By LETITIA STEIN
Times Staff Writer
TAMPA — The Tampa Bay region's largest hospital and its only medical school have a relationship that has been likened to a troubled but long-lasting marriage: Even if the fights get ugly, they'll never split up.
But the differences between Tampa General Hospital and the University of South Florida are far from a private matter.
Emails obtained by the Tampa Bay Times reveal a behind-the-scenes power struggle with reverberations for health care institutions from St. Petersburg to Lakeland:
• Who leads USF Health? The medical school dean, Dr. Stephen Klasko, was pondering his own future as he sparred last fall with David A. Straz Jr., the chairman of Tampa General's board. "I really do believe that he (Straz) will want me to be totally out of being responsible for USF Health strategy," Klasko wrote in an email to USF president Judy Genshaft.
• Who runs Bayfront Medical Center? In an email, Klasko blamed Tampa General for the sale of the last independent hospital in Pinellas County to a for-profit hospital chain affiliated with the University of Florida. Why? Because Tampa General declined when Bayfront asked if it was interested in partnering.
• Who teams up with USF Health? The university, eager to grow, is creating a new health system with Lakeland Regional Medical Center as its first hospital member. But a move meant to create opportunities also opened rifts with both Tampa General and the Watson Clinic, one of the region's largest doctors' groups. And USF needs a new training partner in mental health, or else risks its accreditations, since Tampa General has stopped accepting involuntarily committed Baker Act psychiatric patients.
Klasko now calls the tension described in his fall 2012 emails "ancient history."
"David Straz is very passionate about Tampa General, and I'm very passionate about USF," he said. "We need to move to a model where that passion is more aligned."
But what may be old news for Klasko is still fresh for Straz. Asked if USF would be better off without Klasko, Straz had this to say:
"When you have someone that is supposed to be your partner going off and wanting his own hospital on the USF campus, that does not make for good relations," Straz said, referring to one Klasko-led effort.
And, he noted, tempers are still raw over USF helping create new trauma centers that have siphoned patients away from Tampa General.
"When your partner goes off putting some trauma centers or staffing some trauma centers in a for-profit hospital, HCA for example, that does not make a for a good relationship among partners,'' Straz said.
• • •
The 42-year-old USF medical school is eager to raise its national profile. But its leaders have been clear they can only get so far without their own teaching hospital, which would bring opportunities for more research, training and recognition.
USF and Tampa General, where 300 USF residents train, always have been deeply intertwined. Klasko seeks an even closer relationship.
In December, the emails show, USF hired a public relations firm — at a cost of $10,000 a month for six months — to educate the community "on the benefits of a strategically aligned relationship" with Tampa General. The 1,018-bed not-for profit is the region's last independent general hospital, as Bayfront finalizes its sale to Health Management Associates.
Last year, when Tampa General was named the best hospital in Florida by U.S. News and World Report, each of the nine specialities recognized involved USF.
"Like two giants who can injure each other, they can also work together and help each other and help our region," Hillsborough County Commissioner Mark Sharpe said.
In December, alarmed by reports of escalating tension, commissioners demanded the equivalent of marital counseling. Rather than their usual multi-year deals, USF and Tampa General just had signed an affiliation agreement for just one year.
Publicly, they said all was well. The USF emails, obtained by the Times through a public records request, tell a different story.
Predicting that Straz wanted him out, Klasko noted that he had removed himself from direct negotiations with the hospital. He asked Genshaft for direction:
"Do we deal with TGH from a position of strength, which means we will have positive and negative issues to deal with, or do we come up with a model whereby we assume that we are 'under TGH's control,' which limits our strategic options but would ensure peace in the land," he wrote.
"If you and the board believe that I am the problem, then we should talk about a transition plan that protects me and the organization," he concluded.
In a statement, Genshaft was careful to praise both sides, calling Tampa General's new leader "dynamic'' and Klasko "visionary." Declining to be interviewed, she wrote, "as we forge closer ties, we will improve health for patients and families across the Tampa Bay Region and beyond.''
Klasko said in an interview he's here to stay, with a contract that extends to 2016. But even his supporters acknowledge it's a tricky situation.
