November 17, 1999

Ad Hoc Survey Team, 

Liaison Committee on Medical Education

Myron Genel, MD (Chair)

Frank A. Simon, MD (Secretary)

Linda H. Distelhorst, MD (Member)

Dear Survey Team Members:

With regards to the Medical Faculty Assembly (MFA), we understand that you requested information and documentation regarding these two issues:

1.The role of the MFA in the governance of the medical school.

The MFA consists of representatives elected by faculty by a secret ballot.It meets once every month. Its meetings are open, and the minutes are posted promptly on-line.The Governance Document of the School calls on the MFA to address issues directly related to faculty status, responsibilities, and welfare within the School of Medicine.In discharging its functions, the Medical Faculty Assembly serves as a fact-finding, deliberative and consultative body with the authority to make studies, reports and recommendations on all matters that have a significant bearing on the work or status of the faculty. The Medical Faculty Assembly is to discuss and debate current issues and matters of interest to the faculty and may advise the Dean and the Executive Council on academic and faculty status matters.Documentation regarding MFA activities can be accessed on-line from:

http://www.usc.edu/schools/medicine/faculty/mfa/index.html

2.Issues that concerned the MFA during 1999.

• Facilitating democratic faculty input into school governance.

The free flow of information improves democratic processes.The MFA, with help from the Administration, created a set of email listservers that facilitates communication.In addition to its own messages, the MFA frequently broadcasts messages for the Administration.However, the MFA has insufficient resources to:

• Ensure that its email lists are accurate and complete.
• Properly archive its documents and post them on-line.
• Independently and reliably identify full-time faculty members and ensure they can vote in elections for MFA representatives.

Discussions with the Dean have pointed out the need for resources, and the Governance Document calls for support of the MFA.However, the problem remains unsolved.

•  The renewal of the CPSA.

The County Professional Services Agreement (CPSA) is the contractual agreement between the County of Los Angeles and the University of Southern California that describes how the County pays USC to provide physician services at the Los Angeles County - USC (LAC+USC) Medical Center. The County is hospital is the primary location for training USC medical students, residents and for clinical research. The contract year runs from July 1 to June 30. Including an initial trial period, during which physicians-in-training (house-officers) were also included in the contract, the agreement has been in place for 12 years. Since 1997 it has been renewed annually, often at the eleventh hour, as there has been no success in negotiating a new contract.

On June 28, 1996, the USC administration sent letters to some 29 long-time clinical USC faculty who worked primarily at the County hospital, informing them that their positions had been designated for potential reassignment away from the County Hospital due to cuts in funds received by USC under the CPSA. This group of faculty included both tenured and non-tenure track faculty associated with USC and the County Hospital for more than ten years. The letter to the non-tenured faculty informed them that the faculty contract defining their faculty appointment at USC would not be renewed. In effect, this letter terminated the faculty member from USC, with no mention of what USC would do if the County restored funding.

Since that time, USC has continued to negotiate with the County of Los Angeles towards a new CPSA. The negotiations continue without any broad input by Faculty and remain stalled. In June 1999, documents sent to the LAC Board of Supervisors stated that: "The issue that led the University to determine it would be better suited to pursue an affiliation agreement for only academic services was the issue of faculty participation in research under the agreement. It was never the County's intent to reimburse the University for physician time devoted to research. An analysis performed by DHS finance staff of the information provided by USC indicated that some $6 million was being spent for physician time involved in clinical and other research. The University has provided the Department with information that indicates a more thorough investigation of this matter is required. Pending completion of this review, these funds will remain in the agreement as part of the contract obligation. However, the amendment provides that if the County should confirm that physician time is being spent on research activities, the contract amount may be reducedaccordingly."

This uncertainty about salaries, coupled with a move by the County to stop payment for Fellows in training and to (at least) discourage research led to a vote by LA County Physicians to form a Union. The UAPD was certified as the bargaining unit for physicians’ salaries and benefits in July 1999.While many USC employed physicians are not eligible for representation by the UAPD, the absence of a CPSA between USC and LAC and that fact that the UAPD will now lead negotiations for physicians working at the County, without much input from USC, profoundly affects the Faculty and their ability to concentrate on their academic mission.

• Obtaining School budget information.

Budgets affect faculty work and status.The MFA recommended to the Dean that the Dean provide a consolidated budget document to the Finance Committee and the MFA each year, so that he might be better advised.The Dean agreed and provided the document for the 1998-99 year.

• Representation on the Educational Policy Committee (EPC) and payment of stipends.

During 1999, the MFA discussed with the Administration the provision in the new Governance Document that states that the appointment of the departmental representative to the EPC "shall normally be in accord with the recommendation of departmental faculty."Concerns were expressed that this policy has not been followed.The MFA suggested the MFA Executive Board bring recommendations back to the MFA regarding implementation of that statement.The MFA also discussed whether there should be a policy regarding payment of stipends for service on the EPC.The Governance Document is silent on this issue.No formal action has been taken on either issue by the MFA.

