccurring primarily in the Nedical Assistance, commercial insurance, anc H.':'Jcategories. Minnesota Medical Assistance receivables showed the largestincrease and reflects their continued back-log of claims follo~ing a conver-sion in their payment system last fall. We have also experienced an increasein claims audits by insurance companies which results in delay of the payment.

Conclusion: The Hospitals overall financial position through the end ofApril continues to remain within the fiscal plan implemented in ~ovember.

Operational changes that are necessary and appropriate continue to be rr.adein relation to changes in acuity level and ancillary service utilization.

Ijem

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UNIVERSITY OT MINNESOTA HOSPITALS , CLINICS

STATEK!~l OT OPERATIONS

rOR THE PERIOD JVLY I, 1983 TO APRIL 30, 1984IIIIII

IIII

Cross Pati~nt Charg~s

Deductions fro~ Charges

Other Operating Revenue

TOTAl REVEI\t'E TROM OPERATIONS

ExpendituresSa lar ieaTringE BenefitaContract ComrenaationMedical Suppli~s, Drug., BloodCampus Adcini.tration Expen.eDepreciationCeneral Suppli~. , Expense

Total Ezpenditures

Net Revenue from Operations

Non-Operating RevenueAppropriationsIntere.t Income on ReservesShared ServiceInveEtment Income on Truatee

Held Aneta

Total Non-OperatinL Revenue

RevenuE Over I -Under Expense.

Varianc~

Over I-Vnde rludgu~d Actual Budget VII i.nce %

---------- -------- ------------ ----------~156 ,531,095 ~150,314,837 $-6,216,258 -4.0:

30,014,949 :'>P,65~.33~ -1.36~.615 -~.5

2,670,568 2,916,543 245,975 9.2------------ ------------- ------------ -----------5129,186 ,714 ~l~~.5i9.f)~f S-L • 6 r;, • f~' -:'. t'

$ 65,157,149 ~ 63,952,809 $-1,204,340 -l.P:12,102,330 12,808,474 706,144 5.~

6,228,200 6,664,706 436,506 7.021,275,443 20,298,374 -977,069 -4.64,355,000 4,355,000 0 0.05,377,627 5,069,876 -307,749 -5.7

20,789,620 19,270,305 -1,519,315 -7.3------------ ------------- ------------ -----------5135,285,369 $132,419,546 $-2,865,823 -2.1:------------ ------------- ------------ -----------5 -6,098,655 ~ -'7,~L.",50n 5-1.7~l.R~5 -~~.6·

S 10,350,375 ~ 10,350,375 01,532,161 3,797,054 S 2,264,893

307,688 310,032 2,344 O.S:'

1,487,133 1,487,133 0------------ ------------- ------------ -----------5 13,677 ,357 S 15,94~,594 S 2,267,237 16.6:------------ ------------- ------------ -----------S 7,578,702 S 6. J f)~ • nQ~ S 5~5. 1.0:' (])------------ ------------- ------------------------ ------------- ------------

II

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(1) Variance ~quals n.~· of total budgeted revenue.

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....UNIVERSITY OF MINNESOTATWIN CITIES

May 23, 1984

Un1Ilers't" Hosp'tal~ a"l!J CI'nICS420 DelawarE' StreE" S EMinneapolis Mlnnes::>ta 55455

En~losed for your revie~ are the Operating Bud~et Schedules for 198~-85.

(Th~ volatility inherent in th~ current 1983-84 census and revenue levelshas necessitated that we develop a contingency budget for 1984-85, as~ell as the base budget that has been in development since February c~

19S~.) The budget schedules for 1984-85 have been designed around t~0

different sets of assur.?tions regarding utilization levels and therefor~

represent a base budget, i.e. that budget ~hich has been developed as inthe past through a budget process incolving all levels of managenentpreparing forecasts of revenue, expenses, revenue deductions and ca~ital

needs. The second budget is a contingency budget based on assu~Ttions c~

ad=issions, patient days, clinic visits, and revenue and expense levelsthat r.ay occur should the recent declines in utilization continue int~

195":'-85.

IIIII~

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TO:

FRO:~ :

SrBJECT :

Board of Governors

C. Ed..... ard Sch\,,'artz~~~Hospital Director

1984-85 Operating Budget for tniversity of ~in~es~ta Hospita!sand Clinics.

IIII

The schedules ~hich you have before you outline th~ base bud~et ~ilich ~i

~ill operate ~ithin should the higher lev~ls of utilization occur, andprovid-=- you \,,'ith the levels of operations \".( exp~ct slH'uld tt"h c\.;,rc:,t tr·.:-:':in utilization occur throughout the next fiscal year.

The annual Equipment and Renovation Budget is also includ(Od f('T revit' ...· \"'itiJthe Planning and Development Committee at a joint luncheon today. Levflsof capital expenditures for the 1984-85 fiscal year are not expected t~

vary based on the different levels of volume assumptions. Th~ anount of theCapital Budget for 1984-85 is $5,103,000.

In constructing the base budget and conting~ncy budgets for 1984-85,planning assumptions, requirements and covenants related to th~ 198~ S(,riesBonds hav~ b~en incorporat~d as required.

B~ginning July 1, 1984, University of Minnesota Hospitals &Clinics ~ill

begin receiving reimbursement for Medicare patients under the new Diagn0sticR~lated Groups (DRGs) prosp~ctive payment system. Medicare contract

HEALTH SCIENCES 30

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Board of GovernorsMay 23, 1984Page tt.'o

deduction calculations have been based on this new payment system. Alsofor 1984-85, net.' Medicaid reimbursement policies which pay Universityof Minnesota Hospitals & Clinics $7,209.00 per admission, and the Blu~ CrossBlue Shield of ~linnesota A~ARE payment schedule have been incorporated incalculating the revenue deductions for 1984-85.

Rate increase requirements for the 1984-85 base operating budget and thecontingency budget are consistent at 7%.

/ jer..

.. ,_,_"""'. __ ' ...... , .... '.r: .... ':a·. ......,. ;».,. ..._,•. ".... .'.,' -"'",

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rniversity of Minnesota Hospitals b Clinics

Budget LetterFiscal Year 1984-85

Introduction

The volatility in patient census and patient reVEnUe levels during th~

1983-84 fiscal year have dictated that management take a substantiallydifferent approach to the operating budg~t for 1984-85 fro~ that inprevious years. Declines in census levels in Septemb~r (primarily crEatecby reductions in the average length of stays in most clinical services)dictated that a minimum of eight months of patient activity be used as abase for projecting 1983-84 activity levels. ~1ajor declines in andll.::r::utilization in January 1984 provided a further need to defer the bUG~~:

process fror:; its normal January through April devt?lopment to a ~:arc!-,

through June development.

As the budget was under development in ~:arch 1984 at thE' detail depart:--e:-.:level, further declines in the average length of stay occurrt?G alon~ ~it~

declines in average revenUES per ad~ission. With the month of April shc~i~~

a recov~ry of approximately 25~ of the March declines, manage~ent decide~

to co~plete the 1984-85 budget based on its original projection using Jul~

throug~. February data, and to deVElop a contingency budget for 198~-8S

baste on experience levels existing in March and April of 1984.

T~e budget schedul~s included for your revie~ today incorporate both thebase and contingency budgets and outlin~ thE' FTI reductions r.ana~~~,nt r.u~:

r.a~, to achieve tile conting~ncy budget levels of expenditur,s shouldthe activity remain at ~arch and April 1984 l~vels.

In addition, manage-T:lLnt has initiated sevt:ral efforts to ('ffst! t:«, Ctclin,oin patient c",nsu"': and reduct, th~ need to adjust its ...·ork forc.:' by 1°,:, :-=-:"',,0.ScheduJe Xll is a SUT:".T7".ary of th~s~ initial efforts.

The 1984-85 BudfPt

As in the past, the 1984-85 budget (both the base and thF contin~ency

budgets) hav~ been developed by management consistent with the fol1o~in~

budget objectives:

1. To provid~ the capital and operating reS0urces that are necessar~

and essential to fulfill the Hospitals' mission.

2. To reinforce the need for cost containment am0ng the mana~e~~nt andmedical staff at the Hospitals, by communicating throu~h th~

limitations imposed by the approved budget, the need for fiscalrestraint and budgetary accountability.

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Budget LetterFiscal Year 1984-85Page t\.,'o

3. To restrict the price increases necessary from the effects ofcost shifting to the levels identified in the financial feasibilitystudy. More specifically. to operate the Hospitals ~ithin th~ .financial limitations imposed by ne~ federal. state. and oth~r

third party payor payment systems.

4. To provide the cash flo~ necessary to ,fund the financial obligationsresulting frorr. the Rene~al Project bonding. consistent ~ith th~

targets established in the financial feasibility study and th~ l~gal

obligations contained ~ithin the Bond Indenture.

5. T~ incorporat~ the Cost Containment Task Force recor.~~ndatior.~.

In addition to these broad budget objectives. several key variables hav~

been introduced into the 1984-85 budget projections. These include:

• Medicare Prospective Payment System

The Social Security Anend:nents of 1965 (Pub. 1. 89-97) estab1is~,e::

Title XVIII of the Social Security Act (the Act), ~hich authorizt::the establishment of the Medicare program to pay part of the costsof health care services furnished to eligible beneficiaries. Part Aof the progra~ (Hospital Insurance) provides basic health insura~:e

protection against the costs of inpatient hospital care and otherinpatient or home health care. Part B of the program (Suppleme~tary

Medical Insurance) provides voluntary supplementarv insurance coveringmost physicians' services and certain other items and services notcovered under Part A.

Generally. there are two bases for payment under the Medicareprogram. The first is "reasonabl~ cost" and the second is "reaso::able charge". Essentially, reasonable costs include all directand indirect costs that are necessary and proper for the efficie::tdelivery of needed health services to beneficiaries. ~ithin thisgeneral framework, there are numerous rules regarding the reasona~le

ness of certain categories of cost. how they are to be calculate::,and how they are to be reported and how they are paid.

Because actual reasonable costs cannot be determined until the endof the provider's cost reporting period. interim reimbursement a:nounts.approximating actual costs are determined by the fiscal intermt.~diary

serving each provider and paid to the provider through0ut the year.

Providers are required to maintain sufficient financial records andstatistical data for proper determination of costs payable under theprogram. Cost reports must be submitted to the intermediary on anannual basis. Final settlement is made follo~ing further reviewand/or audit of th~ cost report and records.

33

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Budget LetterFiscal Year 1984-85Page three

The second basis of payment. "reasonable charge". is for physicians'services and other medical and health services that are not furnish~d

directly by a provider of services or by others under an arrange~~nt

with the provider. The principles of reasonable charge reimburse~ent

are primarily limited to the usual and customary charge in a givengeographical area.

The Social Security Amendments of 1972 (Pub. L. 92-603) containe~

numerous prOV1Slons affecting the Medicare prograrr.. Two sections.ho...:ever. are particularly relevant to changes in Medicare reir::burse;,;.ent.

Section 222 of the 1972 Amendments authorized the Secretary to en~age

in experiments and demonstration projects in order to deterr::ine th~

advantages and disadvantages of making payments to Nedicare prcvieerson a prospective basis.

Section 223 of the Social Security Amendnents of 19i2 amendec section1861(v)(1) of the Act to authorize the Secretary to set prospectivelirr.its on the costs that are recognized as reasonable under Medicare.Section 223 authorized the Secretary to apply limits to direct a~c

indirect overall costs or to costs incurred fer specific ite~s orservices furnis~ed by a Medicare provider and to base these li~its

on estirr.ates of the cost necessary for the efficient delivery ofneeded health Services.

Cn September 3.1982. the PrE:sident si£nec into 12"" the Ta:-: Equityand fiscal Responsibility Act of 1982 (TEFR~). Pub. L. 9i-24S.Section 101(a) of that legislation added section 1886 to the Act.This new section included two provisions that limited Medicarereinbursernent for costs of inpatient hospital services. Section1886(a) of the Act provided for the extension of the section 223hospital cost limits. which had previously been applied only toinpatient general routine operating costs. to the total operatin~

costs of inpatient hospital services. The expanded limits were t~

apply on a per discharge or per admission basis. and were to tak~

into account the mix of types of Medicare cases treated by th~

hospital. Section 1886(b) of the Act provided for a ne~ three-yearlimitation on payment for hospital costs and provided for incentivipayments to hospitals that keep their costs below a target amount.

On April 20. 1983. the President signed Pub. L. 98-21. the SocialSecurity Amendments of 1983. Title VI of Pub. L. 98-21 providesfor Medicare payment for hospital inpatient services under aprosp~ctive payment system, rather than on a reasonable cost basis.Essentially. M~dicar~ payment will be made at a predetermined.specific rate for each discharge. All discharges are classifiedaccording to a list of diagnosis-related groups (DRGs). This listcontains 470 specific categories. The prospective payment rate ~ill

not include capital-related costs (e.g .• depreciation, taxes. rent.etc.) or direct medical education costs, which will t~mrorarily

continue to be reimbursed under a reasonable cost-based system.

34

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Budget LetterFiscal Year 1984-85Page four

The statute provides for a 3-year transition period during ~hich

a declining portion of the total prospective payment will be ba5econ hospitals' historical costs in a given base year and a graduallyincreasing portion will be based on a regional and/or nationalfederal rate per discharge. Beginning with the fourth year andcontinuing thereafter (i.e., cost reporting periods beginning on orafter October 1, 1986), Medicare payment for hospital inpatientservices ~ill be determined fully under a national DRG pa:~ent

methodology.

The federal payment rates are determined based on the mean urbanor rural standard amount per discharge. This amount is then acjustecto account for area differences in hospital ~ages. The standardamounts per discharge ~ill be updated annually. For FY 84 andFY 8S, the prospective payment system must be "budget neutral". T~at

is, payments may not r.e greater than nor less than thE- payT.',E-r;tsthat ~ould have been paid under the la~ previously in effect.E~ginninf, with n: 86, the Secretary \o.. ill deterr.;ine the update facte:taking into consideration recommendations made by a cor.~issicn 0:independent eh~erts appointed by the Director of the Office ofTechnology Assessment.

Additional paysents ~ill be mad~ to hospitals for discharges meet:~~

specified criteria as "outliers". Outlitrs are caStS that havt.- a::extremely long length of stay or unusually hi&h cost when co~part.-~

to most discharges classified in the saSE- DRC. Additional payse~t5

~ill also be nade for indirect costs of approved graduate medicaleducation programs.

