A bill that diverts tax dollars from Jefferson County’s indigent care fund, which once supported Cooper Green Mercy hospital, plus a proposal that would give the money and the hospital’s assets to the state-run county health department, have little chance of passing the legislature this session.
But they have added to fuel to fire being fanned by advocates for the poor to build more support to restore inpatient and the emergency room at Cooper Green. The Republican-led county commission ended those services last year to get out of the hospital business and save money.
State Representative Jack Williams said the bill he introduced April 16 was potentially a debt-relieving solution for commissioners wrestling with the largest government bankruptcy in U.S. history. He said the commission could leverage millions in savings by divesting Cooper Green of its emergency room and related hospital services to solve its $3 billion-plus debt crisis.
However, he also knows it virtually has no chance of making out of the legislature before its session ends this week. “It was an idea that came to me later in the session, so I was a little behind in getting it on track,” he said. “If we don’t get it this time, we’ll get it next year.”
The bill proposes to redirect the portion of tax dollars that goes into the indigent care fund, currently about $44 million, as follows: 25 percent to the county general fund; 15 percent to programs that fund for indigent families’ housing, transportation or food; and 60 percent for indigent healthcare.
Williams said that before introducing the bill, he didn’t consult with County Manager Tony Petelos or County Health Officer Dr. Michael Wilson to determine exactly what the cost would be in providing the needed indigent healthcare.
“I’ve worked pretty closely with the county for a number of years, and I felt like I was in the ballpark with my projections,” he said. “I did not go to the county to say I was introducing this particular piece of legislation, but have had conversations with Tony. I don’t feel I was willy-nilly pulling numbers out of the air. I’ve also had several conversations with Dr. Wilson at the Health Department.”
Williams said he wanted to avoid back-and-forth bickering between the county and the local delegation. So he introduced the measure as a general bill, which bypasses discussions among local leaders only, but requires that the entire legislature vote on it. “I wanted to give this a try and see if we didn’t involve the county directly, we might better get the legislature involved in the process.”
Petelos, when contacted, said he had not seen the bill or talked directly to Williams about it. Williams said it was time to have a “healthy debate” about un-earmarking the indigent care fund and ways to make Jefferson County “a stronger and more viable place for all.”
But State Representative John Rogers said Williams’ end-run around the local delegation won’t work and it will be even harder to get it passed statewide. And un-earmarking the indigent healthcare tax dollars for political reasons is a dangerous game that he alleges is costing people their lives.
Rogers has become a vociferous critic of County Commission President David Carrington and of Petelos for failing to put an adequate healthcare system in place to take care of the poor, as they had promised to do once Cooper Green was reduced to a super clinic. “It seems to be a bona fide attempt to punish poor and indigent people at all costs,” he said. “ And why, I don’t know.”
Rogers said Republicans in the legislature are taking away women’s reproductive rights, attacking unions and taking away healthcare’s treasured safety nets, including Jefferson County’s indigent care system. “Because they have a supermajority, they can cut off debate and do whatever they want to do.”
They’re more concerned about paying exorbitant debt to Wall Street bankers than taking care of people, he said. “It’s all about the money. And what’s happening, people are dying in the streets or staying at home. It’s worse than murder; these people are dying slowly.”
Rogers said administrators from UAB, Brookwood, Princeton and St. Vincent’s hospitals have privately come to him and county leaders begging for help because they’re being overrun by poor and under-insured patients. He said it’s time for them to speak publicly about the unfolding crisis. “They are beginning to realize this is a crucial medical problem.”
Dr. Wilson, health officer for the state-run Jefferson County Department of Health, said that without a direct cause and effect correlation, it’s hard to prove that the dismantling of Cooper Green’s hospital is a direct cause of death reported among poor and indigent people in the county.
But he did say that many doctors in Birmingham’s healthcare community are concerned about what’s happened with indigent care. They were working behind the scenes, before and after the changes at Cooper Green, to resolve the shortage of primary care doctors to assist with healthcare for the poor. Wilson said hospital officials are working with Petelos to craft agreements to take in poor patients and create solutions for a system that Wilson deems broken.
He also said he is aware of Williams’ bill and another proposed by State Representative Paul DeMarco of Homewood that would essentially shift Cooper Green’s remaining assets and the indigent care fund over to him and the county health department. “It’s a relatively new idea being kicked around to try solving the problem, to create a health insurance plan through the state for the people,” Wilson said.
Meanwhile, the architect of the hub-and-spoke model of healthcare delivery for the indigent that county commissioners used to restructure Cooper Green has resigned from taking any more patients there. Dr. Max Michael, dean of UAB’s School of Public Health, no longer works with Jefferson Clinic P.C., the group that provided doctors to Cooper Green.
“I basically do not feel that the system that has been set up provides community standards of care,” Michael said. “That means I should be able to provide the same level of care as doctors at St. Vincent’s, Brookwood or Princeton,” he said. “I don’t feel I can do that because the systems that have been set up don’t function very well.”
Michael said he has notified his Cooper Green patients of his resignation and will contact them once he finds another place to practice.