A pair of state legislators and at least two doctors connected to the University of South Carolina's School of Medicine have raised concerns about the university's plans to expand its medical education program in Greenville.

The Greenville Hospital System, which has promised to contribute $35 million to $39 million over seven to 10 years to help pay for the expansion, had its credit rating downgraded by Moody's in April and announced layoffs in May. And a prominent backer of the USC-Greenville Hospital System deal, former USC president Andrew Sorensen, is a paid consultant for the hospital system, causing some to question his objectivity.

'If that's the case, that stinks to high heaven,' said state Rep. Jim Merrill, a Daniel Island Republican, who, along with state Rep. Chip Limehouse, said he thinks the expanded medical school will, eventually, cost state taxpayers despite assurances from university leaders that GHS and medical school tuition will cover all costs.

'I think that is an absolute crock,' Merrill said of USC's insistence that taxpayers won't be asked to pay for the medical school expansion. 'I would be willing to bet my bottom dollar it will happen.'

Limehouse, a Charleston Republican who is chairman of the higher education subcommittee in the House, said USC's decision to expand its medical school is 'just one more example of people doing their own thing' and not working collaboratively to meet statewide education needs.

In questioning the timing and financial wisdom of USC's plan to expand its medical school, Limehouse and Merrill were echoing comments made by Dr. Ray Greenberg, president of the Medical University of South Carolina.

But the Charleston legislators said their concerns are not based on regionalism or on an effort to shield MUSC from an expanded USC School of Medicine.

Rather, the men said they are skeptical that things will go as USC and the Greenville Hospital System have planned. 'This is just the wrong time to start a new program,' Limehouse said.

State Sen. Mike Fair, R-Greenville, disagrees. 'The need is there,' he said. 'I think it's a win-win proposition, not only for the Upstate but for the whole state.'

The Greenville Hospital System's financial condition has given some opponents of the deal pause.

Because of what it described as the 'erosion in the system's profitability over the last several years,' Moody's credit rating agency downgraded the system from the agency's fourth-best designation to its fifth-best. The Greenville Hospital System's rating is still investment grade, and Dr. Jerry Youkey, the system's vice president for medical and academic services, said its financial health is strong.

Youkey said the hospital system did announce the layoffs of 50 workers, but he noted that it has nearly 9,000 employees. He also said the system will add 220 jobs over the next fiscal year.

'We are not a static organization,' Youkey said.

As for the credit rating, Youkey and Ted Moore, USC's president for finance and planning, said other agencies reviewed the hospital system's finances and maintained their previous ratings.

Sorensen, who holds a tenured faculty appointment in USC's School of Medicine, has been a prominent backer of the deal between USC and the Greenville Hospital System..

Opponents of the USC-GHS deal have quietly complained that Sorensen's objectivity is in question because he has been a paid consultant for GHS since leaving the presidency in 2008.

Sorensen, reached at USC on Monday, said he has been paid to do consulting work for GHS one day a week during the academic year and for three months during the summer.

He referred questions about how much he has been paid to the hospital system's attorney. The attorney's office referred questions to a spokeswoman who did not immediately have the amount Sorensen has been paid.

In addition to his appointment at the USC School of Medicine, Sorensen serves as the president of the Institute for the Advancement of Healthcare, a research collaboration between USC and GHS. He worked to expand collaboration between USC and GHS when he was president of USC. 'I did that getting paid zero by the Greenville Hospital System,' said Sorensen, who argued that his advocacy for the USC-GHS deal is an extension of the work he did as president.

In separate articles, one in The State on Monday and one in the Journal of the South Carolina Medical Association last month, doctors C. Warren Derrick and Charles Bryan questioned the timing of the expansion and doubt it would produce more primary-care doctors.

Derrick is a professor emeritus at USC's School of Medicine, and Bryan is a former chairman of its Department of Medicine.

Derrick said residency slots will need to be increased if the state hopes to increase the number of doctors here since medical students are more likely to stay in the state where they completed their residency. And Bryan wondered whether the current poor economic climate will allow GHS to uphold its commitments.

'Is commitment to indefinite funding of a four-year medical school, and notably of new, academically-credible basic science departments, good business strategy during this time of economic uncertainty for the nation and for health care financing?' Bryan wrote.