By Jonathan Shikes
By Michael Roberts
By Jonathan Shikes
By Michael Roberts
By Michael Roberts
By Michael Roberts
By William Breathes
By Melanie Asmar
When Robert "Chip" Schooley arrived in Denver from Harvard fourteen years ago, the rate of survival among Colorado's AIDS patients was grim. The people in his waiting room had a one-in-six chance of dying within a year.
"At the time, there wasn't much of an AIDS program anywhere between St. Louis and San Francisco," recalls Schooley, head of the infectious-diseases division at the University of Colorado Health Sciences Center. "When people don't perceive that care is available, they don't have much reason to be tested for infection. The virus is being spread mostly by people who don't know they're infected."
Over the past decade, Schooley and other HSC researchers -- including his wife, Constance Benson -- have built one of the most respected AIDS research and treatment centers in the nation. His clinical-trials unit has been a testing ground for new drug therapies that have dramatically extended the lives of patients around the world. A clinic through University Hospital treats more than 1,200 HIV-infected people a year, including hundreds of indigent patients. An educational training center provides outreach to eleven states. Last year, the HSC was designated a National Institutes of Health Center for AIDS Research, one of only twenty in the nation.
Once an obscure enterprise within the labyrinthine medical center, Schooley's division now brings in between $8 million and $10 million a year in research grants, mainly from the federal government. His physicians bill around $1.1 million a year for patient care and do 50 percent more consultations than any other division in the Department of Medicine, the largest department in CU's School of Medicine. And Schooley and Benson have emerged as internationally prominent AIDS researchers.
"The thing I'm most proud of is the integrated way we provide patient care and do research," Schooley says. "We now lose 1.5 percent of our patients a year, and half of that is from causes not related to AIDS. That's a tremendous success, and the research we've done here has played a big role in that."
Long squeezed for space at its 47-acre campus at Ninth Avenue and Colorado Boulevard, the HSC is now in the middle of moving its schools, research facilities and hospitals to a brand-new, 180-acre campus at the site of the former Fitzsimons Army Medical Center in Aurora. The $1.3 billion expansion, in conjunction with a bioscience research park and retail-and-office development planned at Fitzsimons, is the largest construction project in the state since Denver International Airport.
You might think that Schooley, who's been compelled in recent years to lease rooms above a Boston Market for clinical research, would welcome the additional research space and amenities that administrators have vowed to provide at the new campus. Instead, he's deeply troubled by the impact of the move on his division and on the medical center's general direction -- so troubled that he's exploring opportunities elsewhere. He and Benson have been heavily recruited by the University of California at San Diego in recent months but have yet to make a final decision.
"Two issues have been of concern to us for some time," Schooley says. "A significant portion of the resources that are designated in most medical centers for operation of programs are being redirected for capital construction. That leaves you at a competitive disadvantage. The other concern is the geographic disruption."
Although the HSC's top brass have accelerated their original plan for the move and now hope to have most facilities at Fitzsimons operational by the end of 2007, staffers are currently dealing with a split campus. Some patient care and research work has already shifted to Aurora, while the actual medical school and other research activities linger in Denver -- a logistical problem compounded by financial uncertainties that could delay the completion date. Administrators have characterized the divided campus as a minor inconvenience, but Schooley disagrees.
"The institution as a whole does clinical care, research and education," he notes. "If the patients are at Fitzsimons and the labs are in Denver, you're going back and forth and having a substantial part of the day wasted. Research is not a nebulous thing. If you're not able to get the work done, you're not able to get the grants in future years. If we were paid by the state, it wouldn't be an issue. But we have to generate our salaries every year from seeing patients and writing grants. We can't do that if the institution is a difficult place to work."
The prospect of losing Schooley and Benson alarms local AIDS activists, who've praised the couple for being "community focused," promoting education and public forums and making experimental drugs available to patients who have nowhere else to turn.
"We've felt fortunate that we have so many top-notch people in Colorado and that we have access to them," says Michael Dorosh, who serves on the community advisory board of the local AIDS clinical-trial unit. "Chip and Connie brought a great group of people together and developed a great program, and now the first place the pharmaceutical companies call when they're going forward with a new fusion inhibitor is Colorado. If they leave, there are people who will go with them.
