Former Citizen subscribers will receive the Star for the same price, said Mike Jameson, CEO of Tucson Newspapers Inc., which handles production, circulation and advertising for the Star and Citizen.

Jameson said plans call for all subscribers to receive letters with details about the change.

As of 1:15 p.m. Friday, TNI officials had not yet received word from their attorney “green lighting” the changeover.

“We believe Arizona law allows us to substitute something of similar or greater value if a product ceases production,” Jameson said.

Citizen subscribers who don’t want the Star can cancel their subscriptions and receive refunds, he said.

If TNI does not receive the go-ahead to begin distributing the Star in place of the Citizen, Jameson said, then the company would start “sampling” readers next week. Under that scenario, readers who want the Star could purchase subscriptions.

Medical student Nathaniel Rial checks on patient Rachel Trefry at the UA College of Medicine on Tuesday morning. Rial will graduate Friday.

It’s a choice fewer young doctors make.

When they recite the Hippocratic Oath on Friday, University of Arizona College of Medicine graduates Erica Lindsey and Nathaniel Rial will pursue residencies as primary care physicians. Generalists in an industry dominated by specialists, primary care doctors make hundreds of thousands of dollars less than cardiologists or neurosurgeons and work less-than-predictable hours.

Rial will remain in Tucson, beginning a three-year residency in internal medicine that will have him seeing patients at University Medical Center, Tucson Medical Center and the Southern Arizona VA Health Care System.

He spent his last week as a medical student studying for exams and working in a lab at the Arizona Cancer Center.

This summer, Lindsey will begin a three-year residency in primary care at St. Joseph’s Hospital and Medical Center in Phoenix. She spent much of the past two weeks moving into a new place.

The pair will gut out long hours, which, in the end, probably will reduce their salaries to “a little more than minimum wage,” Lindsey joked.

In recent interviews, both of the doctors-to-be said they entered primary care to fill a need.

Nearly half of the 124 students who will graduate from the UA medical school on Friday will remain in Arizona for at least the next three years, as they complete residencies at hospitals throughout the state. More than a third of the class of 2009 will go into primary care.

These are not insignificant numbers given the state’s overall shortage of doctors.

Arizona has 214 physicians per 100,000 patients, a ratio well below the national average of 250 doctors per 100,000 patients. A 2007 study by the Association of American Medical Colleges ranked Arizona 33rd out of 50 states based on that doctor-to-patient ratio.

The state’s ranking drops to 39th when the focus shifts to primary care.

In 2007, the latest data available, Arizona had 4,719 primary care physicians, a ratio of about 77 per 100,000 patients. Nationwide, the number of primary care physicians per 100,000 patients stood at 88 in 2007.

“We have more of a shortage than is found nationally,” said T. Philip Malan Jr., vice dean for academic affairs at the UA medical college. “I like it when our students go into primary care.”

As an area of practice, primary care requires physicians to do a little of everything – pediatrics, family and internal medicine, general surgery and obstetrics and gynecology.

No one can predict how many of the 43 UA medical school graduates will remain in primary care after completing their residencies.

A 2008 report by the Council on Medical Education found that 55 percent of the nation’s internal medicine residents in 2006 chose to enter a subspecialty the following year. Nearly 40 percent of pediatric residents chose to specialize as well.

A residency in primary care or internal medicine constitutes a “gateway” to specialty practices, Rial said.

He has yet to decide whether he will remain in primary care after completing his residency. Because the tuition at UA – around $18,000 a year – remains cheaper than at two-thirds of the nation’s medical schools, Rial said he has the “flexibility” to weigh his options.

“I think another way to look at why so few are going into (primary care), so many are following other pathways, is for lifestyle or quality-of-life issues,” Rial suggested.

The Council on Medical Education report found that nearly three-quarters of medical school graduates “reported that lifestyle had a strong influence on their choice” of specialty.

Mounting debt also factors heavily in medical students’ after-graduation decisions, according to the study. The average U.S. medical student had about $127,000 in debt in 2007, up 43 percent from 2000.

“You have a house in your brain by the time you’re done,” Lindsey said of the cost to complete four years of medical school.

The debt graduates must repay likely forces many of them into more lucrative specialties, she said..

“We don’t compensate (primary care doctors) well,” said Steve Nash, executive director of the Pima County Medical Society.

