Harbor-UCLA Family-Care Facility : Controversy Over Director Plagues Clinic

The Harbor-UCLA Family Health Clinic, which survived a brush with death three years ago and continues to provide low-cost medical care for thousands of poor and elderly people, is having a relapse.

The clinic, whose staff is made up of 15 physicians in a UCLA family-medicine residency training program, was notified in June that the program’s chairman will be replaced. The chairman, Dr. Fred Matthies, also heads the clinic.

Dr. Kenneth Shine, who recently became dean of the UCLA Medical School, said Matthies lacks administrative skills and has alienated colleagues at UCLA. Shine also said the personnel change is an effort to strengthen the program, which is on probation with an accreditation panel.

Split Time

Dr. James Puffer, chairman of the family medicine division at the medical school’s Westwood facility, would replace Matthies, splitting his time between the two programs. Under that plan, Matthies would become acting associate to Puffer.

But faculty doctors at the clinic say that the proposed replacement is in retaliation for Matthies’ successful fight last year to save the residency program after it was ordered terminated as a cost-cutting move by the medical director of the Los Angeles County Harbor-UCLA Medical Center.

Matthies, 59, declined to comment on the matter, but associates say he is deeply disturbed by the proposed change.

Harbor-UCLA, on Carson Street just west of the Harbor Freeway near Torrance, is a county-run hospital that UCLA uses as a teaching facility. For the most part, the county pays the salaries of the UCLA teachers and resident doctors at the hospital and clinic.

First Step

The faculty doctors at the family health clinic said they fear that a change in leadership could be the first step toward elimination of the program and the clinic’s closure.

Patients at the clinic, about 90% of whom are on Medi-Cal or Medicare or pay reduced fees based on income, said that if the clinic closes they will have to return to what they called impersonal care and the long lines at the huge county hospital across the street.

Earlier this month, the county Board of Supervisors ordered a study of the effects that the proposed change would have on the clinic. The action delayed the change for at least 60 days, when a report is expected.

The dispute is the latest in a series of struggles to keep the 16-year-old family-medicine residency program alive at Harbor-UCLA. The university has similar programs in Westwood, Santa Monica, Northridge and Ventura.

Family medicine, a three-year program that trains doctors in general medicine, pediatrics, obstetrics, cardiology, psychiatry and other specialties, has been controversial in the medical profession because one of its aims is to lessen the need for treatment by specialists.

Doctors of family medicine, who say they can treat more than 90% of a family’s medical problems, also consider a patient’s home and work environment when determining diagnosis and treatment.

Family medicine physicians say they often are snubbed in academic environments because they are not specialists and are not involved in research.

From 1970 to 1982, the Harbor-UCLA clinic was moved from one location to another on the hospital grounds, including bungalows and a former dental office. The faculty doctors finally formed a nonprofit organization to establish a permanent facility in a small shopping center across the street from the medical center.

The facility, which is operated by a board of directors, pays its support staff and buys its own equipment with patient fees and state aid.

Budget Cut Ordered

Doctors’ salaries were paid entirely by the county until 1981, when the supervisors ordered a 10% budget cut, and county and university officials decided to eliminate the family medicine program at Harbor-UCLA. But UCLA had a change of heart and agreed to pay the salaries of the program’s three faculty doctors, and the county agreed to pay its residents.

Two years later, the clinic was in danger again when UCLA said it could no longer afford to pay the faculty salaries, and the medical center said the residency program would have to become self-supporting to continue.

The doctors at the clinic organized patients and other doctors to protest the closure, and received a $125,000 grant from the state and about $20,000 in private donations and equipment to support the program.

UCLA agreed to make up the balance of salary costs, but hospital officials said not enough long-term financing had been arranged and the clinic would have to close. Most of the family medicine residents were told they would have to choose among more specialized departments.

Overturned Decision

But six months later, after the county supervisors ordered an investigation into the matter, the county Department of Health Services overturned the decision, saying the clinic had enough financing to continue.

