THE TUFTS-NEW ENGLAND MEDICAL CENTER. One of the most tangled sets of relationships in which Tufts was ever involved were those concerning the New England Medical Center (NEMC) which had been created, with legislative approval, in 1930, and was opened the following year. The nucleus represented a joint endeavor of Tufts, the Boston Dispensary, and the Boston Floating Hospital for Infants and Children, both of which had long histories.

Tufts had advanced money to acquire land in downtown Boston to build another hospital and to enlarge the Boston Dispensary. A diagnostic ward was added to the Dispensary in 1932, financed by a Maine philanthropist, William Bingham 2d. It was he who had provided additional funds in 1938 to build the Joseph H. Pratt Diagnostic Hospital. This expanded into a 250-bed general hospital with the addition of a surgical wing, and was known as the Pratt-New England Center Hospital. By 1953 the medical complex also included both the Tufts medical and dental schools, and an administrative board had been established and approved by the state legislature to supervise the Center. The entire complex of the NEMC in the 1950s included four components: the aforementioned hospitals, the Tufts medical and

Organizational relationships among the various components of the Center were a constant topic of study and discussion. A report on the subject was made in 1957 by Ralph M. Hower of the Harvard School of Business Administration, who served as a consultant. In the fall of 1957, President Wessell contacted Joseph C. Hinsey, director of the New York Hospital-Cornell Medical Center in New York City and requested that he survey the New England Medical Center and make recommendations based on his investigation. Arrangements were made by a trustee of the Boston Dispensary to finance the survey from its funds. Wessell's concern was that "in the period ahead of us, the Center grow with a definite university orientation." The survey could become, according to the president, "the single most important step we could take in the New England Medical Center during the next decade." Hinsey made a number of visits to the Center, beginning in January 1958, and submitted his report in November. He included as appendixes the legislative act of 1930 as amended in 1946 and

Relations between Tufts and the Center hospital complex remained strained throughout the 1950s and beyond. In the interim period in 1966-67, when Leonard Mead was acting president of Tufts, he saw so many difficulties seeming to confront the institution

The medical school complained that there was not as much clinical teaching as Tufts wanted, and that the Center's share of support of the medical-dental library was grossly inadequate. The lack of coordination among the various components of the Center, especially the hospitals, had resulted in "rivalries, suspicions, and fears." Tufts conceived the Medical Center as primarily a commercial operation which did not take teaching seriously and charged excessively high prices for its services to patients and for allowing teaching privileges within its walls. The goal, according to President Wessell, was "a truly university-oriented medical center" stressing the academic as well as the strictly clinical. Even the redesignation as the "Tufts-New England Medical Center" (T-NEMC) in 1960 as a sign of closer relationship was more of an aspiration than an accomplished fact. A further attempt to build a bridge between the two organizations was the creation in 1960-61 of the combined position of Vice-President for Medical and Dental Affairs of the university and Executive Director of the Medical Center. Wessell had considered this "the most important event in the history of the Center." George A. Wolf, Jr. was appointed to the new position, serving also as Professor of Medicine.

After serving for five years, Vice-President Wolf resigned in 1965, and the administration of the T-NEMC was handled by a joint board consisting of three individuals each from Tufts and from the Center who nominated the dean of the medical and dental schools as well as the chief hospital administrator. (Louis J. P. Calisti, dean of the dental school, was the first chairman of the joint board, and served until October 1966.) Day-to-day operations were conducted under the direction of an administrative committee (as distinct from the administrative board) and consisted of the deans of the medical and dental schools and the hospital administrator. Responsibility for long-range planning continued to rest jointly with Tufts and the trustees of the Center hospital.

The organization was not considered satisfactory and in 1967-68 there was discussion about whether a single head, subject to the administrative board, would not be more advantageous to all concerned than attempting to administer by committee. An important step was taken in 1965 when the Boston Dispensary and Rehabilitation Institute, the Boston Floating Hospital, and the New England Medical Center Hospital were finally merged as the New England Medical Center Hospitals. T-NEMC was thereafter

In 1972 the administrative board of the T-NEMC made two requests of Millis: to examine the relationship between Tufts, particularly its Schools of Medicine and Dental Medicine, and the NEMCH; to examine the T-NEMC corporation "as a mechanism for the accomplishment of the mutual purposes of the two parent institutions and to make recommendations for its strengthening and future operation." President Hallowell made a third request subsequently: to examine a closely related question of the role of the institution in the education of allied health personnel. Millis made his report in September. The first task had been to examine the purposes, programs, and aspirations of both Tufts and the hospital, accomplished in part by extended interviews with officers, staff, and students. Another was to inventory the resources, both financial and human, of each. The hospital's strengths he found to be generally "excellent," with finances noticeably less abundant. Because of the limitations imposed by relative lack of resources, reflected in part by physical facilities that were "lower in quality than the people who use them," every effort had to be made to achieve "the highest efficiency through substantial improvements in organization and operation." After studying the organization of each institution, including its various affiliations, and the structure of the faculties, including both medical and support staffs, Millis undertook to project an overall organization best suited to achieving the purposes of each component. Finally, he examined in some detail the current state of health care and of health science education.

