From today's Washington Post:
http://www.washingtonpost.com/wp-dyn/content/article/2009/02/22/AR2009022202031.html
Medical School's Problems Were Worse Than Described
GWU Blamed Probation on Superficial Reasons
When the medical school at George Washington University was put on academic probation last fall, school officials said the reasons were mostly superficial matters, such as problems with administrative paperwork and student complaints about a shortage of lounge space.
In fact, according to interviews and documents obtained by The Washington Post, the school had deficiencies that were considerably more serious.
According to a confidential evaluation document and interviews, GWU has done an inadequate job of monitoring students' time with patients and ensuring that those clinical experiences relate to classroom learning. Student debt levels are among the highest in the country, according to the seven-page letter sent by the accrediting agency in June and later obtained by The Post. Students complained of mistreatment. Problems flagged as long ago as 2001 still had not been addressed when the school was put on probation.
The George Washington University School of Medicine and Health Sciences is the only one of 129 medical schools in the United States on academic probation. In the past 15 years, only five schools, including GWU's, have been singled out for problems that the country's medical school accrediting agency concluded "seriously compromised the quality of the medical education program."
Although it was not a factor in the decision to place GWU's medical school on probation, many people interviewed for this article also pointed to what they consider a potentially serious conflict of interest involving its top official. They said the conflict provided an incentive to keep the institution's focus on improving its hospital's bottom line rather than investing in medical education, research and training.
Since 1999, John F. Williams, GWU's provost and vice president for health affairs, also has received money and stock options for serving on the board of directors of Universal Health Services, which owns the university hospital.
Williams was paid nearly $680,000 in annual compensation by GWU, according to the university's 2006 tax returns, its most recent, and UHS reported in Securities and Exchange Commission filings that he received compensation from the company that calendar year of $122,000, including stock options.
Because he has a stake in the company's profitability, some at the school complained that Williams had no incentive to push for spending on new equipment and programs at the school. Others said it was not appropriate for Williams to be paid so well when the tax-exempt school is one of the most expensive in the country.
GWU leaders asked Williams to resign from the corporation board and this month accepted his resignation, effective by the end of the academic year. They said his position at both institutions could create the appearance of a conflict of interest.
"No information emerged to indicate an actual conflict of interest," the university said in a statement.
"It's surprising that this relationship went on for many years," Sen. Charles Grassley (R-Iowa), ranking member of the Senate Finance Committee, which has scrutinized salaries at nonprofit organizations like the medical school recently, said in a statement. Officials at nonprofit agencies are responsible for ensuring that their assets are used for the public good, while company leaders must maximize profit, he said. "It would be very hard for one person to wear both hats and fairly serve both interests."
Williams's supporters praise his skill as a doctor and his dedication to the program. "He's an alumnus of this medical school, and he's been supportive of me and this medical school and the students," said James L. Scott, the medical school dean. Williams declined to comment, as did GWU President Steven Knapp, who took office in August 2007.
Founded in 1825, GWU's medical school is one of the oldest in the country. Former president Ronald Reagan and other leaders have been treated at the hospital, just blocks from the White House. The school has enjoyed a solid reputation for teaching its approximately 700 students, garnering praise for its variety of clinical opportunities and pass rates on national exams that are equal to or higher than U.S. averages.
But unlike most medical schools, which receive state support, GWU gets nothing from the District of Columbia. Nor does it bring in a lot of grant money. It ranks near the bottom on a list of National Institutes of Health research award dollars, for example.
"It's very difficult for medical schools to make it on their own," said John Kastor, a professor at the University of Maryland School of Medicine who recently wrote a book about GWU's and Georgetown University's medical schools. "They basically need their teaching hospital" to help fund them, he said.
In the 1990s, GWU's hospital was losing so much money it was starting to eat into the school's relatively small endowment, in part because the patient population includes many uninsured District residents.
In 1997, the for-profit Universal Health Services bought the hospital. GWU retains a 20 percent stake, and for years now, the hospital has been making money. UHS replaced the worn-out old building, and several students and professors said they are very pleased with the clinical learning area at the new hospital.
It is rare for a teaching hospital to be run by a for-profit company; there are only a handful of such arrangements in the United States. Because medical schools exist to educate doctors and treat patients, money from teaching hospitals is typically used to improve education and care rather than given to shareholders.
Some faculty members said the deal was a smart business decision for GWU and the hospital but bad for the medical school.
But former GWU president Stephen Trachtenberg, who pushed to sell the hospital, said the school had no other options at that point. "If we hadn't worked something out . . . at some point the medical school would have turned into a black hole and sucked in all the resources of the university," he said.
GWU officials said that students receive an outstanding education and that their test scores and placements prove it. They declined to release documents from the accreditors but contended that the deficiencies cited in them could be corrected easily and that some already have been. They noted that the accrediting agency, the American Medical Association and Association of American Medical College's Liaison Committee on Medical Education, already has endorsed their corrective plan.
No one believes the probation means students are leaving GWU unqualified to care for patients. But the letter that lays out accreditors' concerns, and interviews with faculty, trustees and others, depict a school leadership that has overlooked too many details of the educational program for too long and that isn't in total control of students' clinical training.
The committee's standards are meant to ensure that the administration knows that doctors are teaching students what they need to know; that the clinical experiences align with material taught in the classroom; and that students receive comparable training at all sites, among other factors.
The committee cited inconsistent oversight of the clinical experiences in its letter to school officials. Not all the doctors who supervised students at another hospital had faculty appointments at GWU, so there was no guarantee they were reinforcing what students had learned in class. The committee noted pressure to see patients might affect the time doctors have for teaching and research.
Problems were allowed to linger. The accrediting committee noted in June, as it had in 2001, that the school still didn't have a system for monitoring student achievement and hadn't reviewed the curriculum to avoid gaps or redundancies.
Students complained of mistreatment at higher-than-average rates, according to the letter. Nationally, about 17 percent of students surveyed say they have experienced mistreatment, primarily belittlement and humiliation.
Accreditors noted a potential conflict at GWU because the ombudsman who handled student complaints also led the committee that evaluated students.
Scott, the medical school's dean, noted, however, that "there were only positives about the outcomes of the curriculum, the quality of the students, the residency matching rates, the board passage rates."
The committee praised the school for its diverse student body and patient population, which offered a wide range of clinical experiences for students.
GWU remains fully accredited while on probation. It has until October 2010 to regain compliance. Losing accreditation -- which is highly unlikely -- would effectively kill the school.
Some students are worried about getting medical residencies, and applicants have asked professors about whether they will receive a flawed education. But many students still want to go to GWU: The school has more applicants this year than last.
"I think students get an excellent education at GW," said Jordan Cohen, professor of medicine and public health.
"The decision on probation status is going to be resolved," Scott said, "and in the end we'll be the same medical school -- but better than we've been."
