Why Tampa General is going broke

The hospital of last resort for the region's poor, TGH now cannot afford to continue providing indigent care while operating costly specialty units.

[Times photo: Thomas M. Goethe] Jamie Tyson of Tampa General Hospital takes care of Gricelda Ramos Hernandez, a 12-month-old girl, suffering from a rare disease that affects the muscles. Gricelda spent about two weeks at TGH before being released last week. Her parents -- two migrant workers from Sydney in Hillsborough County -- can't afford to pay her medical bill. She is an example of the many patients who use costly services at Tampa General, which has lost $30-million in the last three years.

By DAVID KARP

© St. Petersburg Times, published April 9, 2000

TAMPA -- The meeting starts every Tuesday at 7:30 a.m. around a dimly lit conference table at Tampa General Hospital. Women and men in white coats ponder a list of the hospital's sickest patients one by one.

There is the patient burned over 70 percent of his body who has been in the hospital for 191 days. His insurance maxed out at $5,000. He has no way to pay his $447,000 bill.

There is the illegal alien who was treated for 238 days until he could be flown home to Mexico at the hospital's expense. He has no way to pay his $600,000 bill.

There is the patient treated for 15 days after he was hit by a car. His insurance was canceled because he may have been trying to commit suicide. He can't pay his $135,000 bill.

The caseworkers look at their charts and talk about each patient's progress and how to help the patients start their recovery. But they don't usually bother with the one question looming over the hospital these days:

Who will pay these bills?

That unanswered question is critical to the future of TGH, which has lost more than $30-million since it became a private, non-profit company in 1997. If finances don't improve by October, the formerly public hospital says it will be forced to cut essential medical services that serve thousands of patients throughout west Central Florida and make it unlike any other hospital in the region.

TGH is seeking what it had said privatization would avoid: a public bailout. In the next three weeks, the Legislature and the Hillsborough County Commission will decide how much financial aid Tampa General will get. TGH says it needs $11-million now to avoid drastic cuts, but a long-term solution could require $30-million a year.

At stake are hundreds of jobs, Tampa's standing as a medical teaching center, and the ability of the sickest patients in west Central Florida to get critical medical care near their homes.

But often lost in the debate, hospital officials say, are the people who depend on TGH, many of them the poorest and most vulnerable.

It is they who would suffer most if Tampa General closed its burn unit or scaled down its Level 1 trauma center. They would have to travel to Orlando, Gainesville or Miami to get the same care.

Long seen as the hospital of last resort for Tampa's poor, Tampa General has become a regional center. About 30 percent of all patients admitted to Tampa General are from outside Hillsborough -- counties such as Pinellas, Pasco, Hernando, Polk and Highlands.

The hospital writes off about $11-million a year caring for out-of-county indigent patients.

But the figure for patients who need TGH's costly specialty units is even higher. About 56 percent of patients at the trauma center, burn unit, neonatal intensive care unit, and transplant programs don't live in Hillsborough.

So Tampa General's future is being watched around Florida. Not only will its losses affect patients throughout the region, its fate will become a case study for what to do with Florida's other five money-losing teaching hospitals.

All of them, including Miami's Jackson Memorial, are expected to lose money this year as the federal government continues to reduce the amount it pays for health care.

By cutting payments, Congress hoped to force hospitals to economize and pay doctors less. What happened instead, experts say, is the weakest hospitals like TGH -- which provide the bulk of charity care -- suffered the most.

If teaching hospitals such as Tampa General cut unprofitable services, it would weaken grand medical institutions that are citadels for training young doctors and laboratories for medical discovery.

"I think it would be much more expensive to rebuild that," said Dr. Sally Houston, an infectious disease specialist at TGH and member of the county hospital authority, "than to try to save it."

-- David Karp can be reached at (813) 226-3376 or karp@sptimes.com.

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