Friday, August 19, 2005
Chicago Defender
by Kate Marshall

After a state inspection early this summer revealed several violations, Provident Hospital now has approval for a corrective plan, helping the South Side facility avert a massive funding loss.

A spring inspection at the hospital, 500 E. 51st St., by the Illinois Department of Public Health revealed such violations as incorrect prescriptions, improper maintenance of radiology equipment and unlocked cabinets containing narcotics. Provident, which has the third busiest emergency room in the city, has been owned Cook County since 1993.

Centers for Medicare and Medicaid Services Spokesman Robert Daly said Provident's plan, which was submitted earlier this month, laid out "what they're going to do to address the deficiencies, who is going to be responsible for addressing them, and by when" the problems will be fixed. CMS, a federal agency under the U.S. Department of Health and Human Services, is overseeing the process.

"A lot of things had to do with revising policies," Daly said.

For example, he said, as of July 29, Provident implemented a policy immediately enabling the governing body of the hospital to oversee the pharmacy, which was run by a contractor and not properly regulated by the hospital.

Other fixes include a newly implemented weekly review of radiology equipment. According to the initial report, at the time of the inspection, the hospital was not ensuring that radiology rooms were maintained properly and the equipment stored properly. Also, needles and syringes that were not being safely stored have been placed under lock and key.

"If they implement the plan as they say they will, it should bring them back into compliance," Daly said.

The final step in the corrective process is a surprise review of the hospital by CMS that will take place sometime before September 29 – the date when, according to the initial report, Provident would lose its Medicare and Medicaid funding if all violations were not corrected.

If the hospital can pass that final inspection, it will be in the clear indefinitely. "Once we establish compliance," Daly said, "they won't get another inspection until they have another complaint."

The hospital opened in 1891 and two years later, it was the location of the first open-heart surgery performed Dr. Daniel Hale Williams. But Provident's more recent history has been troubled. "The hospital has had a history of deficiencies," Daly said. CMS has threatened to revoke its funding in the past – as recently as last year – but the hospital has always managed to reach compliance in time to avert a funding loss.

Representatives from the hospital are optimistic about Provident's future.

"They're working to address all the problems that the state raised," said Rindy Jones, communications director for the Cook County Bureau of Health.

Provident has "always provided great care," Jones said, "and they'll continue to do that."

Indeed, public hospitals treat the neediest individuals, those without health insurance who cannot be treated at privately owned medical facilities. "We take care of anyone that comes to our doors," Jones said.

But, some county officials say, Provident is not serving its community as it should. Cook County Commissioner Mike Quigley called Provident "dramatically underutilized."

"If it was operated more efficiently and more effectively, it would be a big draw," Quigley said. Quigley said a lack of good management has kept the hospital from succeeding. "It certainly isn't a place that attracts folks," he said.

And there is some doubt that Provident's new administrator, John Fairman, can solve the problems. Fairman, Cook County Board President John Stroger Sr.’s controversial pick, was accused of mismanagement and fraud as an administrator of hospitals in Denver, Houston and Washington, D.C.

Quigley acknowledged that the facility's problems can't be blamed solely on the management. He said that because there aren't enough primary care physicians available to the uninsured in the community, "people let their chronic conditions become acute."

Then, patients end up in the emergency room, which is the most expensive way to treat medical problems, Quigley said.

Provident has an obligation to the community to maintain its facilities well, according to Commissioner Forrest Claypool. And when the hospital fails to comply with state-established rules, "the people who are harmed are the poor people who depend on this hospital for medical care."

The commissioners agreed that if Medicaid and Medicare funding were revoked from Provident, the hospital could not survive. Then, Quigley said, "there'd be a big gap" in safety net health care.

Dr. Kathryn Stewart, an administrator for Mt. Sinai, a non-profit South Side hospital, said closing Provident would threaten other nearby hospitals. "If Provident weren't around, she said, "The wait lines to get into this place would go out the wazoo."

At present, 15 percent to 20 percent of Mt. Sinai's patients don't pay for their care, and the hospital is already stretched – both financially and in staffing – by a large number of uninsured patients.

"Either one of us would be in a horrible mess if we didn't have the other," Stewart said.

Rick Wade, vice president of the American Hospital Association, echoed that sentiment. Public hospitals "can't go away," he said. "County-owned hospitals have got to survive."

By their very nature, Wade said, public hospitals will never run with ease. "We won't let them perish, but they're always going to be institutions that are going to struggle."

Kate Marshall is a reporter for the Medill News Service.