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TGH plan to privatize is quickly opposed

Published Oct. 1, 2005

The disclosure that Tampa General Hospital has a secret plan to go private elicited criticism and concern Thursday from state and local lawmakers, members of the black community and county officials who say they could be stuck with a higher tab for indigent care.

TGH president Bruce Siegel said in a news conference Thursday that poor people will continue to get adequate care, but county officials said a private Tampa General Hospital wouldn't have the same legal obligation to provide extended care for the poor.

Hillsborough County health plan administrator Cretta Johnson said the county could be forced to make more people eligible for coverage under the county's plan, which cares for 27,000 of the poorest uninsured residents. At least one state lawmaker, whose colleagues already are skittish about extending the half-cent sales tax that finances the plan, said Thursday that he won't approve such a measure.

"We're not going to be supportive of expanding the program," said state Rep. Carl Littlefield, R-Dade City, the House sponsor of the reauthorization bill.

Several members of the board that oversees TGH, the area's only public hospital, told the Times this week that TGH must convert to private, non-profit status so it can contract with private companies and escape the intense public scrutiny allowed under Florida's Government-in-the-Sunshine Law.

They said Siegel was given the authority to pursue a joint operating agreement with Tenet Healthcare Corp., the nation's second-largest, for-profit hospital chain.

Reaction was swift.

The Tampa City Council voted to discuss Tampa General's future next week, and council member Charlie Miranda said it must remain public "no matter the cost."

County commissioners, who appoint 14 of the 15 trustees on the TGH board, raised concerns about the effect such a change would have on indigent care and questioned the responsibility the TGH board has to the public.

"I'm surprised they could do that with just a simple vote," Commissioner Ed Turanchik said.

"I think that sends a mixed signal about whether or not this community is committed to helping indigents," Commissioner Joe Chillura said. "If Tampa General is privatized, there is a fear that (commitment) is going to be greatly jeopardized."

Commissioner Jan Platt, a former hospital board member, requested time at Wednesday's County Commission meeting to ask her colleagues to urge their appointees on the hospital board to conduct at least three public hearings before any change in hospital governance is made.

In a memo to County Administrator Dan Kleman, Platt wrote that "it is essential that the public have ample opportunity to address the issues involved in any changes to their hospital."

Meanwhile, Rep. Lars Hafner, D-St. Petersburg, said he wants to thwart any attempt by Tampa General's board to privatize without benefit of public hearings through a bill that would require public hospital boards to have such hearings. Hafner said he will try to push the bill through the Legislature in the next week and get it to the governor before the TGH board can take a vote.

Hafner said he is accelerating his support of the bill, which requires two public hearings and public scrutiny of documents relating to a change in status of a public hospital, in reaction to a published comment from board member Joe Eleana Weachter. She told the Times that a public hearing, which is not legally required, is unnecessary because "public hearings don't bring out people who are knowledgeable about it."

Siegel said Thursday that he disagreed with her comments and promised that public discussions would precede any vote.

Board members said the secret strategy to take the hospital private without raising public ire was led by Chairman H. L. Culbreath and included blunting opposition to the plan through the visible support of Siegel and County Commissioner Thomas Scott, both of whom are black. Scott, who said he was told the issue would come to a vote March 26, confirmed that his race would be used to garner support from the black community. Black residents led a successful protest in 1990 against a nearly identical proposal to privatize.

The Rev. W. Paul Matthews Jr., a vice president with the Hillsborough County NAACP branch, said he was appalled by the board strategy and called such attempts to appease the black community "blatant racism."

"It is very insulting and it inflames (the debate) even more," he said.

The NAACP chapter will meet Thursday to discuss its response to any TGH action.

"Dr. Siegel needs to earn the trust of the black community, and I'm not sure what he has done to earn that," Matthews said.

TGH administrators long have complained about the disadvantage they face with their Government-in-the-Sunshine obligations, the cost of running a teaching hospital and an indigent care mission that must be carried out without taxpayer support for operating costs. The hospital is paid by the Hillsborough County Healthplan for services delivered to eligible clients, but TGH officials say that isn't enough to ensure the hospital's survival.

Administrators say they have been backed into an impossible corner, unable to sign lucrative managed care contracts or forge a link with other health care networks.

Dr. Martin Silbiger, dean of the University of South Florida College of Medicine, agreed that the Sunshine Law has caused problems in past negotiations between Tampa General and private companies.

"It creates all kinds of problems because of negotiations," he said. "If there are two networks, and you have to disclose your negotiating position, you're at a competitive disadvantage."

But Silbiger said Tampa General's problems won't be instantly resolved by privatizing. The hospital could address some problems by having an efficient, private management structure that could move quickly to keep up with changes in the health care market, but it still must have a corps of competent employees to run it. Silbiger said that is lacking.

"They've never done managed care well," he said. "Tampa General is a detriment to us when it comes to managed care. They've never paid attention to it, or had the proper people involved in negotiations."

Siegel is seeking a chief operating officer.

As the area's only remaining public hospital, TGH operates without direct taxpayer support for operating costs. State law dictates that all hospitals treat and stabilize patients who enter their emergency rooms. But Tampa General is chartered to take the next step.

"They have to treat and admit. The other hospitals can treat, stabilize and transfer," Johnson said.

Officials at private, non-profit hospitals say they assume the same level of responsibility for their patients. Bayfront Medical Center, St. Petersburg's 502-bed Level 2 trauma center, absorbs about $20-million in annual charity care write-offs without any taxpayer support.

"If they present to our emergency room with any type of condition, we're going to take care of them," said Robert Carter, Bayfront's vice president of corporate communications. Still, Pinellas County officials have recognized that thousands of uninsured residents may not be receiving needed non-emergency health care.

_ Times staff writers Larry Dougherty and Richard Danielson contributed to this report.