by Hope Katz Gibbs and Ken Ibold
New Miami magazine
Photos by Cindy Seip
Design by Kevin Jolliffe
JACKSON MEMORIAL HOSPITAL IS A study in contrast and controversy. This month’s referendum on a half-penny sales tax for Jackson is a turning point in the hospital’s history—but it won’t be the last. Other issues will arise. New proposals will follow. New debates will flare up.
But dramatic turning points tend to overshadow everyday reality. While the money problems at Jackson are serious, so are the health problems of those who depend on Dade’s only public hospital.
Here, then, is a look at the human story behind the public debate—a day in the life of Jackson.
ANATOMY OF A HOSPITAL
From gunshot wounds to drug overdoses, from people injured in car crashes to those in need of organ transplants, Dade County turns to Jackson Memorial Hospital to cure its most profound health problems.
But with nearly 10,000 people on waiting lists for non-emergency procedures, Jackson’s administrators have issued a tough ultimatum: more money or more pain.
“The issue is, do you want your public hospital to be a third-rate human warehouse or do you want it to offer the best care to whoever happens to need it?” asks Jackson President Ira Clark. Voters this month will decide whether to impose a half-penny sales tax that would generate $60 million for the 1,400-bed hospital.
The money would be used to increase operating-room hours, staff a new trauma center, expand pediatric services, upgrade computers, improve primary care, and pay delinquent bills. The need is staggering. Jackson patients may wait six months for a CT scan, a year for gall bladder surgery, three months for a mammogram or six months for heart surgery.
The hospital’s trauma room, which handles patients with life-threatening injuries, operates at 176 percent capacity. Proponents of the half-penny tax say the money would wipe out waiting fists and make the hospital more efficient-but they admit the money is only a stopgap solution.
“The tax will not solve all the problems, and the people should know that up front. But it’ll go a long way toward solving much of the human misery that goes with a large urban hospital,” says Metro-Dade Commissioner Larry Hawkins, who led the fight to get the tax question put to the voters.
Jackson lost $14 million on operations in its fiscal year that ended in September 1990—and will lose a projected $8.6 million this year—largely because it treats many patients who can’t pay.
Nearly one in four Jackson patients are uninsured and ineligible for Medicaid or Medicare.
“Much of this is a problem of poverty,” says Bernard Fogel, dean of the University of Miami School of Medicine, which works in partnership with Jackson. “Everything we do is chipping away at insurmountable problems. [The tax] will allow us to make a dent.”
Critics say the tax might be better spent revamping the health care system for the poor. Many of Jackson’s patients do not seek medical help until their problems become severe, leaving them no alternative but to wait in line in Jackson’s overburdened emergency room. Too often, what once was a minor, inexpensive health problem becomes a matter of fife or death.
Giving Jackson more money would help reduce the hospital’s financial stress. But critics say more money won’t address fundamental issues, such as insurance for the poor, or how to ration care so that the greatest number of patients can be treated.
At the same time, Jackson’s status as one of the nation’s finest hospitals puts pressure on administrators to throw expensive, sophisticated care at every patient, regardless of the cost. But costs at Jackson and many other hospitals are soaring, and some critics say rationing health care is the fundamental social issue that must be tackled.
High tech often means high cost. For example, it costs $300 to $600 to hospitalize a relatively healthy newborn baby for a day or two. It costs an average of $3,800 a day in the neonatal ICU.
“One of the problems of the health care industry is that we need to make some hard decisions about what to pay for,” says Don Friedewald, president of North Shore Medical Center. “There probably isn’t enough money now for indigent care and there probably won’t be enough money in the future.”
In any case, supporters say the half-penny sales tax would help Jackson care for the 210,000 Dade County residents who are uninsured or underinsured. But others say it’s wrong to pump more money into a hospital that loses so much.
“I think we blow an opportunity to have a long-term, well-thought out plan when we go to the voters with this short-sighted approach,” says Metro-Dade Commissioner Alex Penelas. “Because then, when we do have a better system in mind and go back to them in three or five years, we have to ask for money again. And I don’t think they’re going to like that.”
A DAY IN THE LIFE
9:51 AM—Inside an incubator, a baby girl struggles to breathe. Weighing just over a pound at birth, the tiny newborn was three months premature—too young to have fully developed lungs or heart. The mothers of one-third of all babies born at Jackson have had no prenatal care, a factor that leads to complications in most cases. Caring for a sick baby in the neonatal intensive care unit costs $3,800 a day. The neonatal ICU was the first home for 3,000 babies last year.
10:02 AM—A complication at birth caused this eight-pound boy to choke during his first bowel movement. Pneumonia set in quickly. Linked to a ventilator that makes him breathe 500 times a minute, he must be paralyzed with drugs. Human touch could worsen his condition. Problems at delivery like this one have strained Jackson. Inside a third-floor conference room, 35 bassinets crowd into the space once occupied by an oak conference table. Considered “well” babies here, some of them might be candidates for intensive care at another hospital.
11:42 AM—A technician carves a new plastic leg. At the turn of the century, blacksmiths crafted artificial limbs. Since then it has become a science of its own—one of the many ancillary services, provided by Jackson. With 280,000 patients annually, Jackson employs 8,000 people, including 2,200 nurses. Salaries alone account for more than half of the hospital’s annual budget of nearly $500 million.
5:37 PM—Emergency room patients are lined up in wards and hallways. Overcrowding has led Jackson to mount dozens of hooks on the walls to hold IV bags and charts. People without health insurance often neglect their health until minor problems become acute, turning what would have been relatively simple treatments into major procedures. They usually end up here, waiting in hallways for medical tests to come back from overwhelmed laboratories.
9:07 PM—A trauma team goes to work on the victim of an automobile accident. He was ejected from his car after spinning out on a rain-slick road. Suffering from a serious head injury, he didn’t know where he was or what had happened. In groggy voice he asked a trauma room nurse if she wanted to go dancing. Jackson’s trauma center, the only place in Dade County where people with life-threatening injuries can get immediate attention, operates at 176 percent of its capacity.