"The clinic isn't going to fall apart, but I don't think we will have quite the priority we've had. Everything depends on getting grants, and if there's a brain drain, the grants aren't going to be there. It's a downward spiral."
Schooley's personal situation is hardly an isolated one; his division has already lost two key researchers because of issues related to the Fitzsimons move. And more than a dozen other heavyweights in various areas of medical research -- men and women whose work has contributed substantially to the Department of Medicine being ranked twelfth nationally in NIH funding, out of 126 such departments -- have left in recent months, taking millions of dollars in research grants with them. The list includes several division chiefs, nationally known experts in liver disease and cardiac electrophysiology, pioneering researchers in cancer and arthritis, and the entire core of the center's bone-marrow transplant unit, formerly a source of tremendous pride and press.
Some of those who've left say that they simply took better jobs elsewhere. Others who've fled, though, say that their departures were a direct result of the turmoil surrounding the Fitzsimons move -- which is "symptomatic," they say, of ongoing problems in the HSC's financing and leadership that have demoralized the medical school's faculty and drained resources from critical programs.
"I saw myself at a fading institution," says Ferric Fang, a bacterial geneticist and former member of the infectious-diseases division, now a professor of microbiology at the University of Washington. "On the face of it, the move just looked really foolish. The ostensible reason was that we didn't have enough space, but the departments that were moving were being told they weren't going to get any more square footage than they already had. It was going to cost billions, and nobody would be better off."
HSC officials say that most, if not all, of the faculty objections to the move have been addressed. They insist that Fitzsimons will provide state-of-the-art facilities that will attract "world-class scientists" and give CU a competitive edge in vying for research grants.
"It's so much more expensive to retrofit old space than to build new space," says John Sladek, vice chancellor for research. "If we didn't move, we would have been behind. There's little way we could have built on the old campus and expanded the research possibilities."
Sladek views many of the complaints about "disruption" as exaggerated. "How much disruption can a person handle?" he asks. "Having moved an active research lab twice, I can say this is a whole lot easier. For two or three years, faculty will shuttle back and forth. It's a fifteen-minute drive. It's not an overwhelming problem. Will there be grumbling? Sure. We're faculty. We grumble."
But critics of the move say their misgivings run much deeper than the nuisance of fifteen-minute commutes. They have to do with massive debt, wildly optimistic financing expectations and a raid on the same research coffers that were supposed to benefit from the move; with an imperious administration that has steamrolled faculty since the abrupt 2002 firing of Robert Schrier, the renowned chair of the Department of Medicine, an action related to the battle over Fitzsimons; with the deal that CU made for the sale of the existing campus, which will produce little or no direct financial return to the university for the disposal of a prime piece of Denver real estate; with disrupted programs and an exodus of talent; and much, much more.
From many angles, the ultramodern complex of hospitals, clinics and research towers rising amid the weeds and memories of Fitzsimons is an impressive sight. It's been a windfall for construction companies, and it's eventually expected to generate hundreds of high-tech jobs and serve as the centerpiece for the revitalization of Aurora's faded "downtown." Yet some of the complex's most respected employees say that the move will prove to be far more costly than it appears on paper -- costly in terms of the way it's altering the character of the medical center and the way research is done there.
"They should have started out planning how they were going to stabilize [the move] and keep critical personnel, but that just became an afterthought," says Roy Jones, who left as co-director of the bone-marrow transplant unit two years ago. "Money was invested in bricks and mortar and disinvested in human capital."
The decision to move CU's Health Sciences Center to Fitzsimons dates back to an unharmonic convergence of events a decade ago. Landlocked on its eighty-year-old Denver campus, a gift from Denver Postpublisher Fred Bonfils, the HSC was eager to expand onto property it owned west of Colorado Boulevard, despite steadfast opposition from Congress Park homeowners. At the same time, the Army was looking to unload its own historic but outmoded medical garrison in Aurora, which had treated generations of military patients, including President Dwight Eisenhower (heart attack, 1955) and Senator John Kerry (birth, 1943).
