Hadassah's Contentious CEO to Continue to Steer Hospitals for Another Term

Problematic decisions and difficult style of management notwithstanding, Prof. Zeev Rotstein to manage Jerusalem hospitals for three more years. 'I didn't come to find favor in anyone's eyes,' he asserts

Prof. Zeev Rotstein, director general of the Hadassah Medical Organization, September 2019.
Emil Salman

Despite a particularly stormy four-year term at the helm, Prof. Zeev Rotstein has been given another three years as director general of the Hadassah Medical Organization.

Approval for Rotstein's new term, to begin in February, was recently given by the medical center’s board of directors, with backing from its controlling owner, the New York-based Hadassah Women’s Zionist Organization of America. The directors general of the health and finance ministries are expected to endorse the decision soon.

The medical center is responsible for two hospitals in Jerusalem: Hadassah University Hospital, Ein Karem and Hadassah University Hospital, on Mount Scopus.

In an interview with Haaretz, Rotstein summed up his tenure – which was rife with conflict and criticism – as follows: “Whenever someone buys a new pair of shoes, at first they chafe and cause blisters, but after a while, he doesn’t want to take them off. I don’t intend to remove these shoes, and the team at Hadassah also doesn’t want to remove them.”

The extension of Rotstein’s term as CEO means he will be steering Hadassah through the critical period when its recovery plan comes to an end, in December 2020. The seven-year plan was meant to rescue the medical center – one of the two largest in the Jerusalem area – from financial straits that threatened its future.

In recent years, the government allocated 1.3 billion shekels ($370 million) to the hospitals, so they are now defined as a state-supported organizations rather than private ones. For its part, the Hadassah women’s organization has transferred over 850 million shekels to the medical center, and also transferred property to the state in exchange for its financial support. The hospitals were, in turn, required to fire more than 500 employees and reduce salary expenses.

Hadassah Medical Center finished 2018 with a deficit of 38 million shekels; without funding from external sources, that figure would have exceeded an estimated 200 million shekels. Its cumulative deficit at the end of 2018 was 574 million shekels, down from 646 million in 2017 and from 770 million when Rotstein took over in 2016.

“Anyone who thought that at the end of the recovery plan, Hadassah would stand on its own two feet, independently, was wrong,” Rotstein acknowledged. “We did many things and improved the situation, but Hadassah will need support from the state after the recovery program as well.”

One sensitive issue at the medical center is pay – especially after hundreds of workers and a number of professional staffers were fired and others had to take pay cuts as their contribution to saving the hospitals. However, it emerges that those cuts weren’t across the board.

Hadassah’s financial reports show that from 2016 to 2018, salary expenditures for doctors actually rose by 100 million shekels, to 697 million. The cost of nurses' wages also increased, by 60 million shekels (to 556 million), while those of paramedical professionals rose by 20 million shekels.

In August, Haaretz reported that from 2016 to 2017, the wages of dozens of senior staffers, both doctors and administrators, had risen by tens of percent. Rotstein’s own monthly salary jumped by 32 percent during that period, to 142,000 shekels. It now turns out that it increased again in 2018, to 155,000 shekels a month, bringing the total annual outlay for his salary to 1.862 million shekels.

Rotstein and other senior hospital officials were investigated over this issue by the Finance Ministry’s wages department, which then referred the case to the Civil Service Commission’s disciplinary department. But in October, that department decided to close the case without taking any action.

Rotstein’s appointment to another term comes as no surprise. Even his critics understood that nobody would oppose him and the appointment would get the green light. But his management style doesn’t have many fans at Hadassah, with many staffers being sick of it.

There’s almost nobody, within the hospitals or outside them, with whom Rotstein hasn’t fought – whether it's the treasury’s accountant general, the accountant overseeing the progress of the recovery scheme (who quit because of this), doctors, workers unions and even Hadassah’s longtime partner, the Hebrew University of Jerusalem.

“He simply enjoys strife and conflict,” one senior hospital official said. “It energizes him.”

Recruiting 'stars'

Many people in the realm of health care are familiar with Rotstein’s style of management, but he's still been considered to be the right man for the rescue operation. Even people who aren’t among his fans admit that it’s hard to run such a complex organization with a light touch, especially given its many conflicting power centers, first and foremost the women’s organization in America, which some sources claim was overly involved in the hospitals' management.

Rotstein entered the job, with backing from Deputy Health Minister Yaakov Litzman, after many years of running Sheba Medical Center at Tel Hashomer. For a short time, until Prof. Yitshak Kreiss was appointed to replace him at Sheba, he was running both medical centers simultaneously.

Thus, Rotstein has made his presence felt at Hadassah, for better and for worse. “He has done a lot of things that some people liked and others liked less,” one senior source there said.

For instance, he was the first CEO to change the hospitals' culture of private medical service (sharap, in Hebrew), which provided a nice source of extra income for physicians and other staffers.

