(Crain's) — A decade ago on an August night, Ramanathan Raju was in charge of the emergency room at Lutheran Medical Center in Brooklyn when paramedics rushed in a pregnant mother, her son and her sister who had been struck by a car driven by an off-duty New York City police officer while they were crossing the street.
Dr. Raju, who on Monday starts as CEO of the Cook County Health and Hospitals System, says the case still bothers him.
“This is the one trauma case in which I lost everyone,” he told Crain's in an interview this week.
The trauma surgeon, 60, isn't accustomed to losing, whether it is in the ER or the boardroom.
As chief operating officer of the New York City Health and Hospital Corp. since 2006, he played a key role in erasing half of a $1.2-billion deficit for that city's public health system, which has an annual budget of $6.7 billion.
At the Cook County health system, he must immediately fix a budget gap of at least $35 million for the next fiscal year, which starts Dec. 1. Tackling the system's crippled finances is just one of the challenges that lie ahead. He must also lift the morale of employees after years of layoffs, cajole unions into cost-cutting changes, boost the system's reputation for medical care, and establish close working relationship with other hospitals.
All the while, he must grapple with cuts in Medicaid and Medicare, key sources of revenue for the county health system, which treats a largely uninsured population.
“You aren't going to be able to please everyone,” says Jose R. Sanchez, CEO of Norwegian American Hospital in Humboldt Park, who worked with Dr. Raju in New York.
“But I think the key to all of that is in the fabric of his personality,” Mr. Sanchez says. “He is very respectful. He's a good listener. And he doesn't really mind to explain over and over what he wants to do, and then at the end, he has the ability to execute what he wants to do.”
On his first day with Cook County, Dr. Raju will join a brewing budget battle when the independent board that oversees the county health system formally presents its 2012 fiscal year budget to the Cook County Board of Commissioners, which controls the health system's purse strings.
The hospital board proposes cutting the budget by 9%, to $827 million, compared to the current year.
On Wednesday, health system officials reduced their requested tax subsidy to $283 million, from about $328 million previously. But the request still is 14% more than County Board President Toni Preckwinkle is willing to give.
Dr. Raju grew up in Madras, now called Chennai, a teeming city of 4.6 million people in Southern India. His father spent time behind bars for protesting as part of the national movement to escape British rule, which resulted in India's independence in 1947.
“You don't just live for yourself and your family alone,” Dr. Raju says he learned from his father. “You've got to also live for the community around you.”
Dr. Raju dreamed of becoming an architect, but his father wanted one of his sons to practice medicine, and Dr. Raju's brother couldn't stomach cadavers and dissection. So Dr. Raju headed to medical school, graduating from Madras Medical College in 1976. He immigrated to the U.S. in 1982 and later earned an MBA from the University of Tennessee.
In New York, where he plans to work until Friday, Dr. Raju supervises the CEOs of 21 facilities and is responsible for a budget of more than $3 billion. While cutting costs, Dr. Raju also kept his eyes on improving patient care. He slashed waiting times for doctor visits and shortened pharmacy lines to just 60 minutes from nearly 4 hours.
At Cook County, he is walking through a revolving door. At least six people have held the position of CEO since 2004. Dr. Raju succeeds William Foley, who resigned unexpectedly in March to head Chicago operations for Vanguard Health Systems.
“One of the reasons he was chosen was that this would be the last stop of his career,” says Warren Batts, chairman of the independent county hospital board.
Dr. Raju is married to Dr. Samanthi Raju, a urologist who must still wrap up her practice in New York. The couple has two grown children.
To prepare, Dr. Raju has been poring over documents and traveling to Chicago to dine with local hospital executives and public health officials. Last weekend, the avid cyclist moved into an apartment in the South Loop.
As he ticks off the goals he would like to achieve, he pauses to say, “That's what keeps my adrenaline going, my juices flowing.”