According to the U.S. Bureau of Labor Statistics, a family or general practitioner in Tucson can earn an average of $148,030 annually. Doctors in other specialties earn on average $52,000 more per year.

“One can live pretty well as a doctor in any specialty,” Malan said. “A student has to have a passion for primary care.”

The 43 UA graduates headed into primary care this year represent 35 percent of the graduating class.

“That’s about average for us,” Malan said.

It’s about twice the average in Pima County.

Of the 2,800 or so physicians practicing in PIma County, about 500 – 18 percent of them – focus on primary care, according to Nash. That’s about 50 primary care doctors per 100,000 patients, or 38 below the national average.

In rural or impoverished areas, like the Navajo reservation where Lindsey grew up, the average can be much worse.

“There’s a big need for primary care doctors,” Lindsey said. “It’s kind of always been the focus for me.”

Because Rial and Lindsey will remain in Arizona for their residencies, they are more likely to stay in the state afterward.

Arizona ranks 12th in the nation based on the number of its doctors who studied and completed residencies in the state, according to the Association of American Medical Colleges.

The UA medical school hopes to incrementally increase the number of doctors it trains annually, Malan said, by increasing its enrollment to 115 students per year, up from 110. “It’s all about training more physicians,” he said.

It’s long been a rule of thumb in medical circles that a doctor stays where he or she trains.

Lindsey said there’s a simple reason for that: life.

“You’re almost 30, you have a family or are thinking about starting one,” she said. “You’ve got relationships with the doctors you’ve worked with.”

Rial and his wife moved to Tucson 12 years ago.

“We’ll be here at least three more years,” he said.

Source: Association of American Medical College’s “2007 State Physician Workforce Data Book”

———

BY THE NUMBERS

The University of Arizona College of Medicine will confer doctor of medicine degrees during a ceremony on Friday. The 2009 class includes:

• 124 graduates

• 66 women

• 58 men

• 17 Hispanics

• 2 Native Americans

• 61 who will remain in Arizona for their residencies

• 43 who will go into primary care

Source: University of Arizona College of Medicine

———

Arizona Doctor Shortage

The University of Arizona produces about 100 medical school graduates per year, according to the Association of American Medical Colleges. Nationwide, about 16,000 graduate from medical school every year, not nearly enough to keep pace with the country’s growing population, most observers say. Compared to national averages, the shortage of doctors in Arizona is more pronounced.

Active physicians per 100,000 patients

U.S.: 250

Arizona: 214

Arizona’s national rank: 33

Active primary care physicians per 100,000 patients

U.S. 88

Arizona: 77

Arizona’s rank: 39

Percent of active physicians in each state who completed undergraduate medical education in the state

U.S. average: 29 percent

Arizona: 10 percent

Arizona’s rank: 41

Percent of active physicians in each state who completed a residency or fellowship in the state

U.S. average: 45 percent

Arizona: 25

Arizona’s rank: 38

Percent of active physicians who graduated medical school and practice in the same state

U.S. average: 39 percent

Arizona: 47 percent

Arizona’s rank: 14

Percent of active physicians who completed graduate medical education and practice in the same state

U.S. average: 47 percent

Arizona: 47 percent

Arizona’s rank: 18

Percent of active physicians who graduated from medical school, completed graduate medical education and practice in the same state

U.S. average: 66 percent

Arizona: 73 percent

Arizona’s rank: 12

———

Convocations and graduation

The University of Arizona’s colleges and schools began holding convocation ceremonies Wednesday. The College of Medicine convocation for candidates for a degree in medicine, will be at 5 p.m. Friday at Centennial Hall.

The campuswide commencement ceremony is 8 a.m. Saturday at McKale Center.

The following are the remaining school and college ceremonies scheduled for this weekend.

Friday:

Eller College of Management, undergraduates, 1 p.m. at McKale Center

College of Nursing, 1 p.m. at Centennial Hall

College of Social and Behavioral Sciences, 2 p.m. at Tucson Convention Center arena

University College, 3 p.m. at Integrated Learning Center

College of Optical Sciences, 5 p.m. at Integrated Learning Center 130

Saturday:

College of Agriculture and Life Sciences, 11 a.m. at Centennial Hall

College of Architecture and Landscape Architecture, 11 a.m. at Crowder Hall

College of Medicine, physiology undergraduates, 11 a.m. at Student Union Memorial Center

College of Law, 2 p.m. at Centennial Hall

Eller College of Management, graduate students, 5 p.m. at Centennial Hall

For more information on each college convocation, visit commencement.arizona.edu/collegeconvocations

Leslie Boyer, director of the Venom Immunochemistry, Pharmacology and Emergency Response Institute, holds a tube containing a dead bark scorpion at her office at Drachman Hall, 1295 N. Martin Ave.