• The use of overload budgeting to compensate faculty.

In October, 1999, the Administration proposed to make additional payments to faculty using formulae based in part on the number of hours of contact with Year 1 students, and the results of Year 1 student votes regarding professors.The MFA considered evidence that this plan violated University policy regarding compensation of tenured faculty with 12-month appointments, and voted to recommend the funds be banked until other proposals could be considered.A plan based on similar principles was proposed in 1995to substitute for the superseded contracts of the basic science faculty.Efforts underway at that time to thoroughly revise the curriculum then ceased.

• The Faculty Contract, economic security of faculty, stability of the School’s educational activities, and the protection of academic freedom.

The Faculty Contract helps define the economic security of faculty.Economic security for faculty is needed to maintain a stable educational institution.The economic security of tenure is the foundation on which academic freedom rests.The Faculty Contract issued to tenured faculty states:

• The University agrees that this contract shall be renewed annually.
• Faculty member and University agree that this contract may be altered, amended, or changed only by a written agreement between the faculty member and the University.

In 1999, members of the MFA became concerned that the University is breaching the Faculty Contract of tenured faculty.In March 1999, tenured faculty in clinical departments in the medical school received contract documents altered so that the source of their salaries was termed "external funding."The contract documents stated that "the University's guarantee of the external funding portion of the Faculty Member's compensation is contingent upon the availability of such funds from the external funding source(s)."

These changes concerned members of the MFA because the language gutted the economic security that protects academic freedom, and the documents resembled those that triggered the litigation by tenured basic science faculty.They were further troubled by:

• The apparent lack of concern of the School’s Executive Council when informed of these events.
• The apparent belief of the Provost that the issuance of these contract documents was “based on the best information available.”

In June 1999, the MFA discussed evidence that candidates for faculty positions labeled "tenured" or "tenure-track" were sent offer letters stating:"By signing below, you acknowledge that, whether or not you are tenured, your salary could go up, go down, or stay the same as the result of annual merit and budget review processes."These events troubled the MFA, because the terms of Faculty Contracts have in the past been agreed to by the Academic Senate (composed of faculty elected from all schools in the university), and these terms were never considered by the Senate.

In September, 1999, the MFA received evidence that the above text was removed from offer letters, suggesting that the new letters might be failing to fully disclose terms of employment.This event troubled the MFA, because, in 1998, a jury found USC officials made false promises to lure a candidate to accept a chairmanship in the School of Medicine.

On November 13, 1999, many of the basic science faculty who were part of the settled lawsuit received faculty contracts.It appears that no other faculty in the School received contracts.If this appearance is true, then it is likely that differential treatment of faculty with regards to contracts will be a concern of the MFA.

• The Faculty Handbook.

The Faculty Handbook contains rules and procedures that govern the faculty of the University.

In January 1999, after the Academic Senate approved a revised faculty handbook, the Administration posted online a document labeled as the faculty handbook that contained language never considered or approved by the Academic Senate.Some of the language can be construed as asserting that the handbook can be superseded by amending other university documents rather than only by a joint agreement including the Academic Senate.To many MFA members, the insertion of this text, without the consent of the Senate, represents a breach of the amendment process of the Handbook.

The Faculty Handbook requires the University to issue contracts to all faculty.The Handbook states that:

“....The Provost shall issue annual contracts to all tenured and tenure-track full-time faculty. Vice-presidents or deans shall issue contracts to all other faculty...No full-time or part-time employee is considered to have faculty status unless the President or appropriate vice-president or dean has signed a written contract for that employee specifying a faculty title....”

"Whenever possible, contracts shall be issued and delivered to all continuing faculty by May 1....”

Members of the MFA are concerned that the University has not honored these terms of the Faculty Handbook, making it difficult to determine who is truly a faculty member of the School.

The Faculty Handbook defines the grievance process a faculty member can use to reverse a violation of faculty rights.Many members of the MFA are concerned that the University is not honoring the terms of the grievance process, particularly with respect to grievances involving the issuance of faculty contracts.

• Participation in national conferences regarding the function of academic medical centers. 

The MFA voted unanimously that the MFA President attend an AAUP-sponsored conference, entitled, “Academic Values in the Transformation of American Medicine” to be held May 20-23, 1999, in Boston.The November-December issue of Academe summarizes points made at the conference, including those contributed by the MFA President.

Conclusion:

The standard set by the LCME for accreditation requires:“a sufficiently rich environment to foster broad academic purposes.”The Faculty Contract and Faculty Handbook form a contract that can sustain the academic freedom needed to meet that requirement.The failure of the University to enforce the terms of these documents in the School makes it difficult for the School to meet this requirement, because the threat to academic freedom diverts faculty from their academic duties to attempts to protect that freedom.At the Keck School of Medicine, faculty have at times felt compelled to seek that protection in court.

Harvey R. Kaslow

President-Elect, Medical Faculty Assembly

Immediate Past-President, Medical Faculty Assembly