Med school faces long odds

December 6, 2008 

The road to campus is flanked by half-built suburban homes that would seem ideal for a faculty family or a young doctor putting down roots in Merced.

Just a minute up the road is the youngest campus of the University of California -- and the future headquarters of a potential medical school that could radically improve health care throughout the San Joaquin Valley.

But construction has stopped. Instead of young professional families lounging on their lawns, wood-framed skeletons and weedy vacant lots scar the landscape. Orange mercury-vapor lights cast shadows on empty dream homes.

Victims of the credit crunch and fiscal crisis, these residential shells symbolize the economic currents that have washed over Merced and most of the San Joaquin Valley. In their wake, worries have surfaced that the plan for the UC Merced School of Medicine, too, will face its own form of foreclosure as the state budget crisis worsens fast.

"We don't know the depth of the crisis yet. We don't know when it's going to turn around," said biochemist Maria Pallavicini, dean of the UC Merced School of Natural Sciences and a prominent champion of bringing a medical school here.

Looming UC budget cuts are planting seeds of doubt that a UC Merced School of Medicine -- initially set to enroll its first students in 2013 -- will open within the next decade.

In the best of times, launching a new medical school is a monumental task, requiring the mustering of huge amounts of money and political will. In the worst of times, it can seem nearly impossible.

Still, Valley residents -- whether bankers, politicians, farmers, business people or potential patients themselves -- cling to the dream. Every meaningful constituency in the Valley remains committed to making the med school a reality.

Some people are so confident it will happen, they're looking forward to being part of it. Tran Nguyen is 23 and in her last semester at Merced College. She will be transferring to UC Merced as a biology major in the Spring semester. When she finishes her undergraduate degree, she hopes the cards will fall so that she can be a part of the inaugural medical school class. She thinks a medical school will bring to the area doctors "who really, deeply care."

A new day in health care for the Valley

Whatever happens with UC Merced's med school, a new day in health care services may be on the horizon for the Valley. Take Merced, for example. In the northern part of the city, on G Street, two major medical buildings are going up right across the street from another -- a modern hospital and a new allied health education building at Merced College.

Those two buildings also rise from bare land as a symbol of hope. The new hospital will be up and running in the first half of 2010, and could draw potential medical school faculty members. The allied health building broke ground in 2007, funded by private donors and a generous bond measure passed by local voters.

Dr. Hanimireddy Lakireddy, a local cardiologist, contributed $1 million toward the building -- which carries his name -- and the college's health sciences program. "I was born in a poor, Third World country. Just because of education I became someone in this world," Lakireddy said in a recent interview about his donations. "Education is the easiest way to make someone, to make their life better."

Other changes in local health care are also in motion. In 2007, Southern California-based Loma Linda University moved services into the Valley, creating a rural health family-practice residency program in Hanford. UC Irvine School of Medicine is working with a Visalia hospital on a program that could bring even more residents to Tulare County.

And, as paradoxical as it may seem, a federal designation as a Health Professional Shortage Area, or HPSA, will improve access for a number of patients in the area. The designation is common in the Valley and gives those areas more opportunities for grants and loan repayments to attract new doctors, John Alexander, executive director of the Merced County Health Care Consortium, said.

"It is an exciting time to live in Merced. Sure it is depressing to see the health care problems and the foreclosed homes and the stories about crime, but on the other hand, there are enough of us here that see the diamond in the rough," Alexander said. "The people here have heart."

Money problems prompt Plan Bs as fallback

The drama playing out in Merced in many ways reflects tensions unfolding on public and private campuses nationwide as public funds and endowments dry up. Projects that seemed doable in richer times only a year or so ago now are threatened with delays or even oblivion.

In the case of California campuses, the drama pits research faculty against those favoring primary care medicine; better endowed campuses versus cash-starved start-ups, local legislators against those 500 miles away with their own favored education projects.

Some in the UC system and state government are already sketching out potential "Plan Bs" to reduce costs while attempting to improve health care in the Valley:

Focusing the Merced medical school more on educating doctors than expensive research, an approach favored by Lt. Gov. John Garamendi, a UC regent.

Moving medical studies 54 miles to the Fresno campus of UC San Francisco, with its brand-new medical education building.

Expanding the Valley-based medical residencies of existing UC medical schools in San Francisco, Davis and Irvine to attempt to meet rural needs.

Yet many in the Valley say they're not ready to be shunted aside again, especially in favor of what they view as long-favored UC campuses in more flush metropolitan areas.

Regional support for a Merced medical school runs so deep that it crosses political and economic lines and includes virtually every interest group: business, government, health care advocates, farmworkers and farmers. "It will be the pulse of new technology, new techniques, new teaching methods. Our residents will be the recipients of that knowledge; they will become healthier. Everyone in our community will become healthier," said Deidre Kelsey, a member of the five-seat Merced County Board of Supervisors.

