National report urges probation of med school

By Beverly Creamer
Advertiser Education Writer

The national body that accredits medical schools has recommended that the University of Hawai'i medical school be placed on probation, citing key points of concern, including "serious underfunding from limited revenue sources" and a loss of faculty in the basic science departments.

Edwin Cadman, dean of the University of Hawai'i's medical school, said there is still a lengthy appeal ahead before the school loses its accreditation. Jeff Widener • The Honolulu Advertiser

The medical school's dean, Edwin Cadman, was highly critical of the findings, saying it was like "being hit upside the head with a 2-by-4."

A recommendation for probation is not final until after a lengthy appeal process.

"If you appeal," said Cadman, "the school will continue to be fully accredited without being on probation."

Only if the appeal fails, he said, does probation take effect. In such a case, the school would have two years to correct all deficiencies before being faced with the immediate threat of loss of accreditation.

Cadman said the committee has never removed a school's accreditation.

The Liaison Committee on Medical Education, which accredits all of the nation's 125 medical schools, cited several areas of "serious and long-standing" concern dating to 1995, with heavy emphasis on the financial underpinnings of the school.

In response, Cadman cites major advances in the last two years, including action by the Legislature to authorize a $150 million medical school complex in Kaka'ako; a doubling of research money, from $25 million to $50 million; and $1 million in renovations to existing research space that will now speed faculty recruitment.

Paul Costello, UH vice president for external affairs, called the letter "the Sleepy Hollow Report."

"They've awakened to systemic problems from the '90s that have been or are being addressed (under the new leadership at UH and in the medical school)," he said.

"When you look at the $150 million for the medical school, the funding and support is certainly there," said Costello.

But Costello also sees the stern letter as a political move by the committee to serve notice that it recognizes a new leadership team is now in place and that it expects additional improvement.

The action comes in the wake of three years of warnings — in 1997, 1998, and 1999 — that the school needed to address its financial security, financial support of the medical library, and faculty attrition, among other things.

At that time there were also major concerns about the school's interim leadership, a concern that ended with Cadman's recruitment from Yale-New Haven Hospital in Connecticut.

Cadman has already launched an appeal that will be heard in October, just about the time the university breaks ground in Kaka'ako for the first phase of the new Health and Wellness Center, which will incorporate the Medical School and the Cancer Research Center of Hawai'i.

"I was working feverishly to not have this happen," said Cadman, who is confident the appeal will be successful. "It's the most cruel thing to do to the university, the state, the faculty and students. We're much better than we were two years ago.

"This is not about our training of medical students or faculty quality or the product we're turning out. This has everything to do with their perception that the state has not done enough over the last seven years. But while the Mainland has been economically vibrant, Hawai'i has been suffering."

U.B.S./Paine Webber, the University's bond counsel, told UH officials that this action will have no effect on the university's bond rating. Bonds go on sale in July to pay for the new med school complex.

Cadman also said he didn't expect the action to affect recruitment and new enrollment. "We've accepted about 80 percent of our class and the additional acceptances will go out in two weeks."

He met with students and faculty yesterday afternoon to apprise them of the situation.

The committee listed these other concerns:

• "Operating deficits occurred for the 1989-99 and 2000-01 fiscal years" and this "continues to threaten the ability of the school to fulfill its educational and other missions."
• Faculty in basic sciences dropped from 55 in 1995 to a low of 37 in 1999 and stands at 48 today.
• Cuts in money intended for the Hawai'i Medical Library have meant a 50 percent reduction in journal acquisitions and a 75 percent reduction in book purchases.
• There should be a system to make disability insurance available.
• Comprehensive review of the curriculum does not yet exist, and there has been no in-depth evaluation of the third and fourth years.
• There is a lack of "outcome data" on the school's graduates to assess program effectiveness.

Cadman said the medical school does conduct an extensive evaluation of students and programs annually, and tracks all of its students who typically receive residencies at the nation's best hospitals.

He also said that with another $1 million in renovations coming to existing research space, recruiting should go ahead at a rate of six new positions a year for five years — with the aim of adding 15 faculty members to teach basic sciences. Only four new faculty positions have been filled over the past two years because of space problems, he said.

The committee also cites a number of strengths, including:

• The leadership and vision of the new dean and university president.
• The school's dedication to improving the quality of health care in Hawai'i and the Pacific.
• he enthusiasm and commitment of a culturally diverse student body.
• The full-time, part-time and volunteer faculty.

And the committee recognized that coming changes, including the Health and Wellness Center in Kaka'ako, have "the potential to be of significant benefit to the school and to provide economic stimulation to the area." The committee also praised Cadman's proposal to add clinical departments in geriatric medicine, Native Hawaiian health and alternative medicine.

Reach Bev Creamer at bcreamer@honoluluadvertiser.com or 525-8013.