Vince Fulginetti, the HSC's chancellor at the time, urged city officials to intervene with neighborhood groups on CU's behalf. Then-mayor Wellington Webb's people declined, denouncing the university's approach to the problem as arrogant and inflexible. Aurora beckoned and, in a collective snit, CU's Board of Regents inked a deal to acquire up to 250 acres of the Fitzsimons site, at no cost -- except, of course, to the City and County of Denver, which will lose thousands of jobs and megabucks in parking fines when the bustling Colorado Boulevard campus shuts down for good.
University officials hailed the deal as a remarkable piece of synergy. But many faculty members felt left out of the decision process and were alarmed by its implications.
"People were aghast," recalls Ferric Fang. "We knew this was a medical school that barely had enough money to keep its own physical plant going. The idea of moving everything seemed preposterous to us. How were we going to afford it?"
Some doctors wondered how the new synergy would affect the existing relationships forged between the medical school and Denver Health, Children's Hospital, the National Jewish Medical and Research Center and the Veterans Affairs hospital. (Children's and the VA have since decided to move to Fitzsimons as well.) Others questioned the need to abandon some of the buildings on the Denver campus, such as the Skaggs School of Pharmacy and the Biomedical Research Building, which were practically new and still being paid for.
Faculty leaders pushed for a moratorium on the move until it could be further studied, to no avail. The debate intensified, as did suspicions that some influential division heads had been wooed to join the bandwagon with promises of extra goodies on the new campus. Fang, who worked in Schooley's division for nine years and ran University Hospital's clinical microlab, found the atmosphere at the medical center growing increasingly toxic.
"This was really dividing the faculty," he says. "Every day, you would come to work and people wanted to know what side you were on. This was very unpleasant, and it went on for years. The dean, who'd initially been opposed, became an advocate of the move. Anybody opposed to the move was seen as being disloyal."
Fang finally decided to move to Washington after learning that he was expected to divide his time for several years between his research duties on the new campus -- his area of expertise involves studying resistance to infection on the molecular level -- and the clinical lab in Denver. "It was a no-win situation," he says. "One of the activities I was involved in was going to be compromised. Other people I knew were already looking around or leaving. Without the move and the way it was handled, I would certainly still be in Colorado."
Several observers say the heavy-handed push for Fitzsimons is part of an ongoing problem in the "governance" of CU's Health Sciences Center. Although its $600 million budget makes the campus a major force in the university system, it's overseen by an elected board of regents and a university president in Boulder, who have no background in medicine and are often preoccupied with matters such as the football program's recruiting scandal. Consequently, much of the decision-making power rests with Fulginetti's successor, HSC chancellor James Shore, and Richard Krugman, the long-entrenched dean of the School of Medicine.
"The administration treated faculty as a bunch of second-class citizens who were merely transient presences at the school," says Daniel Kuritzkes, who left his position in Schooley's division two years ago to become director of AIDS research at Brigham and Women's Hospital and principal investigator at Harvard's clinical-trials unit in Boston. "The planning proceeded initially without any faculty input and included a variety of financial projections that seemed completely unrealistic."
Kuritzkes believes that the center's upper administration was never sufficiently supportive of a strong AIDS research program or of research in general, despite the fact that research programs fund almost half of the HSC's operating budget. (Tuition and state funds, by contrast, amount to less than 15 percent of the total.)
"To be working in an environment where you're clearly not valued became increasingly uncomfortable," he says. "In the twelve years I was there, from the day I arrived, I raised not only my entire salary and my benefits [from research grants], but salaries for an increasing group of people in my department. By the time I left, it was easily over a million dollars. They need a culture based on faculty governance, one that recognizes that the faculty make the place run."
Clashes between faculty and Shore and Krugman are nothing new; at times they've led to purges affecting entire divisions and embarrassingly high-profile lawsuits ("The Strange Case of Dr. Schmidt," September 20, 2001). But the most damaging controversies in recent years, from an FDA shutdown of human research studies to the firing of Robert Schrier to the Fitzsimons move itself, have all involved battles over how research funds are used.
