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HMPRG founder Quentin D. Young quoted in article on December 11, 2010 about Cook County Health System

Kristen Pavle
December 15, 2010

"Staffs Worry About Shifts In County Health System"


As Tia Speat strode through the quiet halls of Oak Forest Hospital last week passing out fliers about the nurses union’s contract negotiations with Cook County officials, angry nurses accosted her with questions and complaints about proposed cuts in service and staff.

As the county health system shifts strategy to deliver care with leaner resources, many who provide medical services say they are approaching a breaking point. An analysis by the nurses union predicted that the county health system’s 2011 budget would cut about 1,000 jobs, including 114 nurses and 19 doctors, to help close a $487 million countywide budget gap.

After the Cook County Board of Commissioners approved staff reductions and closed eight clinics in 2007, an independent board was appointed to oversee the health system. Toni Preckwinkle, the newly elected County Board president, said “the system was hacked with an ax” during that round of cuts, and she has been an outspoken supporter of the independent board, which recently submitted its budget to her.

The budget is based on a plan called Vision 2015, which the independent board adopted last summer. The plan is designed to shape budgets and operations over the next five years, shifting the focus of the health system to primary-care service from in8patient care. Because the new plan sets out an overall strategy, Ms. Preckwinkle has said, the pending staff reductions will be more in line with long-range goals and less painful.

Lucio Guerrero, a spokesman for the Cook County Health and Hospitals System, said: “We’re cutting superexpensive services that are underutilized and adding services that are needed in the communities. This isn’t just an exercise in the bottom line; this is a medical model that makes sense for the next five years.”

“I don’t blame people for not really trusting us,” Mr. Guerrero added. “Maybe in the past they didn’t have a reason to. With the independent board, it’s a different day.”

Under Vision 2015, emergency and inpatient services at Oak Forest Hospital will be eliminated, and at Provident Hospital in Bronzeville inpatient care will be greatly scaled back, meaning that many of the sickest patients from the South Side and south suburbs will have to travel to John H. Stroger Jr. Hospital of Cook County on the West Side. The cuts would be offset by increases in primary care and outpatient services at Oak Forest, Provident and Stroger and county clinics.

Many nurses are not convinced that the plan is workable. The layoffs will most likely be heaviest at Oak Forest, where nurses said staffing levels had been winnowed to bare-bones levels. They are already hard-pressed to give adequate attention to patients, the nurses said.

If county officials are going to close inpatient units, “they should just do it, instead of expecting us to work miracles in a horrible situation,” said Kathy McKinney, a registered nurse. “I’m just tired. I still love my career, but I dread coming to work at this place.”

The County Board’s finance committee will begin deliberations on the budget Tuesday.

The health system, like all county departments, was ordered to trim 21 percent from last year’s budget, even as federal aid was being reduced. Doctors and nurses say the budget squeeze could not come at a worse time, with rising unemployment producing an influx of newly uninsured patients.

On Dec. 22, the National Nurses Organizing Committee, which represents 1,300 registered nurses in the county health system, will tally the results of a mail-in vote that would authorize union leaders to call a strike to protest the staffing cuts and other concerns. Administrators at Stroger Hospital, the largest institution in the health system, have prepared a contingency plan that would include early release or transfer of patients to other hospitals, cancellation of elective surgery, mandatory 12-hour shifts and other measures.

The Service Employees International Union’s Doctors Council, which represents 500 county doctors, is also in the midst of contract negotiations. In a recent report, it described the county system as “cut to the bone.”

Despite bureaucratic obstacles and long emergency room waits for patients — some reportedly as long as 14 hours at Stroger — the county’s health care system has long been known for its top-notch specialists and services. “You’ll die waiting at county, but then they’ll bring you back to life,” goes a popular saying.

Quentin Young, chairman of Cook County’s Department of Medicine from 1972 to 1981, called Stroger “a spectacular place that has provided care for millions.” Now, Mr. Young and other experts say, the system’s challenge is to cut costs while maintaining a high standard of care.

Mr. Young supports the independent board’s plan to cut emergency and inpatient services in favor of expanded primary and outpatient care. “Any kind of cut is painful,” he said. “They’re trying to choose between the lesser of two evils.”

Doctors and nurses say they fear that the sickest, most vulnerable South Side and suburban patients who had relied on Provident and Oak Forest will fall through the cracks in an efficiency-driven corporate model. They say they are being pressured to increase the numbers of patients they see, which gives them less time to spend with each one.

“There is a business mentality that exists on the board now,” said Dr. Fred Martin, a family medicine residency supervisor. “They don’t have a good feel for what’s happening on the front lines. The only measure of productivity that we have is numbers of patients seen. The consultants have not been taking into consideration that a doctor might see a 62-year-old diabetic with thyroid disease, hypertension — and, oh, his back hurts, also. We need to spend time with people like that. He’s not just a number.”

At Stroger Hospital, nurses say they worry about the expected increase in seriously ill patients after changes in inpatient and emergency services at Provident and Oak Forest. Dennis Kosuth, an emergency room nurse at Stroger, said administrators had demanded that nurses provide better customer service, even though they were taking care of up to nine patients at a time — 18 when their partners are on breaks.

“The best customer service attitude in the world doesn’t help when you just have too many patients,” Mr. Kosuth said. “We give the best care we can with the resources we have, but an overcrowded emergency room where people are waiting 12 hours is a disaster waiting to happen.”

An analysis by David Goldberg, a Stroger doctor and president of the executive medical staff, said previous cuts in service had been financially self-defeating. With each dollar of services cut in 2007, the study showed, revenue — from fewer potential patients — dropped by $1.62 in 2008. Dr. Goldberg said many patients might have given up on the county system after the 2007 cuts and gone without care or found other options, causing a drop in reimbursement from Medicaid and health insurers.

County officials and taxpayers should be willing to spend more on the health system, he said.

“We’re doing our part to support the work force and the residents of Cook County by caring for all these people,” Dr. Goldberg said. “We need a county who stands behind us. If everyone’s going to walk away from us, that’s not a society I’m proud of.”

You can also read the full story here: "Staffs Worry About Shifts In County Health System" , with pictures, from the Chicago New Cooperative.