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Strong minus Stein 

Almost exactly two years ago, Dr. Jay Stein, CEO of the University of Rochester Medical Center, joined a group of notables on the Hochstein Music School stage to discuss socioeconomic change in Rochester.

            Under the baton of visiting National Public Radio host Juan Williams, Stein said "the key" to our future "is academic institutions." Stein boasted that the Med Center was getting around $200 million annually in medical research grants.

            Subsequent events show it was no idle boast. The Med Center's research side has been growing steadily. A UR news release this month said that grants just from National Institutes of Health totaled $122.4 million in 2002, up almost 14 percent from 2001. This, said the release, "represents a 60.8 percent increase in research funding since the Medical Center opened the Arthur Kornberg Medical Research Building in 1999 and hired the first of 100 scientists in a planned 10-year, $550 million expansion of its medical research programs..."

            But back to that May day two years ago. The audience at Hochstein didn't give Jay Stein accolades for his success in growing the Med Center. Instead, it responded to his remarks with "groans and hisses," to quote a City Newspaper report. Why? Like many Rochesterians, the audience members were shocked at hearing in April 2001 that Genesee Hospital would soon close. They blamed Stein personally for the death of the hospital, which anchored an eastside city neighborhood and served many low-income patients. In fact, Stein had lured many physicians away from practices at Genesee, and this arguably quickened the pulling of the plug. (Genesee's owner, ViaHealth Inc., was facing a big-time financial mess in connection with the hospital, too.)

            Stein --- a Pittsford resident who hails from Chicago and has worked in Texas, Oklahoma, and other states --- was better received in other venues, and Rochester gave him a mixed reception overall.

            And today, just a couple of weeks after he resigned or was removed from this Medical Center post, Rochester is giving Stein a mixed farewell.

University officials have left some questions hanging.

            On May 16, UR president Thomas Jackson announced the end of the relationship. He mentioned "serious concerns about issues and methods of coordination involving the Medical Center and the University," but did not specify. Make of that what you will; but Jackson had good things to say, too. He lauded Stein's "enormous contributions" and "visionary leadership," and he affirmed that the "Medical Center's strategic direction is clearly the right one" for all concerned. (University spokesperson Robert Kraus told us Jackson and Provost Charles Phelps would not comment further. Jay Stein couldn't be reached for comment.)

            How is this playing in-house? "In terms of Jay Stein's leaving Strong, I think he leaves a big hole, one that time will tell as to how its is filled," says Sarah Trafton, director of the Master of Public Health Program of the UR Med School's Department of Community and Preventive Medicine. "It may be, since much of his most public activity lately has been with various community groups, that the business/economic development folks will miss him most," she says by e-mail.

            Indeed, Stein was named to the Greater Rochester Enterprise, a private-sector economic development group, in early 2002; he's also been involved with High Tech Rochester, a not-for-profit organization whose sponsors, according to an HTR backgrounder, include the Rochester Business Alliance, local campuses and corporations, and local and state government. But again, the big question for many people has been Stein's involvement with --- or rather influence over --- institutions like Genesee Hospital.

            On this point, Trafton gives a measured response. "I don't think Dr. Stein alone was the cause for the demise of Genesee; that whole situation was incredibly complicated and most likely was not caused by any single individual."

            Trafton refers to another controversial matter --- the University's decision to "self-insure," that is, to remove itself from the community-wide health insurance pool by which "The Blues" have covered most Rochesterians. But here again, Trafton doesn't go after Stein with a vengeance. "Even as much as many people would like to blame a single person or corporation for what's happened to Rochester's health care, health system, and its various parts, it is simply too complicated to lend itself to that sort of blaming," she says.

County Legislator Bill Benet, who helped spearhead the Save the Genesee [Hospital] Committee, notes Stein "came from outside this community."

            Such newcomers, says Benet, "may have a commitment to their individual projects" but lack the longtime resident's deeper appreciation of the area.

