If Cooper Green Mercy Hospital were a patient in its own emergency room, the doctors there would likely forward the ambulance to UAB, where the most severe patients eventually go. The indigent care hospital is bleeding to death, and the wound is self-inflicted.
On Monday, hospital administrators and Deputy County Manager Walter Jackson explained to the Jefferson County Commission just how dire the hospital’s financial situation has become. Six months into the fiscal year, Cooper Green will soon be more than $4.2 million behind on past-due invoices. Some of those invoices are more than 90 days old. A few of them date from the last fiscal year, which ended last October. If vendors aren’t paid soon, they will discontinue services to the hospital and possibly the rest of the county, too.
All of this was avoidable or, at the very least, predictable. Nonetheless, the commissioners on Monday did their best to look surprised, whether their shock was feigned or not.
Cooper Green is supposed to live out of the indigent care fund, a legislative earmark which gives the hospital more than $40 million per year. In addition to that money, the hospital receives federal reimbursements and some payments from patients. Despite those funds, the hospital has ended the last several fiscal years with deficits of between $7 million and $9 million. To close that gap, the county has supplemented the hospital with the general fund, its main bank account.
But last year, that changed. After the Alabama Legislature refused to reestablish an occupational tax for the county, the commission told the hospital in June that the last infusion of funds would be just that — the last. The commission made it clear to hospital administrators that it could no longer afford to be a financial crutch. The hospital would have to tighten its belt. Dr. Sandral Hullett, Cooper Green’s CEO, appeared her normal sullen self but said the county hospital would make due.
But it didn’t. In fact, it doesn’t appear the hospital ever slowed down. If Cooper Green were to continue spending for the rest of the year the way it has burned through money during the last six months, it would end the year somewhere between $10 million and $14 million in the red.
To make matters worse, the hospital dealt with its funding shortfall, not by cutting costs, but by sitting on invoices. It’s unclear when hospital administrators began doing this, just as it’s unclear now how much the hospital owes. It’s at least $4.2 million and maybe more.
The trouble with these sorts of problems is that they never reveal themselves all at once, but rather in bits and pieces.
In this column before, I’ve told the story about the flat tire my older stepbrother had when we were in high school. One afternoon, he walks up to my parents’ house in the country in the middle of the pouring rain. He was soaked and had mud all over his clothes. When my stepmother asked him what had happened, he told her he’d had a flat tire. My stepmother says changing a flat is easy enough, so they get in the truck and head for where the car is.
That’s when my brother says the car is kind of in a ditch. That’s no problem, my stepmother says. My dad had a winch on his truck that could pull it out if it was stuck.
So they go a little further, and my stepbrother says the car might be dented a little bit. And this routine continues until they get to the truth: The car spun out in the rain, ran off the road and hit an embankment. The frame was bent and the car totaled. And somewhere in the midst of all that, there had been a flat tire.
On Monday, when the county officials tried to tease the truth from Hullett, all I could hear is another flat tire. I can’t help but believe we’re only at the beginning of something ugly.
Nevertheless, the commission should have known there was trouble. Every other week, when the county holds its marathon committee meetings, the hospital would come hat-in-hand with another lists of requests. Most weeks, hospital administrators said the expenses they needed approved were “budgeted,” not new expenses. The trouble is that when your budget is out of balance, it doesn’t matter one bit whether they’re budgeted or not — the hospital didn’t have the money to pay for them.
The current county commission has only been in office for about a year and a half, so perhaps the five commissioners didn’t have a point of comparison, but to those of us who had haunted the courthouse halls could tell the hospital was still spending money unabated.
Two things have further complicated the management of Cooper Green.
First, the Health Services Committee chairman is Commissioner George Bowman. Rather than giving Cooper Green the adequate oversight it has needed, Bowman has made excuses for the hospital when it came to the county with expensive operating and capital costs. When other commissioners questioned how much money the hospital was spending, Bowman would become defensive.
To make matters worse, Bowman completely blundered through an attempt to put the hospital under a healthcare authority. The plan has floated around for years, but when Bowman brought the proposal to the commission last year, there were too many traditional public-trough feeders in the room — Charlie Waldrep, Earl Hilliard Sr., out of state bond lawyers, consultants no one was paying. The whole thing smelled like a grand jury waiting to happen. The rest of the commission got spooked and pigeonholed the plan.
Second, the county has not yet transitioned fully to its new manager-commission form of government. When the commission appointed County Manager Tony Petelos last year, its administrative duties were supposed to end then, but that didn’t happen, at least not entirely. Commissioners have continued to lord over their respective county departments like little fiefdoms, and the transition of power away from them has been slow, if not stagnant.
For the commission, the crisis couldn’t come at a worse time. The county still needs new revenue from Montgomery, and the latest blunder gives fresh ammunition to its enemies there. On Monday, Rep. John Rogers had to attend the commission meeting in person.
“I’ve never seen anything like this,” Roger said. “They don’t know what’s going on. This ain’t the Three Stooges. It’s the Five Stooges.”
Jefferson County might be a comedy of errors, but on Monday only one thing was funny: Of everyone in the county courthouse, Rogers was the only one smiling.