A typical National Institutes of Health research grant takes into account not only the direct costs of the research, but associated expenses, such as lab space and support staff; for example, a grant to fund a $100,000 study would include an additional $54,000 in "indirect cost recovery" (ICR) funds. HSC administration takes a cut of the ICR money, and another portion goes to the department for research-related expenses, such as equipment, renovation, recruiting efforts and so on. But researchers claim that the state's skimpy funding of the medical school, along with shortsighted decisions of administrators, have led to an increasing drain on ICR funds, with disastrous results.
In 1999, the FDA suspended thousands of clinical trials at the HSC for months after finding that the studies had been inadequately monitored and evaluated. Several former faculty members, including Kuritzkes and Roy Jones, say they'd warned Krugman and other officials that the review board that supervised the studies was badly understaffed. "We warned them they would get shut down if they didn't do something," Kuritzkes recalls. "It was no surprise when they did get shut down."
The episode cost the university millions of dollars in lost revenues and was a significant blow to its national reputation. To correct the problem, Krugman instituted new procedures that went well beyond FDA requirements and imposed new burdens on researchers, which were quickly characterized as "unfunded mandates" from the dean's office.
"The bottom line was that there was a contraction of support and a massive enlargement of paperwork and regulatory demands we had to meet," says Jones. "When I went to the hospital for support, I was told I needed to do less research and cut down on my overhead so that I could be more cost-efficient. My view was that was incompatible with what I was at the institution to do."
The aftermath of the FDA flap was a strong factor in Jones's decision to leave the Health Sciences Center two years ago. He and Elizabeth Shpall, his wife and co-director of the program, are now at the M. D. Anderson Cancer Center in Houston, which receives $130 million in annual support from the State of Texas. "It's a night-and-day difference," he says. "Here there's a deep understanding of the kind of administrative support needed to do this."
Four more key figures in the bone-marrow unit have since left; two are now running a private transplant program at Presbyterian-St. Luke's Hospital. The HSC's nickel-and-diming of research projects cost the center a profitable and prestigious program, Jones says.
"Transplants should be very profitable for most hospitals," he notes. "There were bad business decisions made, and something that could have been a real cash cow became something else.... The bone-marrow transplant unit was, in certain respects, like the canary in the mine. There are a lot of activities that don't get supported by NIH grants, where an investment on the institution's part is amply paid off over the years. They made millions of dollars in profits that they could use for supporting indigent patients and other money-losing programs. When they took away the support, it cost them a great deal."
The 2002 firing of Schrier, chair of the Department of Medicine for 26 years, raised even louder protests about the HSC's direction and leadership. Krugman has staunchly defended the decision, saying that it was "time for a change." In a federal lawsuit seeking damages, Schrier has claimed that his dismissal was a result of the concerns he'd expressed about the financing of the move to Fitzsimons and its impact on ICR funds.
Schrier, who still teaches and does research at the HSC, declined to comment for this article, citing the pending litigation. But in a column he wrote for a department newsletter shortly before his removal, he noted that half of the ICR money that the Department of Medicine had previously used for recruitment and other purposes -- $800,000 a year -- was now being appropriated to help build research space at Fitzsimons. (According to HSC officials, roughly 16 percent of total ICR revenues is now being used for debt service at Fitzsimons, and that percentage could rise to as high as 25 percent in coming years.) He also noted "several other issues" regarding the operation of a split campus and the projected $300 million in bond debt that the HSC would be shouldering for the move. If his department couldn't afford to recruit enough top-drawer, research-funded faculty to keep building the ICR pot, he wondered, how would the debt ever be addressed?
A kidney specialist with an international reputation and the lead investigator in grant programs worth millions of dollars, Schrier had numerous allies at the medical school. His unceremonious removal may have hastened the departure of others. Faculty leaders warned that the shabby treatment of such a distinguished chair would make it difficult to attract a replacement of similar stature. (Serious accreditation problems in neurosurgery, orthopedics and other departments, the result of internal feuding or underfunding, didn't help matters.) Indeed, the search dragged on for almost two years, making long-term planning difficult and frustrating division chiefs.
"It's hard to recruit without a permanent chairman," says Michael Bristow, co-director of CU's Cardiovascular Institute, who recently stepped down as chair of the cardiology division. "You certainly don't want to leave a major research department without leadership for any significant period of time."
