The Galveston County Daily News

Compassion’s Bitter End: The Demise of Health Care in Galveston

WHAT’S IN A NAME?

I got a call two weeks ago from a UTMB physician, upset by the title of this talk. What, she asked, did I mean by the title: “Compassion’s Bitter End?” I’ve now had four similar calls.

Here’s my answer: I am not slamming UTMB physicians, and I am not just trying to hype the speech.

But I still think the title is apt, and I don’t apologize for it. I think the University of Texas Board of Regents is playing a dangerous game of chicken with the state Legislature and with taxpayers in Galveston County, using human illness and misery to create pressure for money.

In other words, the unspoken questions are: How many people will we allow to suffer in public without help, how much disruption to the whole region’s health care system will we allow, and for how long, before the dam breaks and more public money begins to flow?

This already affects our county’s thousands of indigent and working poor citizens. If it has not yet affected your personal health care, it soon will.

However, I want to make this clear: I have enormous respect for the physicians and other professionals I know at UTMB. Most are both highly competent and compassionate.

CHANGING THE TONE

In truth, what I’ve been trying to do since mid-November, in the title to this speech and in much of what I’ve written in The Daily News, is to deliberately change the tone of the discussion about what’s happening at UTMB.

I want UT’s regents to know that people in our county are prepared to work for UTMB, but also that we’re no longer afraid to ask questions and demand accountability, even of the regents themselves.

In addition, we should all begin to think about the issues surrounding UTMB in their full moral context — not as isolated bits of information, statistics, as dry and unemotional as the bottom line on last month’s profit and loss statement.

Finally, the University of Texas must understand it has a major credibility problem that affects its ability to function effectively in our county and perhaps in the state Legislature.

Many people — I would say most of the leadership in Galveston County — simply no longer have faith in the promises of UT’s leadership.

That’s a huge problem in creating an effective local partnership to support UTMB, and it hurts us all.

THE CHALLENGE

In the future, those of us who support a bigger, stronger and healthier UTMB must persuade taxpayers in Galveston County to invest more money. We must also persuade the Texas Legislature to step up to the plate, too.

In the process, we have to join the chorus of voices calling for more sweeping national solutions to the huge problem of un-insured and under-insured Americans.

Before we can accomplish any of this, the University of Texas itself must demonstrate, through actions and a specific plan, its commitment to the future of UTMB.

LACK OF TRUST?

I understand that UT’s regents have been shocked by the criticism aimed at them by our newspaper, by the Houston Chronicle, the Dallas Morning News and Texas Monthly magazine and other publications all over the state of Texas.

Serving as a regent is not supposed to be quite so messy, and the regents don’t understand why many people question and criticize them.

I’ll tell you why … Simply put, the regents and UT’s top administrators have not been straight with us, and they still are not being straight with us, at least not yet.

There are many reasons people are skeptical.

Creating a health care monopoly:

During the 21 years I have worked in Galveston, I watched as the University of Texas methodically eradicated private health care competition on Galveston Island.

I watched it happen and never fought it, and shame on me for that. We all should have been more vigilant.

Now, having eliminated all private health care on Galveston Island, UT apparently feels little obligation to continue serving the community as it did in years gone by.

UTMB’s shifting mission:

Somewhere along the line, regents and the Legislature have made essential changes in the mission of UTMB.

The mission now apparently is solely to make money, and there has been little or no public discussion of whether that’s even feasible or in the best interests of our citizens. Is it in the best interest of medical education or in the best interest of medical research?

Why, exactly, must UTMB be run like a Wal-Mart? Who decreed it?

Accepting public accountability:

Next, I know there’s disagreement about the legality of the closed meeting in El Paso — the one that resulted in UTMB’s most recent round of massive firings.

UT says it didn’t break the law; many of us who have studied the law and what happened believe they did.

Sadly, that debate hardly matters now.

What is clear, however, is that somebody made a decision to very quickly and without much long-range planning fire thousands of people — and that happened without the regents ever fully vetting the issues in public.

Wouldn’t it have been wiser to have a plan first for UTMB’s future?

UT has traditionally paid lip service to public involvement in its activities, but — once again — its actions have not matched its spoken ideals.

What they say versus what they do:

There’s a major disconnect between what UT says and what it does.