“One of the first things he did was to say there’s no private medical service before 3 P.M.,” the source continued. “This was a positive step that has contributed to creating more egalitarian medicine and better public medicine.”

Rotstein was also responsible for a crisis that made waves not just at Hadassah, but throughout the health-care system and the entire country. In the summer of 2017, the devoted head of the pediatric hemato-oncology unit, Prof. Michael Weintraub, quit together with the department’s entire medical staff – six doctors and three residents. Their battle, waged at the expense of children suffering from cancer, harmed not just the patients, but also the medical center's reputation.

Neither the health minister nor senior staffers in his ministry handled the situation well, but most of the fire was aimed at Rotstein. Moreover, according to hospital sources, the department in question, staffed with other doctors, is still battered and scarred. “The department hasn’t gone back to what it was, and most of the patients are Palestinians and medical tourists from the former Soviet Union,” one said.

Other steps taken by Rotstein drew fire as well. “He froze all the academic staff positions, which first and foremost hurt dozens of young doctors who have a future here and need to get promotions,” one Hadassah doctor said. “He stopped them brutally and transferred payments for such positions only for people that he wanted, as a way of pressuring the physicians’ union.”

Frustration among the medical center's professionals mounted in recent years when Rotstein began recruiting “stars” to Hadassah. Hospital sources said the new hires received exceptionally high wages – at the expense of highly regarded doctors within the organization.

“What you might call ‘the spirit of Hadassah,’ has been suppressed,” said one veteran employee. “Once, you’d come to the hospital at 7 P.M. and the employee parking lots would still be full. Today, after 3 P.M., everything is empty. Everyone goes home.”

Rotstein’s aggressive behavior has also caused good doctors to leave, the staffer added: “He recruited ‘stars,’ though it’s not always clear what their star qualities were, and he controls the hospital via a few members of his 'court' and administrators whom he brought in from outside.”

The employee also claimed that Rotstein is disconnected from what’s happening on the ground at the hospitals and has failed to set a personal example for his staff: “One joke about him is that if you'd put him on the subbasement floor, he wouldn’t know his way back. He doesn’t wander around the hospital at all. Workers know him only from his letters and emails.

“He leaves the office on Thursday and comes back only on Sunday – if at all,” this employee continued. “It was different with the previous directors, who would come in on Fridays, and sometimes even on Saturdays as well.”

Another source at Hadassah agreed with the accusations but sounded more conciliatory.

“I understand his problem," he said. "The CEO of the medical center bears a very, very large responsibility. He needs to move things forward. Rotstein knows how to identify the places that bring money in – like the maternity and cardiology departments – and he pours a lot of money into them. His problem is with striking a balance.”

Another physician offered a similarly mixed assessment.

“Rotstein's behavior is very aggressive, and apparently, he considers a day on which he doesn’t fight with someone a bad day,” he said. “But when I look at the situation four years ago compared to today, I would give him a passing grade rather than a failing one. Hadassah was like a patient who arrived in critical condition, but today, it is alive and functioning.

“Does that mean everything was done as it should have been? That his behavior is appropriate? Definitely not. But you have to remember that managing doctors in a place like this isn’t for the softhearted or gentle-mannered.”

Sources at Hadassah noted that during Rotstein’s tenure, the medical center has acquired an advanced PET-CT scanner and inaugurated its new Heart Institute, as well as new operating rooms, the women’s cardiovascular wellness center at Hadassah’s Ein Karem campus, catheterization labs, new delivery rooms and a rehabilitation center on Mount Scopus.

“I didn’t come here to find favor in anyone’s eyes,” Rotstein told Haaretz. “I came to reestablish Hadassah practically from scratch, to develop it, to bring in outstanding people. If someone doesn’t like the ‘stars’ or isn’t happy with how Hadassah is run – he can go anywhere else in Israel. But to my great joy, most people don’t want to leave.”

In February, the organization that oversees the services Israeli hospitals provide to the Palestinian Authority stopped its work. The Palestinians claimed at the time that the cost of treatment at Hadassah and other hospitals was too high, that some of the fees were unjustified and that the facilities were charging for treatments provided without a referral from PA physicians. Today, Palestinians are sent to Hadassah only under exceptional circumstances.

“Hadassah never did anything of the sort to Palestinians,” Rotstein retorted. “We have a contract with them that defines the nature of our relationship and the fees. The PA gets a discount as if it were an Israeli health maintenance organization.

“The only point of friction between us and the Palestinians is on the issue of treatments without a referral,” he continued. “But we can't allow ourselves to send someone home with his life at risk and cause his death. There have been no other disputes or differences of opinion.”

About a month ago, the Finance Ministry arranged a meeting between PA officials and representatives of several Israeli hospitals, at which the issues of contention were resolved, Rotstein said. The PA will soon resume referring patients to Hadassah.

“We’re returning to normal,” he asserted. “We hope this will actually happen on the ground.”