Officials vowed to conduct a vigorous search for a new chair of medicine, one that would consider outstanding external and internal candidates. Robert Anderson, a professor of internal medicine, was named the department's interim chair. It was the search committee's initial understanding that Anderson himself was not a candidate for the permanent post; although well-respected, his credentials hardly compare with those of Schrier, who's authored more than 800 articles and 45 books, won numerous awards and helped to bring thirty endowed chairs to the HSC over the past three decades.
Two weeks ago, the HSC finally announced Schrier's replacement: Robert Anderson, the only remaining candidate after months of delays in the selection process.
Escorting a visitor through soon-to-be-occupied lab space on the upper floors of Research Complex 1, Chester "Chip" Ridgway pauses to demonstrate the versatility of a single chest of drawers. The thing can be stored under a table, he notes, or wheeled out and transformed into a desk. Or a bench. Or God knows what.
"You'd never see this at our medical school," says Ridgway, senior associate dean for research at the Health Sciences Center. "This is all new stuff. You can move it around and do what you want with it."
The recently completed, $210 million Research Complex 1 is actually two high-rises at Fitzsimons, linked by bridges on several floors. The twelve-story south tower is already fully occupied, primarily with cancer and biochemistry researchers. The nine-story north tower is filling up fast, as the HSC shifts labs in pediatrics, neuroscience, psychiatry, microbiology and other fields to the new campus. In all, roughly half of the center's research enterprises are being be moved to Research Complex 1; the rest are expected to be moved into the $205 million Research Complex 2, scheduled for completion in late 2007, and the more ethereal Research Complex 3, which as yet has no completion date or identified source of financing.
But never mind about RC 3. Ridgway and Vice Chancellor for Research Sladek can be expansive on the here-and-now virtues of RC 1. Every floor features a dazzling array of space-saving features, modular furniture and new equipment, fully customizable alcoves and the like. The cavernous research spaces themselves embrace an "open lab" concept, literally breaking down the walls so that researchers from different disciplines can interact and compare notes. It's part of the overall intent of the Fitzsimons design, which, according to one brochure, will address the health-care needs of the future by "shifting from program isolation into collaborative, team-driven learning."
From his office on the ninth floor of the north tower, Sladek has a prime view of the construction cranes and the emerging building blocks of CU's own version of Tomorrowland: the $145 million Anschutz Inpatient Pavilion. The $119 million Anschutz Outpatient Pavilion. The $28.7 million Anschutz Cancer Pavilion. The $12 million Rocky Mountain Lions Eye Institute. The $12 million Nighthorse Campbell Native Health Center. And currently under construction, the Barbara Davis Center for Childhood Diabetes, the new Children's Hospital, the orthodontics center...and, of course, the research buildings still to come.
"When I was being recruited here three years ago, I was chairing a department of neuroscience in Chicago and had done that for twenty years," Sladek says. "There are six medical schools in Chicago, all competing against each other. Any one of them would kill for this opportunity. There's no other institution in the United States that has an opportunity to move five schools, 10,000 people and three hospitals to facilities like these and in the process generate millions in philanthropy. It's a pain when you do it, but this move is occurring in such a smooth way; it's almost seamless. It's worth the price, in my opinion."
Not everyone agrees. Among HSC researchers, the most persistent complaint about the move is what they're going to wind up getting for the money diverted from their programs. Three years ago, Chancellor Shore vowed that the new buildings at Fitzsimons would double the center's available research space. But many researchers and division chiefs say they expect to end up with roughly the same amount of space they already have.
"This is a lateral move," says Curt Freed, head of the division of clinical pharmacology. "The space will be uniform and high-quality, but the actual square footage isn't changing much."
Sladek and Ridgway say that high-quality space is nothing to sneeze at, particularly in contrast to the cramped and outmoded research warrens at the Denver campus. And they insist that over time, the new enterprise will offer plenty of space for programs to grow. The entire Denver campus has around 344,000 assignable square feet (asf) of research space; the 385,000 asf at RC 1 exceeds that, and RC 2 will add another 260,000 asf in four years. (RC 3, if and when it's built, is projected to supply another 188,000 asf.) The space is being assigned on the basis of divisions' productivity and growth in research grants, a bottom-line approach that has resulted in the move being a "lateral" one for many divisions.
