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County starts cutting care
ER crowded as clinic begins closing earlier

Thursday, January 11, 2007
Chicago Tribune
by Judith Graham

The ax has begun to fall on Cook County's beleaguered health system.

On Sunday, anticipating budget cuts, administrators slashed by a third the weekly hours for a large walk-in clinic near the Stroger Hospital campus. Last year, the clinic handled 105,000 patient visits.

On Monday, the clinic began turning away people who had come for care at 2 p.m.--five hours earlier than usual--and frustrated patients began walking over to the hospital's emergency room.

By Wednesday, the first come, first served clinic couldn't accept any more clients after lunch because of long lines, and ER staff members were complaining loudly about how many extra patients were showing up on their doorstep.

"We're only three days into this, and it's already a mess," said a clinic doctor who asked not to be identified because she is worried about losing her job.

This early experience will likely be magnified several times over if Cook County proceeds with proposed cuts to its far-flung network of 26 community clinics, as expected, sources suggest.

Lines for medical services will lengthen, people--many of them elderly and with chronic conditions such as diabetes--won't know where to get care, and emergency rooms across the city will be flooded with patients who have no means of paying for services, they said.

"It's very scary what could happen to poor people in this city," said Judith Haasis, executive director of Community Health, a free private clinic in Chicago.

On Tuesday, the county's new health chief, Dr. Robert Simon, confirmed that more than a dozen Cook County clinics could close as part of the health bureau's effort to cut $140 million from its operating budget.

"A lot of these sites see seven, maybe 10, maybe 12 patients a day," Simon told reporters, justifying the plan.

But Simon's figures appear to be off base, according to information the Tribune has obtained.

The only county medical clinics that see so few patients are the seven based in public schools. But those clinics don't report students' mental health visits--a primary reason youngsters seek care--for reasons of confidentiality. Also, school-based clinics run group sessions on health education that aren't counted toward the total.

In addition, Simon's staff seems to have calculated daily volume at medical clinics on the assumption that they are open seven days a week. Virtually all the smaller clinics are closed on weekends and holidays.

Taking that into account, the lowest volume clinic in the Cook County system, the Woody Winston Health Center in south suburban Phoenix, saw about 28 patients a day in 2005, according to data from Cook County reviewed by the Tribune. This figure assumes the clinic was open about 250 days a year.

"All of us asked ourselves: What numbers are they using?" said a clinic staffer who asked not to be identified, again because of the widespread fear of job losses in the health system. "We all have waiting lists for people to get in, not open slots."

Attempts to reach Simon's office for a response were unsuccessful. Steven Mayberry, spokesman for Cook County Board President Todd Stroger, said: "Dr. Simon doesn't have a history of misleading, and it's his budget to craft."

"I know from my own experience ... that the majority of county health centers are overbooked and do not have capacity for new patients for two or more months," Barbara Shaw, a nurse at Hayes Health Center in Chicago, wrote in an e-mail Wednesday to the Tribune.

Meanwhile, other community health centers in Cook County said they, too, were financially strained. Treating thousands of extra patients without the means to pay for care "has the potential to bury us financially," said Alan Channing, chief executive at Sinai Health System.

"You're talking about a health clinic system that's already overburdened and underfunded" as the number of uninsured Cook County residents grows, said Dr. Lee Francis, interim chief executive at Erie Family Health Center.

"We will do everything in our power to help, but we have finite resources also, and many of our health centers are at capacity," said Donna Thompson, chief executive of Access Community Health, which operates 47 private health clinics for needy patients in and around Chicago.

Even if Cook County drastically reduces its clinic network, the savings are likely to be minimal. The entire clinic budget is about $51 million.

Late Wednesday, amid swirling rumors, Stroger issued a statement asserting that he would not close Provident Hospital, one of three hospitals operated by the county health system.

On average, only 60 patients stay at the hospital and only one or two babies are born there on any given day. An earlier proposal by interim chiefs at the health system suggested Provident's labor and delivery unit and pediatrics department should be closed or the hospital shuttered altogether.

- - -

Clinics at risk

The approximate number of patients seen daily at the lowest-volume clinics in the Cook County system, according to a Tribune analysis of 2005 data:

- Woody Winston Health Center, Phoenix: 28 patients

- Cottage Grove Health Center, Ford Heights: 39 patients

- Vista Health Center, Palatine: 44 patients

- Cicero Health Center: 51 patients

- Robbins Health Center: 53 patients

- Woodlawn Health Center, Chicago: 56 patients

- Austin Health Center,

- Chicago: 59 patients

- Near South Health Clinic, Chicago: 60 patients

Note: Does not include clinics based in public schools.



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