Parkland's Future CEO Can't Heal Hospital Without Support Missing from Austin and D.C.

Categories: Schutze

SHZ_GetOffMyLawn_TitleImageV2.jpg
Warren Fagadau, a Dallas ophthalmologist who has been involved in health insurance reform efforts in Texas, has a piece on the op-ed page of The Dallas Morning News today about the qualities our public hospital in Dallas should look for in its ongoing search for a new chief executive officer. His views are measured, well-informed and reasonable, so I thought maybe this was an instance where I might help balance things out by offering the other kind.

In the end, none of what is really wrong at Parkland will be solved at Parkland. Even in the chaos that is Texas politics, we have to look for the wave, and the wave is this: Texas shirks its responsibility to provide healthcare for the indigent and working poor at the state level but leaves that obligation open at the local level. And that happens because the advocates of denial are afraid to state the necessary implication of their beliefs.

The thing our new Senator Ted Cruz lacks the balls to say -- but clearly means - is that he thinks we need to slam the doors shut at Parkland and just let people die in the streets. That is what he wants. That is what his supporters in the Tea Party want. But they won't say it.

The future of public health care under Tea Party leadership.
Fagadau in his essay today offers several suggestions for the kind of research-based collaborative leadership we need on the issue of public health and care for the uninsured at Parkland. Given his past involvement with the Texas Health Institute, a nonprofit that argues for health insurance reform, it's obvious that Fagadau knows this ground well. But I wonder if he's too focused on the ground.

The bigger picture is this: We don't just let people who don't have insurance die in Texas. We pay for their care locally, here in Dallas at Parkland, largely through the property tax and subsidies padded into private insurance premiums. We don't want to just let them die because they don't have money.

But Cruz does. That's not my idea. I didn't dream that up. That's what the state's largest association of doctors said last July when Cruz said letting poor people go to public hospital emergency rooms was a better cheaper solution than expanding Medicaid. Arlo Weltge, a Houston emergency room doctor who is chairman of the Texas Medical Association's political action committee, told Bob Garrett of the Morning News that Cruz was dead wrong about cost. Then he said, "If it's the cheapest solution you're after, Mr. Cruz, why don't you just let the poor people die in the streets?"

Hospitals like Parkland are screwed because the Tea Party people and their new regent, Senator Cruz, lack the moral courage and the integrity to follow their own dicta through to the inescapable conclusion and consequence. They want people who can't afford private insurance to die in the streets. They won't say it out loud. I don't know: Maybe they even lack the courage required to say it to themselves. The position they take instead is a gutless kicking of the moral can.

They won't pay for it at the state level, where the law of the land says the responsibility is supposed to abide. Texas, in fact, is one of the worst places in America for healthcare for the working poor, a fact the rest of the country glimpsed during Governor Rick Perry's National Oops Crusade in 2011: Fully 26 percent of Texans that year were uninsured compared to the national average of 17 percent.

Parkland has its own problems. I detract absolutely nothing from the brilliant reporting the News has done on problems at Parkland over the last few years. But one can't help noticing that almost all of the problems have involved some failure to deal adequately with the sheer crush of indigent patients coming into the emergency room. So we have to wonder how much of the ultimate solution is even in the purview of Parkland itself and how much of it must occur in Austin.

What Perry has done at the state level and Cruz will now try to replicate in Washington is a gutless shirking of that responsibility. They deny it is the state or federal government's responsibility to help make insurance available to the non-affluent. But they lack the fiber required to follow their own position through to its logical implication -- go die in the streets. And so they kick the can straight to the door of the ER at places like Parkland, creating fog-of-war conditions where terrible mistakes are made.

There's a kind of face-hiding hand-over-mouth giggle in the way Cruz and his followers handle the issue. "It's not our job to help them stay alive. But if you've got a lot of extra money at the local level, well then ... be our guests." I wonder which is more despicable -- the impulse to let people die or the refusal to own up to it? I guess if you are one of those people, maybe it's not an interesting distinction to make.