Beneficiaries may be charged only for deductibles, coinsurance a~~unts,

and non-covered services (e.g., phone, television, etc.). They maynot be charged for differences bet~een the hospital's cost of providi~;

covertd care and the ~edicare payment amount.

[nder the prospE-ctive payment system, payment will be mace to ththospital on a per discharge basis. Therefore, hospitals nay haveincentives to increase admissions or redUCe services. To safeguar~

against such practices, th~ statute requireS the establish~ent of amonitoring system to revie~ admission practices and quality of cart.If an abuse of the prospective payment system is discovered (e.&.,unn~cessary multiple admissions of the same beneficiary (lr inap;-ropriatemedical practices), payment may be partially or totally denied to thehosptial.

All the relevant elements of this new la~ have been, incorporatedin ~~rn&C's forecasts for fiscal year 1984-85.

• Blue Cross Blul' Shield of 1-1innesota "AWARE" Program

Blue Cross and Blue Shield of Minnesota (BCBS~l) introduced D newpreferred provider organization program called AWARE on April 1, 1983.As of this date, all 27 hospitals in the metropolitam ar~a have

35

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Budget LetterFiscal Year 1984-85Page five

agreed to provide services to patients whc choos~ this health carecove rage. Currently, BCBS~l is only marke ting the AWARE prograrrin the metropolitan area.

The AWARE program is an insurance coverage where hospitals agree toprovide services to patients at the fifty-fifth percentile (55~) ofthe average metropolitan area hospital charge in five general areas,i.e., Medical, Surgical, Obstetrics, Mental Disorders and ChemicalDependency and other limited speciality areas. l~&C chose toparticipate in this program as of January I, 1984. Through March 31,198~ the discounts prOVided to Blue Cross under this progra~ have beenaveraging 7~ of Blue Cross charges. For 1984-85 budget purposes, wehave included discounts at a 8.5~level to insure agains~ a chan~~ inpatient nix within this payor group. Discounts are providec or. al~

Blue Cross Blue Shield of Minnesota policies except those co~pa~ies

who have inter-state policies. All out of state Blue Cross cor-tractsare paid on a full charge basis.

• De~and Assess~ent

~umerous assess~ents of Dmf.C's future demand have beer: perfo"17.cc. C'''OcT

the last six years. Each of these assessments has forecast a declin~

in averafe length of stay and adr.issions for l:lli&C through 1988. Forfiscal year 1983-8.. D!H&C used the forecast decline in census procucecby Touche Ross and Co~par.y for their 1982 financial feasibility stu~y.

As a result O! this forecast, the 1983-84 budget was set at 20,~75

ad~issions, 196,000 patient days and 208,950 clinic visits.

As a result of the occupancy declines in Septer.bl2r of 1983 anc experiencethrough February of 198~, managern~nt revised the 1983-~" forecasts to183,500 patient days, 19,500 ad~issions and clinic visits weT~ project~d at 208,000. With these 1983-S~ revised forecasts as a base,management established the following demand bud~0ts for 198.. -85:

TheSe levels of volume were used to develop the 1983-S" d~part~~~:a1 buc~ets.

With the decline in occupancy experienced in March and April of 198~,

further reductions in forecast volumes became necessary. Based onApril 1984 year to date volum~5 with projections for May andJun~ 1984 based on April levels of activity, th~ f0llo~inr r~vis~d

volume levels have been established for 1983-84i

IIII

I~II

Pati~nt DaysAdrr.issionsClinic Visits

Patient DaysAdmissionsClini c Visi ts

181,21519,331

208,000

181,06019,850

208,000

- .. - , '._- .. ;-',~ .- , ',,'(" . " ..

36

Budget LetterFiscal Year 1984-85Page six

Using these revised volume estimates as a bas~ and adjusting th~

admissions and average length of stay to reflect the forecastdeclines in the feasibility study, the following vo1um~ forecastshave been established as the as ' 1 • base budpet for 19S~-8S:

I

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Patient DaysAdmissionsClinic Visits

178,86119,676

208,000

II

This base budget assumes that the declines in occupancy experiencedin March and April of 198~ will not continue. In order to pr~pare

for the probability that these levels do continu~, mana~ement dEv~loped

a contingency budget for 1984-85 based on this recent experience. Ifthe March and April 198~ utilization levels continue, the f011ovin~

will be the de~and budget for 1984-85.

T~e Series 1982 Bonds

Schedules I, II, and III su~rarize the d~mand forecasts fora:ld 198':'-85.

[noer the Indenture of the Series 1982 Bonds, r~S&C is required tocontribut~ 54 million in equity to the Renewal Project, provide cas~

to a~ortiz~ $2.8 ~illion of abandoned planning costs and ~ener2:e

suffici~nt cash to cover $5.103 million in capital needs expecteddurinf the fiscal year. These factors have all been included in th<proj~ction for 1984-85.

163,46518,923

20S,OaO

Patient DaysAdmissionsClini c \'isi ts

•

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• ~e·..; Programs

~ev program re~u~sts for 1984-RS have been ~inimal. For 198':'-8~.

16.4 new full time equivalents have been added to thf budget ~as, .11.4 of these positions have been justified by reduced oreratin~

expens~ in non-salary areas, and 5 of the positions have beenjustified through increases in outpatient revenues. Schedule Vprovides th~ detail of these new positions.

• Cost Containment Task Force

I

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Another critical internal effort has been the work of the CostContainment Task Force. You have all recieved a summary of thisreport. Its essential message is that management and the medicalstaff must work together in controlling costs and in respondingto the constraints of the environment. Our budget for next yearreflects the recommendations of thE" Task Force, including much ofwhat has already been accomplished to date relative to the recommendations in the Task Force Report. In addition, the advice we havereceived more recently from the Medical Staff Bud~et Advisory Committeeis reflected in our budgeting guidelines.

., .__.. , ,_ 37

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Budget LetterFiscal Year 1984-85Page seven

• 1983-84 Budget Base

In conjunction with each of the above elements, the primary basisfor the fiscal year 1984-85 budget is the current year 1983-84experience. In forecasting the 1984-85 fiscal year budget ele~ents,

the current experience in each category was used as the startinfpoint to determine expected 1984-85 results. As described belo~ andsho~n in the attached detail schedules, forecast ad~issions, patientdays, clinic visits, expenses, revenues, and revenue deductions havebeen made based on current year experience adjusted for chang~s

predicted in the feasibility study, requirements of the Indentur~

and ne~ federal reimbursement regulations. The fo1lo~in~ are ge~c~E:

d~scriptions of ho~ the major elements in the 198~-85 bud~et fortcEst\\'ere project.::d:

Full Time Equivalent Analysis

Budgeted full time equivalents for 1983-84 were 3626.5. Du~ t~

activity levels in excess of budgeted levels for the first GUE~te"

of 1983-84, FIEs in use as of October were 3653.3. In order tcachieve the 1983-8':' financial objectives 161.6 full tir.1e eq:;ivalents~ere eli~inated from the current year budget as of 12-15-E3. T~t

result ~as an adjusted operating budget of 3491.7 FIEs.

R.::ductions in March and April vclum~s re~uired most depart~ents tcleave vacated positions open. These ne~ vacancies have produc~~ acurrent FIE count of 3460.

In developing the base bud~et for 1984-85 a target of 34~~ FT~5 ~as

established based on our long ranp~ planning model productivityforecasting asseSSr.1ent. This, in addition to the 16.4 ne~ rr~~ra~

FIEs, brought our base budget for 1984-85 to 3441.4 FIEs.

In analyzing the volume forecasted in our contingency bud~L t, afull tir.1€ equivalent requirement of 3286.4 is forecast inclucin~

tho 16.4 ne~ FIEs.

Based on our current position it will require a reduction of 35FIEs to reduce our FTrs to the base budget and it will require atotal reduction of 190 FIEs to achieve our contingency budget FIElevels.

Schedule IV summarizes the FTE status for current operating levels,the base budget and the contingency budget.

Ancillary Service Utilization

This is an area of particular focus, given that over 50~ of ouradmissions will be paid for on a fixed cost per stay or fixedcost per day basis next year. The Cost Containment Task Forcereport also identified the need to control the use of ancillaryservices, and several departments and committees are alreadyworking on this important issue.

-.. - ....;--' ..•., ~.

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Budget LetterFiscal Year 1984-85Page ei ght

The use of ancillary services has two key variables - the numberof admissions/patient days, and the number of tests, procedures,etc. per admission/patient day. As noted earlier, we are budgEtingfor a decline in admissions/patient days, and ancillary serviceareas have been budgeted accordingly. In addition w~ have budgetedto achieve decreases in the use of such services per adMissio~

or per patient day ranging from 0% - 5%. This is a relativ~ly

moderate decline in ancillary service use; it is also one thatwith the mutual support and cooperation of our management staffand medical staff should be realistically achievable.

Expenditure Summary

Schedules VI & VII are comparative summaries of expenditures for fiscal1983-8~ and for the base budget and contingency budgets for 195~-E~.

These eh~enditures have been determined usin~ the nurr.ber of fulltime equivalents sho~n on Schedule IV as a basis for salariesand the April year to date actual experience as the basis forthe other cate~ories of expense. Decreases in supply andexpense categories apparant over the January - April timeperiod have been incorporated in all forecasts. The follo~i~~

inflationary assu~ptions were used in forecasting 198~-8S:

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Salaries- July I, 198~ increase- Carry fo~'ard of 1/1/8~

increase- 1/1/85 increase- COMparable worth increase

4. 5 I~

•5 ~~

•5 ~~

1.83c

Inflatior. ~,

Depr~ciation has been calculated using the capital equipm~nt

budget as the base for new purchases.

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Fringe BenefitsInterest Eh~ense (Short-term ~otes)

Acade~ic/Resident ContractPhysician CompensationOther ContractVtilitiesInsuranceCampus G/ADrugsBloodFoodLaundry /Li n('nRentalMaintenanceCommuni cat ionsGeneral Supplies/Expense

7.0 ;;5.9 ;c5.5 ;,5. 5 ~~

10. 0 ~~

(1. 0);,B. 0 ~c

8. 0 ~:

4. 0 ~c

4.5 ;c5. 0 ~o

4.8 iS. 3 ~o

~. 6 ~D

5.3 %

I

I~

IIIIIIII~

IIIIII

I~II

......... ,- ••_,,_ ._ .'.~ " 0< •••••

Budget LetterFiscal Year 1984-85Page nine

Series 1982 Bond Indenture Requirements

Schedule VIII is a summary of the $15,308,000 in cash n~eds

required under the Series 1982 Bond Indenture.

Deductions From Revenue

Schedule IX is a summary of the expected deductions from revenuefor fiscal years 1984 and 1985. The fiscal 1985 forecast isbased on the new prospective payment system and Medicaidregulations.

Non-Operating and Other Operating Revenue

Schedule X is a summary of expected appropriations and othernon-patient revenues for fiscal years 1984 and 1985. Inflationaryincreases on the appropriation are forecast based on kno~n

allocated appropriations from the Vniversity.

• Fiscal Year 1984-85 Cost, Price and Revenue Increases

To finance the expected increases in costs, revenue deductions andRenewal Project cash f1o~ needs for 1984-85 will require an increaseof 7.0% in price increases which increases gross revenues 2.48~ inthe base budget and represents a 2.72% decrease in gross revenues inthe contingency budget. Gross patient charges will increase$4,433,700 under the base budget and will decrease $4,855,600 underthe contingency budget. The Comparative Statement of Operationsand Projected Cash Flo~ Statements on Schedule XI su~~arizes oureh~ected position for fiscal year 1984-85.

4Q

~..~.._~ ....,..~ ,#-:"'J-' •.• ' .. -._"'- .... _, .....~ ~ -_ ••

Schedule I

UNIVERSITY OF MINNESOTA HOSPITAL & CLINICSBUDGET YEAR 1984-85

COMPARATIVE DEMAND ANALYSISINPATIENT ADMISSIONS

61 61

86 91

41

726

79

64

106

380

253

127

564

819

733

835

909

996

2,540

1,227

1,105

1,048

2,943

3,469

18,923

1984-85CONTINGENCY

BUDGET

19,676

107 109

841 829

172 172

257 257

778 778

420 420

800 796

795 795

939 945

991 991

613 660

1,062 1,062

2,614 2,490

1,102 1,096

1,333 1,333

3,542 3,492

3,337 3,299

19,850

1983-84 1984-85PROJECTION BASE

BUDGET

42

272

114

136

189

932

912

363

787

818

887

434

1,053

3,810

847

1,104

2,877

1,573

3,325

20,475

1983-84PLANNED

BUDGET

Neurosurgery

Neurology

TOTAL

Orthopaedics

Obstetrics

Med ic ine

Newborn

Ophthalmology

Urology

Otolaryngology

Gynecology

Family Practice

Surgery

ADMISSIONS

Dermatology

Clinical Research

Dentistry

PM & R

Psychiatry - Child

Pediatrics

Psychiatry - Adult

II,IIIIIIII~

IIIIII

I~II

ISchedule II

I ~ UNIVERSITY OF MINNESOTA HOSPITAL & CLINICS

IBUDGET YEAR 1984-85

COMPARATIVE DEMAND ANALYSISPATIENT DAYS

I 1983-84 1983-84 1984-85 1984-85PLANNED PROJECTION BASE CONTINGENCY

I ADMISSIONS BUDGET BUDGET BUDGET---------- ---------- ---------- ---------- -----------

IClinical Research 1,631 1,940 1,940 1,919

Dentistry 665 530 530 555

I Derma t 0 logy 1,479 1,424 1,438 1,653

Family Practice 142 389 389 204

I Gynecology 9,427 7,691 7,691 6,037

IMedicine 36,153 32,982 32,640 31,587

Neurology 9,193 8,340 8,340 7,311

I ~ Neurosurgery 9,341 8,507 8,507 7,699

Newborn 3,881 3,184 3,166 2,876

I Obstetrics 4,424 4,474 4,091 3,779

IOphthalmology 3,990 3,633 3,413 2,946

Orthopaedics 8,143 7,769 7,769 7,062

I Otolaryngology 3,467 3,531 3,507 3,301

Pediatrics 39,987 39,310 39,058 33,129

I PM & R 9,723 7,199 7,199 6,621

IPsychiatry - Adult 11,748 14,780 14,809 13,997

Psychiatry - Child 6,895 3,313 3,467 3,629

I Surgery 29,725 25,879 24,722 23,507

Urology 5,986 6,185 6,185 5,653

I~ ---------- ---------- ---------- ----------TOTAL 196,000 181,060 178,861 163,465

---------- ---------- ---------- ----------II 42

1983-84 1983-84 1984-85 1984-85PLANNED PROJECTION BASE CONTINGENCY

AMBULATORY CARE BUDGET BUDGET BUDGET--------------- ---------- ---------- ---------- -----------Clinic visits 174,758 175,197 176,246 176,246E.R. Visits 16,064 14,550 13,684 13,684Therapeutic Rad. Visits 15,265 15,351 15,197 15,197Ambulatory Surgery Visits 2,863 2,902 2,873 2,873

---------- ---------- ---------- -----------TOTAL 208,950 208,000 208,000 208,000

---------- ---------- ---------- -----------

II~

IIIIIIII~

IIIIII

I~II

UNIVERSITY OF MINNESOTA HOSPITAL & CLINICSBUDGET YEAR 1984-85

COMPARATIVE DEMAND ANALYSISCLINIC VISITS

Schedule III

43

I .., ..-,N;.-:.....~.~._.. " ..

