By Dr. Andru Ziwasimon
Community Coalition for Healthcare Access
There are facts, there are truths and there are a whole lot of lies surrounding our public hospital.
Here is one truth: The University of New Mexico Hospital faces a looming financial crisis. It is currently breaking even, but in two years the hospital needs a profit of $14 million a year to pay for the new "west wing."
Hospital administrators say the cause of this crisis is uninsured patients and illegal immigrants not paying their bills. They constantly cite a figure of about $95 million for "uncompensated" care and claim that uninsured patients pay on average only $5 on their bills.
But the figure of $95 million in uncompensated care is wrong. University Hospital receives $54 million from the county, $9 million from the state and $18 million from federal sources, all of which administrators refuse to acknowledge as "compensation." This drops the estimate to $14 million.
Here is another truth to consider, and I know that many patients can attest to this fact. Most people are paying way more than the $5 per person claimed by administrators. We have witnessed the billing department make huge errors including billing women twice for the same pregnancy and charging patients for parts of their bills already paid for by Medicaid.
Doctors in the system have been sent to collections for bills they were never supposed to have received because of professional courtesy. Is all this double-billing counted as uncompensated care?
The looming crisis is due in large part to poor investment decisions by top hospital administrators who operate in a health policy vacuum. They shun the advice of duly elected officials, public health and primary care experts, and uninsured patients themselves.
The scapegoating of the uninsured has allowed University Hospital administrators to create a culture of antagonism against uninsured patients in the hospital and clinics. And this has allowed our public institution to put payment policies in place that effectively create a two-tiered system of health care based on insurance and citizenship status.
Here is an example, one of many, from recent weeks. A young pregnant woman was sent to the hospital by an outlying clinic for treatment of dehydration. She was asked for $35 prior to being seen. She didn't have it, so she was sent away before a doctor or nurse could evaluate her.
In this particular case a colleague of mine intervened and the young woman was admitted for two days and treated with IV fluids. Not that it should matter, but this woman is a resident and would have qualified for public assistance to pay her bill.
The unfortunate reality is that this up-front payment policy, in place for over four years, has recently been reinforced with a heavy hand from above due to the hospital's financial worries, thus intensifying the pressure that pits front desk clerks and intake personnel against the sick and suffering.
Is this a value system we wish to support for our public hospital? Many staff, providers and community members say no. We are supported by the hospital's code of ethics as well as a legal contract, the lease agreement with Bernalillo County. It states that as long as the hospital gets public tax monies it must treat patients equally, with insurance or without.
Dr. Andru Ziwasimon formerly worked at the University of New Mexico Hospital. E-mail: aziwa@null.net
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