Photo by David Garrett.
Patients and their advocates continue to worry about the quality of healthcare, including psychiatric care, delivered by Cooper Green Mercy Hospital, which has been converted by Jefferson County officials into the community’s most prominent outpatient clinic.
And as they worry, State Rep. John Rogers, D-Birmingham, continues to work a series of bills he’s introduced through the Alabama Legislature to restore the hospital, or at least to create a healthcare authority that can do the job the county no longer wants to do.
A healthcare management professor at the University of Alabama at Birmingham said the messy fallout – resulting from county officials’ decision to close Cooper Green’s in-patient services and emergency room – could have been avoided if the healthcare authority model he advocated had been followed.
Scott Douglas, executive director of Greater Birmingham Ministries, said that Cooper Green’s psychiatric clinic has become a particular area of concern. While the patients can get their medicines, their access to counselors who help them get through mental challenges is in question because of funding, he said.
“One of the scariest things I heard was that one of the patients, right after the Newtown shootings, said, ‘I could see myself doing that,’” Douglas said. “These kinds of patients, who already have the stigma of being poor, also have to deal with the stigma of mental health challenges.”
Douglas said he is concerned about what appears to be “the gentrification of healthcare” with the end of Cooper Green’s inpatient and emergency room services on December 31, 2012. That concern is shared by one of GBM’s principal funders, the Marguerite Casey Foundation, which “exists to help low income families strengthen their voice and mobilize their communities in order to achieve a more just and equitable society for all.”
Kathy Mulady, a former investigative reporter who works for the Foundation’s Equal Voice newspaper, said she is interested in doing a story about healthcare for the poor in Birmingham because of Cooper Green and because Republican Gov. Robert Bentley plans to opt out of the “Obamacare” healthcare exchange, part of the Affordable Care Act that expands Medicaid to more people.
Douglas also said the Foundation’s board of directors, chaired by Birmingham-native Freeman Hrabowski III, will meet in Birmingham in May. That coincides with commemorations of the 50th anniversary of the Birmingham Movement, particularly the May 1963 Children’s March in which Hrabowski was a participant.
Bills, bills, bills
Rogers says he finds it difficult to sleep at night as his office has fielded calls from worried patients who have racked up bills as county officials work to transition inpatient and emergency services care to other hospitals. As a result, he has taken the fight to the Legislature with four bills.
One bill would create a Jefferson County Health Care Authority to operate an indigent care hospital. Another bill would allow Jefferson County to sell Cooper Green and its facilities to the City of Birmingham, which would receive the proceeds from the county’s Indigent Care Fund.
A third bill directs revenues generated from taxes that go into the Indigent Care Fund to the Alabama Department of Health to be administered by the department or transferred to a Healthcare Authority to create an indigent care hospital in Jefferson County. And a fourth bill would require the County Commission to submit quarterly accounting reports of the collections and disbursement of proceeds from the Indigent Care Fund or face fines and other civil penalties.
Rogers, one of the state’s most influential and controversial lawmakers, said he plans to move the bills through committee this week.
“I would like to see all of them have a fair hearing, because it will restore a hospital for the indigent,” Rogers said of his bills. “But once they [Jefferson County] come out of bankruptcy, they are going to have so many lawsuits” from Cooper Green patients, employees, vendors and doctors who’ve suffered during the transition, he says.
County Manager Tony Petelos responded in writing that Cooper Green’s transition from a hospital to outpatient clinic is moving forward and that officials are working to ensure patients get quality care.
“We continue to negotiate with area hospitals, where we have entered memos of understanding, to assure seamless care for our patients. We are communicating with people in the community that Cooper Green Mercy is open for business,” Petelos wrote. “During this ongoing transition, we continue to address needs and actions to assure appropriate, accessible, quality healthcare at Cooper Green Mercy Health Services.”
The ignored report
UAB professor and health management consultant J.M. “Mickey” Trimm said the headaches county officials are facing now could have been avoided if they had followed his advice to turn Cooper Green’s operations over to a healthcare authority.
He referred to a report he wrote last year for Dr. Sandral Hullet, Cooper Green’s CEO and medical director, to counter “very serious misinformation” about the hospital’s operations that he said led the public to conclude incorrectly that it needed closing. His report predicted some of the problems county officials are now facing.
Trimm’s report said eliminating inpatient care, while it would save $15-17 million, would cost $7 million in federal dollars Cooper Green got for taking care of poor patients. It would also lose $20-24 million in other coordinated services that other hospitals would likely charge more to perform.
The loss of the Cooper Green ER would result in 33,000 patients overwhelming other hospitals’ emergency rooms and creating a financial burden on their entire operations, Trimm’s report predicted. “Many fear these hospitals will either covertly or overtly discourage these patients from coming to their hospitals. Many of these patients will decide not to seek care at all and will either suffer unnecessarily or even die,” the report says.
Spreading poor patients around to other hospitals would make it difficult for Cooper Green doctors to coordinate their care. That would be particularly true for specialists who could have referred patients to clinics within Cooper Green’s own on-site system. And doing so would likely be more expensive.
“Cooper Green was founded in 1972 as a result of the perceived failure of existing hospitals to adequately care for the indigent,” Trimm’s report said. And while there needs to be more coordination among area healthcare providers, “none can adequately handle the volume that Cooper Green currently covers.”
Trimm said these and other issues — including personnel and purchasing restrictions, even nepotism and cronyism — could have been avoided by turning Cooper Green over to a board comprised of local healthcare, business, legal and community leaders in a healthcare authority. Trimm said his report was basically ignored, as was Commissioner George Bowman, who strenuously advocated the creation of an authority but was overruled by the Republican commission majority.
“I took it to every politician and community leader I could find, but no one acted on it,” Trimm said.
He said Jefferson County should have followed the example of Denver Healthcare, which was in the same shape in 1996 as Cooper Green was last year. Denver turned its county hospital over to an authority on January 1, 1997. Now, it runs a 400-bed hospital, coordinates indigent care in clinics across the city and receives millions in federal grants.
“Denver is doing the kind of thing that we should be doing in Birmingham, coordinating all indigent care, and doing that with half of the financial support that Cooper Green gets from the county’s indigent care fund,” he said. “If our leaders had some vision and forethought, we could have been able to cut the indigent care fund tax in half and still had an efficient [indigent care] operation.”