"I think TGH could benefit a lot by his input," said Frank Morsani, the largest donor to the USF medical school, which now bears his name. "By the same token, if you are not a welcome guest at the party, you are better off to stay on the sidelines. I think that (Klasko) is attempting to practice that."
• • •
Days before the announcement of a deal to sell Bayfront Medical Center to a hospital chain affiliated with the University of Florida, Klasko tried to stall it.
"Having UF set up shop in St. Petersburg would be disastrous for USF Health," he said in an email to Genshaft and university trustees. "It means that more specialized care would leave Tampa Bay to go to Gainesville."
But USF wasn't included in the conversation when the financially struggling Bayfront reached out to Tampa General — which declined to partner.
"It wasn't a good fit," Straz said, "and the financial risks were too great."
Bayfront officials declined to comment.
Klasko later blasted Tampa General for dropping the ball — not only on Bayfront, but also with other local institutions swept up by the merger trend.
In an email to Genshaft, he described USF's attempts to grow its reputation — simultaneously partnering with Tampa General and others — as "a high wire act."
"The reason we have been put in that position is that TGH has failed," he wrote in late October, giving the examples of Bayfront and the former University Community Hospital system, both of which ended up in chains based outside Tampa Bay. He even jabbed at Tampa General for failing to "look for positive options with the largest health system in the area, HCA,'' the chain that it's suing over the trauma fight.
Today, Klasko's tone is softer.
"The beating of the chest was at a difficult time. It was at a time that didn't have the optimism of the new leadership that we have today," he said, referring to the arrival last week of Tampa General's new CEO, Jim Burkhart.
Klasko notes that he participated in his selection, calling this a sign of improving relations.
"We are two strong organizations in Tampa Bay that need each other, with two leaders who are going to be here for a while," he added. "I plan on not even thinking about the past."
• • •
Even as USF says it sees no future that doesn't include Tampa General, it's looking elsewhere for growth. Last fall, USF announced plans to create a new health system with 851-bed Lakeland Regional as its first hospital partner. Discussions also are under way with Citrus Memorial Hospital.
But the road to putting the USF name on a hospital is bumpy.
The Lakeland announcement became a flash point last fall in negotiations with Tampa General, which wanted to study the details, emails revealed.
Initially expected to launch this month, the complex Lakeland merger has been set back by at least six months, according to USF officials.
Tampa General has agreed to study what a three-way relationship with USF and Lakeland would look like, Klasko said. Leadership is one of the many questions about how it would work: Klasko plans to hire Lakeland's CEO, Elaine Thompson, to run the new USF health system — while she also would remain CEO at Lakeland.
Still, Klasko stressed, "Anything we do with anybody will be in the context of what we try to do with Tampa General."
USF is going ahead with plans to create 200 residency positions at the Lakeland hospital, which currently has none. That's been an issue with the Lakeland-based Watson Clinic, a highly respected regional group of more than 200 physicians.
Watson abruptly terminated its contract to provide clinical experience for about two dozen USF medical students. "They are not thrilled" about the Lakeland hospital — where many Watson doctors work — becoming a teaching hospital, Klasko said.
Watson officials did not respond to interview requests.
Meanwhile, USF has a bigger problem with its primary partner. Tampa General has stopped treating psychiatric patients involuntarily committed under the Baker Act. Losing access to such patients could put the medical school's accreditations at risk.
"That one isn't ancient history," Klasko said.
Tampa General's psychiatric department has continued to grow, sending involuntary Baker Act patients to other facilities for mental health services once their medical conditions are stabilized. The hospital wanted to change the focus of psychiatric services.
Klasko's internal emails outlined the ramifications: "TGH's unilateral decision was not only (a) concern to USF and its psychiatry program, it was a major concern to the rest of Tampa Bay's mental health community," he wrote in January.
"This is an example of the need for strategic alignment between a great medical school and its academic affiliates," the email continued. "In this case, unfortunately, that did not occur."
Letitia Stein can be reached at firstname.lastname@example.org or (727) 893-8330.