Some of the world's most respected medical specialists work at the UCLA Medical Center. Or at least they used to.

High-profile specialists are fleeing UCLA in favor of fee-for-service hospitals that have promised them state-of-the-art equipment and higher pay.

These physicians, some world-renowned in their fields, say UCLA has made a push to sign more contracts with health maintenance organizations, which means the hospital has been forced to drastically trim costs and cut back on the support given to many specialists' research projects.

"Two or three years ago, UCLA made a conscious effort to get into the managed care medicine game. To be honest, no one goes into managed care to improve the quality of care but to make more money. And the only way you can do that is to cut services," said Dr. Rick Delamarter, an orthopedic surgeon who left UCLA six months ago after 13 years with the institution.

Delamarter is one of a handful of key specialists who have abandoned UCLA. They include world-renowned neurosurgeon Keith Black, urologist Gerhard Fuchs and orthopedic surgeon Matthew Shapiro.

Delamarter was one of UCLA's busiest surgeons. As co-founder of UCLA's Comprehensive Spine Center, he performed 400 to 500 surgeries a year, treating professional athletes and international government leaders. He declined to identify patients by name, but said they have included members of the Oakland Raiders, Denver Broncos, Miami Dolphins, Olympic gold medalists, and heads of state from Canada, France and Saudi Arabia.

The orthopedic surgeon said he decided to leave the renowned medical facility in Westwood because he felt the quality of patient care had declined and that the medical center was no longer interested in buying expensive state-of-the art equipment.

When Delamarter left to set up the Spine Institute at St. John's Health Center in Santa Monica, he took two other spine surgeons with him.

"When you get into a subspecialty and develop an international reputation, 30 to 40 percent of your patients come from out of state or out of the country. They expect a certain level of care," Delamarter said. "With all the cutbacks that UCLA has had to do, they were not able to deliver that quality of care.

"They were not able to support my research programs in a similar way," he added. "I have a busy research lab that is doing cutting-edge things on spinal cord regeneration. The university had a philosophical change (about research) with this whole managed care thing to cut costs."

An exodus of specialists

While officials at UCLA Medical Center don't deny they have cut costs by reducing nursing and administrative personnel, they say they are no different from the hundreds of other California hospitals that have been dealing with the same problem.

Eighty percent of all Californians with health coverage belong to health maintenance organizations. HMOs are renowned for holding down costs and paying low reimbursement rates to medical centers.

"What is happening at UCLA is being mirrored all over California," said Dr. Marie Kuffner, president of the California Medical Association and an anesthesiologist at UCLA Medical Center.

Other local hospitals, such as Childrens Hospital Los Angeles, are also having problems keeping specialists, who move out of state or are lured away by medical facilities that de-emphasize HMO contracts in favor of fee-for-service medicine, Kuffner said. When patients pay their own way, physicians nearly always make more money than they would from HMOs.

Last summer there were 26 full-time surgeons at Childrens Hospital in Los Angeles. In the past year, seven have left, five of them moving to facilities out of state where HMOs are less prevalent. Low reimbursement rates were cited as one of the reasons for the departures.

One medical center's loss is another's gain. In Orange County, the University of California at Irvine Medical Center is making a conscious effort to shed many of its HMO contracts while recruiting more specialists in a county where affluent residents want better health care and are willing to pay for it, said hospital spokeswoman Kim Pine.

While some hospitals are dropping HMO contracts, UCLA Medical Center is pursuing them, executives at the medical center said.

But that does not mean that patient care or the facility's commitment to research has diminished, insisted Dr. Michael Karpf, chief executive at UCLA Medical Center.

"Like every other hospital in California, we have had to go through cost reductions over the last 10 years," Karpf said. "The cost reductions have been substantial in the last two years because of the federal Balanced Budget Act in 1997 that decreased reimbursement in Medicare. We are trying to make it work and keep up the quality of our care."

Focus on research

Not only is research as important as ever at UCLA, it is more prevalent, he said. He noted that funding from the National Institutes of Health has increased over the past five years, totaling $248.5 million in fiscal 1998-99, up from $205.5 million four years earlier.

"We have not diminished the scope of our research in any shape or form," Karpf said, noting that the medical facility has a recent Nobel Prize winner on board and was ranked by U.S. News & World Report as one of the top five hospitals in the country.

But that is little comfort for specialists like Dr. Gerhard Fuchs, a highly respected urologist who left UCLA Medical Center early this year after 15 years at the facility. He relocated his Endourology Institute to Cedars-Sinai Medical Center in January.

"I didn't want to leave," Fuchs said. "But it is painful to see that the house you are living in is falling apart, and there is nothing you can do even though you are working 80 to 100 hours a week."

Fuchs said he encountered constant delays in getting patients scheduled into operating rooms due to cutbacks in nursing staff and administrative personnel. He also felt he wasn't getting the support he needed for his research into endoscopic and laproscopic surgery, minimally invasive procedures he is pioneering.

"This program did not get the attention it needed at UCLA," said Fuchs, who last year was the first UCLA urologist to perform a laproscopic kidney transfer operation, a delicate procedure that reduces a patient's recovery time.

Fuchs followed a trail already blazed by Dr. Keith Black, one of UCLA's star neurosurgeons and researchers who has been on the cover of Time magazine and profiled by CNN for his contributions to health care.

Black left in 1997, after 10 years at UCLA Medical Center, to set up a new multimillion-dollar neurosurgical institute at Cedars-Sinai specializing in brain cancer. He brought with him two brain researchers, a neuro-oncologist, a gene therapy specialist and about 10 support staff members.

Offer he couldn't refuse

Black at the time said he could not resist Cedars' offer to invest tens of millions of dollars in the new institute, including a 21st century operating room.

Recently, Black was awarded a $2.8 million grant from the National Institute of Neurological Disorders and Stroke, a branch of the National Institutes of Health. The grant will help Black and his support staff further study the biologic mechanism that has thwarted doctors' efforts to effectively treat brain cancers with chemotherapy.

Black said he left UCLA Medical Center with no hard feelings, but felt he could do more at Cedars-Sinai, where he and his colleagues in the past two years have been working on a vaccine to treat brain tumors.

"UCLA is a great research institution," he said. "But I think Cedars is a very special place. It has provided me the opportunity to translate the discoveries we are making in the laboratory into new treatments for patients."

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