Even after 30 irate speakers denounced the idea at a packed public hearing, Jackson Health System’s board decided Thursday to allow management to continue to explore whether outsourcing emergency room services at the public hospitals is a way to cut costs, reduce waiting times and provide good care.
Politicians, leaders of women’s groups, union members and taxpayers spoke for almost three hours in opposition to the idea of turning over a government service to an outside company.
“I am outraged that you would take my taxpayer dollars to let someone make a profit,” said Elizabeth Judd, a retired Biscayne Gardens resident.
One board member, Joaquin del Cueto, made a motion to kill the proposal. That was rejected, 5-1.
The board then unanimously approved a motion by Chairman Marcos Lapciuc to direct management to work with labor to improve ER services and report back to the board in January. That means the outsourcing exploration continues.
Martha Baker, president of SEIU Local 1991, which represents Jackson nurses and doctors, said she was dismayed that the possibility of outsourcing the ER was still alive. “It’s disappointing that they missed the message from so many public people today.”
Baker said the union and its consultants have been making recommendations to fix the ER for the past three years. “Why haven’t they done them?” she asked, adding that she would be “pleasantly surprised” if new discussions led to results.
The heated discussions were sparked by a move from Chief Executive Carlos Migoya to seek proposals from outside companies to outsource some of the clinical operations of the system’s emergency rooms, a move that could affect 46 full-time employees — 29 physicians, 16 nurse practitioners and one physician’s assistant.
“No decision has been made to contract services,” Jackson said in a written statement. “This is a fact-finding process that will allow Jackson to make a recommendation based upon facts…. Jackson’s mission will not be compromised…. The emergency room will remain open to everyone.”
But many speakers saw a larger danger.
“I see this as a backdoor approach to the full privatization of Jackson,” said Miami-Dade Commissioner Barbara Jordan.
Commissioner Audrey Edmonson called the exploration “a means to justify or bring about privatization. … It leads to laying off our employees. All it takes is 20 here and 10 there and 10 somewhere else and before you know it, you have the whole hospital privatized.”
Other speakers said that a private company would inevitably provide inferior care to the poor and uninsured who use Jackson’s emergency services.
Jackson’s statement said executives weren’t simply seeking cost savings. “This is not a low-bid process based on price. … The ability to provide excellent care while reducing wait times will be an important consideration.”
Migoya has pointed out that many hospitals, including the public hospitals in Broward County, outsource their emergency room physician services.
But David Woolsey, a Harvard-educated doctor who has worked in Jackson’s ER for 22 years, gave the board a long list of prestigious teaching hospitals, including those run by Duke University and Johns Hopkins University, that staff their own ERs.
Woolsey, like many other speakers, emphasized that Jackson receives hundreds of millions of dollars annually in local sales and property tax money in order to “provide one single high level standard of care, regardless of ability to pay.”
Jackson’s ER doctors do the work because they love taking care of the poor and the uninsured, he said. “We live that mission every day,” Woolsey said.
He said it would be impossible for a for-private company, measuring the profitability of each case, to give high quality care to patients who couldn’t pay.
Woolsey also argued that an outside company couldn’t do the ER service cheaper than Jackson. He said Jackson’s ER doctors earn about a third less than they could get elsewhere, and an outside company would have to factor in about $4 million to $6 million a year for liability insurance – charges Jackson doesn’t have because its staff is protected by sovereign immunity.
Del Cueto, the board member, said he had seen first hand during his three decades with Miami-Dade Fire Rescue the difference between private and public ERs. “I’ve taken patients to the best hospitals in town. They get a Band-Aid and a referral to Jackson.”
Duane Fitch, a Chicago healthcare consultant hired by Jackson unions, said he has given Jackson an analysis showing how it can save $2.2 million a year in ER physician costs though steps including more primary care and follow-up care.
Migoya emphasized that he is not an automatic supporter of outsourcing. He noted that he just made a decision to stop outsourcing clinical services at a Jackson clinic in South Miami-Dade.
Many speakers expressed specific concerns about outsourcing clinic services at the Roxcy Bolton Rape Treatment Center.
Julie Kanter, a Jackson ER physician and clinical director of the rape treatment center, said she couldn’t imagine an outside company showing the dedication needed for the careful treatment of victims.
“I have worked for many outsourced emergency departments,” she said, and they measure performance by strict metrics that don’t allow for much flexibility.
In a statement, Jackson said that one or two patients at the rape center require medical care each day, with the care usually provided by an ER nurse practitioner who devotes 95 percent of her time to regular ER duties. Other counseling and support services would continue to be done by rape center staff, the statement said.
Only one of the 31 speakers urged the outsourcing process to continue. That was Lapciuc, the Jackson chairman speaking as a private citizen. He said management should have the ability to explore alternatives without interference from the board or elected officials.
Others warned that if Jackson continued with the outsourcing move, they might be dealing with a world of pain. “You’re looking at a strong outbreak in the community,” said the Rev. Jerome Starling of Jordan Grove Missionary Baptist Church. The debate overshadowed news that Jackson had a net surplus of $3.1 million for August — the sixth consecutive month of surplus. The number of days of cash on hand was at a precariously low 9.35 days, down from 13.33 in July.