Dawn Bray worried she might lose a second child to a scorpion’s sting.

A bark scorpion stung her 6-year-old son Morgan last May. As the family rushed him to the hospital in Globe, a wave of fear came over Bray. Six years earlier, in May 2002, she lost her 2-year-old son Dally to a bark scorpion’s sting.

“When Morgan got bit, I was thinking that it was happening again,” Bray recalled this week. “With another son, we would have the same outcome.”

From Globe, doctors flew Morgan to Tucson for treatment. He received a dose of Anascorp, a scorpion antivenin used widely Mexico but not approved for general use by the U.S. Food and Drug Administration.

Morgan made a speedy recovery. Just hours after his treatment, the Brays ate dinner together at a McDonald’s before making the two-hour drive back to their home about 25 miles south of Globe.

Morgan’s survival means that his brother “did not die in vain,” Bray said.

After Dally’s death, the Brays met with Leslie Boyer, director of the University of Arizona’s Venom Immunochemistry, Pharmacology and Emergency Response Institute. Dally received an antivenin but died anyway, his mother said. The family wanted answers.

Of the 60 scorpion species and subspecies in the U.S., only the Arizona bark scorpion is dangerous to humans; consequently, scorpion sting deaths are exceedingly rare in the United States, with fewer than a half-dozen in the past decade. But in equatorial countries more people die of scorpion stings than venomous snake bites. More than 1,000 people a year die from scorpion stings in Mexico, according to an article in eMedicine, an online medical journal.

Two years after Dally’s death, Boyer and a team of UA researchers began studying Anascorp, a drug Mexican doctors used regularly to treat those severely affected by scorpion stings. The UA researchers published their findings in the May 14 issue of The New England Journal of Medicine.

The study focused on 15 children hospitalized for severe reactions to scorpion stings in 2004 and 2005. Eight received Anascorp, which the FDA considers an “investigational drug.” Seven received a placebo.

Symptoms of nerve poisoning disappeared in less than four hours in the children treated with the antivenin. In the placebo group, symptoms lasted for several hours. Children not treated with Anascorp required sedation and longer hospital stays, the study found.

Bark scorpion venom “goes to every nerve of the body and tells them, ‘Fire!’ ” Boyer said.

In the worst cases, the bark scorpion’s venom can cause respiratory failure.

Scorpions sting about 8,000 people in Arizona every year. In Mexico, where Anascorp is widely available, scorpions sting 250,000 people a year.

In about 200 cases a year in the U.S., usually involving children, nerve poisoning becomes severe enough to require hospitalization.

Children in Tucson can go to a hospital emergency room for treatment, Boyer said. “But what about the baby in Morenci, the toddler in Globe?”

The UA study has expanded to include 24 Arizona hospitals. About 600 patients have received Anascorp since 2004, Boyer said.

Even in rural areas, severely affected children can receive the treatment within an hour of getting stung, the doctor said.

Whether the study’s findings will lead to FDA approval remains unclear. “We’re the only state in the country where this is important,” Boyer said.

For the Brays, it was a matter of life and death.

“Dr. Boyer was our angel,” Bray said. “If she trusted it, we trusted it.”

Dr. Leslie Boyer holds a tube containing a dead bark scorpion.

Intestine transplant patient Leslie Teran-Richter talks about the transplant experience. Richter's sister Michelle was the donor.

The sisters looked at each other and nearly broke into tears.

Michelle Teran had donated 6 feet of her small intestines to her ailing sister, Leslie Teran-Richter, on April 30. But, as the women shared a quiet moment Friday afternoon, the donor beamed as brightly as the recipient.

Teran-Richter, 44, nearly died in October when her small intestine twisted itself into knots after a sudden illness. Blood stopped flowing to the tangled organ, and the tissue began to die.

Doctors removed all but 5 inches of Teran-Richter’s small intestine. She faced a lifetime of intravenous feedings and the ever-present risks of infection and other complications.

“I couldn’t let her do it,” Teran said of the prospect of seeing her younger sister languish in such a state.