Jerry Callister, local attorney and chairman of the board at County Bank, is another staunch supporter of the school. He's familiar with the UC Davis Medical School in Sacramento because his son is finishing his final year there, and he remains confident that a medical school will still rise in Merced. "I can see what medical schools have done in communities like Davis and Irvine. It would help our community too -- medically and economically," Callister said.

Budget battles fray nerves on many campuses

So a battle looms in coming weeks, possibly playing off Valley leaders against Sacramento budget slashers and rival UC campuses. In May 2008, the UC Board of Regents gave the campus authority to continue planning efforts for the medical school. While the board would make the ultimate decision whether to move ahead, it probably would look to the UC Office of the President in Oakland for guidance.

Others look to the campus of UCSF Fresno as a model for why UC Merced is needed.

They include Joan Voris, associate dean of the UCSF Fresno medical education program. She recalls that the school was established 30 years ago because of a citizen's committee in Fresno that fought for more doctors. Both the Fresno school and the proposed Merced campus, she said, were forged by similar forces: community pressure, a damning report on medical access, poor economies.

Even though UCSF Fresno has helped give Valley residents access to better medical care, more needs to be done, Voris said.

"There are other things we need to think about more than just getting doctors," she said. "We want to make sure they reflect California diversity and understand the issues of people who live in this area."

She is convinced that a new medical school in Merced is the only way to do that.

"I don't think we get that kind of physician if we send students off to San Francisco or L.A. or Chicago or wherever. I think we get that when we have a medical school here in the Valley that is dedicated to producing that type of doctor," Voris said.

But some disagree about the best model for that school.

Lt. Gov. Garamendi, who supports the school, questions if planners should look for a new model rather than the classic UC paradigm that both educates new doctors and conducts top-drawer research.

He wants Merced to take one step at a time "so that the early emphasis is on education, preparing physicians for the Central Valley -- and then, as the school matures, add the research to it."

Merced campus administrators are reluctant to jettison the UC devotion to research. Pallavicini, herself a biochemist and leading stem-cell researcher, says repeatedly that the school must have a strong research base.

One leading skeptic, however, is one of the UC Merced's own research scientists, UC biology professor Dr. Henry Forman, a senior faculty member who doesn't think the medical school belongs in Merced at all.

"It should be in Fresno. Or Modesto. It needs to be in a big place," said Forman, who calls himself one of the few faculty on campus, Pallavicini included, with a medical school background.

Faculty physicians aren't going to move to Merced, he said. And without a clinical research arm, the medical school would be relegated to a third-tier school, too low in stature to help raise the stature of UC Merced.

"Getting more physicians in the Valley is not going to be accomplished by putting a medical school in a tiny place where half the population lives below the poverty level," he said.

Another new UC medical school is first in line ahead of Merced. UC Riverside plans to open a medical school of its own, enrolling its first class in 2012. It has formal regents' approval, depending on the UC president's decision that funding is available. "They're much further along in the process," said Dr. Cathryn Nation, UC associate vice president for health sciences.

Still striving

One cool mid-November afternoon, Pallavicini asked a visitor to wait while she had a telephone conversation with the UC Merced chancellor. Her expression was somber when she emerged from her office in the striking new headquarters of the UC Merced School of Natural Sciences that she helped create and now oversees.

Just a few weeks before, she had spoken more confidently of the medical school that she hoped could be enrolling its first students by the middle of the next decade. Now, her tone was more subdued as she walked past laboratories occupied by current UC Merced students. Someday they are to be used by future medical students and top-drawer faculty.

UC is confronting serious state budget problems, she acknowledged that afternoon. Its endowment has been shriveling in the Wall Street stock freefall. Just that day, the Dow plunged 434 points. The following Thursday, UC would announce a possible decrease in the number of students accepted in the 2009 freshman class, because of a lack of funding.

Minutes later, the worry in her voice was gone. A re-energized Pallavicini, poised and smiling, began an interview that amounted to a stump speech on why the San Joaquin Valley deserves a UC Merced School of Medicine. "There's no denying that there is a very compelling need to increase the number of physicians in the Valley," she said. "I care deeply about the Valley."

Ground zero

Whatever happens in the complicated kabuki unfolding in boardrooms, classrooms and in the state Capitol, the health needs of the Valley's people aren't going anywhere. Sometimes lost in the tactics and strategy of administrators, academics and politicians are those who suffer the most from a lack of ground-zero medical solutions.

In Newman, Rosario Cisneros cradles her 1-year-old son Adrian. His chest scar is a lingering reminder of the health battles he and his family must face later in his life. He got his pacemaker in August. Sitting in his plastic Deluxe Jumperoo chair, which lets him bounce up and down, Adrian does just that. He bounces. Up and down. Up and down. Up and down.

Reporters Danielle Gaines and Deborah Schoch can be reached

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