Regents and UT leaders like Interim Chancellor Kenneth Shine have said repeatedly their support for UTMB is unswerving.

But support for a public, healing institution such as UTMB really means support for its essential mission and for the people it serves. And it means support for the people doing the serving.

It does not mean support for buildings or hardware or bank accounts. It’s about human beings and human needs.

While pledging support, UT over the past decade conducted study after study, engineered wave after wave of layoffs, culminating in a decision in a closed meeting to slash 3,800 FTE jobs in a single week.

Today, UT says it is committed to rebuilding UTMB, but its plans to do so remain vague at best, and it is clear UTMB never will be the same again.

While promising support, UT’s top administrators and regents also have allocated resources in ways that have diminished UTMB while growing other medical education facilities. UTMB’s state funding is today 8 percent less than it was in 2003 while UT’s Southwestern campus in Dallas has 30 percent more state funding than it did in 2003.

What of the students?

UT leaders like Dr. Shine, who has been the chief architect for some time of UT’s medical education policy, have said repeatedly there will always be a medical school in Galveston, but details of that commitment also are so sketchy as to be meaningless.

Everyone agrees that a 250- or even 300-bed hospital does not offer the variety of experience needed to educate doctors, and roughly another 200 to 300 beds are needed for that. Where will they be? Today, we don’t know, and many at UTMB, students and faculty alike, are concerned.

As one UTMB student explained to Texas House members recently:

“Shortly after the storm, we saw many of our best and brightest faculty laid off. I personally lost two of my greatest professors. This organization … may have become bloated with time, but an axe was used where a scalpel would have sufficed. This will no doubt hurt not only the patients who these talented individuals once cared for, but it will and already has hurt the educational mission at this University.”

Aiming the big guns:

Meanwhile, friends and supporters of UTMB like state Rep. Craig Eiland say publicly that UT has failed to fight hard enough for more state appropriations for UTMB. Anyone who has lobbied the Texas Legislature will tell you that the University of Texas usually gets what it really wants from the Legislature.

Maybe that lack of focus has changed, and Dr. Callender says he believes that it has. I hope he’s right.

Walking away from money:

The regents also have declined direct offers of financial support — capital spending — from the Sealy and Smith Foundation to restore several different aspects of campus life and medical care.

As stories about that refusal began to circulate, Interim Chancellor Kenneth I. Shine offered the carefully parsed response that UT had not refused “offers of operating resources from any source.” He mentioned nothing about offers of capital resources.

That’s exactly the kind of half-truth that contributes to UT’s credibility problems.

ECONOMIC AND SOCIAL IMPACT: IT’S HUGE

So, what’s the impact of these actions? The effects could hardly be more dramatic or more serious for the people of Galveston County, especially for the people of Galveston Island, and for health care in our region. And that is especially true right now, as we try to restore a broken economy after Hurricane Ike.

UTMB has for many years sold its value to the community by doing studies proving over and over its enormous economic impact on Galveston County. Honestly, I’ve never questioned it.

Recently, Galveston Mayor Lyda Ann Thomas described the Galveston economy as a three-legged stool, with the three legs being tourism, the city’s port facility and UTMB.

Here’s the truth, the port and tourism combined did not have the economic impact of UTMB alone. Neither comes anywhere close to rivaling UTMB as an economic engine.

By all accounts, UTMB has been a billion-dollar industry for Texas. But even that big number does not tell the full story.

In addition to its raw economic impact, UTMB has been a major force in shaping the social and cultural life in this county for over a century. A diminished UTMB will affect every important community institution.

However, sadly, I don’t think these arguments about the impact on Galveston or Galveston County will make much difference in the legislature. I think we have to focus instead on serious health care problems in the region, problems that have been exacerbated by the cutbacks at UTMB.

IMPACT ON HEALTH CARE

Those health care concerns are even more serious — literally are matters of life and death for some.

I’m referring, of course, to the most fact of what has happened, and that is that health care is not as accessible today on Galveston Island — and elsewhere in the county — as it was before Sept. 13.

Of UTMB’s cutbacks, Mayor Thomas said earlier this month: “Surely they (UT regents) did not know how many lives they were putting into peril, not only by disruption of the venerable institution but by disruption of the entire region’s health-care delivery system…”

Prior to Ike, three Level 1 trauma centers served our region. They were at UTMB, Ben Taub Hospital and Memorial Hermann. Today, there are only two (Ben Taub and Memorial Hermann).

