Yank county away from helm of Titanic at Jackson hospital
By Michael Lewis
For 20 years, no Greater Miami Chamber of Commerce lunch speaker has gotten a longer standing ovation than did Eneida Roldan last week for herculean efforts to rescue Jackson Memorial Hospital.
It's shameful county officials didn't give her the same. Instead, they drove her to resign the CEO's job to replace her with — whom?
Privately, lunch guests stated the obvious: it's hard to replace her with anyone as effective, especially if candidates learn how county hall has botched control of Jackson.
Though commissioners and bureaucrats now moan that the Public Health Trust let Jackson sink, they're disingenuous.
In truth, the trust is between a rock and a very hard place. It's always under county hall's thumb, but in a disaster county officials stand clear and claim an "independent" trust was to blame.
Well, how free is the trust when the mayor and manager have the system under a "management watch," whatever that might mean. What does that say about who is in control — and to blame?
And how free is the trust when the commission formally orders trust members not to think about proper system structure. Any right to think or act, commissioners said, belongs exclusively to them.
Don't act without county hall approval, don't even think, don't look for a better way — but you're in charge when it flops. That's a recipe for total failure.
Look at the voter-created Citizens' Independent Transportation Trust, which county hall also handcuffed as it stripped away all independent action along with most of the cash the trust was to use to build transit.
That's county hall toying with "independent" trusts. The mayor, manager and commissioners play Wizard of Oz, operating levers behind a not-so-secret curtain that even a child could see through.
Jackson's problems are huge, with no simple answers — just simple commissioners who think they know them and are in charge, trust scapegoats in the wings when anything goes wrong.
So commissioners trashed a Jackson unit that lured high-paying foreign patients whose millions help shore up a system undercut by locals who can't pay. The commission knows better.
Forget that while Jackson got a bad name locally with county hall complicity, abroad it has been a magnet of superb care for wealthy patients who subsidize Miami residents.
Penny Shaffer, market president South Florida for Blue Cross and Blue Shield of Florida, told a Leadership Miami audience Saturday, "Medical tourism is going to be a huge part for this growing economy" and is a key cog for our future.
That segment had been a vital fund-generator for Jackson until the commission last month decided that while hugely profitable, too much was spent making rich patients from abroad feel at home. Treat 'em like cattle to appease the commission — but, of course, then big-money patients won't come.
Good going, commissioners.
Good going, too, in telling the health trust not to think. Just sit there and take blame for what county hall lets — or causes to — go wrong.
Good going also in ousting an effective CEO with medical, business and administrative pedigrees. We need someone down on the level of the commissioners with their level of vision. But be sure to have someone else to blame when the system then crumbles.
About none of this did Dr. Roldan utter a word. She took the high road at the chamber, talking about Jackson's $3 billion annual revenue, 11,000-plus employees and high rankings in US News & World Report surveys.
She did talk of negatives in the press, "which is not what Jackson is about," but not about political pressures from county hall.
"She was diplomatically correct, which was a shame," said one observer who hoped she'd pin blame where it belongs.
She pointed out accomplishments in her 18 months — she took over at the verge of bankruptcy with a $165 million shortfall, cut 10 of 24 vice presidents, and erased $60 million of the shortfall in 100 days. Then an audit of the prior year showed a true $250 million deficit, which she trimmed by year's end to $100 million.
Who else, where else, could we get such a turnaround while she held off rising costs, the union and county hall? When government boots her out earlier than the May 31 end of her contract, as is likely, who'll repeat such a cleanup?
One healthcare leader suggested that a recently retired hospital administrator who has nothing to lose spend two years battling all sides in a rescue mission.
Another, looking at county hall pressures, said a five-year ironclad contract will be minimal to get anyone with an ongoing career.
Of course, a salary of over $600,000 will attract hacks willing to kowtow to county hall for the bucks.
Some even suggest County Manager George Burgess, whose job evaporates in 2012 because voters had enough. Forget that his healthcare knowledge is a layman's so a learning curve would be long. At least he can play the game commissioners play.
But we shouldn't want someone who can play that game.
Dr. Roldan didn't — at least, not well enough to avoid battering by the likes of Carlos Gimenez, who knows better but is a mayoral hopeful.
So, has she been perfect? She's made errors, said one person close to Dr. Roldan, but she's far better than anyone else we can get.
One rap from a knowledgeable observer: she's been more than solid, but the system needs a fire-breathing dragon to battle the union. Dr. Roldan has been far too balanced, trying to make change benefit all.
We don't know who should run Jackson as president and CEO. We don't know who's available nationally who'd be up to the multiple challenges.
But we do know that working under commissioners and mayor imperils Jackson's future. Banning the health trust from thinking about governance is the height of arrogance: commissioners know more than anyone about how to fix one of the nation's most complex problems.
Wherever commissioners see power, they claim voters elected them to hold it. Actually, only a few voters probably thought about a hospital that should have been safely free of county hall control.
Jackson under county hall's thumb can't fix its problems or long retain a topnotch CEO. County hall culture outlaws non-political, rational administration and solutions.
Ms. Roldan in her speech hinted at an answer: "The safety-net programs will need to be bolstered" as the US goes through healthcare change, insured patients will get choices and safety nets like Jackson will compete with others for paying business, so safety-net hospitals will be forced to consider mergers, acquisitions and joint ventures with community partners.
Commissioners will pooh-pooh any change because it would undercut their control. Indeed, no such structural change would be possible were county hall to remain involved. A citizen-initiated election — even before a similar move to revamp county government — is vital.
As a grand jury report recently noted, county hall must stop pulling the levers running Jackson. Commissioners, who love playing wizard at the controls, will balk.
But why let them keep on captaining the Titanic after they've steered it into the iceberg?