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A fraying lifeline for those in dire need.

Sunday, November 25, 2007
Chicago Tribune
by David Schwartz

COOK COUNTY BUREAU OF HEALTH SERVICES

A silent, pernicious epidemic threatens the health and welfare of the Chicago area. Unless we act now, untold thousands will be at risk.

No, I'm not talking about MRSA. I'm referring to the financial crisis ailing the Cook County Bureau of Health Services, by far the area's largest provider of health care to the indigent and the uninsured.

I am an infectious diseases physician and have worked at Cook County (now Stroger) Hospital since I finished training in 1993. I am not writing out of concern for my own livelihood; like most of my colleagues, I am good at what I do and can
readily find work elsewhere.

I write because, also like most of my colleagues, I love my job and I'm proud of what we've accomplished. Most of all, I write because a terrible toll will be exacted on the poor and the uninsured if the Bureau of Health is allowed to fail.

"Wait a minute," you might say. "Isn't the Bureau of Health run by the same Cook County government whose nepotism and political patronage are splashed across the newspapers every day?"

Well, the Cook County Board, about whom most of these grievances are alleged, oversees and levies taxes for Bureau of Health operations. But the Bureau of Health is distinct from the County Board and deserves to be judged on its own merits.

The Bureau of Health's mission is to "provide integrated health services with dignity and respect regardless of a patient's ability to pay." Its network of clinics and hospitals gives tens of thousands of people preventive and restorative care every year.

The last decade has witnessed a remarkable transformation in the breadth and quality of clinical services, an achievement that all Cook County residents should take pride in.

- At Stroger Hospital, dedicated and highly skilled physicians provide internationally recognized care and training in many disciplines. In internal medicine, for example, 100 percent of residency program graduates now pass their board exams.

- Collaborative training and research programs have blossomed through our primary academic affiliation with Rush University Medical Center.

- Besides Stroger Hospital itself, we now have the Ruth M. Rothstein CORE Center, where nearly 6,000 people with HIV/AIDS and other infectious diseases receive comprehensive, multidisciplinary care.

- Finally, through clinics distributed across the county and anchored at Stroger, Provident and Oak Forest Hospitals, scores of thousands receive compassionate and competent primary care.

But these resources are now threatened.

The Cook County Board failed to respond adequately to long-projected budgetary shortfalls, leading to sharp cuts in the budget for the current fiscal year. This has led to the dismissal of scores of doctors and nurses and the closing of many clinics. Many more clinicians, some with highly distinguished careers, were prompted to find employment elsewhere.

Untold numbers of patients have had to find alternative sources of care, with some very likely to have gone without.
Though badly buffeted by this storm, the Bureau of Health has survived with its core services largely intact. Dr. Robert Simon, the bureau's interim chief, has submitted a budget request to the Cook County Board that would restore some of the lost services and positions. If the board is unable to make up the projected shortfalls in the 2008 budget and more cuts are imposed, however, the Bureau of Health and its mission will founder, if not sink entirely.

To avert this catastrophe, the County Board must raise the additional revenue necessary.

Then, to conform to nearly all other major American municipal health systems, it must create a voluntary and independent board of trustees with the experience and expertise necessary to guide an operation with the size and complexity of the bureau. Doing so would remove the obvious conflicts of interest that characterize the current governance system. And it would provide the credibility needed for the bureau to sustain its mission over the long term.
(The recently released report by the Cook County Bureau of Health Review Committee, composed of administrators from outside hospitals, is an excellent resource for readers interested in learning more.)

A patient admitted this month to my internal medicine inpatient service at Stroger Hospital -- I'll call her Ida -- exemplifies the stakes in this crisis.

Ida, a hardworking, previously healthy woman in her 50s, noticed increasing breathlessness with exertion over a period of weeks and came to the emergency department when she became short of breath even at rest. She was found to have dangerously high blood pressure and severe heart and kidney failure. With treatment, she quickly improved but now faces chronic dialysis.

Ida's illness and its aftermath could have been prevented with access to even the most rudimentary health care, a story that is all too common. With the erosion of private medical insurance, every day brings more and more patients to Bureau of Health hospitals. These patients are newly sickened from preventable or manageable diseases such as hypertension, diabetes, kidney failure, stroke, HIV infection or cancers of the breast or colon.

Ida and many like her suffer so because they mistakenly believe that health care is inaccessible to them. Unless the bureau is preserved, that will become the reality. Patients who rely on the bureau's services for their continued good health will have nowhere to turn.

David Schwartz is a senior physician in the division of infectious diseases at Stroger Hospital.



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