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Half of health cuts are doctors, nurses.

Tuesday, April 17, 2007
Daily Southtown
by Jonathan Lipman

Nearly half of the jobs cut in the Cook County health bureau belong to doctors and nurses, an analysis shows.

Doctors across the county health system expressed fury and dismay last week as pink slips arrived and they learned just how hard some cuts would hit.

"Patients are being sent to the emergency rooms, and from the emergency rooms, they have no place to send them," said Dr. Dan Ivankovich, an orthopedic surgeon at Provident Hospital, who was laid off Thursday.

According to a list of 1,032 eliminated jobs in the health bureau, provided to the Daily Southtown by the county under the Freedom of Information Act, the final budget eliminated 260 doctors and residents and 230 nurses and certified nursing assistants.

Layoffs for doctors began last week but have not started for nurses, union officials said.

Dr. Pedro Cruz thought his job at Cook County's Phoenix clinic was safe

The Woody Winston clinic was one saved in the high-stakes political negotiations leading up to the county's final budget vote.

But Cruz, a 17-year veteran of the county health system, said he was floored to learn Thursday he would be let go because he didn't meet a new requirement to be certified as a specialist.

"When they told me I was laid off, it took me by surprise," Cruz said. "They said it was due to budgetary constraints. -- I have some of the most seniority in the clinics."

In total, doctors and nurses make up 47 percent of the known cuts at the health bureau. More doctors were cut than any other job.

This does not include the additional doctors and nurses working in administrative posts such as department chairman or nurse coordinator.

An additional 670 positions in the Bureau of Health were reduced to $1, but county officials would not provide a breakdown of those jobs despite repeated requests, so it's unknown how many are doctors.

Although Cook County Board President Todd Stroger's office said the Southtown's numbers are accurate, spokesman Steve Mayberry said it was incorrect to portray the new details as somehow conflicting with Stroger's stance on the budget.

In an angry published retort to the media, Stroger last week insisted he has "chopped from the top" and said he closed the county's $502 million budget gap with "efficiencies and more effective management."

"The numbers reflect that the total of doctors and nurses cut is lower than other positions cut," Mayberry said. "Ultimately, that's what's been consistently stated."

Doctors across the county said they don't understand how health bureau chief Dr. Robert Simon is choosing who to cut, and they worried about their patients.

Ivankovich said his entire orthopedic unit was eliminated at Provident, which would strand poor residents of the Southeast Side who are stuck in wheelchairs with bad hips or knees. He estimated he performed at least $2 million in billable services to the county, but said he could never get the hospital's accountant to send the paperwork to Medicaid for billing. He was paid $190,000.

"All our patients, they're not going to get care, they're all being referred to the Stroger (Hospital) orthopedic clinic," Ivankovich said. "All the patients said, 'We got appointments for May,' so I thought, cool, they're just going to transition them. Then I found out it was May of 2008. -- These things can't wait a year."

Cruz said he and his partner each saw about 20 patients a day in the Phoenix clinic. With his departure, there will be only one full-time primary care doctor at the site.

"I don't know what they will do with the patients," Cruz said.

Doctors are being asked to re-interview with the county in order to keep their jobs, several doctors said, and many are quitting rather than go through the process.

"Morale is incredibly low, said Dr. Jennifer Smith, a general medicine physician at Stroger Hospital. "It's a kind of slow bleed of people. -- Most of the medical directors of the community health care sites just chose to leave. And they're some of our best people."

Dr. Peter Orris retired Feb. 28 as head of Stroger's shuttered occupational medicine department because he knew he'd be laid off otherwise.

"That's extraordinary," Orris said softly when told the total number of doctors cut. "I didn't realize it was that many."

Orris said colleagues tell him they're already limiting hours for clinics and running out of space in hospital beds.

"Some of (the effect of cuts) will be invisible, people will be turned away, people will stop showing up," Orris said. "The illness will take awhile to show up in the community."

But the county says while it expects some lines to get longer during the county's ongoing restructuring, the system still is working.

"While every single employee under the Bureau of Health Services' umbrella has been asked to perform at heightened levels, there is no particular indication of any sort of strain," Mayberry said.

Waiting lines at a public institution such as Stroger Hospital are inevitable, Mayberry said, "which is as much a reflection of the national health care epidemic as any situation in Cook County."

The choice of who to cut was a bitterly debated one at budget time, and county commissioners debated for hours before the final 2 a.m. vote in February.

Opposition commissioners, led by Forrest Claypool (D-Chicago), said Stroger was cutting too many doctors and nurses while he kept high-paid administrators and other bureaucrats. Stroger insisted his final proposal did enough to cut waste without cutting needed managers.

Breaking down the rest of the jobs cut at the county health facilities, only 112 administrators were cut and about 189 other clerk, therapist and technician jobs were cut.

Another 234 jobs were lost to privatization of security, maintenance, laundry and food service functions at Stroger and Oak Forest hospitals.

Mayberry pointed to county-wide trends as proof of Stroger's priorities

Across the county, more support workers were cut than anyone else: 1,011 positions, or 48 percent of all jobs cuts were in supportive positions, according to an analysis by county officials. That includes people with titles such as "personnel analyst" and "project leader," as well as medical professionals such as biochemists and radiology technicians.

Ivankovich said doctors' failure to unionize made it easier for budget officials to target them for layoffs.

"Doctors are completely disproportionately being hit," Ivankovich said. "All the other groups -- nurses, workers, transportation -- they have a union. Doctors, if they don't like your tie that day, they can fire you."

Who's been cut at bureau of health?

Doctors: 260

Nurses: 230

Other (clerks, technicians, therapists): 189

Administrators: 112

Oak Forest building service: 106

Stroger police: 73

Oak Forest laundry: 36

Oak Forest food service: 19

An additional 670 positions in the Bureau of Health were reduced to $1, but the county would not provide a breakdown of those jobs. Stroger's office says those jobs can be restored without county board approval.

Definitions used :

Doctor -- any doctor, physician or resident who is not a chairman or coordinator. Also dentists, psychologists.

Nurse -- any nurse, RN, LPN, nurse practitioner, certified nursing assistant or physician's assistant not a chairman or coordinator.

Administrator -- anyone with chairman, coordinator, administrator, supervisor in their title or any "assistant" making more than $70,000.


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