Rutgers Health Care, RWJ Plan Massive Partnership. Where Does that Leave University Hospital?

Lilo H. Stainton | July 24, 2020 | Health Care
In protest letters to Gov. Phil Murphy and university president, one lawmaker and two unions demand transparency and protections for public health
University Hospital in Newark

Elected officials and labor leaders are worried that changes underway within Rutgers University’s health care programs will harm University Hospital in Newark and undermine historic agreements designed to protect the public health of city residents.

Their concerns are outlined in a trio of letters to the university president and New Jersey Gov. Phil Murphy — obtained by NJ Spotlight — that suggest Rutgers’ partnership with a massive private hospital system and efforts to reorganize its two medical schools will drain staff and other resources from the urban hospital, which serves many vulnerable patients in Newark and functions as the state’s only public acute-care facility.

These shifts could impact millions of dollars in taxpayer spending and they are taking place without sufficient public and stakeholder input, the letters argue. Sen. Ron Rice (D-Essex) sent one of the letters on behalf of members of the New Jersey Legislative Black Caucus. The others came from two health care unions, the Health Professionals and Allied Employees and the Communications Workers of America Local 1031.

“We need transparency. And we’re going to insist on that,” Rice said. In his July 13 letter to Rutgers president Jonathan Holloway, Rice pledged to hold public hearings, pass legislation or “engage regulatory agencies” if University Hospital is not protected from these changes or given a prominent seat at the negotiating table.

The unions, HPAE and CWA, wrote to Murphy on July 20, outlining their opposition to the changes and requesting that he intervene to restrict Rutgers from making unilateral changes. “Protecting public health care must be a top priority for New Jersey, which has become even more evident during the COVID-19 pandemic outbreak,” wrote HPAE president Debbie White, a nurse.

Rutgers officials insist that University Hospital and public health in Newark remain priorities for the university as it evolves. There has been no decision on a proposal to merge aspects of its two medical schools, with campuses in Newark and New Brunswick, they said, and the arrangement with RWJBarnabas Health — one of the state’s largest health care and hospital systems — is designed to create a higher quality, more sustainable health care system throughout northern and central New Jersey.

Rutgers ‘fully committed’ to hospital and Newark

“University Hospital plays an integral role for the people of Newark and Essex County, one that Rutgers strongly supports and will continue to fully support. Indeed, it is our physicians who served as the doctors providing the treatment at University Hospital during the COVID-19 crisis,” said Neal Buccino, associate director of media relations for Rutgers University. “Rutgers is and remains fully committed to University Hospital and Newark, and no future organizational changes, should they occur, will change that.”

The governor’s office said it would not comment on the letters nor the issues at this time. University Hospital president and CEO Dr. Shereef Elnahal, the former state health commissioner, also declined to comment. The authors of the letters said they have not received responses.

Rutgers Biomedical and Health Sciences Chancellor Dr. Brian Strom

The concerns raised in the correspondence — which the authors said reflect broader community fears — have emerged in recent years as leaders at Rutgers Biomedical and Health Sciences, an umbrella entity that includes the medical schools, nursing, pharmacy and other health-related colleges, have sought to expand the capacity and prominence of its programs. Chancellor Brian Strom, who was hired to oversee RBHS in 2013, has said his goal is to create a modern system of medical education and a more robust research program that can raise Rutgers’ profile nationwide.

But some elements of Strom’s vision have sparked controversy, including his proposal to further combine the Robert Wood Johnson Medical School in New Brunswick with the New Jersey Medical School in Newark. While the separate programs have become more aligned in recent years, Strom believes a single accredited institution — stretched over two urban campuses — would be better for students and attract more research dollars. The Rutgers University Senate, which received his plan in February, has yet to take action, officials said.

Credit: NJTV News
Sen. Ron Rice

Rice and the labor unions fear changes to Rutgers’ medical education system would diminish the ability of the medical school in Newark to serve that city’s community, a responsibility enshrined in the so-called Newark Accords, a 1968 agreement and corresponding city council resolution that require the school to operate what is now called University Hospital, provide community health services, opportunities for local residents and more.

The accords were signed in the wake of the Newark uprising in 1967, which was sparked in part by community relocations prompted by the development of the medical school campus; elements of these pledges were reiterated in 2013 when the school’s successor, the former University of Medicine and Dentistry of New Jersey, was dissolved to create the current system. While the names and some operational aspects have changed, University Hospital remains closely aligned with the medical school that shares its downtown campus, and all the hospital’s 300-plus physicians are members of NJMS’ faculty practice.

“We will not stand by and allow a takeover facilitated by Rutgers University that violates the Newark Accords and place the needs of the community of Newark and the greater Essex County region at risk of losing resources and services that will only lead to greater healthcare disparities,” HPAE’s White said in her letter to the governor.

Need for legislative review?

In addition, the letters from the unions argued that drastic changes to the Rutgers medical education system require legislative or regulatory review. “Without transparency and public discussion, it is impossible to know how each medical school will receive the proper amount of support,” wrote CWA president John Rose.

Buccino, with Rutgers, suggested the concerns stemmed in part from misinformation about the changes. “While Rutgers is still in the middle of considering possibilities for the future of its medical schools, any future path will ensure the continuation of each school’s vital commitment to serving the public health needs of the communities in which they are embedded,” he said.

The stakeholders are also worried about Rutgers’ arrangement with RWJBarnabas, which was launched in 2017 and could stretch 30 years. Under the deal — elements of which remain to be signed — RWJBarnabas provided $100 million upfront and will contribute as much as $50 million more each year to support Rutgers’ efforts to recruit and outfit top scientists, expand academic opportunities and encourage medical graduates to remain in New Jersey. RWJBarnabas will also oversee all of Rutgers clinical practices, taking on the costs and revenue streams associated with these operations.

In addition to what they see as a lack of transparency around the process, Rice and the unions fear the RWJBarnabas partnership will divert money, clinical staff and other resources from University Hospital to facilities owned by RWJBarnabas. The system runs several hospitals nearby, including Newark Beth Israel Medical Center, just three miles from UH; many of its other facilities are in suburban areas that tend to generate more lucrative reimbursements, compared with urban hospitals that care for high numbers of patients on Medicaid.

Rice: ‘We know what this means for Newark’

Rice said this partnership will undermine the state support for University Hospital, via the Newark medical school, enshrined in the accords. “We know what this (private partnership) means for Newark. It means physicians, employees, and services being downsized at University Hospital, or services closing,” he wrote.

Previous concerns about a reduction in maternity care services at University Hospital in 2018 led Murphy to appoint a monitor; he and then-health commissioner Elnahal selected Judy Persichilli, who would later replace Elnahal in the DOH when he took the job at the Newark hospital in 2019.

RWJBarnabas officials insist the partnership is not an opportunity to divert resources from urban facilities; they say that, in fact, the agreement calls for the hospital system to provide Rutgers with additional payments if RWJBarnabas achieves certain profits across its network of providers.

“RWJBarnabas Health respects and is sensitive to the unique histories of the medical schools, University Hospital and the City of Newark, and always seeks to demonstrate that respect. We are excited about the opportunities for enhancing the health of all New Jersey residents with our plans, and nothing within RWJBH’s relationship with Rutgers University negates either the terms or the spirit of the Newark Agreements,” a spokesperson for RWJBarnabas Health said.