,j'JI

I~

II

Schedule IV

University of Minnesota Hospitals & ClinicsBudget Year 1984-85

Full Time Equivalent (FTE) Summary

IIIIII~

• 1983-84 Planned Budget

1983-84 Eh~erience

July - October Increase

October YTD Actual

December 1984 Reduction

December 31, 1983 FTE Position

March & April Reductions

April 30, 1984 FTE Position

• Budget year FTE additions based on directsupply and expense cost reductions orsupported by additional non-patientrevenues (see schedule)

• 1983-84 FTE Budget Base

3,626.8

26.5

3,653.3

061.6)

3,491. 7

(31. 7)

3,460.0

16.4

3,476.4

FTE Reductions Necessary to Achieve Contingl?ncy Budgetfor 1984-85

IIIIII

I~II

•

1984-85 Base Budget Target FIEs

1984-85 ~ew Program FIE Additions

FTE Reductions ~ecessary to Achiev~

Base Budget for 1984-85

1983-84 FIE Budget Base

1984-85 Contingency BudgetTarget FTEs

1984-85 New Program FTEAdditions

3,425.0

16.4

3,270.0

16.4

3,4.!tl.4

35.0

3,4711.4

3,286.4

190.0

44-' -_.. _-~

I~

IIIIIIII~

III

Schedule V

Position Increaseswith

Offsetting Income Statement Effects

FIE

.4 Personnel "CARES Project - Non-Patient Revenue

1.0 ~edical Records State Contract - Non-Patient Revenue

1.0 OAD In-House Maintenance - Cost Offset

1.0 Biowedical Engineering - Non-Patient Revenue

.6 Pharmacy - Research - Non-Patient Revenue

.25 Pharmacy - Investigational Drugs - Non-Patient Revenue

1.0 Patient Monitoring - MOA Expense Decrease

1.0 Labs - Outreach - ~on-Patient Revenue

1.9 Outpatient - Hem0phelia Grant - Non-Patient Revenue

.75 Radiology - MOA Expense Decrease

2.5 Quality Assurance - Revenue Deduction Decrease

11. 4 FIE

Ne~ Program Revenue Justified

III

I

Sports Hedicine

NXR

Outpatient Pharmacy

CAPD

Miscellaneous OPD

1.5 FIE

1.5 FIE

.5 FIE

.5 FIE

1.0 FIE

5.0 FIE

45

- - -f' - - - - - - -f' - - - - - - - -It -

UNIVERSITY OF MINNESOTA HOSPITAI.S & CLINICS

EXPENDITURE SUMMARY -- 1983-84 PROJECTION VS 1984-85 BASE RUDGET

FOR FISCAL YEARS 1983-84 AND 1984-85

Schedule VI-_._-------

1983-84 1983-84 Percent 1984-85 Increasel PercentPlanned Projection Var iance Variance Base -Decrease Change

lIudget Budget-------------------------------------------------- ------------------------------------

Expenditures

Salaries $ 78,110,219 76,195,000 -1,915,219 -2.5% $ 80,011,200 3,816,200 5.0%

Fringe Benefits 14,508,242 15,292,800 784,558 5.4% 16,298,900 1,006,100 6.6%

Academic Contracts 1,737,061 1,626,500 -1l0,561 -6.4% 1,722,200 95,700 5.9%

Resident Contracts 4,239,404 4,220,900 -18,504 -0.4% 4,466,000 245,100 5.8%

Physician Compensation 1,497,382 2,183,500 686,118 45.8% 2,303,600 120,100 5.5%-------------------------------------------------- ------------------------------------

Total Salary, F.B. & Fees $ 100,092,308 99,518,700 -573,608 -0.6% $ 104,801,900 5,283,200 5.3%

Laundry & Linen $ 2,464,962 2,130,700 -334,262 -13 .6% $ 2,210,100 79,400 3.7%

Raw Food 1,398,406 1,371,800 -26,606 -1.9% 1,403,100 31,300 2.3%

Drugs 9,594,859 10,261,500 666,641 6.9% 11,348,300 1,086,800 10.6%

Blood & Blood Derivatives 4,920,772 4,371,100 -549,672 -11. 2% 4,206,000 -165,100 -3.8%

Medical Supplies 11,014,901 9,515,200 -1,499,701 -13 .6% 9,634,400 119,200 1.3%

Ut it it ies 1,918,629 1,988,600 69,971 3.6% 2,190,000 201,400 10.1%

Insurance 897,388 842,600 -54,788 -6.1% 834,000 -8,600 -1.0%

Rental 1,428,482 1,381,000 -47,482 -3.3% 1,921,700 540,700 39.2%

Maintenance & Repair 2,827,575 2,837,900 10,325 0.4% 2,968,700 130,800 4.6%

COaalnications 1,I03,1l7 1,078,900 -24,217 -2.2% 1,140,300 61,400 5.7%

Campus Administration Expense 5,226,000 5,226,000 0 0.0% 5,644,000 418,000 8.0%

Depreciation 6,504,726 6,147,900 -356,826 -5.5% 6,824,200 676,300 11.0%

General Supplies & Expense 12,987,449 II ,882,700 -1,104,749 -8.';% 13,237,500 1,354,800 11.4%-------------------------------------------------- ------------------------------------

Total Supplies & Expense $ 62,287,2fifi 59,035,900 -3,251,366 -5.2% $ 63,562,300 4,526,400 7.7%~0-

Total Expenditures $ 162,379,574 158,554,600 -3,824,974 -2.4% $ 168,364,200 9,809,600 6.2%

- - -f' - - - - - - -fit - - - - - - - -e -


EXPENDITURE SUMMARY -- 1983-84 PROJECTION VS 1984-85 CONTINGENCY RUDGF.T

FOR FISCAL YEARS 1983-84 AND 1984-85

Schedule VII

1983-84Plannpd

Budget

Expenditure8

1983-84Projection

PercentVariance Variance

1984-85Contingency

Budget

Increa8el-DecreaBe

PercentChange

76,195,000 -1,915,219Salaries

Fringe Benefits

Academic Contract8

Re8ident Contract8

Phy8ician Compen8ation

$ 78,110,219

14,508,242

1,737,061

4,239,404

1,497,382

15,292,800

1,626,500

4,220,900

2,183,500

784,';,'·;

-110,561

-18,504

686,118

-2.5%

5.4%

-6.4%

-0.4%

45.8%

$ 76,347,300

15,552,200

1,722,200

4,466,000

2,303,600

152,300

259,400

95,700

245,100

120,100

0.2%

1.7%

5.9%

5.8%

5.5%

Total Salary, F.B. & Fee8 $ 100,092,308 99,518,700 -573,608 -0.6% $ 100,391,300 872,600 0.9%

Laundry & Linen $ 2,464,962 2,130,700 -334,262 -13.6% $ 2,070,400 -60,300 -2.8%

.$::'0

"

Raw Food

Drug8

Blood & Blood Derivative8

Medical Supplie8

Ut ilit ie8

In8urance

Rental

Maintenance & Repair

COllllllUnication8

Campu8 Administration Expen8e

Depreciation

General Supplie8 & Exppn9P

Total Supplie9 & Expense

Total Expenditure8

1,398,406

9,594,859

4,920,772

11 ,014,901

1,918,629

897,388

1,428,482

2,827,575

1,103,117

5,226,000

6,504,726

12,987,449

S 62,287,266

$ 162,379,574

1,371,800 -26,606

10,261,500 666,641

4,371,100 -549,672

9,515,200 -1,499,701

1,988,600 69,971

842,600 -54,788

1,381,000 -47,482

2,837,900 10,325

1,078,900 -24,217

5,226,000 0

6,147,900 -356,826

11,882,700 -1,104,749

59,035,900 -3,251,366

158,554,600 -3,824,974

-1.9%

6.9%

-11.2%

-13 .6%

3.6%

-6.1%

-3.3%

0.4%

-2.2%

0.0%

-5.5%

-8.5%

-5.2%

-2.4%

1,324,600

11,008,100

4,089,800

9,346,500

2,190,000

834,000

1,910,700

2,968,700

1,140,300

5,644,000

6,824,200

13,160,100

S 62,511,400

S 162,902,700

-47,200

746,600

-281,300

-168,700

201,400

-8,600

529,700

130,800

61,400

418,000

676,300

1,277,400

3,475,500

4,348,100

-3.4%

7.3%

-6.4%

-1.8%

10.1%

-1.0%

38.4%

4.6%

5.7%

8.0%

11.0%

10.8%

5.9%

2.7%

I

IeIIIIII

Schedule VIII

University of Minnesota Hospitals & ClinicsSeries 1982 Indenture Requirements

1984-85 Budget Year

Reoccurring Capital S 5,103,000

II~

IIIIII

IeII

Short Term Support Projects:

- lipid Clinic Buy-Out

- K~lR

- Urologic Kidney Stone lithotriptor

- Completion of BC Shell Space

- linear Accelerator

Existing Computer Lease

Renewal Project Equity Contribution

Retirement of Short-Term Debt

Total Feasibility Study Requirements

350,000 fv'J

1,000,000 v\v)

600,000

539, 000 ~\jJ0

400,000JV'l

2,889,00Cl

516,000

4,000,000

2,800,000

$15,308,000

48

University of Minnesota Hospitals & ClinicsDeductions From Charges

Budget Year 1984-85

Blue Cross A\-,'ARE

Billing Adjustments:

GA:'lC Rateable Reduction

369,000

6:'0,000

2,509,200

1,277,100

1984-85Contingency

Budget

$16,317,000

390,000

676,200

2,643,200

1,356,100

1984-85Base Budget

$17 ,923,000

380,000

634,500

644,000

2,579,200

$20,166,000

1983-84Projection

Schedule IX

72,875

755,844

944,000

1983-84PlannedBudget

2,419,878

$21,955,959

Laboratory Medicine

Medicare/Ned. Assis. Screen Limits

Medicare/Medical Assistance

I

IsIIIIIII '1 Cancer Detection/I ~ Colon Cancer

Late Charges

I All Other

40,58~

280,588

1,129,320

36,300

80,500

1,635,900

31,100

82,500

1,707,600

29,500

78,300

1,620,900

Other:

I Employee Benefits

Provision for Vncollectables

IIII

I~II

Clinical Research Center

Charitable Care

Kidney Acquisition

Negotiated Contract

O.B. Specials/Group Health

All Other Contract Adj.

Totals

59,193

4,091,294

434,400

250,000

1,647,675

1,909,906

392,135

19,151

$36 ,402 ,806

28,800

3,045,100

469,000

290,000

1,488,500

1,007,000

215,200

52,500

$32,752,500

29,500

2,434,600

475,000

270,000

1,525,400

760,000

63,500

53,800

$30,421,500

28,000

2.051,500

450,000

256,300

1,448,000

744,900

61,600

51,100

$27,932,400

49

Total

Appropriations

Investment Income onTrustee Held Funds

1984-851983-84 1983-84 1984-85 BudgetBudget Projection Bud get Base Contingency

$12,420,450 $12,420,700 $13,041,700 S13,041,700

1,838,596 4,559,000 3,022,000 3,053,000

369,224 387,400 406,800 406,800

1,725,000 1,746,000 1,860,000 1,860,000

50

$18,361,500$18,330,500$19,113,100

Schedule X

$16,353,270


Non-Operating Revenue Analysis

II GIIIIIII

Interest Income

I~Shared Services

IIIIII

I~II

UNIVERSITY OF MINNESOTA IIOSPITALS AND CLINICSSI~RY STATEMENT OF OPF-RATIONS AND OPERATING CASII FLOWFOR FISCAL YEARS 1983-84 AND 1984-85

Schedule XI

- - -f'- - - - - - - -f' - - - - - - -e .(.

1983-84PI.ANNED

BUDGET

1983-84PROJECTION

1984-85BASE

BUDGET

1984-85CONTINGENCY

BUDGET

VI......

