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Doomsday Memo Warns Of County Hospital Peril
County Says Hospitals Chief Meeting With Doctors To "Discuss And Resolve These Issues"

Monday, July 23, 2007
CBS2

Watch video:  http://cbs2chicago.com/topstories/local_story_204124445.html

(CBS) CHICAGO The headline at the top of the memo says it all: "Impending collapse of general medicine at Stroger Hospital."

An S.O.S. is going out Monday from Stroger Hospital. A warning letter was sent by a top doctor there spelling a disaster in the near future.

As CBS 2’s Alita Guillen reports, a doomsday letter outlines an unsettling future for Stroger Hospital of Cook County.

It reads in part "to avert catastrophe, immediate action is needed."

The letter is written by Dr. Avery Hart, the division chair of internal medicine. It is addressed to Dr. Robert Simon, the hospital’s interim chief.

"As you know 13 full time internists were laid off this spring . . . Over the past three months another 13 have given notice. . .you should anticipate that resignations will continue…,” Hart wrote.

The memo is dated July 20 - last Friday - and it says a poll taken the day before suggested that 75 percent of the internists who have not already given notice will be leaving within six months.

That is, given the county's current budget problems.

Hart declined to speak on the record about his doomsday memo, which ends with an appeal for county officials to consider a new "action plan" his memo said he was "synthesizing."

A hospital spokesperson says the letter is a cry for help.

“Issues pertaining to moral and staffing and services is all tied into funding or the lack thereof,” said Don Rashin, the hospital’s director of public affairs.

In February the county hospital took a $130 million budget cut. Since then among other cuts 70 nurses have been laid off and 13 clinics closed. The effort to consolidate high paying staff is worrisome for those on the inside.

"Above all we need to think about the health of our patient population,” said Courtny M.P. Hallowell, M.D. of Stroger Hospital.

While some blame the problem on the county's budget plan, even those who did not support Board President Todd Stroger say it's not his fault but that of the federal government, which has siphoned money from Medicaid to fund the war in Iraq, leaving the most vulnerable helpless.

“We are going to end up with a lot of sick people and a total system that is falling apart,” said County Commissioner Larry Suffredin.

One Cook County commissioner, who asked not to speak on the record, said the memo was likely one part posturing and one part reality, based on the tens of millions of dollars shortfall in the county health care budget.

In the short term the hospital is hoping for a one-time state grant of $1 million. In the long term what it needs is federal money; a hospital spokesperson says they are lobbying for that Medicaid money to come back to the public instead of going to the Defense Department.

The following is an e-mail WBBM received from Sean Howard, the Director of Public Affairs for the Cook County Hospital System regarding Newsradio 780's story about the "impending collapse" memo.":

The memo that you are referring to is an internal memo generated after a meeting among staff.

Its conclusions and recommendations were developed at a recent retreat where Bureau physicians and administrators convened to address issues of funding, physician retention and low morale.

As a result, Dr. Simon, interim Bureau Chief of the Cook County Bureau of Health Services, is meeting with physicians in the Department of Internal Medicine to further discuss and resolve these issues. He is confident that the situation is reversible, but strongly emphasizes the critical need for increase funding to address the budget shortfall.

The Bureau of Health Services is requesting $100 million in funding from state legislators to address fundamental shortfalls in our funding structure. The funding will allow the Bureau to provide quality health services to communities that need it the most.

Here is the complete text of the memo:

July 20, 2007

To: Robert Simon, MD
From: Avery Hart, MD
Re: Impending collapse of general medicine at Stroger Hospital and ACHN

As you know, 13 full-time internists were laid off this spring due to budget cuts affecting Stroger Hospital and ACHN. Over the past three months, another 13 have given notice that they will resign or retire in the summer and fall. Given the number of others who are actively interviewing, you should anticipate that resignations will continue at the present rate of about one per week for an indefinite period, unless we can take bold measures now to slow the trend.

As you heard at our department meeting on May 23, other institutions are rushing to take advantage of our current vulnerability. Northwestern, University of Chicago, Harvard, and other academic centers are aggressively recruiting County doctors, as are excellent private groups. The people leaving are excellent clinicians and teachers. Many are seasoned physician leaders as well: a firm chief; the head of our interdisciplinary palliative care team; co-director of a course at the medical school; principal investigators on mission-oriented federal grant projects. Our division, until now one of the best in the state, is being devastated.

For most of our general internists, working in a public health system is more than a job, it is a calling. Our people want very much to be able to stay. But, in the current environment, loyalty to the mission has come to seem at odds with the direction of our institution. In a poll taken yesterday at our division retreat, division members stated their future plans. In the current environment, with no major changes in the status quo, 75% of our internists – specifically, 75% of those who have not already given notice – will leave within the next 6 months. In an alternate scenario, where all general medicine faculty are transferred from the Department of Medicine into ACHN with the standard ACHN job description, 95% will leave within 6 months.

Successful recruitment to fill the huge number of vacancies, in the slowest season of the annual recruitment cycle, would be impossible even in a normal year. It will be even less feasible in this time of grave doubts about the viability of primary care at our institution. The current exodus of superb internists certainly does not send a positive message to prospective job candidates.

Rapid loss of internists will have predictable and far-reaching effects, including:
• Current patients will find it ever more difficult to access services from the shrinking primary care base;
• Plans to expand access to primary care for ED, ASC, and subspecialty patients will founder;
• Availability of subspecialists for consultations and procedures will fall as they are redeployed to cover ward rotations previously done by generalists;
• Demoralization and resignations will accelerate in our division and department, as remaining doctors struggle to shoulder the burden of work left undone by their departing colleagues.
General medicine is the largest clinical discipline in the Bureau, both in outpatient and inpatient settings. Without our division, the department will collapse. Without our department, the hospital will collapse.

To avert catastrophe, immediate action is needed. There may be a way to increase physician retention. We are in the process of synthesizing an action plan, based on recommendations from the retreat. If you are reachable in the coming week, we will submit a proposal electronically for your consideration, to be followed by a meeting when you return.

CBS 2's Alita Guillen and WBBM Newsradio's Steve Miller contributed to this report.



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