My Voice Nation Help
43 comments
rusknative
rusknative

you are so full of cheese and baloney. no one wants anyone to die in the streets...unless you include pathetic has-been journalists living on past reputations and job history.

urban county hospitals are totally different from suburban and rural area hospitals.  Parkland and major city county hospitals are filled with pork employees, and forced to provide 24/7/365 emergency and clinical services to whatever shows up at their doors...no way to schedule or plan for efficiency, and a wealth of mental health cases dumped on them at the same time with knife wounds, STD infected gunshot wounded pregnant illegal aliens...etc.

the issue is not more humanitarian liberal pity and poor sad plight of the indigent...it is a rational approach to WHO PAYS and WHY.  and why should taxpayers pay for criminals and people with no care for their own health needs in the first place?  liberals are pus lovers.


roo_ster
roo_ster

Parkland would have more money to help actual poor Americans if it used the discretion it has to refuse non-emergency care to illegal aliens.  Mexico as a country is richer than 5/6th of the world on a GDP per-capita basis.  Let Mexico look after the Mexicans with Mexican standards of care.

Also, like leftists everywhere, JS gets his rocks off by calling for other people to pay for his priorities.  Nothing stopping JS from writing a check to Parkland or selling his house and donating the equity to Parkland.  Instead, he wants gov't to do his strong-arm dirty work while he basks in the warm glow of his own self-regard.

Nothing more than cheap grace wrapped in hateful slander of those numerate enough to understand that the Big Rock Candy Mountains are a myth:


http://www.youtube.com/watch?v=JqowmHgxVJQ

MikeWestEast
MikeWestEast

Poor operation at Parkland is no different than administrative incompetence at DISD. They occur because management allows it. What does the income level of students or whether they can afford breakfast have anything to do with operating controls on credit cards, payroll fraud or knowing how much money is in your accounts before you lay off people? Nothing. The same analogy applies to Parkland. If the Federal Government does an audit, hands you a report, and then no one takes any responsibility to start addressing concerns, how does the "crush of indigent patients" excuse the inaction. Parkland's problem is not they ran out of money. It is that the Board and Execs did not start attacking the problems. I have been part of organizations that ran afoul of Fed rules and the entire organization gets involved, fast. Daily, weekly, monthly action plans get worked and every exec and board member gets personally involved. Senior execs get grilled on progress with every employee knowing the status. I do not have any direct contact with Parkland, but news reports do not mention any kind of forceful action. The last thing I saw was it was looking for a Quality Czar, as if he or she would solve the problems. People from Medicare do some probing and are not getting the expected response. Nothing upsets a Fed bureaucrat more than if he or she thinks the regulatee is blowing him off.

tx_jimbob
tx_jimbob

When he says we should pay for it at the state level - expand that and what it really means is I/WE should have to pay for someone else's health care.  I worked hard to get where I am today, why should I be FORCED to pay for their health care - let me pay for my own and they can pay for theirs. 

If Dallas chooses to pay for Parkland - that is fine - their choice.  My choice is not too and that too is just as valid.  Let the locals decide what is best for themselves and leave the State/Federal government out of it.

fernaldus
fernaldus

They should change the name to Parkland Maternity. 

tape_is_glue_and_bac
tape_is_glue_and_bac

The State of Texas is the proper authority to divert existing sales tax revenue from non-hospital counties to their hospital of choice.  


I admire the great people of Dallas and Texas for giving so much free charity to our poor visitors from South of the Border.  


Parkland:  The Best Mexican Hospital.

P1Gunter
P1Gunter

Jim, you forgot to mention that since the Tea party hotbed of Collin County has no public hospital, their indigent end up in Dallas where we end up paying for them.

GetALife
GetALife

“The thing our new Senator Ted Cruz lacks the balls to say -- but clearly means - is that he thinks we need to slam the doors shut at Parkland and just let people die in the streets. That is what he wants. That is what his supporters in the Tea Party want. But they won't say it.”

Yeah, and the Tea Partiers slap babies, beat grandmas, and drown puppies just for fun.

