PALERMO, Sicily -- Less than seven months after opening a $58 million hospital in this sun-drenched city, the University of Pittsburgh Medical Center is the focus of a pitched debate over the venture's hefty price tag and its aggressive expansion plans.
The leading argument: UPMC is in it for the money. Critics say UPMC is cornering the European medical market at the expense of Sicily's weak economy.
Locals here portray the new hospital as a polarizing force. Fans applaud its mission; critics say it is drawing not just patients who need transplants, as originally intended, but those who have routine conditions like appendicitis or who need common procedures like hernia repair and even circumcisions.
The project's woes, tightly guarded in the United States, have circulated Italy's medical community and captured headlines in local newspapers.
"We are spending an excessive amount of money on this project," Alessandro Pagano, Sicily's head of budget and finance, said through an interpreter in his office in the town of Caltanissetta.
As Sicily's chief of health when the project originated, Pagano, 45, was one of its key backers. His thinking changed last year when he started to think Sicilians were not getting what they were promised.
"It's not reasonable and something needs to be done. If this system doesn't change, it could be cheaper to fly patients to Pittsburgh," Pagano said.
Leaders at UPMC, the largest hospital network in western Pennsylvania, say they want to help repair Sicily's crippled health care infrastructure, not create controversy.
"What we are doing here is fabulous. ... We are saving people's lives," Michele McKenney, one of UPMC's key administrators, said at the hospital's administrative offices here in Palermo when initially asked about the criticism. She would not agree to a sit-down interview and insisted that all questions be submitted in writing.
Pagano is working on a plan to cut government fees to the hospital, known as ISMETT, which stands for Mediterranean Institute for Transplantation and Advanced Specialized Therapies.
He intends to seek support from other government officials.
"The region of Sicily needs to have more control of this project," Pagano said. "We should set the fees -- not them."
Leoluca Orlando, a former mayor of Palermo who placed the ceremonial first stone when ISMETT's new construction began in 1999, agrees.
"If you buy a $10,000 car for $30,000, you have to wonder why. Is UPMC only concerned about money?" said Orlando, 57.
In an e-mail message, McKenney wrote that "criticism is always welcome and always present," and that ISMETT and UPMC will "ultimately be judged over time by its success in treating patients, educating professionals and conducting research."
Local doctors are less hopeful, expressing frustration at the probability that ISMETT will duplicate existing medical services.
Dr. Vito Sparacino, a surgeon at Civico Hospital, said it wasn't until he spoke out that ISMETT and Civico agreed to split duties in kidney transplants. At one point, kidney transplants were being performed by both UPMC and Civico doctors, in the same building, only a few floors apart.
The two hospitals agreed last year that ISMETT would perform kidney transplants using living donors while Civico would perform transplants using dead donors.
Sparacino and others argue that ISMETT should be more focused on its promise to train Italian health care workers.
Sparacino said ISMETT has sponsored no programs to educate doctors about heart and kidney surgery -- something he expected to happen months ago.
"We want to have an opportunity to have a collaborative relationship," Sparacino said. "ISMETT and UPMC are completely disconnected from the health system of this region. The hospital is transforming itself into an island."
McKenney said ISMETT and UPMC have exceeded expectations in training and education. She said "scores of Sicilian professionals have traveled to Pittsburgh" for training but wouldn't specify how many of ISMETT's 410 employees that included.
She said the hospital has reversed a so-called "brain drain" from workers seeking better health care jobs outside Sicily. About 30 percent of the hospital's new hires are Italians who had left the country.
At any time, McKenney said, 15 to 20 nurses, doctors and other U.S. workers are in Palermo. Although that figure is far less than the number of Pittsburgh workers there five years ago -- when they represented half of all workers -- McKenney said the reduction is "a testament to the growth and development of our Italian colleagues."
The training has infused American know-how into the way doctors use anti-rejection drugs and has expanded the once-limited role of Italian nurses, who in the past were not capable of administering intravenous medications and didn't even have the nursing stations ubiquitous in American hospitals.
That's good enough for Cardinal Salvatore Pappalardo, a now-retired leader of the Roman Catholic Church and one of the early, most influential backers of ISMETT.
"Yes, things have changed since the project was conceived," said Pappalardo, 86. "But it's not a good thing or a bad thing, so long as the hospital exists. Something is not right, but it's not a battle for me to win."
