The Jefferson County Medical Society issued a press release this week about what it calls a worst case scenario of “indigent patients…now suffering from a breakdown in the continuity of care” as a result of Cooper Green’s closure as a full-fledged hospital. The medical society contends that despite efforts to “volunteer [our] time and expertise to help engineer a workable solution…all of our attempts to work with our elected officials have failed.”
County Manager Tony Petelos not only disagreed that the attempts to work with the doctors have failed, but he also calls the medical society’s characterization of the indigent care crisis “ludicrous.”
County officials have been harshly criticized by various quarters in the community over their decision to reduce services at Cooper Green from the area’s primary indigent care facility to the status of an outpatient clinic. The statement by the doctor’s group – really a call for voters to rally against the county’s plan – is the latest in a chorus of calls for the county to rethink a decision many argue is threatening the very lives of the poorest and traditionally most underserved patients in the Birmingham area. “These issues will certainly result in delays in care and the loss of life – not just in the indigent population, but also for those who are well off and think this issue does not affect them,” according to the statement.
Here’s the statement from the medical society:
The Jefferson County Medical Society – representing the physicians of Jefferson County – has repeatedly discussed our deep professional concerns with our elected county representatives regarding the void created by the closure of Cooper Green Hospital and the drastic reduction in providers at the Cooper Green outpatient clinic. Our doctors have offered to volunteer their time and expertise in order to help engineer a workable solution. Regrettably, we must report that all of our attempts to work with our elected officials have failed.
We are now left with the worst case scenario: indigent patients are now suffering from a breakdown in the continuity of care and the lack of the critical physician-patient relationship. Primary care services – the crucible for preventative care and cost savings – for former Cooper Green patients are almost nonexistent. As a result, these patients are now flooding the emergency departments of area hospitals as their chronic medical problems like diabetes and high blood pressure spiral out of control. Along the way, the time and valuable resources of our hospitals and physicians are unnecessarily being consumed at an alarming rate. We as citizens all depend upon these emergency resources from time to time.
The “plan” set forth by the County Commission is an abject failure. A few agreements have been publicly touted for secondary services; however, these do not address the underlying primary [care] problem. With all due respect to our elected county officials and their well-paid consultant, our county government has no business trying to administer a health plan.
A solution to this problem is obvious to the medical community as we stand united with our area hospitals. However, our elected officials will not listen. That’s where we desperately need your help.
We believe that the funds already earmarked (and currently being collected) for indigent care should be redirected to the Alabama Department of Public Health, retaining their specific earmark for use only in the care of indigent citizens of Jefferson County. The ADPH, under the direction of our State Health Officer, Dr. Don Williamson, has indicated that it can set up a health plan with a third party administrator to identify and enroll qualifying patients. This will be the most cost efficient and least political solution, and will guarantee that the consumer/patient has a choice in where they will receive their medical care.
If we do nothing, the health of the least fortunate members of our county will continue to worsen, forcing them to the area ERs for their healthcare. With increasing frequency, ambulances are already being forced to bypass the nearest hospital because it is full and cannot accept new patients. Treatment in our area emergency departments is taking longer due to the overwhelming volume of patients. These issues will certainly result in delays in care and the loss of life – not just in the indigent population, but also for those who are well off and think this issue does not affect them. Additionally, the healthcare industry in Birmingham – currently a reliable engine of growth for our local economy – will suffer immensely. Important capital improvements to our hospitals and clinics will be delayed which will result in less up-to-date services and treatments. These are very important issues to everyone in our community, regardless of where there they live or how much money they make, and demand our immediate attention.
We encourage the public to call their elected officials now. Let your voices be heard loud and clear on this very important issue.
“We have been long suffering with the leadership in Jefferson County,” said Ayers, who is a doctor of internal medicine at Princeton Baptist Medical Center. “We began talking with members of the Jefferson County Commission back in August of last year, whenever they first announced they were closing Cooper Green Hospital. We met with them individually and in pairs and told them that closing Cooper Green without a plan was a recipe for failure and disaster.”
Ayers also said members of the group talked several times with Petelos and Otis Story, tasked to help downsize the hospital, in person and by phone in the fall.“We met to outline our concerns that, if they closed Cooper Green without a plan, how would the patients would be taken care of? That’s our concern 100 percent,” Ayers said.
The county manager vehemently disagreed with the medical society’s characterization of the current indigent care situation or the way the county has dealt with Cooper Green. “I disagree that it’s a failure,” Petelos said, citing a “massive media campaign” on the radio, in print, and on buses telling people that “Cooper Green Urgent Care is open.”
Petelos said he was in a forum last week and learned that “we had a tremendous outbreak of influenza this past year that extended, and that the outbreak of influenza did create a lot of patients showing up at the emergency rooms, but they’re not the ‘Cooper Green patients,’ they’re just patients who got sick that showed up at the emergency rooms.”
Petelos said that when he was mayor of Hoover “we saw diversions of emergency rooms that went on a lot. Last summer, when Cooper Green Emergency Room was open and Cooper Green inpatient was open, out of 31 days in July, there were 29 days of diversions going on, so this isn’t a new phenomenon.”
