South Florida is becoming more like California everyday.

http://www.miamiherald.com/2010/03/06/v ... pping.html

Jackson puts 2 hospitals on chopping block
The chief of the struggling Jackson Health System announced plans to close the North and South branches and lay off thousands of workers.

BY JOHN DORSCHNER AND MATTHEW HAGGMAN
jdorschner@MiamiHerald.com
With cash set to run out in May, Jackson Health System announced Friday plans to lay off 4,487 employees -- more than a third of the work force -- and close the system's two satellite hospitals.

``We have to act,'' Chief Executive Eneida Roldan told a board room packed with grim-faced employees. ``This is the first step to becoming a sustainable, stronger system.''

The cuts will save Miami-Dade's public health system $165.4 million by eliminating a broad range of services, including the closing of Jackson North and Jackson South hospitals. Even with the cuts, Roldan said there will remain a deficit of $64 million for fiscal 2009.

The closings are likely to mean longer waits for everyone in emergency rooms throughout the county and some people leaving without getting treatment, said David R. Small, Jackson's chief operating officer.

Roldan asked members of the governing body, the Public Health Trust, to act within 10 business days so that facilities could be closed and employees gone by early May.

The hospital closings will also need approval of the County Commission, said Eugene Shy Jr. of the county attorney's office. That's likely to extend the restructuring timetable.

Commissioners, still digesting the plan's details Friday, had mixed reactions. ``I applaud her for a bold initiative,'' said Carlos Gimenez.

Katy Sorenson said she wasn't ready to embrace the closing of Jackson South, which is in her district. County Mayor Carlos Alvarez said he didn't want to comment before studying the 38-page plan.

Roldan said the plan was necessary unless county, state or federal money suddenly became available. Such a rescue may be a long shot.

NO BAILOUT

``The county does not have the dollars to bail them out,'' Commissioner Bruno Barreiro said.

The state, meanwhile, is wrestling with a multibillion-dollar deficit. And a plan by Service Employees International Union -- one of the two big labor groups at Jackson -- to find $50 million in federal funds is likely to be some months away, if it works at all.

``Maybe we will find a Santa Claus,'' said Trust Vice Chairman Angel Medina, but ``we've only got 45, 60 days of cash. Our vendors are already putting us on credit holds,'' meaning they're not delivering supplies because Jackson hasn't paid them.

Many members of the Trust were stunned at the breadth and depth of the planned closings. Previously, Roldan had announced 900 job cuts, then agreed to a 45-day moratorium in order to work with the SEIU to find job efficiencies.

Board members searched out loud for alternatives, hoping Roldan's plan was ``a worst-case scenario.'' Several urged Roldan to ask Jackson's 10,500 union workers for a 10 percent pay cut. ``Unions must understand we're at a turning point,'' Abraham Galbut said.

After the meeting, Martha Baker, president of SEIU Local 1991, said, ``Cuts are not the answer,'' either in jobs or in salaries. She urged Roldan to continue with their 45-day partnership to find cost efficiencies in the system.

Later in an e-mail to union members, Baker urged them to object to their county commissioners. She called the plan ``totally unacceptable.''

Commissioner Sorenson said there was no way around steep cuts. ``The unions must understand that we can't go on like this. It will be pay cuts or layoffs.''

But she agreed there was a need for operating changes. ``There is something radically wrong with its billing structure and that has to be fixed.''

The proposed changes will leave the system with a single hospital, Jackson Memorial, in the central city, three clinics and a long-term care center, serviced by 7,590 employees, a severe drop from the system's present 12,000.

Jackson Memorial will also see cuts. Roldan proposes eliminating 180 beds at the main facility, including 45 in the emergency department. That means there will be times when Jackson Memorial ``is on diversion,'' said COO Small, a situation when ambulances will be directed to other hospitals because Jackson's ER is full. Such a move may reduce the large number of uninsured at the hospital.

SUBURBAN MISSION

Several board members were dismayed that Jackson was abandoning its strategy of building its brand in the suburbs, where more patients have private insurance and fewer are uninsured.

``I was instrumental in the purchase of Jackson North,'' Abraham Galbut said. Jackson bought the hospital, formerly Parkway General, in 2006. It purchased Deering, which became Jackson South, in 2001. North is expected to lose about $9 million this year, South more than $20 million.

To have only an inner-city facility, serving many poor persons, ``I don't think that model works,'' Galbut said. He was angered that executives had ``overnight'' changed the entire focus of the system. ``Jackson North and Jackson South are our core business.''

Treasurer Marcos Lapciuc wondered why major service lines were being cut when the plan did nothing to slash ancillary money-losing departments -- the nursing homes and jail inmate care. Both were considered as cuts last fall. Executives said that the outsourcing of inmate care, first considered last fall, had taken longer than expected and they were having difficulty selling the nursing homes.

Lapciuc also wondered if the system should keep paying $9 million to the Jackson Memorial Foundation to market the hospital as a destination for international patients. ``I would not spend one dime on international marketing,'' he said.

Roldan's announcement came two days after some county commissioners complained that she wasn't acting quickly enough to close a $229 million deficit.

Many major questions remain unanswered, such as what will happen to the $102 million expansion now 40 percent finished at Jackson South and to the Florida International University medical school's hospital training, which has been at Jackson North.

Jackson executives raised the possibility of bringing FIU to the main campus, where University of Miami doctors now work. An FIU representative at the meeting said he understood Jackson's needs for drastic measures, but FIU might need to seek another affiliation. ``We would like to find a stable home.''

It was also unclear what would happen to the satellite hospitals. ``These assets -- we're just going to say goodbye to them?'' asked board member Saif Y. Ishoof. Several board members pointed out that selling nonoperating hospitals was likely to bring much cheaper prices than if they were still functioning.

Another uncertainty: What happens to the doctors Jackson has been hiring in order to attract patients to the north and south campuses.

COUNTY AT RISK

County Manager George Burgess warned the board about ``the consequences of not taking action immediately.''

Since the county is on the hook for about $80 million a month in Jackson union salaries, the county's budget is at risk as well as its credit rating on Wall Street. ``It ripples across communities in real ways.''

In Tallahassee, Rep. Juan C. Zapata, R-Miami and head of the Miami-Dade delegation, said he he knew few details, but ``the hospital at the end of the day has to provide public health services to the residents of Miami-Dade County. I don't see how shutting down operations accomplishes that.''

Erik Fresen, also a Republican from Miami, added: ``Unfortunately, decisions such as these have to be made when you have an unsustainable funding and structural model, coupled with a terrible economic crisis.''

Closing facilities must get state approval, and union workers must be given a 21-day notice before being laid off.

The Public Health Trust will gather again on Tuesday to reexamine the recovery plan.

``We're at a crossroads,'' Chairman John Copeland III said. ``It is time for tough decisions.''

Miami Herald staff writer Robert Samuels contributed to this report.