Level headed editorialism at its finest. Do the editors at the Dallas Observer actually read this crap before they print it or do they just not give a flip.

ivyhall
ivyhall

Hospitals like Parkland are "screwed" because of their own waste, corruption and malfeasance which evidentally includes District VI of CMS looking the other way  for a decade while patients get terrible and (in many cases ) deadly " care."  The number of whistle blower suits recently gives one pause regarding the amount of public funds used for wasteful padding of certain  "academic" department bottom lines (ID, PMR, e.g)   Some heads of Depts make seven figure public funded "salaries"..Zedler, who you guys love to lampoon tried unsucessfully to intorduce a bill in the last legislative session on behalf of one of Parkland's victims which would require Parkland and other public funded hospitals to own up to (via informed consent) the limited amount for which a patient injured by malpractice can obtain in a lawsuit with one of these "fine institutions" protected by sovereign immunity. No one else that I know of , Democrat or Republican supported the victims on this issue.  (this is not  a Tea Party problem).  --It is somewhat "over the top" but perhaps you should check out the "Parkland House of Horrors Blog" which borrows from Riggs and DMN research on this topic.

mavdog
mavdog topcommenter

@roo_ster 

to paraphrase the above post:
"let those Mexicans just die in the streets'.

JS is right, the right won't say it (or write it) out loud, but nevertheless it is the message.

JimSX
JimSX topcommenter

@tx_jimbob 

"let me pay for my own and they can pay for theirs"

what if they are babies?

ruddski
ruddski

@SuperfuzzBigmuff 

If a baby is born at Parland to white tea-party Collin County parents, does that baby become an automatic douchebag?

JimSX
JimSX topcommenter

@frostypj 

Do you know that the heads of departments who earn seven-figure salaries (why the quote marks?) are not worth those salaries? Would you tell me what your approach would be to hiring people of equivalent caliber for less, and how much cheaper could you get them? 

roo_ster
roo_ster

@mavdog @roo_ster  To paraphrase the above post:

"Screw poor Americans; I want someone cheap to mow my damned lawn and to raise my kid.  Someone who isn't mouthy black or white trash that I actually might have to speak to and treat as human."

I think we need to send them back to Mexico to let the Mexican gov't take care of them.  If they are to die, let them die in the streets of Mexico.  If they are to give birth, let them give birth in Mexico.  A plane ticket or bus ride to Mexico is orders of magnitude cheaper than care at Parkland.  They are not Americans, they do not deserve to suck up our tax dollars...tax dollars that could be used to help actual poor Americans. 

Stendahl
Stendahl

Nobody is  "dying on the streets".  Parkland and its dishonest academic partner UTSW are raking in tax payer billions and doing a lousy job of taking care of the poor.  It might be said that the poor are better off outside of Parkland than within it.  Messaging, JS's or yours for that matter is only as good as the facts which back it up.  Blaming everything on Ted Cruz is hysteria. 

albert.finney000
albert.finney000

@JimSX @tx_jimbob - if they are babies born at Parkland, then maybe the Mexican government could chip in a peso or two.

rusknative
rusknative

@mavdog @roo_ster THE MEXICAN DRUG CARTELS ARE DOING A GREAT JOB OF KILLING MEXICANS IN THEIR OWN STREETS IN MEXICO WITHOUT US DOING ANYTHING AT ALL.

mavdog
mavdog topcommenter

@roo_ster

so you want the phrase abridged as follows:

"just let the poor die in our streets, and send those Mexicaans back so they can die in the streets of Mexico"

(/cynical) your position is so compassionate, reveals such a civilized perspective....(/end cynical).

mavdog
mavdog topcommenter

@Stendahl 

seriously? just who would one look to for info on the status of the construction? and you want to dismiss the info without any other source who might back you up?

all the while you cannot make any factual support for your outrageous claims?

gee, apparently I am talking with a 12 year old.

come back to the discussion when you can actually contribute something.

