Miami-Dade County rightly pages specialists for Code Blue at Jackson
By Michael Lewis
A lifesaving examination of governance can help Miami-Dade commissioners save face and funds in cutting lose traumatized Jackson Memorial Hospital.
They'll be aiding not only themselves but, far more vital, taxpayers and patients. Everyone's interest will coincide in averting a fatality.
Commissioner Rebeca Sosa carefully guided the first step through a wary committee last week, sending to the full commission a call for specialists to prescribe a cure for Jackson.
As other committee members objected, she agreed to blend key points into her bid to get 18 experts to probe control. Those ideas included shortening the 90-day reporting time and cutting from seven the members tied to county hall.
As Bruno Barreiro noted, the key question is not how the commission should relate to its ward, the Public Health Trust that's nominally in charge of Jackson, but whether a hospital system now on life support should be cut free to live or die on its own.
"I foresee sometime in 2011... this system is going to go into the red and is going to be brought back into our lap and we are going to have to make a decision" on its future, Mr. Barreiro said, unless the commission operates calmly before the breaking point.
The sole firm opponent of an exam by experts was Martha Baker, a nurse who is president of Service Employees International Union at Jackson. "I think it's not necessary," she said. "We need to focus on operations...." The problem, she said, always resides in the hospital's executive offices.
In the process, she revealed a cancer at Jackson: when the union doesn't like the CEO's actions, she said, it needs to be able to continue to come to the county commission and get decisions reversed.
That political reality can keep any administrator from saving a sick hospital. And the fact that the commission doesn't see the problem compounds the illness.
"We make a decision to help. Where's the politics on that?" Commissioner Jose "Pepe" Diaz replied.
That's the crux of why Jackson's condition is untenable. If unions with votes and clout can get commissioners to reverse a CEO, the hospital's financial health can only be maintained by unlimited transfusions of tax funds — and the taxpayers have been bled dry.
Now the committee has asked the full commission to empanel an expert team — perhaps with tweaked membership — to prescribe Jackson's future status.
As the committee carefully stipulated, the commission needn't swallow the prescribed bitter pill. But commissioners would be foolish not to get out from under Jackson with an expert taskforce's diagnosis as not only remedy but also protection. Acting on wisdom is not only smart but a prophylactic against criticism, warranted or not.
Establishing its own taskforce will also immunize the commission against civic forces now uniting to cut Jackson's county ties.
If officials don't act, the citizen revolt that spawned recall bids against the mayor and five commissioners may unite with other groups to pry the hospital away from county hall via referendum, a black eye the commission should shun by acting first itself.
Far better that commissioners do so than for it to be cut away with no say. That Commissioner Sosa was able to maneuver the first step unanimously through hostile territory shows that nobody wanted to pull the plug on this one.
One pitfall the committee sidestepped is Jackson's CEO slot, which falls vacant June 1 if not before. Commissioners have forced out Eneida Roldan, who stays on for now with per diem consultant Ted Shaw.
Commissioner Diaz noted that the resolution to study governance doesn't bar replacing the CEO in the interim. But it should.
As several on the committee noted, how the hospital is governed will be a key factor for any good CEO candidate, and governance is on the operating table.
Tightening the 90-day diagnostic period for a taskforce means the Roldan/Shaw duo could remain until after governance is decided.
Hastily filling the job would be pernicious, particularly if the commission forced the Public Health Trust to hand a CEO contract to County Manager George Burgess, infecting a future Jackson structure in advance.
Mr. Burgess seeks the job. Voters dissatisfied with his work have killed his present one as of November 2012. A likely recall of the mayor would let a new mayor replace Mr. Burgess earlier — and at least one candidate wants Mr. Burgess out.
So it's urgent for him to become Jackson CEO. As county manager he can help force it, handing himself $650,000 a year as consolation prize for losing the manager's job.
He's not the only choice. Miami Manager Carlos Migoya, a former top corporate banker who helped eradicate red ink at the city, leaves Jan. 1 and is a willing and capable Jackson candidate.
But, to reiterate, don't rush. A new Jackson parent might need an agent of change like Mr. Migoya. Standing pat might favor a bureaucrat like Mr. Burgess. Taskforce recommendations might point toward a veteran who has saved a public safety-net hospital before.
After the taskforce report, the trick may well be a double bypass — get the burden of Jackson off county hall and its tax receipts as transfusions for an anemic system at the same time a new CEO takes the operating helm.
That won't be easy. It will depend on what a taskforce prescribes and, far more important, whether commissioners will yield control of the hospital system in exchange for purging the ills such power entails, the criticism those burdens inspire, and the harm done by the commission preventing the hospital from healthfully serving the public good.
Ms. Baker made it clear as a bell last week: cost-saving steps a CEO takes are overturned by union end runs to the commission.
When a hospital is bleeding $8 million to $10 million a month, as Jackson is today, that burden — as Commissioner Barreiro aptly noted — will soon land in the commission's emergency ward if it doesn't act.
And, if it doesn't, outside civic forces will.
Commissioners have everything to gain and nothing but a power trip to lose by immunizing themselves via Ms. Sosa's plan, consulting experts, listening carefully, and swiftly adopting their diagnosis to save Jackson.