The Letter

The Letter


Leonard Zwelling

         I got a real letter today. And I don’t mean an email. I mean a real envelope with my name on it with a stamp and everything. It was addressed to my house. Well, almost everything. It had no return address. I have no idea who sent this to me.

         I anxiously opened the envelope and out tumbled some printed material.

         The first page was labeled “Chief Operating Officer.” It was from Patrick Hwu representing the Division Heads, Rosanna Morris, the COO, Anita Ying, VP for Ambulatory Medical Practice, and Kent Postma, VP for Ambulatory Operations. The first thing I noticed was how many people had to sign the letter. Did the institution really need that many administrators? Next I looked at the contents.

         It was a letter informing the “clinical teams” that MD Anderson and its clinical operations would be open on Memorial Day. Given the degree to which the institution has been functionally limping along, this was remarkable. Now? All of a sudden there’s such a demand for patient care that the doors of Anderson need to be flung open on a national holiday when bowling balls have been rolling unnoticed through the half-empty halls. How does that work? This didn’t seem to make sense, but it was Shakespearean poetry compared with the other three pages in the letter.

         These three pages were titled “The MD Anderson Cancer Center COVID-19 Recovery Plan Service Line Agreement. Institutional Conditions of Participation and Prioritization of Resource Allocations.” Yeah, I didn’t know what that meant either.

         What these three pages appear to be (and believe me, I am not sure) is a contract between faculty, nurses or staff and the Chief Operating Officer that denotes the game plan and rules for patient care and clinical research going forward. It looks to be a voluntary program with mandatory participation for a Recovery Plan for the institution.

         I will try to make sense of it, but I doubt I can do it justice. These are the “conditions of participation for service line prioritization during recovery.”

  1. There are “new models of care and practice management.” It seems that various “service lines” have been selected for prioritization and will run on a seven-days a week model with extended hours. This is to include all MD Anderson sites in Houston, not just 1515. Virtual patient contact will become the norm. There is something about ICU care that I don’t understand and new rules for the Emergency Center. Here’s a sample sentence. Maybe you can understand this.

“Provider templates that align with clinical activity demand and CARE effort drivers to include independent Advanced Practice Providers clinics.” I just don’t know enough to understand that, but I assume other recipients will.

There must be a decoder ring for this, because it certainly isn’t in English.

  • There’s a need described to develop Goals of Care. I think the faculty of MD Anderson is quite aware of the goals of cancer care. They need not be reminded of this.
  • There is a centralization of support services demanded and a merging of divisional resources with those of the institution. I remember such moves by those on top when I was a VP. It was an effort to grab resources controlled by the faculty.
  • Service lines must commit to using institutional centralized tissue banks. I fear this will not go over well with some of the departments that pride themselves in this activity and are in no rush to hand their valuable assets over to the institutional leadership, although I thought a centralized tissue bank had been established years ago.
  • There is something about Resource Allocation Prioritization. I don’t understand this either, but it includes tight control of clinical research at the institutional level with industry-sponsored trials in Tier 3, the lowest. Cooperative group trials are in Tier 1. A famous ex-Division Head at Anderson used to call cooperative group trials “comparing the heights of dwarfs.” Anyone who knows anything about MD Anderson clinical research knows that cooperative group trials are the least inventive kind and that industry-sponsored work is done with the newest and most innovative molecules. Some industry-sponsored work comes with free drug only, no other support. Some of these trials are spearheaded by MD Anderson faculty who want to use costly unapproved drugs in new ways and could not do the work without the support of free molecules from pharma. Such trials are a critical part of the research portfolio and must be in Tier 1.

This putative contract is an insult to the faculty of MD Anderson. The institution has been operating with multidisciplinary “service line” clinics for twenty years.

         This is a thinly guised attempt to seize central control over the research mission of MD Anderson from groups of people who don’t understand it and cannot.

I suggest that the Faculty Senate take up a discussion of these documents immediately. A bigger collection of bad ideas I have rarely seen. This latter document can only be construed as some sort of heavy-handed threat to the academic freedom of the MD Anderson faculty. It should be resisted at all costs.

And by the way, I would like to thank whoever sent me the letter. I wish I could, but I have no idea who the sender was.

But I bet he or she will be reading this.

Leave a Comment

Your email address will not be published. Required fields are marked *