Tuesday, April 07, 2015

Not with a bang but with a whimper

This is the way the world ends
This is the way the world ends
This is the way the world ends
Not with a bang but with a whimper
     -- T. S. Eliot, The Hollow Men, 1925

Those across the Commonwealth of Pennsylvania who lived through the disaster known as AHERF, the story of the Allegheny Health and Education Research Foundation, ending in one of the biggest non-profit health care bankruptcies in US history, may now note in passing the death some months ago--just recently announced--of its architect, one Sherif Abdelhak.

Many books and articles have been written about this hubristic exercise in go-go corporatism. It was a fiasco that left many endowments decimated and the remnants of two Philadelphia medical schools in shreds.

For those who lived through that era, the death of "the sheriff" is bittersweet. It has passed virtually unnoticed until now. But it's worth remarking, not just for its local but also its national meaning. By the high-rolling mid-1990s, tellingly, the Association of American Medical College's prestigious Cooper Lectureship led through the following roster. Here is the list for the decade commencing 1985 and leading to its 1995 apogee

  • 1985 John A. D. Cooper
  • 1986 Paul B. Beeson
  • 1987 Uwe E. Reinhardt
  • 1988 Henry G. Cisneros
  • 1989 Lauro F. Cavazos
  • 1990 John F. Sherman
  • 1991 Margaret Catley-Carlson
  • 1992 Leroy Hood
  • 1993 Bruce M. Alberts
  • 1994 Merwyn R. Greenlick
  • 1995 Sherif S. Abdelhak

A nice progression. Three years later, in 1998, AHERF and Allegheny University of the Health Sciences, went belly up. Its successors are still recovering. But too many parts of our health educational and health care systems still show signs of the sheriff's avaricious behavior.


Roy M. Poses MD said...

Note that we have posted about the ill-fated (and ill-managed) AHERF before. See this tag: http://hcrenewal.blogspot.com/search/label/AHERF

And see this 2013 post for a summary: http://hcrenewal.blogspot.com/2013/06/a-legal-settlement-of-one-aspect-of.html

Roy M. Poses MD said...

Some further ironies....

The fall of AHERF should have been a warning about the brave new world of "visionary" generic managers running health care ... into the ground while paying themselves very well, and intimidating their subservient employees, including doctors. (look at the summary here: http://hcrenewal.blogspot.com/2013/06/a-legal-settlement-of-one-aspect-of.html) Mr Abdelhak was hailed as a visionary in the media. He gave an prestigious lecture at the AAMC meeting, subsequently published in Academic Medicine, including lots of fluff about vertically integrated health systems. He reportedly threatened his faculty, "don't cross me or you will live to regret it." He was being paid the then princely sum of over $1 million a year while his health care system was heading to the then biggest bankruptcy reported for a non-profit.

Yet the story of the bankruptcy was reported only regionally, and got a mention in only one health care journal, Health Affairs, and that focused on the financial, not ethical or leadership aspects, until I wrote about it in 2003. So hardly anyone now has heard of it, and its warning went unheeded.

So when Mr Abdelhak passed away, there was no public notice until 8 months later, and that consisted of a single article. Apparently Mr Abdelhak changed his name, and lost touch with nearly everyone who knew him. There is no record that he ever took responsibility for the fall of AHERF. In 2007 he was reported to be still blaming everyone else. The article quoted him as saying "I don't have a life. They managed to destroy it 10 years ago." (See: http://www.philly.com/philly/business/20150407_Death_of_Abdelhak__hospital_CEO__reported.html )

But it appears he destroyed a whole health care system, closed several hospitals, and damaged many careers, never mind the effects on patient care.

If we continue to ignore this history, we are doomed to continue to repeat it.