Stendahl
Stendahl

So you get the facts upon which you base your emotional outbursts exclusively   from the Parkland Newsletter?  What is your connection to Parkland?

mavdog
mavdog topcommenter

@morrainepeak

"over one billion dollars" for a new hospital? and you think Parkland or UTSW has those $?

just who do you think gets money for the construction of a  hospital, the operator ot the contractor?

ridiculous.

the hospital is on track for its scheduled opening. there is no "over one billion dollar problem" for anybody, much less the dallas county taxpayers. in fact, "After almost two years of construction, the new Parkland hospital remains on schedule and under budget for opening in 2015."

http://newparkland.parklandhospital.com/blog/page/2/

UTSW students "train" at several hospitals, including the old St. Paul, Childrens, the UTSW hospital and at parkland. UTSW is a school, it is not set up to care for the poor.

get your facts straight, so far your statements are inaccurate at best.

morrainepeak
morrainepeak

@mavdog @Stendahl You are clearly the one with the credibility problem.  Don't like the DMN? Logic? Not our problem.  Dallas County  tax payers are funding Parkland.  Over one billion dollars  according to DMN in Nov. 2012 has been spent on a replacement hospital which is under budgeted because "nobody had a sense of appropriate planning." This is clearly an over one billion dollar problem for the tax payers.Parkland is where UTSW medical students train.  There IS a relationship. You are simply ridiculous!

mavdog
mavdog topcommenter

@Stendahl 

You have a severe reading problem.

My correct assertion is YOUR statements are wrong, I've detailed such and you have yet to show the facts to support the bs you spew about "raking in taxpayer billions", about "parkland and UTSW doing a lousy job of taking care of the poor" (UTSW doesn't "take care of the poor" BTW)  and "the poor are better outside of parkland than within it".

care to show a single "credible source" to validate your false claims and "sad delusional thinking"? you have failed to do it so far.

bwahahaha. too funny. can't defend what you wrote, so you deflect. classic.

Stendahl
Stendahl

@mavdog @Stendahl @frostypj  the title is false?  take it up with Jim then.  Also while you're at it, tell the DMN TDH CMS DOJ and others that their facts are "wrong".  Good luck with that, BTW. Seems to me that there have been quite a few recent  resignations and departures at Parkland UTSW  of high level Administration/Staff which could not be explained because of mistaken facts or impressions... but then, my sources are documented.  Have you got one equally credible  source other than your own sad delusional thinking to document your "facts"?

mavdog
mavdog topcommenter

@Stendahl @frostypj 

You refernce an article by JS in which he criticizes the for profit healthcare industry with the statement "Apparently the real story in America today is that we despise the poor and consider them to be less than human pieces of shit, while we absolutely worship money and are crack-addicted to personal luxury."?

and that story about how the for profit hospitals have $ to burn somehow is supposed to validate all those false statements you made about parkland and UTSW? surprise, it doesn't, and your statements are still false.

too funny. keep up the good work!

Stendahl
Stendahl

@frostypj  I would add only one addtional authoritative source: Jim Schutze's Get  Off My Lawn column of 15 Feb 2012: "The Real Truth About Parkland:  We Hate Poor People" where he goes on to cite DMN chronicaling "Neglect and Malfeasance" in regard  to treatment of the poor at Parkland.... (game set match)...

ivyhall
ivyhall

@mavdog @Stendahl Actually Stendahl is correct.1) DMN Nov 28 2012 references the $1.27 BILLION dollar hospital expansion -replacement project voted on by Dallas taxpayers in 2008/2010 being incomplete because of poor planning 2) DMN and other watch dog groups like Parkland House of Horrors have extensively documented inexplicable poor care given to poor and minority patients in PMR, Ortho dept and Psychiatry just to mention a few .3) Based upon 1 and 2  above, there may be a valid reason to avoid Parkland.

mavdog
mavdog topcommenter

@Stendahl 

no, YOU don't know the facts.

let's recap:

You claim "parkland..and UTSW are raking in taxpayer billions". False.

You claim "parkland..and UTSW..are doing a lousy job of taking care of the poor". False.

You claim "the poor are better off outside of Parkland than within it". False.

that's a fairly complete failure on your part. an o-fer.

keep up the good work....

Stendahl
Stendahl

The above federal agencies-including the dept of justice, national hospital accreditation agencies as well as the Dallas Morning News and other watchdog groups-not to mention highly placed Doctors of Medicine and others with post graduate degrees (who have worked at Parkland and UTSW for years) don't "have their facts straight". Really?!

mavdog
mavdog topcommenter

@stendahl 

you apparently don't know the facts, you just regurgitate the dmn storyline.

