Merger Raises Questions

The presidents of Harvard's two largest teaching hospitals yesterday denied reports that they actively excluded Medical School Dean Daniel C. Tosteson '44 from talks leading to last week's announcement of their planned merger, but they acknowledged that the dean was not directly involved in the negotiations.

The two administrators--Dr. H. Richard Nesson '54 of the Brigham and Women's Hospital and Dr. J. Robert Buchanan of the Massachusetts General Hospital (MGH)--said they accept Tosteson's long-term vision of integrating the operations of all five Harvard-affiliated hospitals. But they painted a picture of a dean without the authority to effect those changes, and who was only peripherally aware of the negotiations' progress.

Nesson and Buchanan's comments came in response to a report in yesterday's Boston Globe. Citing unnamed sources at Harvard, the Globe story suggested that Tosteson and President Neil L. Rudenstine were both "out of the loop"--essentially uninformed and powerless--when it came to the hospital merger.

Both Nesson and Buchanan were critical of the article.

"I thought it was an unfair characterization," said Buchanan in a phone interview from Philadelphia, where he was attending a meeting of medical administrators. "Certainly, that was not a helpful article."

Both hospital administrators asserted that Tosteson was instrumental in launching negotiations among all five teaching hospitals earlier this year. Still, they conceded, those talks ultimately "bogged down"--Nesson said they "weren't going anywhere and people were getting frustrated"--prompting the Brigham and MGH to break off from the rest of the group.

"We all began together in the six-way conversations in January," said Nesson, referring to meetings that included Tosteson and administrators from the five hospitals. "It was in the summer that the...boards [of the Brigham and MGH] determined and told the dean that we thought [it] was too difficult to move and that we were going to try to work it out ourselves, but with the same objectives that he had initially."

In addition, both Nesson and Buchanan acknow- ledged that Tosteson was only informed of thetwo-way talks once the Brigham and MGH had alreadyagreed to hold them. The dean was not invited tothe discussions, they said.

"I believe if he had asked to come he wouldhave been allowed to," Nesson said. "But I'm notsure he could ask, given what his situation was."

"That would have been unfair to him in that hehad brought all of us together and then for him tosplit off with us--I don't think that would havebeen very fair," added Nesson, who will chair acommittee charged with planning the details of themerger.

Tosteson did not return phone calls yesterday.But in an interview with The Globe Tuesday, thedean said he did not see the Brigham-MGH merger asa "fragmenting event," though he admitted that"there are not a few members of our community atthe moment who do perceive it as such."

Still, Buchanan conceded that the decision ofthe Brigham and MGH to break away from thefive-way negotiations did not likely sit well withTosteson.

"I'm sure he's disappointed," Buchanan said."I'm sure he would've liked to have seen the wholegroup of five reach some kind of a five-partiteagreement."Either way, Buchanan suggested,Tosteson was powerless to stop the move.

"That's not the way we function. These[hospitals] are independent corporations," hesaid."

"To say that [Tosteson] couldn't stop it...thatdoesn't suggest that he's not powerful. He's apowerful person," Buchanan added. "But this is notan academic matter, this is a corporate matter. Asan academic dean, this doesn't fall under hispurview."

Rudenstine could not be reached for commentyesterday. But in an interview Wednesday, thepresident acknowledged that he and Tosteson havelittle direct authority over the hospitals.

"Since these are independent institutions withtheir own boards and totally self-governing,there's no particular standing that I have,"Rudenstine said. "I'm ready to play whatever kindof role seems constructive. I'm ready to be quiteinterventionist. But they have to feel that itwould be helpful to them, because in the end, theywill make their own decisions."

Still, Buchanan disputed suggestions that theUniversity has little control over the hospitals.

"The important issue here is that theseinstitutions, as independent but affiliatedinstitutions, retain their capacity to makeimportant contributions to the educational andresearch missions of the University," Buchanansaid. "There is tremendous loyalty...throughoutthe institutions to Harvard as our academicflagship."

