Jackson Bids To Privatize Emergency Rooms

By Lou Ortiz
Jackson Health System president and CEO Carlos Migoya is seeking to privatize the emergency room services in its facilities for adults and pediatric patients by Oct. 1 — a move the union involved is calling "irresponsible."

Proposals requested Aug. 20 by Jackson — which would also include the Rape Treatment Center — are due Sept. 10, county documents show.

The "Proposer will take over the management, supervision and staffing of fast track emergency services upon contract award and execution," according to the proposal request, and the "Commencement date is expected to be on October 1, 2012."

"The successful Proposer shall provide Jackson Memorial-Adult Emergency Department, Jackson Memorial-Pediatric Emergency Department, Jackson South-Adult Emergency Department, and Jackson North-Adult and Pediatric Emergency Department services including management services, in-hospital physician staffing and the supervision required to provide medical services to patients," the proposal request says.

Emergency services at Jackson North are now provided by the Duval Emergency Group LLC, county documents show. The services were outsourced before Jackson bought the facility in 2007. The contract with Duval expires Dec. 1.

"The transformation of Jackson Health System has demanded that we question every old assumption about the way business is done at Miami-Dade County’s taxpayer-owned healthcare system," Mr. Migoya wrote in a memo to County Mayor Carlos Gimenez on Aug. 20.

"During the first year, for example, we asked the private sector to provide proposals for operating services such as corrections health and Medicaid eligibility screenings," Mr. Migoya wrote. "In the first case, we determined that a reinvention of our internal system would provide higher quality and lower cost than any outsourced alternative."

"In the other case, a pilot project determined that a private company could provide the service more effectively, and we negotiated a favorable contract for that service," he said.

But, in the case of emegency services, the union said, patients and the hospital’s mission are at risk.

"To just to hand [emergency services] over to a private company is irresponsible," said Martha Baker, a registered nurse and president of SEIU Local 1991, which represents 5,000 Jackson healthcare workers. "This puts profits over patient safety in this community; turning it over to private company that is driven by profits."

"This is a crazy thing to do," she said. "This is a pretty arrogant move to single-handedly change the mission of Jackson. He [Migoya] is not charged with privatizing the place."

Ms. Baker said the county’s public health system does not have a primary care strategy and residents depend on the emergency room.

"He thinks he’s going to save $4 million or $5 million," she said, "But privatization and public hospitals are counter to each other. You privatize Jackson and you destroy the mission of the hospital."

In his memo to the mayor, Mr. Migoya called emergency room services "a cornerstone of Jackson’s operations, and we will obviously make patient safety and service the single highest priority."

According to the proposal request, any vendor will be required to provide care "regardless of patient’s ability to pay."

The contract would be for three years "with two (2) successive options to renew of one year each," the request says. "This agreement may be terminated by the [Public Health] Trust for convenience (without cause) upon sixty (60) calendar day’s prior written notice of termination delivered to the contractor by certified mail. The Trust intends to award a contract to the single vendor that best meets the requirements of this RFP."

"We are deeply aware of the unique characteristics that make Jackson and its patients different," Mr. Migoya told the mayor. "Outsourced emergency physicians are common in hospitals of all kinds, and are currently being used as Jackson North, as well as the public Broward Health and Memorial Healthcare System in Broward County."

"As such, we believe a review of proposals is not only justified, but necessary," he wrote. "This RFP is ripe for innovative options; proposers could include academic partnerships, and we have informed our labor unions that they are welcome to submit their own proposal."

Ms. Baker said her union would fight to stop Mr. Migoya’s attempt at privatization.

"It was a threat in the past," Ms. Baker said about privatization. "We’ve been fighting back. Now he’s trying to privatize Jackson piece by piece. We don’t see privatization as bringing a high standard of care."

But Mr. Migoya told the mayor that another area of Jackson is also ripe for privatization.

"We will also issue an RFP regarding our central business office, which manages billings and collections," he said. "This function has historically been a challenge for Jackson, despite the honest commitment of well-intentioned staff."

"Again, we will remain mindful of Jackson’s special patient population," Mr. Migoya wrote. "With a diverse base that includes international patients, uninsured patients and others with complex insurance situations, a private-sector partner would need to be able to provide a level of sensitive customer care that is consistent with Jackson’s public mission and evolving standards of service excellence."

Despite the 100-page request, with detailed guidelines for the emergency room services and submission deadlines, Mr. Migoya told the mayor a final decision on privatization has not been made.

"It is vital to realize that we have not made the decision to outsource either of these service lines," he wrote. "We are simply taking the common-sense step of exploring and understanding all the avail-

able options in two important areas."

"Potential financial savings will only be considered after we are convinced of a vendor’s ability to meet or exceed our healthcare and service standards," Mr. Migoya said. "Based on our improving timeline for these proposals, we hope to make a decision about these projects in late fall of this year. The usual regulations regarding the cone of silence will, of course, be attached to these RFPs."To read the entire issue of Miami Today online, subscribe to e -Miami Today, an exact digital replica of the printed edition.