"You have to pay for your space with your ICR," Sladek explains. "That's never been in place in this institution before. Otherwise, you end up with sedentary departments and faculty who may have lost their research funding years ago, and because they're grand professors and we love them all, we don't want to take their space away -- that kind of thing."
But tapping into ICR funds for costly new digs that amount to a lateral move doesn't make good business sense, the critics counter. "It's obviously a very grand building complex," Freed says. "In the long run, it will be a good thing for the campus. But I am concerned about the cost. I think it's unlikely there will be an expansion of faculty in the next decade."
Diverting ICR funds to pay for the Fitzsimons buildings had a profound effect on Freed's division. "We immediately laid off an administrator," he says. "There was less money for programs, for recruitment. There was a direct effect on everyone. And that's true elsewhere. The last several years, there's been a major emphasis on building Fitzsimons and trouble recruiting outstanding faculty to chair departments and head programs."
In response to Fitzsimons naysayers, Dean Krugman has pointed out that the School of Medicine's research grants have continued to show healthy growth throughout the transition period, from $123 million annually in 1996 to $209 million in 2002. Ridgway adds that the diversion of a percentage of ICR funds has been made up by the overall growth in research grants. "The amount being returned to the faculty this year is back to where it was four years ago," he says. "There was a significant dip, but it's coming back."
But faculty say the numbers are misleading, that the HSC has merely been benefiting from a surge in NIH funding that is about to change, thanks to belt-tightening by the Bush administration. "The concern many of us have is that the NIH budget is flattening out," says Ed Abraham, director of the medical intensive-care unit at University Hospital. "It's hard to see how we can continue to grow without additional faculty, and faculty recruitment is remarkably expensive. It becomes increasingly difficult to recruit if you're spending a lot of money on new buildings."
The recruitment package for a junior basic scientist can exceed $400,000. Sladek contends that even if the ICR funds used at Fitzsimons had been spent recruiting top researchers, the center would have had no lab space to offer them. Instead, the HSC has a powerful recruiting tool: a fancy new campus. Ridgway says the school has eleven new hires lined up in oncology, as well as three in his own division, endocrinology.
"A lot of individuals have expressed an interest in moving here," Sladek says. "What you have to have is a critical mass of scientists and the right core laboratories. That's an enormous attraction."
But it's unclear if that attraction will lure enough new researchers to compensate for the departures of veteran researchers. "New laboratories and new space are not unique to the University of Colorado," Abraham says. "A lot of medical schools have put up new research buildings. That's not enough to bring someone here."
Like Schooley, Abraham is not looking forward to dealing with a split campus. But he believes that poor communication between administration and faculty, rather than the move itself, is driving some of his colleagues to look for jobs elsewhere. "I think it's going to be good for all of us to be on a new campus, ultimately," he says. "But it would have been nicer if the communication had been better all along."
Administrators point to countless task forces and committees they've formed to solicit faculty input on various phases of the move. Still, some participants question the effectiveness of that process. "The most important thing they could have done was to sit down with faculty to figure out the best way to do this," says Steven Dubovsky, who recently left the HSC to become chair of psychiatry at the State University of New York at Buffalo. "But my experience with every one of those discussions was that it was just a token discussion."
Those discussions also never made clear the true financial picture of the project. Initially, HSC officials anticipated raising as much as $380 million from private sources to help fund the construction at Fitzsimons. But as fundraising fell short of expectations and the time frame for the move was accelerated, the figure kept dropping, even as cost estimates for the plan soared. As recently as 2000, administrators were still projecting that $68 million could be raised from private donors -- but to date, only $20 million has been raised, with an expectation of raising another $14 million for RC 2. (The fundraising for the hospitals, which comes from different sources, isn't included in the total, nor is the $92 million pledged over thirty years by a Florida executive for the new orthodontics center.)
