bout the only thing certain that emerged from Wednesday's General Assembly hearings on the Health Center's projected $21 million deficit is that changes, quite likely drastic ones, are in the offing.

"These fiscal realities threaten the integrity of all of our schools and, unless changes are made quickly, could seriously compromise not only our academic mission, but also the significant clinical contribution our faculty and our hospital make within the state and in the region," said Peter Deckers, dean of the School of Medicine, during a presentation to the General Assembly's Public Health Committee.

Deckers, UConn President Philip E. Austin, and other Health Center officials appeared before the committee to outline the fiscal crisis at John Dempsey Hospital caused, in great measure, by changes in federal reimbursement and managed care.

"As at so many universities nationally, the fiscal challenges at Dempsey Hospital now have the potential of placing at risk the educational and research programs that are indeed central to the University of Connecticut Health Center's mission," said Austin.

A consultant's report released last month warned that UConn's medical and dental schools are in serious trouble unless the state significantly increases financial support for Dempsey Hospital or the hospital is able to align with one or more area healthcare providers.

"The University of Connecticut Health Center is one of this state's greatest assets," Austin said. "It plays a direct role in meeting the health care needs of thousands of Connecticut residents, and makes an indirect but vital contribution to the health and well being of all 3 million of us."

The Health Center also attracts more than $30 million in federal research support to the state and generates about $14.5 million in other research and foundation grants, Austin said, and its marketable applied research boosts economic development.

The School of Medicine also provides access to affordable, quality medical and dental education to highly qualified Connecticut residents who in large numbers repay the state by practicing here, Austin continued. More than 700 graduates of the School of Medicine are now practicing in Connecticut, and about 55 percent of the dentists practicing in the state are graduates of the School of Dental Medicine.

Dempsey faces the same problems as all hospitals, Deckers said: managed care discounts, declining federal support, price competition and shorter patient stays. As a consequence, the Health Center has had to take measures including reducing its workforce, eliminating budgeted unfilled vacancies, reducing expenses, freezing faculty salaries, and utilizing departmental reserves, endowment income, and UConn Foundation restricted funds. This isn't enough to erase the deficit, Deckers said, and that means additional reductions in staff and faculty must be made.

"We have no choice, since there are no other available revenue streams," he said.

Deckers laid the blame for the crisis affecting Dempsey and other hospitals on the changes in the health care marketplace during the past decade.

"In my personal opinion, the insanity of the past few years is that of allowing health care, a right of all our citizens, to be treated as a marketplace commodity," said Deckers. "This is the root cause of the deteriorating financial condition of our academic health centers and teaching hospitals, including the UConn Health Center."

Any strategy to change Dempsey Hospital's market position must also help realize several "essential objectives to ensure the integrity of the teaching and research programs" at the medical and dental schools, Deckers said.

These objectives include attracting high-quality students; offering a competitive positioning for the clinical practice of the faculty; maintaining residency accreditation; producing funding for its teaching and research strategic plans; recruiting and retaining researchers and clinical faculty; having a dedicated place to conduct clinical research; and maintaining fiscal viability.

Deckers outlined five strategic options for Dempsey Hospital, each of which he said raised serious policy issues, such as the need for additional financial support, political and marketplace sensitivities, and the potential impact on jobs at the Health Center.

Gary Frank