March 5, 2018 Dear Dr. Hawgood and Members of the Board of Directors: The UCSF Benioff Children’s Hospital Oakland (Oakland) faculty is committed to an academic affiliation with UCSF School of Medicine, establishing an affiliated faculty at Oakland and SF hospitals with a common mission, and embracing a renewed vision of excellence in child health. Children’s Hospital Oakland has a 100 year history of providing high level specialty and trauma services and community centered care for the East Bay and Northern California community at large. The affiliation agreement in January 2014 promised to combine world class institutions to create new clinical, research and educational programs and extend our mission in child health. The Oakland faculty has presented several models of reorganization for the combined UCSF enterprise. These have all been dismissed by UCSF. Instead, an organizational hierarchy was presented by UCSF administrative leadership, which will create a two tiered academic and clinical operation, in which the current UCSF faculty assumes all leadership and controls all management decisions. The Oakland faculty formally declares that it has no confidence in the proposed integration plan and its unequal leadership structure. In response, we have drafted universal principles to guide integration of all the affected medical and surgical faculty divisions in Oakland: 1. Faculty in Oakland will be included in strategic planning of the affiliation with transparency about the details to ensure a successful outcome. 2. As this is an affiliation, and not a merger, an acquisition or a take-over, selection of clinical and academic leadership positions will be based upon merit, rather than the arbitrary selection of current UCSF faculty for all leadership positions, regardless of qualification and experience. Selections should not be determined by geography alone, and should be conducted with guidance from current leaders and faculty at both SF and Oakland sites. An acceptable outcome would be a parallel and autonomous structure of governance in Oakland. 3. Integration of activities must be conducted with respectful interactions and cultural sensitivity. Board of Directors 2 March 5, 2018 4. We expect that clinical, translational and basic science research activities in Oakland will not be diminished after integration. As per the initial affiliation agreement, research activities at all levels, commitment to education and training, and programmatic development will be expanded after academic integration in a joint endeavor across both the SF and Oakland sites. We endorse retaining CHORI laboratory operations in close proximity to the hospital because these are vital to current and future translational and clinical research activities in the hospital. 5. We are concerned the present integration plan may result in decreased health equity for our patient population and increased health disparity. We believe that these basic tenets underlying the affiliation are fair and reasonable, are not controversial, and should be embraced and implemented immediately. We invite the Board of Directors and Dr. Hawgood to meet with the Oakland Medical Staff to discuss the obstacles and our solutions. Respectfully submitted by the UCSF Benioff Children’s Hospital Oakland medical staff departments of: Adolescent Medicine Anesthesia Cardiology Center for Child Protection Dermatology Diagnostic Imaging Emergency Department Endocrinology Gastroenterology Hematology/Oncology/Bone Marrow Transplant Hospitalists Infectious Diseases Neonatology Neurology Neurosurgery Orthopedics Pathology Pediatric Critical Care Pediatric Surgery Primary Care Rehabilitation Children’s Hospital Oakland Research Institute Board of Directors 3 March 5, 2018 ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ 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