To make up for the shortfall, the planners turned to the state legislature for a bailout in the form of certificates of participation, a type of bond debt that doesn't require voter approval. But issuance of the COPS has been stalled indefinitely by a lawsuit filed by a prison-reform group challenging the validity of the bond package, which also includes funds slated for building new prisons. That's thrown off the timeline for construction of $203 million in academic buildings at Fitzsimons, compounding the split-campus dilemma.
And building delays aren't the only formidable obstacle facing administrators as they push their "team-driven learning" concept at Fitzsimons. Faculty from the School of Pharmacy recently took their concerns about the move to the HSC Faculty Assembly, protesting that current plans call for a substantial reduction in research space for their work; that administrators had shelved proposals for a stand-alone building for the school, despite calculations that suggested it would be less costly; and that CU was $20 million short of the funds needed to complete the School of Medicine's space in RC 2.
The School of Pharmacy has been one of the HSC's major success stories over the past decade, ever since it moved from Boulder into its $16 million building on the Denver campus in 1992; half of the funding for the building was raised by faculty and donors. The school now receives more NIH grants per faculty member than any other school of pharmacy in the country and is ranked as the top program in the nation by the American Association of Colleges of Pharmacy. But faculty members say that their budget and administrative support have taken a severe hit because of the move.
"It's difficult to go out and fund-raise for Fitzsimons, especially when some people just paid off their commitments on the present building," says Louis Diamond, the school's dean. "Our faculty are very concerned. There are no concrete plans to move us as an intact entity. We've had a meteoric rise since we all moved into one building. If we get squeezed into other places, we won't have room to continue to grow our programs."
According to Sladek, Chancellor Shore plans to meet with pharmacy faculty and address their concerns. "We have a policy of leaving no one behind and doing no harm in the move," Sladek says. "When the pharmacy people move to this campus, they will be provided the same amount of space, under the same criteria, as everyone else."
But Sladek acknowledges that the team approach to Fitzsimons means that the school's space will be "less contiguous" than it is on the existing campus. "There was never a plan to move schools as insular units in their own stand-alone buildings," he says. "Part of it is an issue of whether the School of Pharmacy can embrace the master plan of this campus."
Diamond insists that the uncertainties are clouding the future of his program, which hinges on attracting more talented researchers, not driving the existing ones away. "The raiders are knocking at our door, knowing we're in dire straits," he says. "I'm aware of four individuals who are being courted by other institutions. It took eighty years to get us in one building, and then we started to move up right away. So we're very concerned about what happens now."
The stalwarts of the Denver Rotary Club are all agog as Tim Romani gives a rundown on the Fitzsimons move at a recent luncheon. He hails the new campus as "a true economic engine for this region," one that will "blow away the Mayo Clinic" when it's done. He describes the pending sale of the Denver campus as the best possible deal for the best possible price, "a true mixed-use redevelopment" that will add fresh housing, retail and commercial space, reintroduce a pedestrian-friendly street grid to Ninth Avenue, and decrease "human density" in the area substantially.
What's not to like?
Romani, the vice chancellor of planning and development who's spearheading the accelerated move, is a canny negotiator with considerable experience touting pricey new sports arenas, including the Pepsi Center and Invesco Field. This is his first medical-center redo, but he's persevered through the community-meeting grind like a pro.
He tells the Rotarians that most of the buildings on the Denver campus "aren't very adaptable" to reuse; the more you demolish, the more the land is worth. University Hospital will keep its Critical Care Tower and recently updated emergency room as part of a scaled-back primary-care facility, and some of the newer buildings -- the Biomedical Research Building, the School of Pharmacy, a parking garage -- will probably be reused. But the rest will face the wrecking ball when Shea Properties starts building an urban-infill community on the site, including 1,100 new condos, lofts, apartments and other residential units.
Shea has agreed to pay $35 million for the property. The first $15 million goes directly to the state's general fund, as part of the deal CU made to obtain the certificates of participation to build academic buildings at Fitzsimons. The rest is slated for environmental remediation at the site; if the clean-up costs less than $20 million, it's possible that the university might actually see some revenue from the sale of its campus. But many faculty members aren't counting on it.