Since then, the clinic has been able to add a satellite facility at St. Mary Medical Center in Long Beach with three additional resident doctors.

Matthies’ leadership abilities were first questioned in a 1984 academic review that had been ordered by the county as a condition for keeping the program alive. The review was conducted by a committee of independent doctors selected by the county health department.

While noting that Matthies had shown “remarkable resilience and resourcefulness in the face of adversity,� and that the program had improved considerably since his arrival in 1979, the committee also said his leadership role had suffered in “equanimity, teaching effectiveness, and relationships with colleagues in other clinical departments.� It said Matthies might be suffering from “battle fatigue.�

In October, 1985, the Accreditation Council for Graduate Medical Education in Chicago notified the clinic that the program’s accreditation was being put on probation.

Financial Instability

The Residency Review Committee for Family Practice found 10 problems with the family medicine program, including a lack of institutional support from both the hospital and UCLA, resulting in financial instability and an unsatisfactory educational environment. It also complained that the clinic’s faculty does not have staff privileges at Harbor-UCLA Medical Center under a policy that limits such privileges to faculty working at the hospital.

The program was reviewed again in May of this year. The findings, not yet released, will be reviewed in October by the accreditation committee, which will announce a final decision at the end of October. The program could regain its accreditation, lose it as of July 1, 1988, or remain on probation for another year, according to Dr. John C. Gienapp, executive secretary of the Accreditation Council.

If the clinic loses its accreditation, Gienapp said, it probably would not be able to attract any resident doctors, which would probably force it to close.

A separate review of the program in April by the Residency Assistance Program of the American Academy of Family Physicians noted that the clinic’s faculty was impressed with Matthies’ management and administrative skills, particularly under “extremely unfavorable circumstances.� The reviewer also noted that Matthies has had difficulty with doctors in other specialties and administrators at Harbor-UCLA Medical Center, but said “this has been caused by (him) obtaining support from external sources for the program when its demise appeared imminent.�

Prompted Decision

Dean Shine said it was those reports that prompted his decision to replace Matthies.

“The school of medicine is absolutely committed to making the family medicine program strong and stabilized,� Shine said in a recent interview. “It is true that there have been problems with support from the hospital, but it is my belief that if the organization of the program is appropriately changed so that we have a high-quality program, we can resolve all concerns.

“Although it has been suggested that this is some kind of action primarily against certain faculty members, this is an attempt to try to strengthen a program and put it in a situation with strong academic leadership.�

But faculty members at the clinic say Matthies is a victim of circumstances who is being punished for fighting to keep the program alive at Harbor-UCLA.

“When the university changed family medicine from its own department to a division of internal medicine, that put us in direct competition for funds and residents,� said Dr. Robert Avina, a faculty member at the clinic for five years, adding that the internal medicine department got no additional funds when it took over family medicine. “Of course other doctors are complaining about Fred because we’re now their competition.�

Another member of the clinic faculty, Dr. Douglas Peterson, past president of the Harbor-UCLA program’s alumni association, has been involved in getting his colleagues to support it.

Not Brought Up

Peterson said that clinic, UCLA and the medical center officials had reached a series of agreements last November to stabilize the program. He said Matthies’ qualifications to run the clinic were never brought up.

“There is no documentation of due process,� Peterson said. “I’m hopeful that the explanation for the change will come out of the county investigation.�

The third faculty member, Daniel Castro, who joined the clinic only last year, said he too would like to see Matthies stay.

The alumni group’s current president, Dr. Teresa Nakashima, said the group is again rallying behind Matthies.

“Everyone is behind Fred,� said Nakashima, who is now in private practice with the Redondo Beach Medical Group, a partnership of physicians.

“The people that are coming out of the program are of high quality. Last year and this year, we have hired graduates of the program.

“To have developed the clinic from nothing, Fred had to have had strong organization skills.�

Rejected Conclusions

The clinic’s board of directors has sent a letter to Shine saying it rejected his conclusions about Matthies and asking for further documentation and a meeting.