GROSS PATIENT CHARGES

DEDUCTIONS FROM CI~RGES

OTHER OPERATING REVENUE

TOTAL REVENUE FROM OPERATIONS

EXPENDITURESSALARIESFRINGE BENEFITSCONTRACT COMPENSATIONMEDICAL SUPPLIES, DRUGS, BLOODCAMPUS ADMIN. EXPENSEDEPRECIATIONGENERAL SUPPLIES & EXPENSE

TOTAL EXPENDITURES

NET REVENUE FROM OPERATIONS

TOTAL NON-OPERATING REVENUE

REVENUE OVER/CUNDER) EXPENSES

ADD NON-CASH OUTLAYS:DEPRECIATIONCAMPUS ADMIN. EXPENSEIt.E. UTILITIESINCREASE IN ACCRUED EXPENSEINCREASE IN 3RD PARTY PAYABLEDECREASE IN PREPAID EXPENSEINVESTMENT INCOME HELD BY TRUSTEE

TOTAL FUNDS PROVIDED

FUNDS APPLIED:INCREASE IN ACCOUNTS RECEIVABLEINCREASE IN ACCRUED REVENUEINCREASE IN INVENTORIESTRANSFER TO RESERVES - 3RD PARTY

TOTAL FUNDS APPLIED

TOTAL CASH AVAILABLE FROM OPERATIONS

------------------------------------------------------------188,871,500 ]78,687,700 ]83,]2],400 173,832,100

36,402,806 32,752,500 30,421,500 27,932,400

3,210,457 3,517,200 3,430,300 3,374,700------------------------------------------------------------

155,679,]5] 149,452,400 156,130,200 149,274,400

78,110,219 76,195,000 80,011,200 76,347,30014,508,242 15,292 ,800 16,298,900 15,552,200

7,473 ,847 8,030,900 8,491,800 8,491,80025,530,532 24,]47,800 25,]88,700 24,444,400

5,226,000 5,226,000 5,644,000 5,644,0006,504,726 6,147,900 6,824,200 6,824,200

25,026,008 23,514,200 25,905,400 25,598,800------------------------------------------------------------

162,379,574 158,554,600 168,364,200 162,902,700

-6,700,423 -9,102,200 -12,234,000 -13,628,300

16,353,270 19,113,100 18,330,500 18,361,500

------------------------------------------------------------9,652,847 10,010,900 6,096,500 4,733,200

6,504,726 6,147,900 6,824,200 6,824,2005,226,000 5,226,000 5,644,000 5,644,000

163,456 137,900 149,000 149,000490,669 461,900 867,300 503,300

12,486,538 11,404,000 500,000 500,000179,854 -127,700 136,000 136,000

-1,725,000 -1,746,000 -1,860,000 -1,860,000------------------------------------------------------------

32,979,090 31,514,900 18,357,000 16,629,700

3,303,620 4,033 ,000 925,600 -933,7007,398 274,300 28,000 28,000

815,400 240,400 272,100 163,80012,486,538 11,404,000 500,000 500,000

------------------------------------------------------------16,612,956 15,951,700 I ,725,700 -241,900

16,366,134 15,563,200 16,631,300 16,871,600

II GIIIIIIII~

IIIIII

I~II

Schedule XII


Contingency Budget Plans Initiated as of 5/15/84

1. Initiate discussions with physicians to "bring back" to University patientsbeing cared for by University physicians at other hospitals.

2. Initiate Obstetrics program review.

3. Initiated contacts with Physicians Health Plan regarding renal transplantationand Gynocology - Oncology services.

4. Proceeding ~ith contract negotiations with Group Health on cardiac surgeryand heart catherization.

5. Proceeding with plans to review preferred provider organization in Californiaand the University of Wisconsin Health Maintenance Organization.

6. Developed bed reconfiguration plan to close beds and reduce 23.41 FIEs inprocess of the bed allocation change.

52

I

I~

IIIIIIII~

IIIIII

I,II

PROPOSED CAPITAL EQUIPMENT &REMODELING/RENOVATION BUDGETFOR FISCAL YEAR 1984-85

- CONTENTS -

Page 1 - Five Year Capital Budget Projec"tionsPage 2 - 1984-85 Equipment Budget by DepartmentPage 3 - 1984-85 Equipment Items of $100,000 or MorePage 4 - 1984-85 Remodeling/Renovation Budget by DepartmentPage 5 - Certificate of Need Items

f' l~?_4-8_~_C~_~-l3_~pGE.!.

FIVUlAILCAP ITAL QU_D_G_E_U.H9..L(C}J.9_N.~

- - - - - - -R"/05

- -n5/06

- -UNIT ,I

- -86/87

- -87/88

- -88/89

-"

-NO.N.-~E_C.URR ING .CAP.lTAl_E.XPENSE

lipid Clinic Buyout

N MR Radioloqy

kidney Stone Machine

Computer Upgrade

4 MEV linear Accelerator

$ 350,000

1,000,000

600,000

250,000

400,000

600,000

7',0,000 250,000 250,000 250,000

---.------ -- I -- . -.__.,-

.RU!l.R.R.I.N_G__C.A!,I.rAl_.~ _.UN}T_LREQUE.S_~~

Departmental Not to Exceed Allot"~nts 2,OQ2,OOO 6,650,000 2,nn,OOo 5,192,000 5,942,000

Detai led Departmental Requests I 3,R75,R011

Endoscopy (Unit J Enhancements) I I 360,000

Heart Cath (Unit J Enhancements) I I 1,695,000

Oiagnostic Radiology (Unit J fnhancementc; 1I I 50'i,OOO

Diagnostic Radiology (Unit J RPplacements)

OAD

Unit J Furniture

Miscellan~ouc; Unit J Equipm~nt

Unit J Move Costs

Unit J Equipment Inflation

Mayo Pemodelin~ Furniture ~ Equipment

64R,I30

2,000,000

715,000

5011,000

1,960,000

1,6nO,ono

775,000

1,671 ,000

7R7,OOO

250,000

865,000

250,000

951,000

~f'ml)d,.1 ing

TIlTlll PWIRRIIlG " 'lUlT J rrgIJEsTs

570,"77

5,102,lli'i

'00,0<)0_--1_ ~oo,noo 410,000 410,000

~~'~!1~7_"~'90~ 4,l~~~OO 6,717,000 7,303,000

rurm~ AVAIIAIII.L4 ~ • _

SlJnTl1ACTIOWJ FPOM F1mos. .. - . . - ~ . -

L1 ')l,mn"r

[1-ll001"rminals

litH Computer

5,500,000

717 ,ono

170,onn

n,0611,OOO

n 1,000

120,000

13,;>',0,000 4,679,000

?77 ,ono

l?O,OOn

17"1,000

7,251,000

277 ,000

257,000

7,935,000

277 ,000

355,000 .....Vt,t... Ilrf fllml') AVAllArllE 7,(j~~JOO__J_I~.~?5~~000__ L~,.-!..OQ,OOO__1 6,717,000 I 7,303,000 I

- ..- ...". '- ..,~ .. " ... - ...... ,.

I - 2 -

I~1984-85 CAPITAL BUDGET

EQUIPMENT BUDGET BY DEPARTMENT

I EQUIPMENTDEPARTMENT BUDGETED AMOUNT

I ANESTHESIOLOGY $ 75,489

BIOMEDICAL ENGINEERING 17,000

I COMMUNITY SERVICES 500

ICO-OP LIAISON OFFICE 795

CYSTOSCOPY 98,814

I DIAGNOSTIC RADIOLOGY 918,125

LABS 1,176,621

I MATERIALS MANAGEMENT 198,225

INEUROLOGICAL LAB 37,000

NURSING SERVICES 161,373

I~ NUTRITI ON 5,200

OPERATING ROOMS 287,774

I OUTPATIENT 168,084

IPATIENT MONITORING 328,154

PATIENT RELATIONS 2,175

I PERSONNEL 2,600

PHARMACY 17 ,125

I PHYSICAL MEDICINE &REHABILITATION 17,632

IPUBLIC RELATIONS 13,114

RADIO PAGING 10,000

I RESPIRATORY THERAPY 246,943

THERAPEUTIC RADIOLOGY 62,805

I~ WORD PROCESSING 30,260

I $ 3,875,808

I 55

Diagnostic Radiology

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DEPARTMENT

Laboratories

Patient Monitoring

Computer Services

1984-85 CAPITAL BUDGET

EQUIPMENT ITEMS OF $100,000 OR MORE

ITEM

Replacement ComputerRandom Access Analyzer

Monitoring System CCU/201

Video Tape Recorders(3 @$35,000)Skull UnitTotal Body ScannerCleon Whole Body Scanner

Cost Accounting SoftwareNursing Station ManagementSystem

Data Communications Equipment

COST

$ 778,710125,000

120,000

105,000

185,000145,000150,000

100,000150,000

229,000

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1984-85 CAPITAL BUDGETREMODELING/RENOVATION BUDGET BY DEPARTMENT

DEPARTMENT

Biomedical Engineering

Computer Services

labs

Maintenance &Operations

Materials Management

Nursing Services

Nutrition

Operating Rooms

Outpatient

Patient Accounting

Pharmacy

Physical Medicine &Rehabilitation

TOTAL

REMODELINGBUDGETAMOUNT

$ 5,000

27,050

29»400

80»000

29»500

232»680

1,750

5»000

158»300

1,447

2»300

6,000

$ 578»427

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57

HEALTH SCIENCES

SUBJECT: Annual Employee Compensation Plan

Effective January 1. 1985, an additional 1% increase would be provided.This also reflects past practice and the University's plan for 1984-85.

FROM: C. Edward schwartzC:k~,-,-,.-;,<.lHospital Director

59

University Hospitals and ClinicS420 Delaware Street S EMinneapolis, Minnesota 55455

UNIVERSITY OF MINNESOTATWIN CITIES. '

May 15, 1984


The basic compensation plan increases follow those of th~ Universityvery closely. With the recent delegation of authority. and with thejob evaluation study currently underway. our recommendation is that1984-85 not be a year for major salary plan restructuring. The planthat is presented here is thus relatively straightforward.

The major recommendation is for a 4.5% (or 30e per hour. whicheveris greater) increase in salary scales and individual employee salarieseffective July 1, 1984. This is the same percentage increase which theUniversity is providing, and the same increase called for under ourunion contracts.

The Hospital Personnel Policies and Procedures require that the Boardof Governors approve the employee compensation plan each year. Thepurpose of this memo is to provide recommendations in this regard forfiscal year 1984-85.

During fiscal year 1984-85 we also anticipate the need to make marketplace related salary adjustments for a number of classifications.The bvlk of these are in Nursing related classes, where the salaryadministration structure at the University has caused a large numberof our nursing staff to fall behind their counterparts in the community.The details of this component of the salary plan will be developedfollowing the community MNA settlement. At this point there is $600,000

This will be the second year of implementation of the comparable worthadjustments initiated in 1983-84. It is projected that the additionalcost of the comparable worth adjustments will be $475,000, to beprovided to employees in 35 job classifications, with the comparableworth adjustments ranging from 2.7% to 7.7%. Approximately 561 FTEsand 750 employees will benefit from these additional salary increases.

•\.

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We would be happy to provide additional details or answer any questionswhich the Board of Governors may have.

Each of these components of the compensation plan has been incorporatedinto the 1984-85 budget projections, and thus can be financed withinthe recommended price increase.

budgeted for the nursing related adjustments. We have also budgetedapproximately $300,000 for other classification or salary adjustmentsfor non-nursing personnel.

60

May 15, 19842Finance CommitteeBoard of Governors

In summary, in addition to a .5% salary increase carry forward fromJanuary of 1984, we have budgeted an average increase of 5% for salariesin fiscal 1984-85 and have an additional $1,375,000 incorporated forsalary adjustments associated with comparable worth.

II GI"····t

IIIIIII~

IIIIIII

G,I

~ -.. ', ","-- -, ....-,.- .'

ALLOCATION OF UNIT "J" SHELL SPACE

May 23, 1984

61

2930 NSF6750 NSF1900 NSF

500 NSF200 NSF

1200 NSF

· Endoscopy· Cardiopulmonary Labs· Nutrition· Materials Management· Therapeutic Radiology· Pediatric Dialysis

2. Detailed planning, departmental review and constructionshall commence on all spaces listed, total planning andconstruction costs not to exceed $2.4 million.

1. The allocation of Unit J shell space be accomplishedin accordance with the schematic drawing dated May 8,1984. Approximate assignments of space are as follows:

I

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I

I Office of the Chief of Staff

I~

IUNIVERSllY OF MINNESOTATWIN CITIES

University Hospitals and ClinicsBox 707 Mayo Memorial Building420 Delaware Street S.E.Minneapolis, Minnesota 55455


May 8,: 1984

SUBJECT: Appointment of Chief of Staff

Thank you for your consideration of this request.

Paul G. Quie, M.D. ~ /,It, ,':;"'.-.f4Chief of Staff if~ /v'

PGQ/lk

My last term of office as Chief of Staff will come to an end on June 30, 1984.The Nominating Committee appointed by the Medical Staff-Hospital Councilselected Dr. James Moller to run for election for the office of Chief of Staffand the Council approved the recommendation. Elections were held in April andthe tabulated results indicate that Dr. James Moller has won the election byplurality. I hereby request your approval of Dr. James Moller as Chief ofStaff.

FRON:

The Bylaws of the Medical and Dental Staff, Article V, Part A:, Section 3.(a) states "Election: The Chief of Staff shall be elected by the votingmembers of the medical staff by a plurality vote of the staff ,voting bymail ballot. His or her election shall become effective as soon as approvedby the Board. The Chief of Staff shall serve a three year term and iseligible for a second two year term but in any event shall serve until asuccessor has been elected and his or her election approved by the Board.If the office of Chief of Staff becomes vacant the Vice Chief of Staff shallserve as acting Chief of Staff for the remainder of the term or until asuccessor is elected."

I

III

II

IIIIIII~

I~II HEALTH SCIENCES

62. ,_ ' ,, __ ,_<,",_.~ .,,,......_ ..'. ,.0.;",''''- '_"'-"' ." _.~ ._,,~-',~'. .--,,-.- "'~ --, "',"",'-' c· -'-':>'" ~-- .. ,."- - ....- .. -

II~

I

MinutesFinance Committee

University of Minnesota Hospitals & ClinicsApril 25, 1984

Al France, ChairCarl DrakeCliff FearingRichard Kronenberg, M.D.Jerry MeilahnC. Edward Schwartz

Shelley Chou, M.D.Mary Des Roches

Greg HartNancy JandaNels LarsonJane MorrisBarbara Tebbitt

David CostSteve GrygarLynn HornquistBarbara O'Grady

MEMBERSABSENT:

GUESTS:

STAFF:

MEMBERSPRESENT:

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CALL TOORDER:

MINUTESAPPROVED:

MARCH YTDFINANCIALSTATEMENTS(INFORMATION) :

The meeting of the Finance Committee was chaired by Mr. Al Franceand was called to order at 9:40 a.m. in the Dale Shepard Roomof the Campus Club.

The minutes of the March 28, 1984 meeting of the FinanceCommittee were approved.

Mr. Fearing reviewed the Report of Operations for the period July 1,1983 through March 31, 1984. He stated that the month of Marchshowed a downturn in census levels compared to the levels forSeptember 1983 through February 1984. Inpatient admissions duringMarch were 1,621 or 219 below the projected figure of 1,840.Outpatient clinic visits were also below the 18,659 projected visitsat 17,002 for March. The YTD clinic census is still 0.5% aboveprojected visits, although it is 833 visits below the total of ayear ago.