Indeed, both Buchanan and Nesson indicated, amore powerful player than Tosteson in the hospitalmerger was a colleague of his in the Universityadministration--Business School Dean John H.McArthur, who chairs the Brigham and Women's boardof directors.

"After the point where the decision was reachedto go forward together, Dean Tosteson didn't playan active role in the discussions between the twoinstitutions and Dean McArthur did," saidBuchanan. "He was not there as Dean John McArthur.He was there as chairman, Brigham and Women's."

McArthur did not return repeated phone callsyesterday. The Globe article suggested thatMcArthur's active role in the merger, standing insharp and ironic contrast to Tosteson's relativepowerlessness, was "embarrassing" for theUniversity.

Meanwhile, Buchanan and Nesson both said that,while they support Tosteson's vision of greatercooperation and streamlining of operations amongthe five hospitals, they doubt the feasibility ofsuch a plan in the near future.

"I don't rule it out," Buchanan said. "But Ithink [Tosteson] would acknowledge that that wasan ambitious goal.

"I believe if he had asked to come he wouldhave been allowed to," Nesson said. "But I'm notsure he could ask, given what his situation was."

"That would have been unfair to him in that hehad brought all of us together and then for him tosplit off with us--I don't think that would havebeen very fair," added Nesson, who will chair acommittee charged with planning the details of themerger.

Tosteson did not return phone calls yesterday.But in an interview with The Globe Tuesday, thedean said he did not see the Brigham-MGH merger asa "fragmenting event," though he admitted that"there are not a few members of our community atthe moment who do perceive it as such."

Still, Buchanan conceded that the decision ofthe Brigham and MGH to break away from thefive-way negotiations did not likely sit well withTosteson.

"I'm sure he's disappointed," Buchanan said."I'm sure he would've liked to have seen the wholegroup of five reach some kind of a five-partiteagreement."Either way, Buchanan suggested,Tosteson was powerless to stop the move.

"That's not the way we function. These[hospitals] are independent corporations," hesaid."

"To say that [Tosteson] couldn't stop it...thatdoesn't suggest that he's not powerful. He's apowerful person," Buchanan added. "But this is notan academic matter, this is a corporate matter. Asan academic dean, this doesn't fall under hispurview."

Rudenstine could not be reached for commentyesterday. But in an interview Wednesday, thepresident acknowledged that he and Tosteson havelittle direct authority over the hospitals.

"Since these are independent institutions withtheir own boards and totally self-governing,there's no particular standing that I have,"Rudenstine said. "I'm ready to play whatever kindof role seems constructive. I'm ready to be quiteinterventionist. But they have to feel that itwould be helpful to them, because in the end, theywill make their own decisions."

Still, Buchanan disputed suggestions that theUniversity has little control over the hospitals.

"The important issue here is that theseinstitutions, as independent but affiliatedinstitutions, retain their capacity to makeimportant contributions to the educational andresearch missions of the University," Buchanansaid. "There is tremendous loyalty...throughoutthe institutions to Harvard as our academicflagship."

Indeed, both Buchanan and Nesson indicated, amore powerful player than Tosteson in the hospitalmerger was a colleague of his in the Universityadministration--Business School Dean John H.McArthur, who chairs the Brigham and Women's boardof directors.

"After the point where the decision was reachedto go forward together, Dean Tosteson didn't playan active role in the discussions between the twoinstitutions and Dean McArthur did," saidBuchanan. "He was not there as Dean John McArthur.He was there as chairman, Brigham and Women's."

McArthur did not return repeated phone callsyesterday. The Globe article suggested thatMcArthur's active role in the merger, standing insharp and ironic contrast to Tosteson's relativepowerlessness, was "embarrassing" for theUniversity.

Meanwhile, Buchanan and Nesson both said that,while they support Tosteson's vision of greatercooperation and streamlining of operations amongthe five hospitals, they doubt the feasibility ofsuch a plan in the near future.

"I don't rule it out," Buchanan said. "But Ithink [Tosteson] would acknowledge that that wasan ambitious goal.