In October and November, the two were on diversionary status — unusable for trauma care because of patient overload — 44 percent of the time. That’s a disaster as Mayor Bill White and well-known physicians like Dr. Red Duke have written.

The University has made a decision to cease accepting un-sponsored patients, period, at least for now.

Sources in county government tell me that UTMB also is balking at accepting indigent patients who are, in effect, sponsored at least to some degree by county tax money. So the county is looking elsewhere to serve these patients.

Before Ike, UTMB billed Galveston County about $240,000 to $300,000 monthly for indigent care. The bill in December was about $5,400.

Bottom line: If you are indigent, or even if you are an uninsured single mother working at Wal-Mart to support two kids, you better pray to God your children don’t get really sick.

Others of us, even those of us who can pay, have in the past depended upon UTMB to deliver critical care services that today simply aren’t available.

The trauma center in Galveston, formerly ranked among the best anywhere, does not exist today. Personally, I’d rather have a Level 1 trauma center than some sketchy promise to restore x-number of hospital beds. The trauma center means related specialties must be available, and some indigents and un-sponsored care must be provided.

UTMB acknowledges that opening full emergency services is problematic in that it will require the hospital to accept some un-sponsored patients. That’s something the university absolutely does not want to do.

Will these decisions hurt the general state of health of Galveston County’s people, especially for the working poor? I believe they already have. However, the evidence so far is mainly anecdotal, not scientific or well researched.

Let me cite one statistic I think is very interesting, however.

Between Oct. 1 and Nov. 30, 2008, The Daily News published more than 16 percent more obituaries than it did in the same two-month period in 2007 — before Hurricane Ike.

Let me confess I have a personal stake in this. I had a heart attack and came close to death in 2003. If I had that same heart attack today while on my morning run in Galveston, most physicians I’ve talked to agree with my guess that I’d either die or be so severely impaired by brain damage due to hypoxia that my life would be, effectively, over.

WHERE DO WE GO FROM HERE?

There are many things we as citizens can do to help UTMB.

For example, I was in Austin yesterday working for legislative support for Galveston, Galveston County and especially for UTMB.

Most citizens realize that a partnership must exist for the mutual benefit of UTMB and all of us who depend upon it in so many ways.

But UT itself must take the first steps. After so many years of saying one thing and doing something else, UT has a big job to do to sell many of us on its long-term commitment to UTMB.

We have come to believe that the fact that Ken Shine says it does not make it so.

We need to see a plan. It must be detailed, containing specific commitments and deadlines. More importantly, over time, UT’s actions must match its words.

UTMB officials say that the new report by Kurt Salmon Associates regarding the future facilities and marketing strategy will be released the first week in February. We hope to know more then, but whether the report and UT’s response to it provide a clear roadmap to the future remains to be seen.

Here’s my bet. KSA will say that UTMB should develop a split campus, partly on the island and partly on the Galveston County mainland. I’m not necessarily against that.

However, the report is likely to say that UTMB’s Galveston campus is “outdated” and that building hospital beds on the mainland, due to less exacting building codes, is “cheaper” than on the island.

That report will sound good to those who don’t know much — especially people in Austin. But not a word of the above is true, and it ignores the role of private philanthropy always ready to help to rebuild UTMB on Galveston Island.

It has been a long time since the taxpayers of Texas actually paid for creation of a new hospital bed on Galveston Island.

Trust me. Developing a new mainland campus and building mainland hospital beds will be far more expensive to the people of Texas than restoring UTMB in Galveston. But even that “plan” will be preferable to where we are today — which is in limbo, unable to move forward for lack of direction.

Three weeks ago, testifying before the House select committee in Galveston, UT officials asked the Legislature for a net of more than $300 million in state aid and what amounts to a $500 million line of credit to be reimbursed later by FEMA funds. Legislators, including committee chairman Sylvester Turner, pressed for details of what that money would buy.

To my ears, legislators left that meeting with a huge funding request and no corresponding reassurances. How generous can we expect an already-skeptical Legislature to be under those circumstances?

