In some cases, Jackson says the complaints were not justified. Jackson spokesman Edwin O’Dell said studies show that the time recently needed to get a diagnostic image is about the same or just slightly above industry standards.

Still, Contreras-Soto said there are “so many other issues” in the emergency room, “I’m nowhere near to start demanding that my doctors see more patients.”

He said Jackson was still considering outsourcing as just one exploratory component of finding better efficiency in the ER, and many systemic problems need to be fixed whether the doctors are in-house or from an outside company.

Martha Baker, president of SEIU Local 1991, which includes Jackson’s doctors, says that much of the dysfunction in the Jackson Memorial ER has been known for years — and often ignored. The most recent outside analysis was done in July by Fitch Healthcare, a Chicago consulting firm hired by SEIU, that reported that improved efficiencies in the system could help ER doctors increase productivity to 1.4 patients an hour, saving the system millions.

Fitch’s study of Jackson’s ER doctors found that they spend large amounts of time having nothing to do with medical care: such as battling to get patients admitted to the hospital — a process that now averages two to four hours, when it should take no more than 20 minutes.

Much more time is wasted trying to get a consultation from a specialist about what’s wrong with a patient — something that should be done within 90 minutes, Fitch stated, instead of the five hours it takes at Jackson. Most of the consultant specialists are University of Miami faculty.

What’s more, because of long wait times for patients to get into a primary care clinic, Jackson ER doctors often do tests and procedures in the ER because they know there won’t be a quick follow-up trip to a clinic, the Fitch report said.

O’Dell said Jackson is working to expand its clinics and speed up wait times to take pressure off the ER.

Last month, Jackson’s board approved a proposal by Chairman Marcos Lapciuc to delay an ER outsourcing decision until January and to give management time to talk to the ER staff about how to improve performance. Union leader Baker said that resolution has led to improved communication about exploring ways to fix the system.

Baker questions whether outsourcing would save Jackson money, because Jackson doctors, as government employees, have sovereign immunity, which protects them from large malpractice judgments. Outside companies would not have that protection, meaning they would have to factor into their bids significant sums for liability coverage.

The exception is the University of Miami, one of the nine bidders on Jackson’s ER contract. Last year, the Legislature passed a bill giving UM doctors sovereign immunity when they practice at Jackson. A UM spokeswoman said Thursday the school had no comment.

Contreras-Soto, the Jackson executive, noted that records show a wide variety of performance of Jackson’s ER doctors. One averaged 1.6 patients per hour for the past year, while three averaged 0.5 patients. At some point, he said, those performances need to be addressed.