Though 12 years older than Leslie, Teran said the siblings have remained close. “There was no hesitation to do the right thing,” she said.

Doctors at University Medical Center had never performed a small intestine transplantation. No hospital in the state, or in the Southwest, had attempted such a risky procedure.

Nationwide, doctors perform between 150 and 180 bowel transplants, according to surgeon Rainer Gruessner, who led the team of doctors who operated on the sisters at UMC. Even fewer intestine transplants involve living donors. Almost all include transplanting other organs at the same time.

Small bowel transplants carry greater risks of rejection and infection than transplants of other organs, Gruessner explained.

Spending a lifetime requiring total parenteral (intravenous) nutrition could cost up to $200,000 a year, according to gastroenterologist Khalid Khan, a member of the UMC transplant team.

“That’s just really the nuts and bolts,” Khan said.

Long-term intravenous feedings can increase a patient’s risk of liver failure, Khan said. The cost of caring for patients in that state can top $500,000 annually.

UMC worked with Teran-Richter and her family to convince insurers that a transplant, which would cost $20,000 to $30,000, would be the most cost-effective option.

Once the doctors got the OK, the operation went smoothly.

As surgeons on Friday wheeled Teran-Richter into a UMC conference room, she cracked jokes about how much makeup she put on that day.

She said she’s in a great deal of pain. For the next several weeks she’ll undergo weekly biopsies to determine the continued viability of her newly transplanted bowel. She’ll remain on anti-rejection drugs the rest of her life.

“That is almost a minor issue,” Gruessner said.

About two-thirds of patients who receive small-intestine transplants live well past their first year with the new organ, the doctor said.

Teran-Richter’s operation catapults UMC onto a short list of facilities nationwide with the capability to perform intestine transplants. Just five hospitals, including UMC, perform the procedure, according to Gruessner.

In 2008, just 55 intestine-only transplants took place in the U.S., according to the Scientific Registry of Transplant Recipients. More than 200 remain on a national waiting list for the operation.

Teran-Richter and her sister “are playing around” with the idea of starting a foundation to encourage live-donor transplants, which doctors suggest increase survival rates in organ-recipients.

Gazing into her little sister’s eyes, Teran forced back the tears. “She’s the strongest person I know. She must have 25 lives.”

Teran-Richter survived breast cancer in 2008. Just nine days after her surgery, Teran-Richter on Friday talked of returning to her job as a records manager for the town of Sahuarita.

Her doctors smiled. Her recovery may take a little longer.

“Four weeks, you watch,” she promised.

Intestine transplant patient Leslie Teran-Richter (right), her sister, Michelle Teran, and her husband Eric Richter discuss their experiences. Her surgery was the first intestine transplant using a living donor in the entire Southwest.

The event, organized by the Victory Worship Center and its student ministry, Elevate Youth Church, will take place on the University of Arizona Mall. Registration begins at 6 a.m. The run begins at 7 a.m.

The church’s aim is to raise $250,000 to buy the clinic and diagnostic equipment. The clinic would provide services at the church, 2561 W. Ruthrauff Road, and at other sites throughout town, according to a news release.

For more information about the fundraiser, go to www.elevate10mile.org or call the Victory Worship Center at 293-6386.

UA biologist Michael Worobey and 10 other scientists from around the world have posted their research on swine flu on an Internet "wiki" site.

As it turns out, the recent strain of swine flu has made people sick for far longer than many scientists have thought.

By studying the genes of the virus, University of Arizona biologist Michael Worobey and 10 other scientists from around the world have traced the outbreak’s rather humble beginnings to September, months before the media began reporting on the outbreak in Mexico.

Though new to humans, this strain of swine flu evolved from a variety of influenza viruses already well-known to researchers, Worobey and his colleagues determined this week.

“We’ve kind of shown conclusively that these are pig viruses,” Worobey said Thursday.

The UA professor and other scientists – some from as far away as the United Kingdom and Hong Kong – have published their findings online on a “wiki,” a Web site on which users can post and edit information.

“It’s like being in the same office,” Worobey said. “You’re able to critique and learn from stuff really quickly.”

Typically, scientists might sit on this kind of information and publish it later in an academic journal, the biologist said of the online group’s swine flu research. Worobey and his band of virus hunters thought providing real-time information might help epidemiologists avert a potential catastrophe.

Health officials in Arizona have confirmed 130 cases of swine flu – 22 in Pima County.

