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Debates focus on indigent care

The lines between two public-health dilemmas crossed again Wednesday as debates continued over the future of Tampa General Hospital and the half-cent sales tax subsidy for Hillsborough County's indigent health care plan.

The debates continued to focus on how both organizations will care for the medical needs of the poor.

Hillsborough County commissioners voted to lobby the local legislative delegation to renew the indigent health care tax, which is in political trouble in Tallahassee. They also will ask for legislation allowing them to reduce property taxes in conjunction with the plan. Taxpayers by law now must contribute $26.8-million annually in property taxes toward medical care for 27,000 of the county's poorest residents, in addition to the money raised by the half-cent.

The health plan has built up a $130-million cash reserve, and commissioners say that's too much.

"That's one hell of a cushion," said Commissioner Joe Chillura, who has led the local effort to reduce the property tax contribution to the program, a measure that would eventually reduce the reserve. He also wants limits on a program he fears will become a haven for the country's poor.

"God knows, there's indigents all over the world. I'm Italian, and I have as much emotion as anyone about taking care of poor people," Chillura said. "We want other counties to mirror us, but we don't want to be caseworkers to the entire country."

Richard Ake, clerk of the Hillsborough Circuit Court, and an internal county auditor this week said the county needs the reserve to cover increasing costs, or give officials time to phase out the program if legislators do not extend the half-cent tax for another 10 years. Regardless of the action taken in Tallahassee, taxpayers still will be required to foot the bill for indigent care, Commissioner Jan Platt said.

Also Wednesday, commissioners delayed until April 9 voting on a proposal to hire an outside consultant to lead a task force to determine how to fix the problems in the plan that were uncovered in a series of audits. The board at that time will review a financial audit released Tuesday that concluded that the health plan needs to improve its system of tracking patients, recovering medical costs from other health programs, and processing claims.

In the other big health care question of the day, commissioners voted to recommend that Tampa General Hospital's governing board should establish a "public process" before voting whether to take the hospital private.

Meanwhile, at Tampa General, hospital president Bruce Siegel met behind closed doors Wednesday with about 50 black Tampa residents for a 75-minute information session that appeased some participants and left others skeptical. He would not outline his plan before presenting it to his board March 26, but he tried to convince the audience that the public hospital must change its structure to survive, participants said.

The meeting was organized in response to concerns from some African-American residents who were angered by recent news stories. The Times reported that Tampa General board chairman H. L. Culbreath planned to use the support of Siegel and black board members to blunt opposition in the black community to privatization. Culbreath, who did not attend Wednesday's luncheon, further angered some people Tuesday with release of a letter that characterized the opposition to the board's plans as "hysteria."

"Most people who addressed that question indicated the letter really talked down to people who are sincerely interested in making sure the poor, no matter what their color, are protected in this county," said Bob Gilder, who opposed a similar attempt to take Tampa General private in 1990.

Although only black people were invited to meet with Siegel, several participants stressed that the future of Tampa General is not a racial issue. "The worst thing that can happen is if this gets caught up as a black-white issue. It's not. It's a human rights issue," said participant James Ransom, who is concerned with the welfare of the poor, who have long considered Tampa General the hospital of last resort.

Businessman James A. Hammond said Siegel convinced him that Tampa General is no longer that hospital. He said Siegel convinced him that the indigent burden has been distributed to other hospitals, and that the public hospital cannot succeed under Florida's Government in the Sunshine law.

In fact, Tampa General's board has held six secret meetings to discuss going private under an exemption to that law. Additional legislation is being proposed that would broaden the exemptions.

"I'm concluding the only way for Tampa General to survive is as a not-for-profit corporation," Hammond said.