Total revenues over expense are $7,565,932, a favorable varianceof $1,043,443, and this variance continues to be due in most partto investment income. Net revenue from operations through Marchhowever, showed a net loss of $6,749,442 compared to the budgetedloss of $5,760,816.

I 63

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Minutes - Finance ComndtteeApril 25, 1984Page two

Patient care charges and routine revenues through March are bothbelow budget. Ancillary revenues declined reflecting the declinesin admissions and in revenues per admission. Somewhat offsettingthis is the decline in expenditures (1.8% below budget), continuingto reflect the cost reduction actions taken by management last fall .

. Patient accounts receivable decreased from the February levelof 83.4 days to 81.5 days of revenue outstanding as of March 31,1984. The targeted goal for the end of the fiscal year is78 days.

In addition, Mr. Fearing noted that there has been a change ingeographic distribution of admissions. Metro area admissionshave fallen off while admissions from outs tate and out-of-statehave remained relatively consistent. This drop in metro areaadmissions is consistent with other area hospitals and is partiallydue to more stringent screening and review procedures by thirdparty payors.

In concluding the Report of Operations, Mr. Fearing stated thatthe drop in census levels will effect both 1983-84 year end projections and 1984-85 budget projections making expense reductionsa pecessary consideration to meet financial requirements.

Mr. Fearing gave a complete review of the detail Income Statementwith explanations of areas showing major variations from thebudget.

The Operating Cash Flow Statement shows negative total cash available of $72,147 after transfers to Renewal Project of $3,000,000,transfers to debt retirement of $2,100,000, and transfers to Plantof $3,079,137. Mr. Fearing further explained the negative cashflow by noting that March had the lowest number of outstandingpayroll days. He stated that all committments for the BondIndenture have now been met for this fiscal year.

Mr. Schwartz asked that a discussion and explanation of MedicarePart A and Part B be presented to the Committee at a futuremeeting.

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II

1984-85 BUDGET(INFORMATION):

Mr. Fearing stated that the Budget process is on schedule forapproval in June by the Board of Governors. The June date is twomonths behind the historic timetable for budget approval, but moretime was required to accumulate data to make 1984-85 budget projections in light of the recent changes in census levels and theinstitution of the AWARE program at University Hospitals. TheFinance Committee will possibly be scheduled for two meetings inJune to review and recommend approval of a 1984-85 budget. TheHospital budget will be brought to the Board of Regents forinformation and approval at their July meeting.

I 64

I

I ~9B4-B5 CENSUS

I PROJECTIONS(INFORMATION) :

Minutes - Finance CommitteeApril 25, 1984Page three

Mr. Fearing summarized a report of Inpatient Census Highlightscomparing data from March 1983 and March 1984 for admissions,patient days and average daily census.

Mr. Fearing highlighted a collection of schedules that essentiallyupdated all the assumptions of the feasibility study and explainedhow these revised assumptions were used to arrive at a new longrange plan. These schedules show comparisons of the long rangeplan to the feasibility study, revenue and expense forecasts,and expense forecast assumptions. Mr. France added that the entirereport is a valuable supporting document for the budget and shouldbe reviewed in detail by the Committee members.

A discussion followed focusing on the declining activity levels,and that University Hospitals pursue both increasing its marketshare and decreasing costs. The issue of the Hospitals' marketingplan will be brought to the Board of Governors in June.

Mr. Fearing reviewed a Projected Comparative Income Statement andOperating Cash Flow for the fiscal year ending June 30, 1984. Therevenue over expense projection for this period is $8,080,331or $1,572,516 under the original 1983-84 target. The net cashbottom line was originally budgeted at $16,366,134, and is nowprojected at $15,047,232, assuming a goal of 78.0 days of revenueoutstanding at 6/30/84. Mr. Fearing explained how the amount ofrevenue outstanding would effect the total cash available at the75.0 day and 80.0 day levels.

LO~G RA.~GE

PLAN UPDATE(INFORMATIO:-;) :

YEAR ENDPROJECTIONS(INFORMATIO~) :

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THIRD QUARTERBAD DEBTS(ENOORSEMENT) :

ADJOURNHENT:

Mr. Fearing reported that bad debts for the third quarter of 1983-84amounted to $547,950.30, (represented by 1,497 accounts). Additionalbad debts of $2,282.00 for Home Health Services were also reported.He stated that the year-to-date total for bad debts was $1,513,131.06,which was 1.1% of gross charges (compared to a budgeted level of3.1%).

A motion was made and approved by the Committee to endorse the BadDebt Report and recommend it to the full Board of Governors.

There being no further business, the meeting of the FinanceCommittee was adjourned at 11:50 a.m.

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Respe~te~.

~~r ~Jane E. MorrisRecording Secretary

I 65

The committee seconded and passed a motion to approve the minutesof the April 11, 1984 meeting as written.

Committee Chairman Al Hanser called the meeting of the Planningand Development Committee to order at 10:45 a.m., Wednesday,May 9, 1984, in Hospital Dining Room III.

MinutesPlanning and Development Committee

Board of Governors1-1ay 9, 1984

Mr. Mark Koenig presented background information and a proposedresolution for the allocation of unfinished shell space in Unit"J". He noted that on February 28th the Medical Staff CoordinatingCommittee recommended that the progTams of Endoscopy and CClrdiopulmonar~

Laboratories have priority for occupancy for that unfinished space •

Clint Hewitt

Greg HartEd HowellNancy JandaMark Koenig

David Cost, Board ChairKen MerwinRon WerftSteve Y0ung, Robert Douglass Assoc.

Staff:

Mr. l~rk Koenig reviewed for the Committee the status of the bidpackages, noting that 99% of all bid packages had been awarded.Only two packages, one for site work and one for final cleanup,are not yet awarded. lfr. Koenig also indicated that the newRadiation Therapy facility is scheduled for occupancy onAugust 1, 1984 and that the remainder of Unit "J" remains onschedule for substantial completion by March 1, 1986 and certifiedcompletion by December 1, 1986.

Guests:

Absent:

Mr. Hanser raised a current issue, for the Committee's information, asto whether the coaxial cable in Unit "J" wbuld be most appropriatelyinstalled by the Northwestern Bell Telephone workers or by the ElectricaRepair and Construction workers. Although the telephone workers bidwas well below that of the electrical workers.- the electrical worker~,

on the national level, have been disputing the issuance of coaxialcable contracts to telephone workers.

Present: Al Hanser, Committee ChairLynn HornquistWilliam Krivit, M.D.John LaBree, M.D.Virgil MolineC. Edward SchwartzI. Dodd Wilson, M.D.

II~

I CALLTO

IORDER:

ATTENDANCE:

IIIIII ~

I APPROVALOFMINUTES:

I RENEWAL&

I RENOVATIONSTEERINGCOMMITTEE

I REPORT:

III~

SHELL

I SPACE:

I.. ,.. __......__._.:_... -_"'_..~_., -----:::0_,:,..._

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2

Hospital Administration and Unit "J" planners, he added, have assistedthe departments of Endoscopy and Cardiopulmonary Laboratories inthe development of operational and functional programs and thatschematic drawings indicdte that these prograMs can be accommodatedin the available space on level 1 of Unit "J". A couple of Rmallerareas on that same level have been reviewed by the Hospital StaffCoordinating Committee and have been recommended for assignmentto the Departments of Nutrition and Materials Management. With thatbackground, Mr. Koenig presented the following resolution forPlanning and Development Committee endorsement:

RESOLUTION

1. ~he allocation of Unit J shell space be acco~plishe:1n accordance with the schematic drawins dated ~aj E,1984. Approximate assignments of space are as follo~s:

III

RESOLUTION:

EndoscopyCardiopulmonary LabsNutritionMaterials ManagementTherapeutic RadiologyPediatric Dialysis

2930 NSF6750 NSF1900 NSF500 NSF200 t\SF

1200 NSF

II~I

IIIIII

I~II

ENDORSEMENT:

INSTITUTIONALOBJECTIVES:

ENDORSEMENT:

FEASIBILITYSTUDY:UNIT "J"CAMPAIGN:

2. Detailed planning, departmental review and constructionshall commence on all spaces listed, total plannins andconstruction costs not to exceed $2.4 million.

The Committee seconded and passed a motion to endorse theresolution as written and will forward the resolution to thefull Board for approval at their May 23rd meeting.

Mr. C. Edward Schwartz introduced the Institutional Objectivesfor 1984-85 by noting that they had been reviewed and revisedby several different Management and Medical Staff groups andthat all of the Board Committees would have the opportunity forinput before the full Board considered these objectives at theirMay meeting. Mr. Schwartz reviewed each of the major headingsunder which the objectives are categorized. Co~ittee discussionfollowed regarding the iMportance of defining ourselves as aninstitution in a way that meets the needs of our patient populationand referring physicians. The Committee recommended that an objectivebe added, that in essence, would provide patient activity targets for threspective Medical Staff departments and an incentive system toreward those departments that meet or exceed target levels.Mr. Schwartz agreed to draft such an objective.

With that addition, the Planning and Development Committee secondedand passed the motion to endorse the 1984-85 Institutional Objectives.

Mr. Ken Merwin distributed copies of final report developed bythe Bentz, Whaley, Flessner Firm that assesses the University ofMinnesota Hospitals and Clinics fundraising potential for Unit "J".In light of Mr. Flessner's inability to attend the Planning andDevelopment Committee meeting, Mr. Merwin asked that the Committeemembers review the document before the June Committee meeting, atwhich time Mr. Flessner will make a formal presentation of findings.

67.. . -, ,. .. ,' - -~,.' "'-. '"-~'.''' ," .","' '" .. ~,. ~ '.',"- ,">_••, •

II ~ EXTRACORPOREAL

LITHOTHRIPTERSTATUS

I REPORT:

II

ADJOURNMENT:

IIIII ~

IIIIIII~

II

.. ~. ',_.- .... ,_.,~ .. - .-" -,. --~.

3

Mr. Greg Hart relayed to the Committee the outcome of his meetingin New Orleans with representatives of Dornier Corporation,manufacturer of the extracorporeal lithothripter. He indicatedthat as FDA approval of the lithothripter is not expected until late1984 or early 1985, that the Dornier Corporation is not preparedto develop agreements for acquisition of this technology atpresent. He did note that the Dornier representatives are wellaware of the continued interest on the part of the UniversityHospitals in obtaining a lithothripter and that Dr. Fraley wouldcontinue to communicate closely with the corporation.

Due to time constraints, the Committee tour of the ne\v RadiationTherapy facility was postponed and the meeting was adjournedat 12:50 p.m.


k~C.9-~Nancy C. ~andaExecutive Assistant

to the Board of Governors

68

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I~Ir

ATTENDANCE:

APPROVALOFMINUTES:

CASESTUDY - ETHICS:

MinutesJoint Conference Committee

_.Board ·of Governors

May 9, 1984

Present: Barbara O'Grady, ChairPhyllis EllisGlenn Gullickson, M.D.Robert LatzRobert Maxwell, M.D.Paul Quie, M.D.C. Edward Schwartz

Absent: Paula Clayton, M.D.

Guest: Dianne Bartels

Staff: Jan HalversonGreg HartNancy JandaBarbara Tebbitt

The minutes of the March 14, 1984 meeting of the Joint ConferenceCommittee were approved as submitted.

Ms. Dianne Bartels, co~chair of the Biomedical Ethics Committee,reviewed for the Committee a case which raised several ethicalissues. This was a case in which the Biomedical Ethics Com~ittee

was asked to playa consultative role, in particular to assistthe involved medical staff. The case involved a judgment abouttransplantation of a child and the physician's judgment, thatof several consulting physicians, and the wishes of the parents.The committee's involvement was as a consultative group for theattending physician and as a convener of a group discussion withthe involved medical staff and the parents of the child. TheChief of Staff's role in the process was also an important one,and a satisfactory conclusion was reached in a very difficultcase.

Ms. Bartels indicated that consultations in cases such as thesewill likely become more frequent in the future. The BiomedicalEthics Committee is currently in the process of developing guidelines for this role. The Joint Conference Committee asked that theseguidelines be reviewed with the Committee following their development,and thanked Ms. Bartels for her informative presentation.

69

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JCAHREVIEW:

MEDICALSTAFF/HOSPITALCOUNCILREPORT:

CLINICALCHIEFSREPORT:

2

MS~ Nancy ~an~a provided the Committee with an overview of theJ01nt Comm~ssl~n on Accreditation of Hospitals and their processfor accred1tat10n survey. She indicated that historically theJCAH has looked at three major areas - physical plant, quality~f care, an? the administrative and organizational process used1n the Hosp1tal. In recent history the Joint Commission has focusedit~ efforts in particular at quality assurance and has also begunu~ln~ outcome me~sures rather than looking for specific processesw1th1n the organ1zation.

Ms. Janda indicated that University Hospitals will receive itss~t~ visit ~at: in 1984. She described the process of this siteV1S1t, and lndlcated that we are currently doing an interim surveyand self-assessment in preparation for the site visit. Furtherinformation will be provided to the Joint Conference Committeeas the December date approaches.

Dr. Paul Quie reported on the most recent meeting of the MedicalStaff Hospital Council. He indicated that the bulk of the Council'sdiscussion revolved around a quality assurance study on historiesand physicals. He described the findings and conclusions ofthis study.

Dr. Quie also indicated that the Council had appointed a taskforce on gender identification.

Dr. Quie also reported that Dr. James Moller has been electedas the new Chief of Staff, to become effective July 1, 1984, andthat he will be joining the Joint Conference Committee at this time.

It was then noted that this is the last meeting of the Joint ConferenceCommittee at which Dr. Quie will be present. In recognition ofDr. Quie's outstanding contributions over the past five years tothe Joint Conference Committee and the Board of Governors in hisrole as Chief of Staff, Mr. Latz offered a formal motion expressinggreat appreciation to Dr. Quie for his years of service on theCommittee and the Board. The Committee unanimously and stronglyendorsed this motion.

Dr. Glenn Gullickson reported that the Clinical Chiefs are planninga second retreat scheduled for June 9, 1984. The focus of thisretreat will be on program development, volume levels, and marketing.The assessment process which the Chiefs are currently going throughin preparation for the retreat was described.

Dr. Gullickson also reported that the Hospitals and the ClinicalChiefs have engaged a consultant to review the organization and financinof ambulatory care at the Hospitals. This consulting study willbe done over the next several months.

