Physicians upset about the plan to build a new Children's Hospital downtown are lashing out at the Kaleida Health proposal.
A group of about 50 doctors, many of them specialists who work at Children's, say current plans for a new hospital could dilute the quality of care at the regional pediatric medical center and the national reputation it enjoys.
The group claims a majority of the hundreds of doctors affiliated with Children's would prefer the hospital to remain on Bryant Street.
If a new facility is built connected to Buffalo General Hospital, the doctors insist Kaleida preserve a special focus on pediatrics and the Children's "brand name," avoiding the temptation to consolidate speciality medical services with the adult hospital for the sake of saving money.
They also want a greater say in the decision. The doctors are going public now with concerns that have been simmering since 1996.
That's when five hospitals here -- Buffalo General, Children's, DeGraff Memorial in North Tonawanda, Millard Fillmore Gates Circle and Millard Fillmore Suburban in Amherst -- decided to merge in hopes of reducing costs and improving services.
The Kaleida Health board of directors assigned the new hospital system's administration the task of coming up with a plan on how best to use buildings, what services to invest in most and where to find the money to pay for it.
The administration in February unveiled a set of options, including a proposal to build a new Children's Hospital. But in August, the board of directors postponed making a decision on the future of Children's Hospital and, instead, formed a committee to study the proposals further and make a recommendation early next year.
"We have not had the sort of open discussion on this that we need to have, and that's what we're going to do," said Thomas Beecher, board chairman.
Beecher, president of Beecher Securities Inc., acknowledged that the physicians make valid points and drew a parallel with the debate over a new Peace Bridge.
He said the board must make a decision that's best for medical care, as well as for the city. "I will give that committee carte blanche to do whatever it takes to examine all the arguments, even if it means traveling to cities with other hospitals and bringing experts here," Beecher said.
He added that he is keeping an open mind, although the administration of Kaleida has come out publicly in support of building a new hospital.
The administration has argued that moving Children's would save money by consolidating some services, allow infants and adult women to receive care in one location, and create a central medical campus on High Street next to Buffalo General and Roswell Park Cancer Institute.
They also note that the current pediatric hospital requires expensive updates anyway.
Still, many physicians question whether building a new hospital is the right decision.
Does Kaleida intend to mix subspecialty pediatric services in radiology and anesthesia with similar adult services in Buffalo General Hospital?
If so, doctors worry, children may not be treated by the physicians most experienced and trained in treating pediatric cases. Moreover, they say, Children's runs the risk of being reduced to a big ward of a general hospital.
Will the Children's name, which draws millions of dollars in philanthropy, still pull in the donations at a new site connected to Buffalo General, doctors wonder?
If Children's moves next to Buffalo General, doctors also ask, can it remain a regional specialty medical center, or will hospitals that compete with Kaleida react by building up their own pediatric specialty programs?
"I understand the challenges facing Kaleida. But I also believe that we need to guard Children's Hospital jealously to make sure the level of services isn't compromised," said Dr. Steven Lana, a private pediatrician who refers patients to the hospital.
Children's Hospital is one of only two hospitals here -- the other is Roswell Park -- with a national reputation for medicine, research and education. Children's ranked 17th of 22 hospitals nationwide for pediatrics, according to the most recent annual guide to America's best hospitals published by U.S. News & World Report.
"Everyone agrees that we have a top program here and need to keep it that way," said Dr. Frederick Morin III, pediatrician-in-chief at Children's.
He said the physicians upset with Kaleida's proposals make valid points, but it's difficult for anyone to say with confidence what is the right thing to do until there's better information.
"There are a lot of unknowns about the plan -- how much space is needed for a new hospital, how much money it would cost and how much it would take to renovate the current building," he said.
Why are so many doctors skeptical of plans that, so far, have few specifics?
They see a recent change in hospital name tags as a small but emblematic reason. The tags identify people as working at Kaleida Health and don't even mention Children's Hospital.
They also worry that within the merged hospital system, Children's Hospital has had to compete with the needs of the other hospitals.
"We feel pediatric issues are losing out to adult issues," said Dr. Kathleen Lillis, chief of the division of emergency medicine.
Dr. Lillis was among a small group of physicians who in the past year visited other pediatric hospitals on a fact-finding mission paid for by the Kaleida administration.
She said one of the group's conclusions was that Children's must not jeopardize its unique stature in the community.
One other reason doctors cite for their skepticism is a rough estimate made by the Kaleida administration based on the work of consultants that it would cost about the same to renovate the current hospital as to build new -- "well over $100 million" is the phrase officials have used.
Physicians contend the estimate seems low compared to the cost of other new hospitals elsewhere, suggesting that Kaleida did not intend to build a hospital with a complete set of separate pediatric services.
"We don't know how much it would cost to build a new Children's Hospital, but the number we've heard makes us wonder what's being left out," said Lana.
The problem for the Kaleida board of directors is that there are valid arguments for and against moving Children's.
For instance, even physicians who oppose a move acknowledge that it might be better if women and children could be cared for in one location.
Moreover, the board must figure out how much Kaleida can afford to spend for a new hospital, an expense that would require money from a variety of sources, including borrowing, state grants, donations and perhaps higher rates for services.
Dr. John Antkowiak, an obstetrician-gynecologist on the Kaleida committee formed to make a recommendation on Children's Hospital, said he's hopeful the new effort will offer a fresh perspective.
"Everyone with a stake in this has got to take a look at all the data unemotionally. We've got to shed preconceived notions and take stock of opinions that may have received less attention than they deserved," he said. "In the end, we need to find common ground on what's best for the women and children, and the city we live in."