“I used to have a shirt like that,” Jefferson County Commission President David Carrington said, gesturing at John Rogers.
The veteran state representative, wearing a black dress shirt with a multi-colored dot grid and white collar, grinned and made a comment that was lost in the laughter of a knot of elected and appointed officials gathered in the moments just prior to the April 10 meeting of the county’s governing body. Chief among those were Rogers’s fellow Birmingham Democrat, Rep. Mary Moore, Republican commissioners Joe Knight and Jimmie Stephens, and County Manager Tony Petelos, also a Republican.
The scene was emblematic of the ritual joviality that generally ensues when politicians who are rigidly opposed to one another find themselves obliged to interact in public. It’s often the case as such times that the heartier the laughter, the deeper the animosity. In fact, it was not 20 minutes later that Carrington gaveled the meeting into temporary recess rather than listen to Rogers accuse the majority of the county commission of “playing games” with the lives of Jefferson County’s poorest residents.
Rogers had been invited to address the meeting by Commissioner George Bowman. He presented the commissioners and Petelos with copies of HB 181, which was passed by both houses of the legislature in January and signed into law by Gov. Robert Bentley on April 2. Effective July 1, the measure requires the county commission “to submit a quarterly accounting of the collections and disbursement of the proceeds from Indigent Health Care Fund for Jefferson County to each member of the Jefferson County Legislative Delegation and the public on [the county’s] Internet website.”
Rogers’ appearance was orchestrated to dramatize what he says is the commission’s protracted unwillingness to produce public information about the status of the Indigent Care Fund. Most specifically, he wants to know how much money is in the fund, which in the wake of the Jan. 2013 closing of inpatient and emergency room facilities at Cooper Green Mercy Hospital is to be used to pay other area hospitals for absorbing the flow of former patients at the county’s longtime indigent care hospital. Rogers reminded the commissioners that he first “requested this information months ago,” and said the delay suggests that the commission is trying to hide something related to its handling of the indigent care money.
“Y’all have been playing around with this for too long,” Rogers declared. “According to our figures, you should have $80 million-plus in that fund. If anything has been done intentionally with that money, I’m going to ask that charges be brought against you.”
That prompted a sharp exchange between Rogers and Carrington. The commission president already had ruled on a motion to move the meeting into executive session on an unrelated matter when Bowman requested that Rogers be allowed to speak. Responding to Rogers, he was quick to defend the commission’s actions.
“We’ve shown you courtesy,” Carrington told the legislator, “but you’re making accusations that just aren’t true.”
Rogers countered, “You’ve got to stop taking money from poor people. It has been four or five months we’ve been trying to get this information. People are dying in the streets.”
“We have had conversations with you and every other member of the legislature about this issue,” Carrington said. “We’re attempting to do what’s right.”
“Conversation doesn’t serve the purpose,” Rogers began, but Carrington’s gavel signaled the end of their exchange. He and the other commissioners left the dais.
“People are dying”
Carrington did not appear at an impromptu media scrum in the hallway outside the commission chamber, but Knight and Petelos did. The county manager said he has no objection to providing the information Rogers wants, but has been delayed in responding because the numbers are still being audited to verify their accuracy — part of the backlog of work caused by the cuts in personnel and resources required to get Jefferson County out of bankruptcy.
“When we got here, the county was three [annual] audits behind on Cooper Green,” said Petelos, who started work as county manager in October 2011. “There has been an enormous amount of effort and time just to get caught up. But we’re getting there.”
Asked whether the county will meet the reporting requirements of HB 181, Petelos replied, “We will abide by the law.” Knight echoed that, stressing that “there is going to be a true accounting” of the status of the Indigent Care Fund as soon as the county can provide it. Taking their turn before the cameras and microphones, Rogers and Moore pressed their points, with Rogers becoming emotional as he spoke of what he called “the terrible need” for basic healthcare among underserved populations.
“People are dying,” Rogers repeated, his voice rising. “This is not politics. But they’re playing politics with it. It tears my heart out for Carrington to walk out of a meeting like that. It tells you how he feels about poor people. It’s pathetic.”
Moore said that rather than close Cooper Green, the county should have been looking at how to “maximize” it, given the public health challenges faced by many residents of Birmingham and Jefferson County, most especially lower-income individuals and families. Among other things, she’d like to see a request for proposals to find an entity — another local hospital, a hospital system, a private company — to take over management of indigent care in Jefferson County.
“If it’s true that they don’t want to be in the healthcare business, then they need to get out,” Moore said. “They are not serving the people of Jefferson County. If they want to be out of the business, then find somebody who can run it effectively and not leave the public in the lurch. You cannot exclude people from healthcare.”
A significant impact
According to an analysis conducted by the county commission in 2013, at least 32,000 people in Jefferson County relied on Cooper Green for their healthcare. Meanwhile, local hospitals continue to accommodate the influx of new patients since the county hospital closed.
“Baptist Princeton has seen a double-digit increase in patient volume through our emergency department,” said Ross Mitchell, vice president of external and governmental affairs for Baptist Health System. “That volume has been steady, and it has had a significant impact on our operations.”
In terms of payment from the county via the Indigent Care Fund, Mitchell said, “there is no payment process.” To date, he added, Baptist has been reimbursed for “a portion” of its indigent care expenses for 2013, and is “continuing to negotiate a contract” for payments in 2014.
Across town from Baptist Princeton, UAB Hospital — Birmingham’s largest — has been paid for its indigent care expenses, according to the CEO of UAB Health System, Dr. Will Ferniany. Still, though he believes that eliminating inpatient services at Cooper Green “was the right thing to do” under the circumstances the county faced, Ferniany said the loss of emergency room and outpatient care has created serious challenges.
“It has not gone smoothly at all,” said Ferniany. “We need more primary doctors, more sites, more contracts with other hospitals to take patients. And it’s not just taking patients. We need case managers to work with patients to improve their health, which reduces the cost of care across the board. UAB has done as much as anybody to provide care for people who had been using Cooper Green. But there is much more that needs to be done.”
Doing the right thing?
Both Ferniany and Baptist Health System’s Mitchell expressed optimism that the county is moving toward soliciting proposals for managing indigent care. Ferniany said that UAB has “asked the county to do it and told them that we would bid on it,” and that county officials seem “genuinely interested” in moving that process forward.
“Issues aside, I believe the county commissioners want to do the right thing,” said Ferniany. “I think transparency is a good thing, but I don’t think they’re playing games. I just don’t believe they understand the healthcare business. They need to contract it out to someone who knows what they’re doing with it — and let that someone assume the risks.”
If the inclination of the commission can be discerned from the words of one member of its voting majority, then the move to get indigent care out from under the umbrella of Jefferson County — and the mandate for increased transparency of the Indigent Care Fund — may be well underway. That’s an outcome that should please both sides of the county’s political divide.
“I have said all along that Jefferson County needs to be out of the healthcare business,” Joe Knight said. “I would like to see us continue to work toward that goal.”