70

INSTITUTIONALOBJECTIVES:

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OTHER:

ADJOURNMENT:

3

Mr. S~hwartz went over a set of proposed institutional objectivesfor flscal year 1984-85. The objectives are broadly divided intothe areas of medical staff programmatic development, externalma~ket.share objectives, :inancial objectives, operating and activityobJectlves, and constructl0n and renovation objectives.Mr. Schwartz indicated that at the Planning and Development Committeeearlier that day the group suggested an additional objective underthe medical staff and programmatic development section. This objectiverelates to the development of a fund for program enrichment andthe development of incentives for the medical staff for clinicalactivities. The Joint Conference Committee also suggested anadditional objective, related to delineation of the medical staffand Board's role in process in dealing with ethical issues,particularly those where resource allocation impinges on clinicaldecision making. The Committee discussed these objectives insome depth, with some reservation being expressed. It was agreedthat these two items would not become part of the formal JointConference Committee endorsement of the institutional objectives.but would continue to be developed and examined.

The Joint Conference Committee amended objective #3 underconstructi on and renovati on, adding the phrase "di rected atpatient care delivery efficiency and cost". With this amendment,the Joint Conference Committee endorsed the objectives as proposed.

Ms. Tebbitt reported on the status of the potential nursing ~trikeat the community hospitals and University Hospitals preparatlonshould such a strike occur. Ms. Tebbitt also noted that theHospitals is currently in the process of developing a.ma~or be~reallocation and station reconfiguration plan and revlewlng thlSplan with the medical staff.

There being no further business, the meeting adjourned at approximately 8:50 p.m.


~~/4Greg Hart

71

-The hospitals Involved in the negotiations are Ahbott Northwestern, Ei·lei, Fairview, Fairview Ueaconess,Metrupolltan Medical Center, Chil,dren's Medical Center, Mount Sinai,SI. Mary's, St. Mary's RehabilitallonCenter, all of Minneapolis; St. Joseph's, Samaritan, St. John's, DeIhl'Sda, all 0' St. Paul; FairView South.dale, Edina; North Memorial Medi.cal Cenler, Robbinsdale; Methodist,51. Luuis Park. and Divine Redeemer, South 51. Paul.

Nurses at United Hospital and Chit.dren's Hospllal, both in 51. Paul, onTuesday overwhelmmgly rejected a,imilar contract The contracts cov·ering Ihose 740 registered nursesatso expires May 3I. Two years agoIJnited and Children'!I withdrewfrom the hospital group that IS n~gol·

tating contracts with the other TwinCities nul'Se!l.

There ha!l not been a strike bynurses In the Twin Cilies, althoughthere have been strikes In Red Wing,Winona, Hastings and Hibbing. Minn.

"Who's going to go throu~h fouryears of college knowing they can'twork 'ull time when Iheyget oUI?"said Barbara Bly, a nurse at AbbotNorthwestern Hospital.

Several nurses atso worried thai i'Ihe trend toward part-Iiml' work continues, nursing may lose status as 8profession.

"You I'an't operate a hospital on thesaml' model as an industrial sellingwhere people are interchangeableand ran go 'rom one job to another.You have to lake into account theirahilily 10 move 'rom one service toanolher," he said.

The nurses have asked for a 6Ilercenl wage increa"e in each year,amI Ihe hospitat" have offered 3.5and 4 percent. Under the hospitals'otrer. reglslered nurses With an asso·riale degree would earn $1,714 permonlh, and $2.:J66 per monlh afler12 yl'ars.

Though job security was named asIhe most imporlant issue on the table, the hospitals and the MNA mustalso aKrl'e on wages.

Assistant head nurses with an assochlte degree would start ht $1,849l,er month and wuuld earn $2.502urler 12 years. Nursps al each levelearn more with higher educationald..~n't'S

But Phillips said Ihat Ihe h""pitals

Mike PhilliPS, dlrt'clor 0' labor-relation" 'or Heallh Employers, Inc.,which is representing Ihe hospllals atthe bargaining table, said thaI Ihehospitals need flexibility, parlJcularIy 'or weekend coverage.

I\aren Palek, lahar representativefor Iht' MNA, said Ihal during thelast four yl'urs the number of fUIItime nursing jobs al the hospJtals hasshrunk from 50 percent to 30 per·cent.

In addition, Patricia Dalman, direc·tor 0' puhlic rl'lations 'or Melropolitan Medical Cenler, "'lid Ihal Ihehospital needs 10 be able to adjust itsnurslOg slaff 10 malch Ihe number 0'patient,> on a daily basis. II Is easier10 do thai with a larger number 0'part·time nurses, she saill.

The MNA has proposed that hospi·lals implemenl cuiharks in hours uswell as layoffs according 10 senlllr·ity. In addition, Ihey wanl nurses 10be able 10 trans'er hetween units,and helween hospitals owned by thesame corporation.

"II's like II daily labor IlOIII," saidLori lIanson, a nurse whll ust'd 10

work at St. Mary's lIospital. In February she had hpr hours reduced

. rrom 24 to 16 per we('k, and sincehas found a full-lime job at Children's Hospital In Minlleapolis.

Rf'l!istered nurses at 17 Twin Cltie§hospitals Wednesday rejected a contract offer by a deciSive margin andauthorized a !ltrlke for midnight May31.

They said nurses. are haVing thenumber of hours they work reducedinvoluntarily, and withoul warmng.Then, hospitals frequently will call

The vote tally was compll'ted aboutmidnight. The totals were not released, but Wiesner said there wasmore than a two-to-one marginagainst the offer.

If the nurses and the 17 hospitals donot reach agreemenl by May 31, thenurses could strike.

Bob Wiesner, labor relations representative for the Minnl'sola Nurse!iAssociation, said last night that heexpectt'd the Federal Mediation andConciliation Service would arrange ameeting between the nurses and hospitals before a strike begins.

"The nurses appreciate the seriousness of the situation. They didn'tmake the decision lightly, but theIrstatus as employees is in jeopardy,"he said.

The nurses' biggest concern is jobsecurity, Ihey said al the meetingsheld yesterday. They said winning acontract that prolects their job secu·rily IS far more important than onethat boosts their wages.

~uiSes autnonzeM~ 31stii"kedeadiine ;By Josephine Marcolty Ihem 011 "horl lIolke and ask Ihern 10 cannlll Iransrer nurses tn other unite;slaff Wriler work ('xlra shirts when exIra nursl's unll's.s Ihey are qualified for the

are needed. .....ork.

--

HINNEAPOLIS STAR & TRIBUNE, TIIURSDAY, HAY 17, 1984

Nj.,)

I!

I 1256 THE SEW ESGLAr-;OJOUR~AL OF MEOICIr-;E May 10, 1984

ARE TEACHING HOSPITALS WORTH THEEXTRA COST?

EVERYONE knows that teachin~ hospitals havegreater expenses and charge more for their servicesthan do nonteaching hospitals. In 1981, for example,the average cost ofcare, per adjusted admission, in the

and possibly viral-surface characteristics that pn-"fl"rentially enhance entry into lymphocytes or epithdi·um. Given the large and sophisticated gl"nomes ofthrse viruses, it serms certain that such biologic variants exist.

Thr solutions to these mysteries of pathogrnesishavr more than academic interest. EBV D~A is regularly found in the epithelial elements of nasopharyngeal carcinoma in which the virus returns to its latentstate or, at best, undergoes abortive replication. 12.13

Does this mean that latency by the virus and growthstimulation of the host cell are inexorably linked? Innasopharyngeal carcinoma, stimulation of malignantgrowth of the epithelial cells may be consequent tofailure of the virus to replicate. On the other hand, it isthe rrplicative, not the immortalizing, modr of infection of normal epithelial cells that yields virus, whichpermits thr infection to be transmitted from onr person to another. Therefore, control of EBV infectionand disease through either chemotherapy or vaccination must br directed not only at immortalization butat reducing or eliminating virus from the site of replication in the mouth and salivary glands.

more than 300 major teaching hospitals belongin~ tothr Council of Teaching Hospitals was approximatl"lytwice that in the nonteaching hospitals.' Several rea·sons are usually given for this striking difference.Teachin~ hospitals must brar the direct and indirectcosts of their multiple teaching programs. They alsodo a certain amount of clinical research that is notfully reimbursed through outside grants and contracts. Their patients tend to be sicker, to have morecomplicated illnesses, and hence to require more sophisticated care. Teaching hospitals are usually thrtertiary-care centers of last resort and must maintainrelati\'e1y larger and more specializrd staffs, use moretechnology, and have considerably greater standby capacity. Finally, they usually have a much higher fraction of nonpaying patients than do nonteaching hospitals. Although they constitute less than 6 per cent ofallacute-care hospitals, the hospitals belonging to theCouncil ofTeaching Hospitals provide almost half thl"charity care ip the country.

In the days when hospitals wrrr paid morr or lesswhatever they charged, this difference in cost was noproblem. Thr teaching hospitals provided the sen'icrsthat they deemed nrcessary for their teaching. rl"search, and patient-care commitments, and like othl"rhospitals, they simply billed thr third-party payl"rs fortheir total expenses. Thr third-party payers - ~lrdi

care and ~fedicaid,Blur Cross. and the private insurance companies - were in effect paying for all thl"costs ofthl" teaching hospitals. even though thl"Y wrrl"obligated to pay only for clinical carl". Ofcourse. muchof this extra payment was bl"ing returned to patil"nts inthe form of sen'icrs provided by house staff and students, as well as more sophisticated clinical care. Butat least some of the differential paymrnt was simph across-subsidy - a transfer of thl" cost of rducation.research, and free care to the third partirs.

Now thosr halcyon days are over. The third-partypayers. particularly Medicare and Medicaid. arr running out of funds and arr relentlessly tightening thescrews in an effort to reducr their expenses. Prier competition has arrived, Mrdicare is switching to a prospective payment system based on fixrd payml"nts according to diagnosi..-relatrd groups (DRGs). and forthe first time, teaching hospitals must facr thr nerd tocut their costs if they wish to sun·ive.

The Medicare prospectivr payment system makesno distinction between a patient in a given DRG whois trratl"d in a nonteaching hospital and onr trt"att"d ina teaching hospital in the same region. It is assuml"dthat the aVl"rage complexity of cases in a givrn DRG,and hence the resources needed to treat them, are tht"same in all hospitals. The dirrct costs of house staffand fellows are separated from patient costs and are,for the moment, rrimbursed separately and in full.The indirect costs of the house staff, and all thr othrrdirect and indirect costs of teaching and resrarch, arrdealt with through an added payment calculated byan arbitrary formula based on the number of houseofficers per bed. Under this system, there is no recognition of the costs offree care in the teaching hospitals.

GEORGE MILLER, ~I.D.

REFERENCES

Yale Unrverslf}School of Medlcl~

lIie .. Haven. cr 06510

I. Schwanz RS Epstein-Barr viru~ - oncogen or mItogen' N Enj!1 J Med1980.3011307·8.

2. Hoagland RJ. The transmis.ion of infectious mononucleosis. Am J Med SCI1955.129162·71.

3. Miller G. Niederman JC. Andrews L·L. Prolonged oropharynj;eal excretIonof Epsleln-Barr VIIU. after infectious mononucleosis. /Ii Eng! J Med 1973:288219·)2

4. Lipman M. Andrews L. Niederman J. Miller G. Direct visualization ofenveloped Epstein-Barr h~rpeJ\'iruJ in throat washIng with leukocyte·tran.·fonnrng aCli'·ily. J Infect DIS 1975: 132:520·3.

5 Morgan !>G. Niederman JC. Miller G. Smith HW. Dowalib} JM Site ofEpstein-Barr virus replication in the oropharynx. Lancet 1979: 1:1154·7.

6 Wolf H. Bayll" GJ. Wilmes E. BiologIC propenies of Epstein-Barr Vlru~

In' Grundman E. Krueger GRF. Ablashi DV. eds. Nasopharyngeal carcinoma Cancer Campaign. Vol 15. Stultj!an: Flscher.Verlag. 1981:101·9

7. ~mon SM. HUll LM. Sha.. JE. LiJ·LH. PaganoJS. ReplicationofEBV inepithelial cell. during Infectiou~ mononucleosis. Nature 1977; 268:268·70

8 Slxbey Jw' lIiedrud JG. Raab·Traub N. Hanes RA. Pagano JS EpstemBarr ViruS replicallon 10 oropharyngeal epithelial cell•. N Engl J Med 1984:3101215·30

9. LangerPR. Waldrop AA. Ward DC En1ymatlc .ynthesis of biotin·labeledpolynucleotide. novel nucleic acid affinity probe•. Proc Natl Acad Sci USA19~ I. 786633·7.

10. S,xbey JW. Vesteri~nEH. NedrudJG. Raab-Traub N. Walton LA. PaganoJS Repllcallon of EpsteIn-Barr V\fU' in human epIthelial cell. infected in.."ro Nature 1983: 306:480·3.

II CaJ~k BW. Hitch~r SB. Localization of viral antigen in chickens infecled""Ith Marek's dIsease herpeSVIruS. JNCt 1969: 43:935-49

t2. Wolf H. zur Hausen H. Becker V. EB viral genome. in epithelial nasopha·ryngeal carcinoma cell. Nature New BIoi 1973; 244:245·7.

13. Rub·Traub ". Hood R. Yang CS. Henry B. Pagano JS. EpsteIn-Barr virustranscription 10 na"Jpharyngeal carcInoma J Vlrol 1983. 4~580·90

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I Vol. 310 No. 19 CORRESPO!\DE='ICE 1257

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The Medicare DRG payment system will be phasedin over a period of three years (and possibly more).For the time being, the other third parties continue toreimburse charges or costs or some fraction thereof.But the handwriting is on the wall, and the message isplain: The special needs of teaching hospitals will nolonger be automatically accommodated by a passivereimbursement system. The major teaching hospitalsare now called on to convince the government and theother third-party payers that their unique and expensive blend of education, research, and sophisticatedtertiary care for all comers, regardless ofability to pay,is worth supporting.