The basic problems, as Millis saw the situation, were two-fold and were in no sense unique either to Tufts or the hospital but were shared by many comparable institutions: a basic conservatism which made them unable or unwilling to adjust to changing societal demands and expectations; and complaints that there were too many roadblocks in the way of optimal use of time and energy - from too many administrative and paperwork chores to "endless committees, subcommittees, and task forces." The truth was that, organizationally, most educational institutions were anachronistic, operating on plans and procedures geared to a simpler time, when officers of administration could handle most management responsibilities with a minimal expenditure of time and energy. There was, in addition, "a lack

Centralization of certain management functions operated in common would include such matters as parking, financial record keeping, building maintenance and repair, public relations, land acquisition, and office services. A management organization needed to be created for each component, with a coordinated management service jointly controlled by Tufts and the hospital, with contractual arrangements from commercial firms for those activities where high efficiency could not be achieved otherwise.

The intimate relationship and interaction between Tufts and the Center hospital which approached the ideal should be documented in the replacement of the current agreement of affiliation with "a highly visible public declaration of mutual purposes and of mutual interdependence." Affiliation should be replaced by federation. Interlocking governing boards would be one manifestation of this, with a joint executive agency to carry out the mutual decisions of the two boards. A "New England Tufts (NET) Federation for Health" would be the result. This would include an association with other hospitals in the Greater Boston area with which Tufts had arrangements for obtaining clinical learning opportunities for its students. Millis visited a sample of such facilities and was generally satisfied with what he observed.

The Maine Medical Center, the one medical facility removed from the environs of Boston, seemed capable of becoming much more effective as an educational associate, with impressive leadership, commitment to education, a broadly representative clientele, and fairly sound resources. However, in spite of a long listing of association between Tufts and the hospital in Maine, there seemed to be a feeling on the part of the latter that contacts were too infrequent and

There were complaints by the affiliated institutions. Many considered themselves merely appendages, satellites, or junior partners. There was also resentment against implied inferiority because of a rule that the chairman of a medical school department had to serve also as chief of the corresponding patient service in an individual hospital. The shouldering of both responsibilities likewise created unnecessary complexity as well as the potentiality for ill will. A third complaint was the lack of adequate financial support from Tufts. A further difficulty was the apparent one-sidedness of an arrangement whereby the medical school received the majority of the benefit of affiliation. Millis predicted that the customary internship and residency (which he called "a sophisticated apprenticeship") would eventually disappear and be replaced by the equivalent of the highest educational degree. A further change was the increasing use of peer review which included assessment of postgraduate and continuing education of practicing physicians. Both involved increasing partnership with the university. Out of these considerations came a series of recommendations: that the mechanism of affiliation be dropped and that an association of peer institutions be created, to be known as the "Tufts University Association for Medical Education" (TUAME) embracing all of the health care institutions in which Tufts was involved. A "New England Tufts Federation for Health" would be responsible for the clinical training of the hundreds of allied health personnel (such as X-ray technicians and occupational therapists) and the operation and management of such programs would be centered in the T-NEMC rather than in the university.

The Tufts trustees met jointly with the Board of Governors of the NEMC hospital in the fall of 1972 and in 1973 an ad hoc trustee committee was created to make recommendations for action. However, the carrying out of the Millis recommendations was slow and by no means complete or wholeheartedly agreed to by either party. John Quarles, president of the Center hospital, resigned in 1974 but remained at the hospital. He was replaced by Hester Sargent, a Tufts trustee. A simultaneous search took place for a new dean of the medical school, to replace Maloney. Lauro F. Cavazos became acting dean and then dean in 1975. The ad hoc trustee Committee on Hospital Relations made its report to the full board in the fa11 of

The trustees recommended the enlargement of the joint administrative board from six to ten members, with continuing representation of Tufts and the Center hospital, and the employment of a full-time executive (president) appointed by the board but connected with neither organization. The deans of the two Tufts schools and the executive director of the hospital would serve as vice-presidents. The proposed reorganization was worked out in the fall of 1975 with the creation of the Tufts Medical Center Associate Foundation and an executive council consisting of the president of Tufts, the deans of the medical and dental schools, and the executive director of the NEMC. Both parties finally accepted the plan and the Tufts trustee Executive Committee gave its approval in January 1976, four years after Millis had begun his work.

