On one side of the city, a hospital administrator tried to convince a black audience this week that Tampa General Hospital won't abandon poor people if it goes private.
Less than a mile away, county commissioners discussed ways to continue the nation's foremost health care program for treating a community's poor.
While the politicians and the hospital president spoke, an injured man told his story about health care for the poor from an empty apartment in the Robles Park public housing complex.
Leaning awkwardly on a crutch, R. B. Reynolds thumbed through dog-eared medical bills. The outline of a broken collarbone, which never got the treatment it required, jutted beneath his T-shirt. He wore a ragged plastic splint around his broken ankle.
"I just need my operation," he said softly.
The safety net works most of the time. This time, despite all the laws and programs set up to guarantee health care for the poor, Reynolds slipped through the net. His case illustrates why the mere mention of taking Tampa General private creates fear among poor people. They remember a time when the poor regularly went without the care they needed.
In a time of welfare reform and rapid changes in health care, they worry that the safety net will be weakened. For people like R.B. Reynolds, Tampa General is their last hope. It is on behalf of people like him that community activists will be rallying today at a health clinic for the poor.
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Reynolds, a 40-year-old gravedigger, has seen the inside of county jails and crummy apartments. Until Feb. 4, he made about $210 each week digging graves. It was hard labor, shoveling sandy soil, jumping in and out of 6-foot holes.
He didn't have health insurance.
Reynolds stepped off a bus Feb. 4, his clothes still grimy from digging graves at Rest Haven Cemetery, when a stranger's car hit him from behind. He awakened four hours later at St. Joseph's Hospital with a broken ankle and dislocated shoulder.
At 3:40 a.m., still groggy and with chips of windshield glass imbedded in his arm, Reynolds was discharged with a bill for $3,668, two crutches, a plastic splint and directions to see an orthopedic surgeon. At that hour, a St. Joseph's spokeswoman said, no social workers would have been around to explain his options. Reynolds thought he was getting booted because he is poor.
"They wouldn't keep me in the hospital because I don't have no insurance," he said.
Over the next six weeks, without savings to fall back on, Reynolds lost his apartment and everything in it. He had his hopes raised by two lawyers who smelled a good lawsuit. But they abandoned him when they discovered the motorist who hit him was as poor and uninsured as he is.
His private orthopedic surgeon dropped him when the idea of recouping expenses through a lawsuit disappeared. By now, Reynolds was in constant pain and hobbled by two serious injuries. The chance to set the broken bones had passed. He needed his bones rebroken, set in the proper position and secured by steel pins.
"What do I do?" Reynolds asked.
The doctor told him to go to Tampa General Hospital. "He said don't let them know that he told me to go," Reynolds recalled. "He said tell them to fix me up. He said don't let them know I'd been to St. Joseph's."
Frightened by their words, he called Tampa General anonymously last week to ask if he could have a free operation. No, said the woman who took his call.
On Wednesday, his pain dulled by Tylenol, he said he figured out how he was going to get his operation. Reynolds planned to show up unannounced as soon as his girlfriend cashed the check she gets for boxing fresh shrimp. With about $50 in cash, he figured someone at Tampa General would find him a bed and give him an operation.
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Bob Gilder has never met R.B. Reynolds, but the longtime Tampa civil rights activist worries about him just the same.
In 1990, when Tampa General's public board tried to go private, Gilder was among the strongest voices in opposition. He recalls when poor people died under bridges, before a half-cent sales tax pumped millions of dollars into a network of clinics run by St. Joseph's, Tampa General and two non-profit groups.
Now, Tampa General's board wants to try it again and have asked for the community's trust.
Gilder is unapologetic about his mistrust.
He remembers when St. Joseph's had two rooms reserved for blacks and no black physicians. He recalls how poor people were turned away from most area hospitals, or given the most basic care for complex problems. Tampa General was the hospital of last resort, the haven for the sick in need of more than a splint and an X-ray, and that role as a safety net is held dear by those who fear they'll one day fall.
"Did they turn people away before? You bet they did," he said. "If the half-cent is gone, then some of those new health providers for indigents will also go back to where they were before the half penny was there."
While state law mandates that Hillsborough County provide medical care to the poor, it doesn't spell out how extensive that care should be. Federal laws also require hospitals to treat and stabilize emergency conditions, but what happens next falls into an area so gray that few complaints are ever filed and hospitals are seldom sanctioned.
"It changes case by case because of the medical particulars. A hospital, if they have the capability to take care of a patient, they should take care of that patient," said Colleen Sandmann, a nurse consultant with the federal Health Care Financing Administration. That agency can sanction a hospital that violates patient dumping laws by pulling Medicare funding, which accounts for about 60 percent of the typical hospital's revenue.
"The stabilization point is a key issue," she said.
Susan Byrd, St. Joseph's nurse manager and trauma coordinator, said Reynolds was treated and discharged appropriately and given strict instructions to call the on-call surgeon within 48 hours for additional treatment.
Advocates for the poor want guarantees that medical treatment is comparable to what a sick person with insurance can get.
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In 1991, had R.B. Reynolds limped into Tampa General's emergency room, he would have racked up enormous bills for diagnostic work that could be done cheaper and better in a doctor's office. Back then, Hillsborough taxpayers would have footed the bill from a $26.8-million property tax inadequate to meet the demands of the poor.
Alarmed by the rising cost of indigent health care, commissioners approved a progressive network of clinics set up in 1992 to treat the county's poor.
Audits show that the program has reduced health costs.
As one of the working poor, with an income a few hundred dollars above the $7,750 county limit for a single adult, Reynolds could have gone to the Judeo-Christian Health Clinic, a volunteer group that continues to serve 14,000 uninsured people who earn too much to get county aid. Patients sometimes wait up to four hours outside the Tampa clinic for a chance to be among the 10 patients who see a doctor on any given night.
Cretta Johnson, director of the county's health plan, dispatched a social worker to R.B. Reynolds' apartment 15 minutes after a Times reporter questioned her about his dilemma. Sally Pisani discovered that another social worker hadn't registered him for the county health plan because, at the time he applied for public housing and food stamps, he told them he had a doctor who was supplied by his lawyer.
He didn't understand that the county would step in if the professionals abandoned him.
Pisani fixed his problems. Now that he can't work as a laborer, he qualifies as indigent. The county plan will pay his St. Joseph's bill. He is enrolled in the public program for six months. Pisani ordered a bed and gave him food stamps. She brought him vouchers for pain medicine. She began his application for a state victim's compensation program that may reimburse him for lost wages.
He saw a doctor Friday.