The study reported by Garber and his colleagues2 inthis issue is a timely and important contribution to

this discussion. It compares costs and outcomes for 12types ofsevere medical and surgical problems betweenthe faculty and community services of a major teaching hospital (Stanford Vniversity). Patients on the faculty service were admitted by house staff or facultyphysicians and cared for by the usual teams of housestaff, students and faculty. Patients on the communityservice were admitted and attended by pri\"ate physicians in the community. Students and house staffhelped the pri\'ate physicians care for one third ofthese patients (usually those who were sickest or of thegreatest educational interest). but the other two thirdswere in a completely nonteaching setting.

As expected, costs (i.e., charges) were much higheron the faculty service. but Garber and his colleaguesfound that adjustment for case mix eliminated most ofthe cost differential. Average costs per admission forall 12 medical and surgical problems studied wereabout 60 per cent higher on the faculty service; whenadjusted for DRG mix, however, the difference wasonly II per cent, although still significant. Adjustedcost differences were largest (70 per cent) among thesickest patients - i.e., those judged on admission tohave the least chance of survival. Outcomes were alsodifferent on the two services. The in-hospital mortalityrate, adjusted for DRG mix and other patient characteristics, was about a third lower on the faculty service, with the differences again being largest amongthose who were judged to be the sickest on admission.

These fascinating results must be interpreted cautiously. They may underestimate the contrasts between teaching and nonteaching hospitals becausethey were obtained from two services in the sameuniversity hospital, which differed far less than theaverage teaching and nonteaching hospitals would.Furthermore, the data were derived from only onehospital and 12 diagnoses, and therefore may not berepresen ta tive.

Despite these limitations, this report from Stanforddeserves careful consideration. It tells us that an important part of the added costs of teaching hospitals isprobably due to the increased intensity of workup andtreatment of very sick patients. It also tells us that thisincreased care appears to produce measurably greaterin-hospital survival. The message here seems to bethat the relatively high costs of teaching hospitals

will need to be wei~hed against the medical resultsachieved in such centers. as well as their educationaland research outputs.

Before squeezing the teaching hospitals any harder.policy makers should be certain they understand \,'hatthese institutions have been contributing to the publicwelfare. I suspect that in the end the third parties willdecide that they must make special arrangements to

ensure the survival and vitality of the teaching hospitals. Meanwhile, the academic medical center!> arelikely to be in for some difficult times. To sUr\·i\·e. the\"will need astute leadership, cooperation from thei'rmedical staffs, and more evidence of the kind produced by the Stanford study.

ARSOLD S. RELM.~:'\. !\f.D.

REFI:RENCES

J Hadley J Teachin~ and hospJl'" com J Health EconomIC' I'I~'. :7~·'I

2. Gamc" AM. Fuchs YR. SIlverman JF Case m... cost;. and out.:omc, d,flcr·ences belween facult) and community sen'lce, In a unl\er"l) hosrlldJN Enl11 J Med 19114. 310.1131-7

CORRESPONDENCELetters to the Editor are conside~ for publication (subject

to editing and abridgment), pro\'ided that they are submittedin duplicate, signed b)" all authors, type"'ritten in double spac·iDg. and do Dot exceed J"J pages of text (excluding refer·eDces). The)' should not duplicate similar material being sub·mitted or published else"'here, and the}' should not containabbreviations. Letters referring to a recent Journal anieleshould be received within six weeks of the anicle's publica·tion. We are unable to provide pre.publication proofs. andunpublished material "'i11 not be returned to authors uDI~S5 aatamped, self-addressed envelope is enclosed.

CHRISTIA~SCID.CE A!\D THE C.o\RE OF CHILDRE'\

To tlu Editor: M\" latr husband. Phillip SilZnorini ....a, a mrmhrrof the Christian Sciencr church. and at urious timrs hr comult.d aChristian Science practitioner.

When he was 40 vears old. his l!lands enlarl!rd and thrn inrrr.".ogradually both in n~mber and in'sizr. In thr brlZinninc. he hao h....1l

seen by a physician at work....ho ad\"isrd funhrr studirs The Ch,i,·tian Sciencr practitioner ad\'isrd stronlZh alZainst this. as \\ ..11 a,other medical consultation. About four months beforr hiS death.when his ph\"sical condition had drtrrioratrd and hr hao a couc"and swelling of thr glands in all pans of thr bod,. I pkadro "'lIhhim to see a medical doclOr. Hr was almost rrad, to do this" hrllthe practitioner persuaded him to Ito to a sanitarium run by thrChristian Science Benr\"olent Association

Thr conditions at thr sanitarium wrrr drplorablr. Thr "nornMImeasures of deanlinrss" that ,,'err applird durinc his Sla, "'rrr asfollows: His personal carr as adminislrrrd b, thr prnonnrl wasminimal. The bed Iinrn "'as changrd but oncr wrrkh. Hr hadweeping edema of his Irgs and ascilrs ofgrrat rXlrnt durinc thr lastweeks, and at timrs hr ,,'as sitting on a "'et bed shrrl. I ...as notallowed to give him a grntlr back rub "'ith lotion. I ...as told "\\"rdo not do this here."

During his sta~' therr he had pain and difficulty in brrathinc. Hrwas unablr to stay in bed for any lengtli oftimr and had dllli,-uh, in...·allowing; his apprlilr "'as extrrmrl\ poor. I SpOKr 10 thrm aboutthe administration of oxyltrn. but thry said they neHr did thaI.

During his stay at thr facility hr had t,,·o praetilionrrs. ~Illst ofthe timr a lady from Marshfirld administrrrd thr "trratmrnt .. Shrnever \'isitrd him. but all thr trratmrlll ,,'as door in long phonr

74

arsh Medicine

~e.d... icare's New Limits~ospital Paymentsorce Wide Cost Cuts

toctors Give Fewer Tests,Shorten Patient Stays;

I Institutions Trim Staffs

fuppliers Feel the Frugality

By CARon:" PHILLIPS

1~laff Reporter ,,(TII>. WALl. S·, H>.El JOl H'AI

After years of runaway inflatlon, the t'.S.ealth·care industry is suddenly on a cost·

ru:tlng binge.That sounds about as belle\·able as ..the

Iheck IS in the mall." but It is true, baSI'ally because Cncle Sam grew weary of put·

ting so many checks In the mall. The federal gO\'ernment has changed ItS MedIcare

layment system, forCIng a far·reachinghakeup.

The elderly·ran· program has bE'gun paying hospItals based on what It figures treat-

Eents should cost rather than on what hasitals artually spend. Thus. hospltals that.aH· freely run up the tab. certaIn of heftyrel.spments, now must keep a rlose eyen .... Sf'S.

fr C . mg In under the Medlcare·set markIneans a proht. and exceedIng it means aloss. Because ~1edlrare recipIents accountfor about ·W, of all patient·days in the na·

'

ion's acu!f··care hospitals, some of these In'tltutions no doubt WIJ] bE'come termInalases if they fall to adjust 11_' the new system

and to other expected changes In fed ..r,,: re'Imbursements~. .

i Early RamUlcatJons

~i Though only a. bOL:t ·W·, of hospltals havebeen phased In to th.. "prospertlve pay'ment" system SInce It began last October,

'

the shockwaves are already evident:-Hospitals are laying off staff members,

buying cost·calculating computers and dnv,ing hard bargains with medical·supply'com·

, panies.-Supply companies are changing their

marketing tactics and lowering their gro\l.'thexpectations.

-Doctors arp taking fewer tests. and pa'

And both are concerned about what thiS allmeans for the quality of care.

Patii'nts may also fmd their hospitalstays ~Ilortening. When !lb·year·old Ada Fishbroke ner arm recently, she spent a week ma Lakeland, Fla., hospital, but was then".ed out," as shp spes it. "I think Is< have stayed anuther week," saysM Ish, "but my doctor told me Washing'ton couldn't .pa~ al: that money."

That is tne nrart 01 tne matter. Withhealth·care costs rIsing at more than ]5'; ayear and with Cncle Sam footIng about 30';;of the nation's total health·care bill. Can'gress in ]982 decreed a tightening of the

,Medicare purse strings, The decree dIdn't, get much attention, buried in tax legislation,but it set federal bureaucrats to labormg onan overhaul.

Basis of SystemThe system they developed pays hospi·

Itals fixed amounts to treat specific ailments.based on categories called diagnosis· related

,groups, or DRGs. The amounts MedIcarepays are adjusted to reflect regional aver·age costs and whether hospitals are urbanor rural.

Predictably. the changes haven't been

Iuniversally acclaimed. AdmInistratively. thenew system Imposes enormous burdens. and

. medically it runs counter to an ingrained, hang·the·expense ethos. "Our fear is that ifthese rates are lowered too much. hospitalswill have to hold back on USIng life·savingtechnology, on doing all the things they cando to save lives." says MIchael D. Brom·berg, the executive dIrector of tnf- Federrl'tlOt:...of Am~TICa!, H)splt~ls .. a trad<- g-roL:j:J

1ne real proolem wltn tnt:' prosperlii'e·paymenl system, others fear. is that hospl'tals will berome adepl at getting around it.One possi ble tactlc: arbitrarily assignIngpatients to DRGs that pay more than theirailments would warrant. That was a glitchIn the system in Xew Jersey, whIch has hada stale· run prospectlve'payment setup forseveral years. Another: shlf~ing cos~s tonon·Medlcare patIents. Some software com·pames are peddling computer programsthey claIm wll] shrJ..... hospItals how to do Justthat.

Pm'ate InSllrerS worry about that sort ofthing. "ProspeclJve payment should be InSlJ·tuted for all payments to hospitals," saysColIn C. Hampton, the preSIdent of l'nIonMutua! Ufe Insurance Co. of Portland,Maine. "As long as they app!y only to Medl'care. then the act of shlf~lng costs to privatf'p;jyers is exacerbated,'Wider Application?

FrdpraJ health officials say they are als/'interested In WIder use of the prospertj\'epayment program and are currentlv sludv·Ing Its applIcatIOn to doctors' fees and nur'sIng·home charges.

Hospitals are apprehl'nslve because undfr the new system. "one or two ven expensjH' cases could bankrupt a small hospl

, tal." says Jack Flaig, the finance \'Ice presl'dent of TuaJlly Community Hospital In Hills·

, boro, Ore.Some of the nation's :i,OOO acute·care hos·

pltals surely will go Into bankruptcy. pre·dicts Alex McMahon. the president of theAmerican Hospital AssociatIon. anothertrade group. There is general agreementthat small. not·for·profit institutions are

• most vulnerable. They have been muchmore oriented to community pride than thebottom line, and they aren't generally long

• on management.Investor-owned facilities, whIch have al·

ways kept an eye on the bottom Ime and oncost controls. are expected to fare better,"Our costs are already lower than the DRG

PI/I/\{ 7'''1'0 (,} PI/I/I· />', ('llluJIIII /

cont:

Continued From FIrst Pagrrates, so for us prospective payment is agreat positive." says David Jones, the chw.man of Humana Inc" a Louis\'ilJe-based op·erator of 86 U.S. hospitals. "I see low-costproducers having a field day in this em;ron·ment."

In the main, however. hospitals arescrambling to reach that point. The firststep for many is slashing the payroll. In Ev·ergrt"en Park, III.. Little Company of MaryHospital rE'cently laid off 226 employees, orabout lor;; of its staff. In Lancaster. S.C., EI·Iiott WhitE' Springs Memorial Hospital rutsix of its 2] management positions. hadother salaried employees take a temporary10"'c pay cut and reduced the workweek forhourly employees. Allover the country, has·pitals are imposing hiring freezes.

They are. however, hiring legions of can·sultants to help streamline their operationsand buying .comr,uters and software to helpget a handle on their costs. :

Administrators are lect:mng thf':r stallsabout cost conS'.HlUS"""'. and urging doctors;to reduce patient :es:s-(,r to have the testsdone outside th.. hosp:ta!. where old reim·:bursement standrds J.pr'iy. They also are:

; implOring doctor~ te, th:n~ t\l.ice before ad· ;i mitting patients dnd 10 I:>t' qUicker about dIS-I charging them I

At teaching hospitals, the new economics·i of health care are par-Icularly hammered!

home. At the University of Alabama in BIr':mmgham, residen:s an~ physiCIans discusscosts as well as trf;'t.'TJ~nts ~ the\' makf'their rounds, Al H.t- rn1\,ersity of Chlcagc.hOl.pitals and (Iin,rs, s:o.ff membE'rs get·pot:'kel manu;~:s I;S:Jll~ laboratory·tes~ .costs, j

Elsewhere lr Chi('~gO. Illinois Masonic'Meiical Center IS p.lakir.i: moves that reflectott-,er national tr<>nds. It has set up a "self'car," unit. where p::::er.ts v.ith relative~y·

mJn(lr ailments rar recuperate \l.1th min!' ,rna! nursing and at rf'lauvely minimal cost i

It should thus rome Oll~ nicely ahead on pr(\· :spectiw·payme:-.t reimbursement. Otherhospitals are startmg 10w'overhead satellitebusinesses. such as en',ergency centers andhome·health·car.. se;\·lc€>s. both to take ad I

vantage of the new Medicare payment p0!',!icy and to fine n" ..... S(lurces of revenue.

lI!Jn0is Mas·)r,;c a!S~1 made a loral splash Iby announcing (i 2~', reduction in its semI iprivate'room rates, It did that partly be· icause it had trimmfd its staff 7l'"c and partly Ibecause it w~ apr!}ing a classic businessprincIpII': Inrreal'i'd v0!ume compensatesfor rpduced rr.argms. Ir. the same spirit.other hospitals have taken to renting bill·boards and nmninr npwspapers. radio andtE'levlSlon ads.

As hospitals feel the heat. they pass it onto thpir suppliers. "Pricing pressure hasbt'en fierce." says Karl Bays, the chairmanof ArnE'rican Hospital Supply Corp. in Evanston, III. That applies even to the littlethings. Northwestern Memorial Hospital ofChicag(\ recfntly sought competing bids forsurgical gloves, to see whether it could get abreak on the price it was paying. It did.low,ering its cost to 33 cents from 31 cents. At281.000 pairs a year, that is a saving of Sl1..000.

This nf'wly thrifty mind-set also appliE'stl' choice of produrts. N~frills urinary bags

75

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~re in; the fancy ones with access valves< hanging apparatuses are out. Generic

sterilants art' in favor, the brand-nameones aren't. "Hospitals are definitely look-

l ing to buy Chevys instead of Cadillacs,"I says Art Spirakes, Northwestern Memorial's

I,purchasing director. "And that's got compa·nil's very nervous. We're seeing more ag

I gressiveness on the part of sales reps. Theyshow up more frequently and are more in-sistent. ..