As quoted in President Hallowell's last annual report in 1976, The final version of the proposal embodied several critically important elements: a broadly based membership including essentially all Tufts trustees and all NEMCH Governors; a strong Administrative Board; a full-time salaried Presidency; an understanding by the constituent institutions of their mutual interdependence and of the role of T-NEMC as the focus for discussion and decision in areas of mutual concern; and a delegation of initiative and of decision-making authority in these areas to T-NEMC, subject only to overruling Board action by Tufts or NEMCH.

New bylaws for T-NEMC were drafted and approved; an initial orientation meeting of the membership was held, and a search committee was formed to find a head for T-NEMC. The outgoing president considered the first meeting of the new trustees of T-NEMC in May 1976 to symbolize an "historic advance in University-NEMCH relationships" and breathed a sigh of relief that a knotty problem had finally been solved - even though, in perspective, only temporarily and partially. One other problem, of much less complexity than dealing with the Center hospital alone, but of much concern to President Hallowell, was establishing improved working relationships with the thirty other hospitals that provided indispensable clinical opportunities. To

Problems which the Center faced from the very beginning were space and adequate facilities. The entire complex was located in a congested area of Boston, bordering on Chinatown, and any expansion had to take place at the expense of existing property owned or occupied by individuals or companies having no direct connection with either Tufts or the Center. Probably the most pressing space problem in the 1950s involved the dental school. Overcrowding was especially critical in the outpatient department. A long-range planning study was made in 1954-55, directed by a faculty member from MIT, which resulted in a proposal for a federally subsidized urban redevelopment program in cooperation with the Boston Housing Authority and other city officials. A planning office for the Center was established in 1961, under the direction of Hermann H. Field, an expert in urban institutional planning and the design of health and education facilities. He had a staff of nineteen by 1967. Field became Director of Long-Range Planning for the Center in 1970, a post which he left two years later in order to teach and direct a new Tufts program in urban social and environmental policy in the Department of Political Science. The South Cove area of Boston in which the Center was located was declared to be a candidate for urban renewal by the Boston City Council in 1962-63. Following Field's planning efforts the Center became an integral part of the renewal effort with an elementary school (the Quincy School) involved in a cooperative arrangement with the Boston School Department and the local community. The innovative building complex which was planned joined educational efforts to those of community housing, recreation, family health, and day care, all under one roof. A three-year program of the planning office was completed in 1964 and the firm of Marts and Lundy was retained to assess the fund-raising potential of a building program amounting to $17,650,000. Tufts shared one-third of the planning office expenses.

An even more ambitious plan was drawn up over a two-year period (1967-69) for constructing a new physical plant for the Center, which was projected to cost more than $70 million, and a capital gift campaign was announced. One step was taken in 1969 when Tufts took title to the South Cove Building, acquired at a cost of $400,000. It

The relationships between T-NEMC and the neighboring Chinese community were as complex as those between Tufts and the Medical Center, and had existed with the Tufts medical school long before the Center was created. Boston's Chinatown was an old settlement, having been established in 1874-75 with about 100 occupants in what was known as the South Cove area, about half of which consisted of filled-in land. At first the Chinese had mixed in with Syrian and Lebanese immigrants. By the mid-1970s some 5,000 Chinese occupied twelve square blocks. Most of them had service jobs in restaurants and laundries and approximately 70 percent had less than an eighth grade education. The median family income was less than $6,ooo, the lowest in the city, even with working wives. Infant mortality was high, and tuberculosis was found among some of the residents.

The problems of Chinatown were intensified in the 1960s and 1970S by the dislocation of 1,000 families because of the construction of the Massachusetts Turnpike extension and the Southeast Expressway, which hemmed the neighborhood in on the South and East, and by plans formulated in 1967 to build a new and enlarged physical plant for the T-NEMC. This necessitated the taking over in 1972 of one building housing a dozen Chinese and a laundry. This paralleled two other problems of growing intensity: the fact that at least half of the Chinese did not speak English, and that relaxed federal immigration restrictions had resulted in the doubling of the population of Chinatown in little more than a decade. Both business and housing facilities were strained to the utmost.

Tufts and the Center found themselves in a very delicate and fragile position as these developments took place, and much of the image projected by the mass media pictured the university as an overbearing colossus systematically devouring the Chinese community because of the inexorable need to expand. One could easily get the impression that the Medical Center had destroyed half of the housing in Chinatown to make way for expansion. In actuality the Center had been responsible for the elimination of less than 15 percent of the housing units, and that dated back to 1940. Most of the property purchased by the university was not in Chinatown, and almost all of the property was either dilapidated or condemned and a logical candidate for urban renewal.