Similarly, last Wednesday, at a Chamber of Commerce forum in Galveston, I asked Dr. Ben Raimer, point man for UTMB’s legislative efforts, to make some guesses about restoration of un-sponsored health care at UTMB facilities and the number hospital beds to be added back over the next five years.

Raimer said the future depends on how much funding the Legislature provides and whether the people of Galveston County approve a hospital taxing district.

Dr. Raimer is a good man and a good friend, but I would suggest that UTMB must adjust its thinking.

UTMB says the plan depends on the funding. I say the funding depends, to a large degree, on the plan.

If Galveston County brings a hospital taxing district to the voters for approval this coming November as expected, each property owner will be asked to make an investment in health care of about 8 or 9 cents per $100 of assessed value on their homes and businesses. That’s a total of roughly $15 million per year in new taxes.

Passing any tax in the next year, as people struggle to recover from Hurricane Ike, will be very, very difficult. Also, having recently fired several thousand people — people with children and aunts and uncles and friends — won’t help. Many people are angry at the University of Texas. It’s that simple.

On Nov. 16, The Daily News ran an editorial I wrote arguing for creation of a hospital taxing district. Here’s one typical reaction from a reader on our newspaper’s Internet forums:

“NO MORE TAXES!!! Now, Dolph and the rest of the usual suspects WANT OUR MONEY. Well, you can't have it!!! To hell with UTMB and their horrible business practice of catering to illegals and indigents.”

One more comment from a reader, and this is typical:

“The hospital district may get support, but first UTMB would have to have a huge PR effort to clean up its image. Senior leadership must be replaced, as their credibility is very low. I will avoid the use of UTMB physicians/clinics from now on because I no longer want to support what is happening there.”

Securing public support without a generally acceptable plan for the future, a plan that is both detailed and believable, is impossible. That’s true even though County Judge Jim Yarbrough and Mayor Thomas have pledged to fight for it.

Jim Yarbrough is an effective politician, one of the best, but he’s not a magician.

HOW DO THINGS LOOK TODAY?

Actually, I have the sense that we are in a better spot today than we were six weeks ago. In fact, if I had to come up with a title today, it might be somewhat less angry-sounding than “Compassion’s Bitter End…”

However, if I’m right, and if the University of Texas is listening and shaping its position to create a better fit with the realities and needs of Galveston County, I think that has happened in part because some of us worked in a very deliberate way to change the tone of the conversation with UT.

There are encouraging signs.

I know for a fact that Dr. Callender and key personnel at UTMB in recent days have been working even harder to reach out to the community for discussion. They seem to be listening, and they seem to want a real, working partnership.

I commend them for that effort.

But then, on the other hand, I don’t think the problem in the past has been so much a problem located at UTMB’s administrative offices on Galveston Island.

Our problem has been domiciled mainly in Austin, where regents with a tin ear and unsympathetic legislators have failed to listen, understand and sympathize with UTMB’s unique circumstances and unique mission.

I am anxiously awaiting the Kurt Salmon Associates report about future directions for UTMB. I very much hope it suggests a path we can all get behind.

Realistically, however, I’m skeptical, and I think community leaders like Mayor Thomas, Judge Yarbrough and Craig Eiland and others ought not to accept the KSA report as gospel. They should study it critically and use that report as a starting point to negotiate for a better health care system for the county and especially for Galveston.

There is some urgency to see the plan put in place quickly. That’s needed to put together an effective effort to pass a hospital taxing district, and it’s necessary to mount a truly effective campaign for full funding in this year’s session of the Texas Legislature.

Let me also add another caution. Private doctors and hospitals on the mainland have watched what happened to private health care in Galveston. Many are extremely wary of UTMB’s plans, and, based on history, they probably should be.

Private doctors on the mainland are a significant stakeholder group that UT must win over if UTMB chooses to move northward in order to change its payer mix. Winning them over won’t be easy or cheap.

IN SUMMARY

In summary, as Galveston County digs out from Hurricane Ike, we face no bigger issue than doing whatever we can to bring back UTMB to the greatest degree possible. As a citizen of Galveston, I think it is absolutely the key to our survival and recovery as a viable community.

Most leaders in this county are ready to roll up their sleeves and word hard for UTMB. We just hope that UT finally gives us the support we must have to be effective advocates in their own behalf.

Thanks for being patient enough to listen to my ideas.