Nationwide, the virus has infected nearly 900 people in 41 states, according to the U.S. Centers for Disease Control and Prevention.

Epidemiologists have diagnosed nearly 2,400 people in 24 countries with swine flu, the World Health Organization reported Thursday.

In the event of a pandemic, WHO officials warned that as many as 2 billion could contract the virus.

From his reading of the data, however, Worobey doubts this iteration of swine flu poses such a dire threat.

Worobey, who has taught at UA since 2003, has spent much of his time studying the HIV virus that can cause AIDS. In 2007, he published findings that showed the HIV virus in the U.S. as early as 1969 – more than a decade before scientists had thought.

Worobey draws a common conclusion from his HIV and flu studies: “Epidemics take a long time to build up from the first case.”

Worobey and his colleagues will continue tracking the swine flu, trying to predict how it might evolve in the coming months.

“Everything we’ve seen so far is that it’s evolving the same way as the seasonal flu,” Worobey said.

———

Read the report:

To check out the research conducted by Worobey and his colleagues, go to http://tree.bio.ed.ac.uk/groups/influenza/.

Statewide, the number of confirmed diagnoses is 130.

Details about the new cases have not been released, Pima County Health Department spokeswoman Patti Woodcock said in a statement. “It is, however, my understanding that all have recovered or are in the process of recovering.”

Sunday, the first six cases of swine flu in the county were announced. Two involved middle school students in Tucson and Marana, the other four cases were on the Tohono O’odham Nation. By Tuesday, the number of cases had risen to 10.

“Keep in mind, we expected additional cases,” Woodcock said Thursday. “This does not change our approach to this virus.”-

Health officials recommend that people experiencing flu-like symptoms stay home and call a doctor before heading to a clinic or emergency room.

In line with recommendations by federal, state and local officials not to close schools because of the flu, Tucson and Marana schools have remained open. However, Tohono O’odham and Nogales schools have been closed as a precaution.

Tucsonan Sirena Dufault, who has fibromyalgia, plans to complete an 800-mile hike of the Arizona Trail on Tuesday.

When she set out to hike the 800-mile Arizona Trail last spring, Sirena Dufault worried that she might not finish.

The daunting trail stretches from Utah to the U.S.-Mexico border.

Tucsonan Dufault’s concern stemmed from her decade-long battle with fibromyalgia, a little-understood chronic pain disorder.

“I was a little hesitant to publicize it because I didn’t know how far I could go,” Dufault said this week. “Now I can comfortably do a 15-mile day with a big pack, no problem.”

Tuesday – on national Fibromyalgia Awareness Day – the 35-year-old will make a final, eight-mile hike north of Oracle to complete the trail, trudging from the Tiger Mine Trail head to the American Flag Trail head.

Dufault kept an online journal throughout her trek, which she made mostly by herself in one- to five-day trips. Tuesday’s leg will mark the 80th day Dufault has spent on the trail.

Dufault said she hopes her success will inspire the 10 million Americans who suffer from the disorder. “There’s not a whole lot of positive information out there about people getting their lives back after fibromyalgia.”

Fibromyalgia’s symptoms include chronic, widespread body pain, according to the National Fibromyalgia Association. Symptoms can stem from an acute illness or injury, as in Dufault’s case. Her diagnosis came in 1998, a year after she was hit by a car as she crossed a street. For months afterward, even as her initial injuries healed, Dufault’s pain and fatigue worsened.

“I saw her probably at her worst,” said Angi Edge, a nurse and massage therapist who treated Dufault after her diagnosis and became a fast friend. “So many people give up on themselves. They become their disease. She was just not going to give up.”

Dufault’s pain has not flared up in a major way in the past three years, she said. “I attribute that to being very, very active.”

For her next big adventure, Dufault might hike the Tonto Trail in the Grand Canyon. She walked 25 miles of that 90-mile trail last winter.

———

Read about Sirena Dufault’s experiences hiking the Arizona Trail in her online journal: www.aztrail4fms.org.

Asthma expert Fernando Martinez had been scheduled to give a public lecture on the subject this week. Instead, he will make his presentation – “Genes and Environment at the Onset of Asthma and Allergies” – from noon to 1 p.m. June 30 at the Kiewit Auditorium at the Arizona Cancer Center, 1515 N. Campbell Ave.