“Diversions” refers to the practice of one hospital redirecting a patient (for any of several reasons) to another hospital facility. Petelos said that he does not believe there are now more patients being diverted to other area hospitals despite the fact that Cooper Green’s level of service has changed. “Are some patients showing up at emergency rooms? Yes. But I don’t think it’s our patients, the Cooper Green patients that have been characterized in this letter.
“We had the perfect storm hit us in January when we closed inpatient care and then you had one of the worst influenza outbreaks this season, which lasted for an extended period of time.”
He repeatedly noted that he’s willing to talk to the medical society about their concerns. “I’ve met with the Jefferson County Medical Society and would love to meet with them in the future if they would like to meet,” he said.
“But I think that their characterization that all of our patients are showing up in area emergency rooms is totally ludicrous. … We have worked very hard, if our patients…are showing up in emergency rooms, in trying to bring them back. I don’t think you can blame it on Cooper Green.”
About meeting with Petelos, Ayers said that after Cooper Green ceased its inpatient and emergency room services, the medical association and administrators from area hospitals formed a committee to take a more aggressive stand about their concerns with county officials. “We felt like together we would have a stronger voice. And we made a renewed effort to meet with them. We repeatedly requested meetings with Mr. Petelos and Mr. Story. A meeting was never granted.”
“Is there a lot that has to be done?” Petelos asked. “Yes. We’re advertising for more doctors, we’re continuing to advertise, we have ads running for primary care doctors and again if anybody needs to see a doctor, they can come to Cooper Green urgent care and see a doctor 8 a.m. until midnight, seven days a week.”
Urgent care is not exactly the right answer, Ayers said. “An urgent care center does not make up a health care system. It is a piece of a healthcare system. The crucible is the preventative, primary care and that’s the piece we’re missing here.”
Since then, doctors are hearing stories of patients not being able to get primary healthcare, which causes their chronic conditions, such as diabetes or high blood pressure, to spike out of control and turn into chronic illnesses. And that forces patients into emergency rooms. Some doctors can’t get access to Cooper Green patients’ medical records, and others have difficulties scheduling doctors’ appointments. Pleas for help, from doctors and the community, seem to go unheeded at the county level, Ayers said.
“The patients are suffering and no one seems to care about it,” Ayers said.
Petelos disagreed. “I think what’s happened is there’s been so much misinformation out there that our patients did get confused. … We’ve tried with our media campaign to let our patients know that we’re open, that we’re open for business and that we’ll continue to be open for business.”
The fact is that the county should not be in the healthcare business at all, Ayers and others argue. “It’s very obvious to us that the county’s plan is a failure,” Ayers said, “so we need a plan that will work to provide access to care for these patients with the funds that are already available. I think we have to wrench control away from the county commission and the only way to do that is through legislation.”
So the medical society members took their case to local lawmakers. They lobbied Rep. Paul DeMarco, (R-Homewood), to craft a bill that would turn the Jefferson County’s earmarked indigent care fund dollars over to the Alabama Health Department under the leadership of Dr. Don Williamson.
“Dr. Williamson has indicated that they can take this money already being collected, retaining the special earmark for Jefferson County and contract with a third-party administrator, like Blue Cross or Viva, that already had primary care networks, to develop a health plan for these patients. They can give them their own access that provides them with choice. They could go to one of the health care centers or their own private doctor,” according to Ayers.
Petelos disputed the notion that giving the indigent care money over to the management of the healthcare authority would improve care to the degree that critics of the county plan believe.
“Unfortunately, there’s this assumption out there in the medical community that we have now $45 million that’s available for indigent care and so any write offs that the hospitals have done in the past – not all the hospitals; we have a great working relationship with doctors and hospitals – but some of them feel that this is a way that they no longer have to write off patients. But there’s not enough money in the $45 million to handle every indigent patient, or every patient in Jefferson County who doesn’t have insurance. Has never has been in the past and will not be.”
Petelos contends that despite the protestations of the doctors at the medical society and a host of other critics, Cooper Green is a better facility for indigent care – at least in some ways –than before.
“What we’re trying to do with our patients who were at Cooper Green, we want them to continue to come to Cooper Green,” Petelos said. “If they need other treatment, if they need to see a specialist, we still have our specialists there, if they need inpatient service we will do the authorization form for them to go to the hospital so that the dollars can follow them.
“We see patients every single day, we have seen thousands of patients since inpatient closed on January 1. We expect to stay open and to continue to see thousands of patients in the future and to offer quality care.
“These issues that they’re referring to, these issues of doctors, of primary care, these are issues that were there before the transition occurred,” Petelos continued.
He told a story to illustrate why Cooper Green is better as an “urgent care” outpatient facility than it was at the end of its life as an inpatient hospital. “I was at CooperGreen back in the fall. There was a lady there, it was 7 o’clock at night. I had asked her what she was doing. She had taken her mother to Cooper Green. They’d been waiting for seven hours to see a doctor. That’s totally unacceptable. So we’re trying to fix this problem and it’s not going to fix overnight. Yes, there’s a lot we can do better. We will do better. And we have done better since January 1 and we’ll continue to do better.”
The best the county can do just won’t be enough, Ayers contended. If indigent care funds are not moved to the health department’s management, he argued, “Tony Petelos and Otis Story will keep deflecting our questions, throwing dirt at the doctors and not speaking to us, and the system will be in the same state for another year. … They need to leave healthcare to healthcare professionals and to the physicians.”