            Yet Benet doesn't open up on Stein, either. "I certainly respect and applaud his sense of trying to strengthen the Medical Center, to enhance its capacity," he says. "That's all terrific."

            The former director of the Finger Lakes Health Systems Agency --- currently an attorney who specializes in Medicaid law --- takes a slightly different tack on Stein v. Genesee. "Whatever [Stein] was doing, I believe he was doing at the behest of the University and his board," says René Reixach, now with the Woods Oviatt law firm. "He was not a loose cannon."

            Reixach adds that Stein "would have been let go long ago" if he hadn't been getting the okay from his superiors.

            In any case, what's past is past --- but what will Stein's departure mean for the future? "In the short run," says Reixach, "I don't think it will mean anything." But Reixach does wonder if Stein and higher-ups had differences over basic policy. "Time will tell," he says.

            But there's a good side already, according to Reixach. And it's connected to the touchy professional relationship between Stein and Howard Berman, who recently retired as head of The Blues. (Technically, it's BlueCross BlueShield of the Rochester Area, a division of Excellus, which is owned by The Lifetime Healthcare Companies.)

            Perhaps it was to be expected that the head of the top local insurer and the head of the top hospital would have their differences. But the fact that both CEOs have left their posts "may signal an amelioration of the intense battles" between The Blues and the Med Center, says Reixach.

            "I share the concerns a lot of people have had," says Reixach, mentioning Stein and company's expansionist designs not only toward Genesee, but also toward Greece's Park Ridge Hospital. But Reixach also appreciates the Med Center's unique position. "Unlike every other university hospital in New York State, [it] is not a separate entity," he says. (He cites Manhattan's Mt. Sinai Hospital, a self-contained teaching institution and comprehensive-care facility.)

            "A lot of universities are happy to distance themselves from their hospitals," says Reixach. "If [the Medical Center] were independent, Stein would have worked only for the hospital board."

Much commentary on Stein and Strong comes from boardrooms and elite planning circles. There's a view from the trenches, too, of course. But it's not entirely what some might anticipate.

            In an e-mail to us, Bruce Popper, executive vice president of SEIU Local1199 Upstate, which represents hourly workers at the Med Center, says his attitude has changed. "At first," he says, "I was skeptical of Dr. Stein's ambitious plans for a medical-research-industrial complex in Rochester. But as the Medical Center plan began to unfold, I became convinced that it held out one of the few positive hopes for economic growth in Rochester. I came to support Stein's views. 1199 SEIU union members asked to be part of that growth. Stein deserves credit for his vision and leadership..."

            Yet Popper sees problems elsewhere. "At the same time," he says, "the corporate culture of Strong and the Medical Center turned toward an arrogance and sometimes a bullying attitude that said 'We know best and we can do no wrong.' This arrogance became evident in the Medical Center's treatment of the collective bargaining process... It became evident in its treatment of competing hospitals, payers, and the community as a whole. This ultimately led to Dr. Stein's undoing."

            Popper believes the trick is to continue fostering medical care, education, and research at the Med Center while also making the latter "a good corporate citizen... accountable to the public." But this, he says, can only be done "by major reform of the Medical Center governing authority."

            Health advocates are attempting this kind of reform through entities like the Rochester Health Commission, which was created to find ways of improving local systems. (Popper is an RHC board member; Sarah Trafton is the RHC vice-chair. The board includes representatives of local businesses, not-for-profit groups, health facilities, physicians' groups, and other "stakeholders.")

            Whatever the RHC has accomplished so far, don't expect any immediate, decisive change at the University or the Medical Center.

            Trafton puts it this way: "[A] community solution, involving all the various stakeholders, is necessary... Such an approach, however, requires a lot of fits and starts, measured in years rather than months, to assure ourselves of progress, or lack thereof."

            And that's not even considering future action, or lack of it, by state and federal officials, who could trump anything local --- if the political stars ever come into alignment.

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