Jackson Health System to lay off 20 from nurses Union

Facing a $230 million deficit and in danger of running out of cash by May, Jackson Health System took a small step Tuesday by announcing it is laying off 20 union members Tuesday and abolishing 27 vacant positions -- far fewer than many employees feared.

Chief Executive Eneida Roldan warned, however, that this was just the beginning.

``We must make drastic changes,'' Roldan said Tuesday. She is still considering shutting down a broad range of services, including the emergency room at Jackson South, where 45 percent of entering patients are uninsured.

When pressured how many more she will have to lay off -- 800 or 1,200 or 2,000 -- she said, ``I really don't have a number at this time.''

Roldan said she planned to have a restructuring proposal by the end of the month -- about the time that a much anticipated Ernst & Young audit is completed for fiscal 2009. Estimates of the losses for that year have grown from $46.8 million to as much as $243.8 million.

Combined with 22 managers and executives laid off last week, moves Tuesday will result in an annual savings of $7.5 million, Roldan said. The system is expecting to lose $229.4 million this year unless drastic changes are made.

Local 1991 of the Service Employees International Union reported Tuesday that 21 members were being laid off -- one doctor in radiology and 20 associate nurse managers.

``There is no good number that directly affects patient care,'' said Martha Baker, president of the local. She said associate managers help out when nurses are busy, meaning that patient care could suffer.

Roldan said that she was thinking of consolidating service programs that are now in three locations -- Jackson Memorial, Jackson North and Jackson South -- so that patients could still be served, but in fewer locations.

Jackson's union contracts require that employees get 21 days notification before being laid off. That means those notified Tuesday won't be out of a job until March 9.

If the next round of layoffs comes after she reveals a restructuring plan at the end of this month, those might be on the job until March 21 or later. By the end of March, Jackson expects to be down to six or eight days of cash on hand -- far below the requirements for normal financial operations.

When asked Tuesday whether she was moving too slowly in dealing with the financial crisis, Roldan said she was talking to county and state Medicaid officials to get cash advances to keep operating.

At a meeting with The Miami Herald editorial board last week, Roldan mentioned the possibility of closing the Jackson South ER, although she said it would be done only after surveying community needs and getting regulatory approval.

Jackson South, now undergoing a $102 million expansion and renovation, is expected to lose $20 million to $25 million this year. More than 70 percent of inpatient admissions come through the South ER, so it is both a revenue source for paying patients and a drain because of the high numbers of uninsured.

Baptist Hospital, to the north of Jackson South, reports that 12 percent of its ER visitors are unfunded. At Homestead Hospital, south of the Jackson facility, 25 percent are unfunded. Kendall Regional Medical Center, to the west, did not respond to a request for how many of its ER patients are unfunded.

Tiffany Vause, press secretary for the Agency for Health Care Administration, said that Jackson could close an ER in a month if it chose. ``Operating an emergency department is not required by licensure, so it is possible for any hospital to close their emergency department. However, the agency would require 30 days notice.''

Vause said the agency has not received such a notice from Jackson.

Baker said she knew more changes might be on the way. ``Twenty-one is not going to produce a drop in the bucket'' to stem the losses that Jackson is facing, she said, once again urging that the system find more efficient ways to handle its billing system.

``There is no sense putting a Band-aid on an eyebrow when the body is hemorhaging,'' Baker said. ``They need to be held accountable,'' she said of the executives, for the efficient running of the hospital.

Joe Reed, spokesman for the American Federation of State, County and Municipal Employees, said there have been ``no layoffs yet'' for its Jackson employees, which number about 5,000.