Medical-supply companies are also pushing some different products and doing somedifferent sorts of marketing. They are sell·ing cost· figuring software. in competition\\ith the likes of Big Eight accounting firms.They are developing more products forhome health care. They are holding prospective-payment education seminars for hospitals, the better to establish themselves asstalwart friends in the storm. They are locking In customers where possIble by guaranteeing qUirk delivery on orders to enable

I

hospit,lls to kt'ep low inventariI'S. ISq';:,!:"rs Jrf J!so taking steps to trim

theIr nWTl costs. Baxter Travenol Llbora· Ii

tories Inc. has automated much of its manu·facturing. Sevt'ral pharmaceutical cnmpa-'nit's art' developing proct'sst's to makt' cer·tain drugs for less. Philadt'lphia'based ISmithKlIne Bt'ckman Corp. has laid off hun·dreds of workers in its diagnostic-Jnstrui~ts business.• t has been a painful time for companiesaccustomed to galloping growth in salesprofits. In the 19b3 fourth quarter, when thepr(1spectivt'-payment system kicked Intogear and hospitals turned cautious in purchasing. medical-supply concerns took it onthe chin, reporting depressed results.

That was a harbinger of things to come.Industry executives don't see disaster in theaffing bu~ mnst see an J.ge of di;TIlTllshed ex~~c:,itl'.)ns. Baxter Tra,enol, a company ac,";s~ompd to ,lnnual eamin~s g-ains exceed-: if. ~'J ;, rfIX)rtt'd that fIrst'quarter profit :"'; -," , .:tho!.Jl:'h It does expect an earnings",n ;r'r ~hf' :.~ 1~ .-\merican Hospital Sup-; 1), ·... hlch has enjoYE'd similar grov:th ratE'S,St"ps ItS 3nnual profit percE'ntage rise slip'png to the mid·teens. For others, thE' slip[Jage could be more severe. -

'Tnti! now, everybody's done relatively.....E'll IT! the hE'alth business," says Charles.-\schauer, executive vice prpsident of AbbottLAboratories of North Chicago, III. "But Ithink these new constraints are going tobrIng out the diffprpncps in managerialslulls. The good guys will look evpn bettpr.The marginal guys wont look so good,"

IeII

•

- - - - - - - - - - - - - - - - - - -Dr. Sylvester Sterioff of the MayoClinic said that only about 20 percentof families refuse to donate a lovedone's organ when asked.

Donating organs often allows peopleto resolve their grief, said GaylRogers, the Red Cross's assistant director for transplant donor services."Often a tragic accident is involved.Sometimes donating an organ gives apositiveness to a tragedy that otherwise seems senseless," she said.

McCullough predicted that organprocurement programs such as thismay become common in the future,just as centralized blood banks havecaught on during the past 20 years.

"I think this probably is the wayorgan programs will go," McCullough said. "" allows people to go tothe public with one simple messageand one simple way to access thesystem. We need to make it simplefor everybody."

Last month, the University transplantprogram was offered 48 livers, 14hearts, nine pancreases and 14 kidneys, NaJarian said, but only 15 to 20percent of organs offered prove suitable for transplant.

Last year, University surgeons transplanted 16 livers, 12 hea~s, 24 pancreases and 190 kidneys, he said.University Hospitals has 500 peoplewaiting for organ transplants, andsome experts estimate that 20,000people are on transplant waiting listsnationwide, he said.

The new program "should improvethe outcome" of orKan donations because, with the thr('£' centers cooperating, the chames are beller that oneof them will have a patient whomatches the donor, McCulloughsaid. Finding a match quickly is important, because surgeons usuallyhave only hours to retrieve an organand transplant it.

hearts, livers and pancreases.

The Red Cross has heen coordinatingdonors for the Unlwrsity SIn! P July,and "it's inereast-d our efft-cllvt-nessby a major amount," NaJarian said.

The new program is expecteclto usedonors more efficiently lJecause dIfferent organs from the same donorcould go to different institutions, McCullough said.

The Red Cross chapters throughoutthe state are "in a way, the ideal network," and they probably will helptransplant teams locate donors insmall rural hospitals that might otherwise go undiscovered, said Dr. JohnNajarian, the University's chief ofsurgery.

Donors and organ recipients must becarefully matched to have compatible tissue types, so the chances offinding a match increase as thenumlJer of potential donors rises.

of St. Paul Red CroS!; Blood St-rvices."As the 'system' lIt-ts bellpr .lOdbetter, more transplants willlJe doneand more lives will be saved."

National and regional networks already exist with computerized lists ofpatients awaIting transplants, but thisprogram focuses on locating donors,most of whom are young and healthypeople struck down in accidents thatleave them brain-dead.

When the family of such a patient isinterested in donating the patient'sorgans, a Red Cross coordinator isdispatched to the hospital to answerthe family's questions and m.lke theappropriate arrangements if theydecide to donate.

The three Minnesota transplant centers combined have more than bOOpeople on transplant waiting lists atanyone time, doctors said. All threeinstitutions do kidney transplants,and the University also transplants

The St. Paul Red Cros!; and Minnesota'!; three organ tran!;plant center!;will cooperate in a unique networkfor recovering and di!;tributing donororgan!; in the Upper Midw~t, doctOr!;announced Monday.

The arrangement. which u!;e!; 24hour toll-free telephone number!; andRed Cros!; nur!;~ acting a!; coordinator!;, i!; directed at increa!;ing thenumber of organ!; available for tran!;plant at Univer!;ity Ho!;pital!;, Hennepin County Medical Center and theMayo Clinic in Roche!;ter.

Phy!;ician!; from the Red Cro!;!; andthe !;tate'!; three organ transplant centers announced the agreement at apress conference in SI. Paul.

"The aim of our coordinated efforts isto make it as easy and convenient a!;possible to make organs availahle,"said Dr. Jeffrey McCullough. director

RedCross will coordinate transplant netwolIKBy Delores Lutz

minnesota dailyTueede.,. Aprt124,1914

.....,

.....,

Thr~tranSprant centEi5stocoordinateetiOris

""-Jco

B) lewis CopeStott Wrller

Minnesota's three transplant centers- with more than 500 patients ontheir waiting lists - announced apioneering program Monday de·signed to speed donor organs to recipients.

"This is n tremendous mo\'e forwardlor transplantatIon," said Dr. JohnNajarian, chief of surgery at the University of Minnesota Hospitals,which has the nation's largest kidneytransplant program and also doesheart, pancreas and IIvf!r transplants.

"We hope that as mOR organs aRmade available for use at all thetransplant centers, more lives will besaved," said Dr. Jeffrey McCulloughof the St. Paul Red Cross. The RedCrO!l6 cbapter will serve as the clear·Inghouse for organs that will 80 toUniversity Hospitals, HennepinCounty Medical Center and tbe MayoClinic In Rocbester, Minn.

Another aim Is to get the best possl·ble match of tissue and bloed fac·tors, so that Ihe organ ~s to theperson whost body Is least likely toreject It, McCullough saId. Najariansaid the program should belp patients sucb as J.year-old CherylBjerke. who because 01 unusual lac'tors In ber blood. bas been waitingmore than two years lor a donorkidney.

She, like otbers awaiting kidneytransplants, Is belnB kept alive on akidney dialysis machine that removes Impurities form the blood."But cblldren like Cheryt don't growmuch on dialysis," Nalarlan 'l8ld. SoIt's vital to live children new kIdneys

a~; soon as ~Ible

There is no backup machIne torthose needing hf'Rrt ulld U"a transplarlts. "We average about one deothevery two weeks ot patients waitingtor /lver transplants alone," Najariansaid.

In the past, all three transplant cen·ttors have operated their own donororgan program.'!. They have main·talned contacts with hospitalsthroughout the state and, through national rcgistnes, with some hospitalsaround the country. The organscome from people who die, and areused only wllh permission 01 thedonor's family.

There have been some exchanges oforgans between tbe three Minnesotaprograms, but there often have beendelays, officials of the three Instltutlens ~Id. Sometimes organs havebecome too damaged to use becauseof delays.

The Red Cross now will contart hospitals regularly, promote donation oforgans and ofter toll-tree phonenumbers. This is designed to get themaximum numt:>er ot donor organs.and get them to the right patlenls Inlime, McCullough said.

Najarian said this Is the first time Inthe nallon that an Int.lependent grouphas become the statewide clearinghouse tor organ donations. He saidthis could be the model lor otherstates, and then be linked to a nationWide network that experts long havewanted.

There are now 300 people on thewaiting list at the University of Mln-

Transptants conllnued on paJlf' I J8

nesota Hospitals tor kidney transplants, Najarian said. Surlleons theredid 190 kidney transplants last year.There are about 35 waiting lor livertransplants, 35 tor pancreas transplants and 12 for heart transplants atthe hospital, he said. About 15 liver,24 pancreas and 12 heart transplantswere done there last year.

The Mayo Clinic has about 60 patients awaltlnB kidney transplants,and Hennt!pin County Medical Cen.ter has about 75. Each did about 55kidney transplants a year.

Information on tile donor programcan be obtained by contacting theRed Cross at 291·-4654 (trom theTWin Cities area), toll-tree (/i00) 3DONATE (trom elsewhere in Minnesota), or (800) 24·SHARE (from elseWhere In the nation).

MINNEAPOLIS STAR & TRIBUNE

Wednesday, April 25. 1984

Ethicl}-eview advisedfor 'Baby Doe' cases

.......\0

By Delores Lutz

The American Academy of Pediatricswill recommend this week that hospital ethics commillees review all decisions to withhold treatmpnt fromchildren who are "not imminentlydying," according to an academymember.

Commillee review is necessary because withholding treatment from achild who otherwise could have along life raises ethical questions, saidDr. Norman Fost, el pediatric.:-!> professor at the University of Wisconsin.

"That doesn't imply thelt such deciSIOns are unethical or that most areunethical:' Fost said, but a reviewmechanism is wise because somepast decisions have seemed "indefensible."

One of those indefensible decisionswas made two yt'ars ago In

Bloomington. Ind., in the case thatprovoked the Reagan administration's controversial "Baby Doe"rules, Fost said in a speech Friday toabout 100 people in the CoffmanUnion Theater. Fost's visit was sponsored by the University's StudentCommillee on Biomedical Ethics.

In the Indiana case, a baby who hadDown's syndrome and a correctablestomach defect was allowed to starveto death at the request of the parents.

Their decision was based on "misinformation" aboui the extent of thebaby's retardation and the chances ofsurviving surgery, Fost said. Such adecision "is no longer permissible inthis country:' he added, particularlybecause many people are willing toadopt retarded children whose bio-

Ethics to 8

Ethics from 1IO~I(allldrl'lll' dOIl'I "'.lIlI Iht'lll.

"illS nol oplum.11lm ph V'll i.lm mparenls 10 colllldt- III SU< h.1 tlt-( ISIOIlIrs wron~. Il"s mor.1l1y wroll~ anti il\legally wron~," 1o,t s.lIti.

Another ('xamplt- ot .1 wrc 1Il~ dpl i"ollis th!' C,lse of Phillip Bpt kpr. who was10 wht'n his l1.1rl'llts rl-hN-d hl'.lrt ,urgery 1m him becausl' he "'<IS n°·tarded; a court uphl'ld tht' p.Ul'lllS·nght to make the dec "'1111. "1 ht, doctors wert' stunned. Phillip W.IS condemned to rlll> .1 slow, Iin~enngdeath:' f'ost said.

There are situations m whi( h it isethical to witholrllift'-suslamingcare. however, Fost said. lorexample, rloctors woulrl not attt'mptto prolong the Iiie of a chllrl who IMdanencephaly (the ahst'ncp of d hram)because trying to treat SUl h a c1l1ldwoulrl make no sense.

"Not only is it permissibl!'. it's ohlig·atory to withhold trt'atmenl wh!'n Itdoes not serve the child's int(,rt-sl,"Fast said.

Fost. who is a nationally recogni/l'dexpert on issues in care of till' handi<.apped newborn, helpt'd makt' thl'film Who Should Surviwl , whilhexamint'<' the case history of an infantmuch like the Indiana "nahy Doe."

The ethics committees shollirl rt-vi!'wall del i<,ions in whic h Iifp-sdvingtreatment i<, being withheld, hut Ilwymust playa "consultative" rol.. lh.ltfo<,t~r<, con~ensu .. imtf'ad of m,l"in~

mandatory del jsions, f osl s.lid. 1111'final decision still rt-sls with Iht'family and rio< tor.

Still, evt>ryollf- involvl'd w,1I h.IVI' I"rl'( 0Knile th,lltlw l l,mmilll'l" Willhavt' the potenll.11 10 lml t' d,'( ''l"nmaklOR through pt-l'r pr'-''lIU- .lIl<llhpthn!al of rl"tnhution ,lg.III1't n'ht-Ihou,phySlCi,lIls, he ...lIll.

f'

"1 hI' l ommilll'l''' will illl'vil •• hly IIC'wolves in shpl"l'" clolhlll~," I o,tsaid.

The "infant (are revil'w committPps... as lhe ft'dl'r..1~ovprnnll'nl ( ,Illslhem, are rt'cognl/l-d hy till' t urrl-nlset of fl'dl'r,ll rt'!\ul..tion" IIllrochlll'dlast Fl'bru.IrY. Tht' orl~lIl,ll "BahyDoe" rulf's reqUlrt'd III "pll.lb 10 postsi~ns advi'lng Ihl' publu oi .1 hotlimfor repmlln..: c,hI''' 01 .lll"~l'd "dlslrlmindtion" ,1Kall1st h,mllit ,Ippl'd infdnt ... Tho.... rull's. wllll h weresupported by rlght-to-hit' I-:roups ,mdoppoSt'd by m,my ht-,llIh prol..s.,lon·als, were struck down hy a fl-dprdlcourt.

Fosl sairl he Iwlit-V(" th.1t ft'wt'r dt't isi(Jns simil.H to the Indi,lI1.1 c.N- h.IVIbeen m,ldl' durin~ tht' p•• ,1 fwo yt'.H'becaust' "B,II)Y Dol''' i..,lIps h.lvt' (t'

l.elvl'd so muc h public dlslu"'lon

Norman Fost

Mlnneeotll O."y

MondIIy.ApnI23.1984

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