1 in 10 hospitals in the usa get the CMS "critical report". methodist hospital is currently working thru theirs. the report included such egregious errors such as referring children to Children's (gasp! why would they send children to a facility devoted to of all things children???) and that "Parkland failed to post prominent and conspicuous Emergency Medical Treatment and Active Labor Act (EMTALA) in the Emergency department and other public spaces". how could the professionals at parkland do an adequate job of treating patients if the EMTALA wasn't posted correctly??? oh the horror!

1.2 MILLION patients a year get outpatient health services at parkland. over 18,000 surgeries a year. those patients are who will confirm that you are an idiot to say they would have been "better off outside of parkland than within it", for they are living proof of the accuracy of you being an idiot for making such a claim.

stendahl
stendahl

If I am an "idiot" then the  United States Dept of Justice, CMS, JCAHO and a dozen or so well re-imbursed whistle blowers--most of them well educated MDs and or faculty members-- as well as multiple journalists at the Dallas Morning News are the  credible sources of my "idiotic" ramblings.  If you want to believe everything is just fine at Parkland, it is up to you...also I would hasten to add many who have been given "treatment" have been maimed for life or are no longer with us according to the  above sources .

mavdog
mavdog topcommenter

@Stendahl 

what complete and total bs.

first, UTSW doesn't get "tax payer billions", and it does a good job fulfilling its goals, which btw is being a school. they have the word "university" in their name for a reason. the faculty have been awarded nobels, they have discovered many medical advances that benefit the afflicted. their purpose is not to take care of the poor, that is part of parkland's mission.

second, parkland does a great job of fulfilling its mission, which is to provide healthcare services to all seeking help. if you truly believe "the poor are better off outside of parkland than within it", you are an idiot. those who have been to parkland and given treatment would certainly agree with me.

nobody is "blaming everything on ted cruz", although if his policies are put into place it will certainly come to tht point.

Tom434
Tom434

@mavdog @albert.finney000 and that is the first thing of any immigration reform, no more birthrite citzenship to children born to illegals

Stendahl
Stendahl

See : Tannenbaum : Mexico the Struggle for Peace and Bread (1950)

albert.finney000
albert.finney000

@mavdog @albert.finney000 - Yes they are Americans, and thank God their parents, primarily foreign nationals, can depend on Americans to foot the bill -young Americans are frightfully expensive to raise! Especially when the great majority of these newly-minted Americans will never contribute through taxes anywhere near the cost of life- long care and feeding they'll require.

rusknative
rusknative

@Stendahl actually, Mexican doctors in Guadalahara and Lake Chapala area are inexpensive, responsive and excellent.  Poor Mexicans don't get a lot of help from Mexican doctors, granted.  But they are still Mexican citizens, not US citizens.  Compassion does not mean paying for everyone's lunch.

Stendahl
Stendahl

That's because we live in a fine and generous country, although it galls you to admit it.  The only services in Mexico free to Americans, I know of lately are unwarrented incarcerations in Mexican jails at the whim of their dysfunctional government --which should be providing a better standard of living to their own population.

morrainepeak
morrainepeak

Actually,it seems to me that if you did your research properly, you wouldn't have any further questions.  Dr. Fagadau brings nothing new to the table and appears to praise some of the worst administrators in the history of public hospital administration (Dr. (wine cellar) Wildenthal and Dr.  Anderson).  The TMA loves corporate medicine and supports anyone who wants to mindlessly expand Medicaid.  Judging from the California and Oregon Medicaid experience, there is no solid evidence that enrollees in Medicaid will use the Hospital ER any less--and that is why, among other reasons (budget shortfalls) those states are re-examining their Medicaid policies (contraction).  Until hospital re-imbursements for Medicare and Medicaid come more into line with the outpatient world and CMS actually probes the goings on in large hospital chains, there will be no real incentive for hospitals/hospital executives to behave properly.

JimSX
JimSX topcommenter

@frostypj 

But why won't you answer my question?

ivyhall
ivyhall

Also-- former Boston hospital CEO Paul Levy has an excellent blog@ Not Running A Hospital Blogspot.com which examines some of the  above issues as well as other comtemporary medical dilemmas.

Now Trending

Dallas Concert Tickets

From the Vault

 

Loading...