Critics of the Fitzsimons move argue that it doesn't make good economic sense to unload the HSC's current infrastructure -- which still has some years of use in it -- at wrecking-ball prices, then mortgage the future on all-new buildings that cost far more per square foot. But ultimately, the debate is about much more than economics. For all its limitations, the Denver campus has advantages that will be difficult to replicate on the new campus, including its proximity to other major medical complexes and its own cramped scale, which generated a certain coziness. Tunnels and bridges made every corner of the enterprise readily accessible; students, professors, researchers and patients mingled freely.
The plan for Fitzsimons calls for distinct "zones" designated for research, education and clinical functions. On paper, at least, the zones have some overlap, but the reality is a sprawling expanse that will require some ingenuity from a researcher who, for example, might want to shuttle a cart of tissue samples swiftly from the hospital to a research lab. Initial plans to build tunnels and bridges similar to those of the Denver campus were quickly abandoned as too expensive.
"Students will be in one place, faculty in another," says Freed. "Except for grad students working in labs, there will be little interaction. Those of us involved early on in the planning were chagrined to learn that this wasn't an integrated plan."
Sladek points out the proximity of the new hospital to Research Complex 1 and the planned new academic buildings, all situated within a quarter-mile of each other in the nexus of the overlapping zones. "I like coziness as well, but that's not a real issue," he insists. "This is now a 400-acre campus, half of which is the Health Sciences Center. Yes, it means you walk a little. But Colorado has the lowest obesity rate in the nation, and there's a reason for it. This same faculty will spend their weekends hiking 14,000-foot peaks and think nothing of it."
In medical circles, the catchphrase du jour is "translational research." The NIH is pushing it as an emphasis in future research grants, and research institutions are scrambling to show their general capacity for it. The exact definition is a bit elusive, but translational research basically involves an integration of lab work, clinical diagnosis and therapy -- working with patients, taking discoveries from the lab to the hospital ("from bench to bedside") and back again to yield measurable benefits in health care. CU's team-oriented new campus would seem to be a perfect place to put the concept into practice, but researchers say the Fitzsimons model fails to address the need for these kinds of interactions. The hospital has become more monolithic and less interested in supporting research, they claim, while the research complexes are at a remove from actual patient care.
Translational research is particularly important to projects such as Chip Schooley's AIDS research. "For us, it's critical to be able to efficiently see patients, talk to them about their medical care, get the samples we need and get them processed efficiently," he says. "That's a real dilemma for this new enterprise."
"There will be multiple sites on the new campus for clinical research," Sladek responds. "But for three years, there will be people in transition, no doubt about it."
Ridgway says the administration recognizes the need to address the issue. "The hospital and the Health Sciences Center planning have not been coordinated, that's true," he acknowledges. "But I think the Health Sciences Center has tried very hard to integrate clinical, research and educational programs. The campus is in the process of trying to develop what the resource needs are for translational research. Every institution is going to have to change its way of behavior to access research dollars."
Twenty years from now, the move to Fitzsimons may be regarded as a critical step in the HSC's quest to become one of the top medical schools in the country. Or it may represent the beginning of a plunge into debt and declining reputation that will transform the place into an elegantly appointed doctor mill.
Steve Dubovsky believes that the administration's disregard of the faculty's concerns, and the resulting loss of talent, will make recovery difficult. "If this was a private company, the board of directors would have fired everybody by now," the former psychiatry professor says. "In a medical school, you have people who could be working for industry and making millions. The main reason they're at a medical school is that they have very high self-esteem; some are arrogant and pushy, and that's why they're successful.
"When you have a management approach that says, ŒWe don't want anyone that's going to make trouble,' you're eliminating about 90 percent of the people with traits that make them successful in academic medicine. You'll have people who will go along to get along, but you won't be that successful anymore."
Chip Schooley has never been one to go along to get along. He knows what gets results in the world of AIDS, and that's what he plans to keep on doing, whether in Colorado or somewhere else.
"If we didn't do the lab work, we wouldn't be where we are now," he says. "That's the kind of medicine that appeals to me -- where you have an immediate impact on patient well-being, and at the same time learn fundamental things about how the disease works. That requires a real health sciences center, not a hospital on one side of the street and some laboratories on the other."