Bad Medicine

With The Recent "Reform" Of The County's Health System, The Cure Seems Far Worse Than The Disease.

By Emil Franzi

THE PIMA COUNTY Board of Supervisors recently voted 3-2 to surrender direct control of nearly one-third of the county's $700 million budget.

These health-related responsibilities--from Kino Hospital to Long-Term Care, from Home Health to Animal Control--will be placed in the hands of a self-selected and self-perpetuating entity called The Pima Health Care System Commission. This new system is defined in the resolution, which set it up as "quasi-governance."

There was no public debate over the move, even though it has been coming for many months and supervisors Sharon Bronson and Dan Eckstrom, along with Huckelberry, have expressed strong reservations about its soundness and its effect on representative government.

Currents The guiding force behind the new "integrated health system" is Supervisor Raul Grijalva, with the support of Board Chairman Mike Boyd along with Boyd's chief aide, Ron St. John) and Supervisor Ray Carroll. The move has been billed as "integrated healthcare," which it is, and a method to "remove healthcare from politics," which cannot be done.

The politics which created this shift in power began some time ago. The vehicle was a "blue-ribbon panel" whose recommendations were based around this new, so-called "quasi-governance." Webster's defines "quasi" several ways, but the closest would be "seeming" or "resembling." In other words, what we have here is "sort of governance."

THE POWERFUL 11-member Health Care Commission is selected as follows:

  • One member employed by the County Health System, chosen by the Commission (Jon Miller, currently the assistant director of Long-Term Care)

  • One member each from the Public Health Advisory Board and the Kino Hospital Advisory Board, appointed by each body's president. (Each one, Sharon Reburn and attorney Michael Rollins respectively, appointed themselves);

  • Three members from the Blue-Ribbon Committee as a "transition," and selected by that committee to serve for two years, after which their positions will be filled by the Commission. (Those three are former TUSD Board member Sylvia Campoy, currently a City of Tucson employee; Tucson business woman Dorothy Finley; and public accountant Christine Granillo.)
This group, chaired by Campoy, then selected the other five members, whom the supervisors also approved 3 to 2. Those five are:

  • Retired UA Medical Center employee Dr. Clifford De Benedetti;

  • Former Pima County Charter Commission chairman and real-estate developer Paul Lindsey (who lost trying to sell us similar "quasi-governance" last year);

  • UA College of Medicine faculty member Dr. Joel S. Meister;

  • Sheila Parker, deputy director of student affairs in the UA graduate program in public health,

  • Sherrie Schuldheis, a UA research associate and PhD candidate in nursing,
Nine seats chosen by the Commission itself, two by the presidents of the two advisory boards--if this all sounds a tad convoluted, like an old Ernie Kovacs bit involving 38 former mayors of Hong Kong, the bottom line isn't at all funny: It leaves the elected Board of Supervisors and their administration out of the loop. And also note the large proportion of UA types. And further note the influence of Supervisor Grijalva--Campoy, his long-time political ally, lost a recent re-election bid to the TUSD Board.

So healthcare comes out of "politics" by having it led by another politician--and a defeated one at that. Quasi-governance at its best.

Grijalva says he wants healthcare run by people who know about it, not a "road warrior" like Huckelberry, an engineer. But the current system puts Dennis Douglas in charge of the County Health Department. Douglas, while seemingly capable, is a retired Sheriff's major.

The resolution empowers the Commission to choose the outfit's CEO, who in turn chooses the balance of the staff. The current holder of that exalted position is Dr. Richard Carmona, also one of the 100 or so applicants for the permanent $180,000 position. The Commission resolution, under the guise of eliminating "politics" and ensuring of "non-interference," gives the supervisors and their management team one clear message: Bug off!

The Commission, through its own finance department, will draw it's own budget for submission to the supervisors, and will (it appears) be in charge of hiring all county healthcare personnel. The commissioners will allow the supes to "make policy," but that role will be passive--exercised only concerning items the Commission itself recommends. Thus, the Commission will have more powers than elected line officers, whose budgets are reviewed by county administrators, and whose employees are currently in the county merit system.

Supervisor Boyd has publicly stated that one problem he wishes to "correct" for healthcare is the current "outmoded" personnel policy. So you can expect health employees to be quickly dumped from the merit system. Carmona has already cut back on Home Health nurses, downsizing and knocking many back to part-timers and reducing their benefits. Their complaints have drawn threats from Carmona to simply contract their jobs to the private sector and lay them all off--the type of privatization Boyd and St. John have lusted for since Boyd's election. Campoy, when questioned by Home Health employees, said she wasn't familiar with the issue.

We thus have the incredible irony of Pima County, with a long-standing program in Home Health serving the "notch group"--the working poor who have no health benefits--placing its own workers into that very "notch group." The problem, we are told, is that Home Health is "losing too much money."

Well, there's a reason for that: It's a welfare program! What idiot thinks it's a profit center?

THE ROLE MODEL for this form of "integrated healthcare" is supposedly Denver, Colorado, where the city and county formed Denver Health as a separate governmental entity. But as Huckelberry pointed out as early as last July, there are significant differences between the Denver model and Pima County's plan. The Colorado Legislature passed enabling legislation to allow for a transfer of governmental power; contracts spell out all the details and allow current employees to transfer from their old merit system to a new and similar one; and--most significantly--the directors in Denver are appointed by the mayor with the confirmation of the city council. They do not get to pick themselves. The Commission's real role model would appear to be the Tucson Airport Authority, another unelected and self-perpetuating group that controls a governmental entity.

An additional problem is left unanswered: The large debt incurred by Kino Hospital--currently totaling $18 million--that Pima County has carried for years. In prior years, the supervisors have papered it over in a variety of ways, usually by having a surplus in other funds at the end of the year. But the fiscally responsible GOP majority of Boyd, Paul Marsh and Ed Moore blew that surplus sometime ago, and the creative bookkeeping is about over.

One reason Denver Health is working is that it began debt-free. Proponents of Pima County's new system claim the debt is a phony issue. But Supervisor Bronson thinks it might be relevant when the bond lawyers rate the county on the issue voters recently authorized. She adds that bond bean-counters are notoriously leery of governments that set up bifurcated responsibilities and shuffle debts. This move could cost Pima County a higher interest rate, meaning fewer projects--from roads to open-space acquisition--get done.

Another big question: Who will replace Carmona? Although he claims he's sacrificing higher pay elsewhere by serving for a mere $180,000 a year, Carmona has applied to keep the job. When the other applicants discover the system is a can of worms established by a 3-2 vote, plan on seeing most of them withdraw--at least the better and smarter ones. And for Carmona it's clearly more than just the money--it's the power, and the opportunity to be unavoidable for comment to his sycophants in the local media.

But the biggest problem with this fevered scheme is the shameful negation of the principles of democracy and representative government. We've all become disgusted and cynical with our politicians, but have we gone so far that we'll simply allow them to be replaced by self-appointed bureaucracies?

The 11 people now in control of the county healthcare system were not elected. Most of them were not even appointed by an elected official, and their successors certainly won't be. Is this how we really want to be governed--by the quasi? How do we get rid of them if they grow arrogant, aloof, self-serving, or just plain nasty?

In a recent editorial, the Tucson Citizen wrote, "It just might work out fine if the Commission stacks itself with competent members." Monarchy works pretty well, too--when you're lucky enough to draw a good king. But the odds suck. And so does the transfer of power from those we choose to those we don't.

We expect action and accountability from those we elect. We can't have it if we allow them to be downgraded to onlookers and converted to potted plants. Voters and citizens are the ultimate losers in this game. TW

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