Martinez, who serves as the interim director of UA’s Bio5 Institute and heads the Arizona Respiratory Center, researches the natural history of childhood asthma and the genetic, physiological and environmental factors behind it.

The lecture is open to the public at no cost. A reception will follow at 1:30 p.m.

The anticipated losses, mostly for providing indigent care, are driving the hospital’s request for $31 million in taxpayer support for fiscal 2010, which begins July 1, and nearly $30 million a year in county money in the years to come.

The county in March agreed to pay HFS Consultants $30,000 to review expenses at Kino. The group’s report, released Friday, paints a bleak picture of the hospital’s finances and managers’ actions to curb spiraling costs.

In a letter accompanying the report, County Administrator Chuck Huckelberry cautioned the Board of Supervisors against “drawing specific conclusions regarding the snapshot analysis conducted by HFS Consultants.”

UPH officials said the report offers county leaders at best an incomplete picture of operations at Kino.

“We were somewhat stunned,” UPH CEO/President Larry Aldrich said Monday. “It’s flat-out wrong in so many areas.”

Consultants criticize UPH’s methods for writing off bad debts, saying that the hospital is too quick to refer late payers to collection agencies. The hospital should wait longer to find out if those patients qualify for the state equivalent of Medicaid, the report said.

“UPH does not give patients adequate time to pay prior to referral to a collections agency, which hurts the patient’s credit rating and causes bad public relations in an already disadvantaged population,” the report said.

Providing care to those without insurance will cost the hospital about $12 million in fiscal 2010 and up to $17 million by fiscal 2014. Anticipating the increase, UPH management should work harder to find ways to reduce the cost of providing such care, the report said.

Instead, consultants “didn’t find evidence of (hospital financial counselors) aggressively working with the patients to obtain charity care.”

“There’s a fixed amount of indigent care that won’t go away,” said William Crist, vice president for health affairs at the Arizona Health Sciences Center at the University of Arizona. “I understand the county has needs, and one of them is poor, sick patients.”

The university has begun, under Crist’s leadership, to forge a better working relationship between Kino Hospital and University Medical Center. Doing so might lower some of Kino’s operating costs, Crist said.

But providing care to those who can’t afford it gets expensive, Crist said, and much of those expenses fall to Kino, the only hospital south of Broadway.

The HFS report noted that “the county has very little control over hospital operations, which makes the subsidy request tantamount to allowing UPH to operate the hospital as they see fit while shifting the financial risk to the county.”

Supervisor Ray Carroll, for one, can’t stomach spending another $31 million to keep Kino running.

“I won’t support that,” Carroll said Monday. “We have to get the issue out in the community. I think we need to have some stakeholder meetings.”

Under the terms of a 2004 contract, the county in fiscal 2010 would pay UPH $10 million to operate the hospital.

That’s all Carroll plans to support paying UPH.

“This hospital cannot be run for $10 million,” Aldrich said. “That cannot happen.”

Shutting it down would thrust an estimated 42,000 emergency room patients, including psychiatric patients, into other hospitals in the region, documents show.

“That’s not a very well thought-out position,” board Chairman Richard Elías said. “I think there are some things we can do to improve the patient mix that, if it doesn’t reduce costs, puts a hedge on them.”

In its response to the consultants’ report, UPH said no amount of effort on its part would reduce the cost to the county of caring for uninsured patients.

County hospitals across the country require significant taxpayer subsidies to cover such costs, Crist said.

In 2003, the last year the county ran Kino, it lost an estimated $33 million, officials said. The hospital that year had relatively few patients, most of them in the psychiatric ward.

“Yes, we’re still spending $31 million, but we’re spending it a lot better,” Crist said.

———

Finances at UPH

A county-commissioned report on the operations at University Physicians Hospital at Kino outlined several reasons for ongoing financial losses, including:

• Writing off too many accounts to bad debt.

• Being too quick to send accounts to collection agencies, rather than waiting to see if those patients qualify for Arizona’s version of Medicaid.

• Not identifying enough ways for patients to qualify for charity care.

• Poor overall financial management.

All told, the Kino center will spend an estimated $12 million providing uncompensated care in fiscal 2010, said the report by HFS Consultants. By 2014, the amount likely will increase to $17 million, the report said.

UPH officials, who had one week to respond to the report, said the consultants miscalculated certain losses and that the conclusions don’t fit the facts, namely that the hospital aggressively seeks to reduce its level of uncompensated care.