“Take Me To Your Leader”: In Washington, In Houston, In Austin


Leonard Zwelling

If the proverbial aliens landed on the Potomac today and tried to ascertain who was really in charge of the American government, they may well have a dilemma.

“Take me to your leader,” they might ask.

Would you send them to 1600 Pennsylvania Avenue, up Capitol Hill to the Congress or just to the east to the Supreme Court? Good question.

Mr. Trump is trying to end all doubt by declaring himself omnipotent. He even sent Stephen Miller onto the Sunday talk shows to emphasize the President’s absolute power. (I liked Steve better when he led his band, didn’t you?)

The 9th Circuit of the US Appeals Court upended that pretense pretty quickly by suspending the President’s travel ban. Now the executive ukase will need to be assessed for its constitutionality. The Trump White House is licking its wounds and trying to determine its next moves which may be another lesser court challenge to get a ruling in its favor to take to the Supreme Court which will likely split 4-4 and sustain whatever a lower court sent it. If that occurred now, the Trumpees would lose, so they may not go to the Supreme Court just yet.

You see how hard answering the aliens might be. As it should be. That difficulty identifying the center of American power is just as the Framers planned it to be.

Up until last week, the same would not be true if the aliens landed on the bayou and asked an MD Anderson employee (preferably one who had not been fired) who was in charge.

The answer would have been President DePinho or maybe Dan Fontaine. Now the answer is less clear.

There may not be a new sheriff in town, but there is a new deputy, Steve Hahn, and exactly what he is to do and how he will interact with the lame duck atop Pickens is not at all clear. Whose deputy is he anyway, Ron’s or Bill’s? Lame ducks and wounded tigers can be very dangerous. They may only be tamable by SEALs.

So, in the hopes of clearing things up for the aliens, you know the ones on this side of the Wall, it would be advisable that the forces of good (?) in Austin clarify what the heck Dr. Hahn’s job really is.

Slipping a layer of accountability anywhere in the system would be a good idea at Anderson, but just keeping the President from his assistant mayhem producers in the Provost’s Office and that of the Chief Medical Officer, won’t get the job done.

So first, what’s the job?

I would think an examination of clinical operations would be job one. Templates must be reasonably sized and faculty and staff should not be overworked.

Coding, billing and scheduling clearly need overhauls. Metrics of all of these need to be created and followed for whether or not any managerial exercise in amelioration actually improves things.

The budget, finance and allocation of resources need additional looks.

Programs need to be re-evaluated for their utility to either research, prevention, patients, or the bottom line. Everything remaining should contribute to something in a meaningful and quantifiable way and contributing to the bank account of the president doesn’t count.

Levels of bureaucracy need a hard look. The org chart should be streamlined and if that entails additional layoffs, the dismissals should be accompanied by a real understanding of why these people were let go, if that is what is determined to be necessary.

Finally, an independent assessment of all leaders of all facets of the institution should be undertaken to improve their communication with those whom they lead and hold them to real accountability in progress of measurable parameters.

Dr. Hahn could do all of this and should be empowered to do these things as the wheels of justice turn in Austin. Those wheels are on the stagecoach hitched by the Chancellor to a team of Regents’ horses to escort the DePinhos back across the Mississippi. Rolling those wheels will undoubtedly require a change at the top of MD Anderson. The Regents should allow Dr. DePinho to serve out his contract, which I assume ends on August 31 of 2017, thank him for his service and send him on his way.

Sure, they should provide the transportation. Stage coach sounds about right.

I understand that the “sunk cost” here has been tremendous. Watson, IACS, Moon Shots, equipment, personnel, furniture, it all cost in the millions. But these are dollars that can never be recouped in investments that were dogs. That their cost was astronomical in the past should have no bearing on future investment decisions. That’s Finance 101.

Any further money invested in the DePinho vision is bad money thrown after good.

You would be better off giving it to the aliens or better yet, answer their question. Who is the leader? In DC and on Holcombe.

Leonard Zwelling