Miami-Dade County Commissioner Audrey Edmonson told participants in a public forum Thursday night that she is open to all options to ensure that the publicly funded Jackson Health System keep its doors open, but she was clear that she will not support job cuts there.
Jackson Health System employs more than 12,000 workers and consists of four primary care centers, 17 school-based clinics, two long-term nursing facilities, an outpatient diagnostic center, a children’s hospital, a rehabilitation hospital, a mental health hospital, two community hospitals and Jackson Memorial Hospital, the primary teaching hospital of the University of Miami. Jackson is obligated to ensure “that all residents of Miami-Dade county receive a single high standard of care regardless of their ability to pay.”
During the forum — one of several (.pdf) to be held over the next few weeks — the Hospital Governance Taskforce presented its recommendations on how to resolve the problems facing Jackson. The Miami-Dade County Commission created the Taskforce in January, citing concerns that the Public Health Trust that oversees Jackson Health System was in crisis due in large part to its governing structure, which must be changed.
The 20-member Taskforce that met from March through May wrote in its final report that “it is the general consensus of the Taskforce that the best governance model for Jackson Health System is for the county to establish a new not for profit corporation to manage and operate Jackson Health System under contract.”
The Taskforce report adds that the managing board of that nonprofit will be initially appointed by the mayor and the Board of County Commissioners, but for subsequent appointments, the board “will nominate and elect its own membership.”
Martha Baker — a nurse at Jackson for 27 years, the president of SEIU Local 1991 and a member of the Taskforce — said at the forum that creating an unknown governing board with the power to decide and design policy for Jackson is not a solution. She added that a governing body that takes public money must be accountable to the public and remain under the control of elected officials.
Baker, who issued a dissenting view to the Taskforce’s final report, writes, ”Given the short term of the task force and the lack of any legal, financial, operational, strategic or other due diligence or modeling of alternative governance models as they would impact Jackson Health System, it would be inappropriate for the task force to author any specific recommendations to the County Commissioners at this point.”
Baker writes that Jackson is undergoing a major leadership transition with the hiring of a new CEO. The county recently approved a Financial Recovery Board she says must be allowed to mature before introducing a new governance structure. She also points out that a nonprofit governance structure could jeopardize federal money that Jackson is actively pursuing.
Testimony came from Miami residents who support Jackson’s pre- and post-natal care, cancer treatment center, HIV/AIDS medical services and pediatric care, which they said they have benefited from despite their inability to pay. Jackson employees also spoke about the need to maintain the system as a publicly funded entity.
Norberto Molina Jr., a registered nurse who has worked at Jackson Memorial Hospital for 18 years, said at the forum that job and pay cuts at Jackson will affect the Miami-Dade economy. He also questioned the membership of the Hospital Governance Taskdorce, made up of at least seven CEOs of private companies that compete with Jackson for paying clients.
Paul Silverman, a lawyer with the state attorney’s office who attended the Taskforce meetings, said he took exception to Molina’s portrayal, adding that members of the Taskforce came up with ideas to benefit Jackson, to make it more competitive.
Dr. Edward Feller, who runs a private practice and is a member of the Taskforce, said that Jackson must remain open for the indigent and semi-indigent to receive care. Feller added that the present governance structure at Jackson does not work, and that the creation of a nonprofit was an attempt to “get politics away from running a hospital.”
John Ratliff, public policy coordinator for the Service Employees International Union, said in response to Feller’s comments that under new management Jackson has already seen some turnaround and that some of the Taskforce recommendations are already being implemented. He added that as part of the process of correcting operational problems, Jackson employees accepted pay cuts in 2010 to help the hospital. According to Ratliff, they totaled $100 million, thousands of dollars per year for each employee.
Ratliff closed the forum, saying that Jackson has historically cared for the chronically ill, something private hospitals do very little of, and that Jackson Health System cannot be handed over to a board that over time would be allowed to reappoint its members without public oversight.