Patients before politics

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HCMC is in trouble. I am a practicing physician and medical staff leader at HCMC, and I am worried. I am not worried about the care we provide. Hennepin County Medical Center is an amazing place to work; we provide outstanding care for some of the sickest and most injured people in our state. We provide care for the poor, the marginalized, the addicted, the incarcerated, the abused, the traumatized, and we do it well. We have some of the most skilled physicians and teams anywhere, and we provide medical care at a world-class level. We are also an elite teaching facility; more than half of the physicians practicing in Minnesota spent time here in training. We are passionate about service, about our “mission.” It’s a buzzword in many places, but a real living thing here.

We are in trouble at the top; but not, in my opinion, in our C-suite or board level. Hennepin Healthcare System, or HHS, is a subsidiary corporation of Hennepin County. We have a CEO and executive team with substantial physician involvement and a shared sense of mission; while there is always room to improve, our physicians and providers are generally supportive of our local leadership. Our executive team is not perfect, but their job is incredibly difficult, and from my experience they do it well. We have always and continue to provide care for patients who are not great for “business.” We provide care for uninsured, undocumented, often unbefriended, marginalized and other human beings whom most health care systems try to avoid. We love this work, but trying to make it function in the U.S. health care system is a nearly impossible task. Miraculously, we continue to do so.

We have a governance board at HHS. This board is unique, and was established with great thought and collaboration in 2007. We have physician membership on the board, along with county commissioners and community members. This mix is powerful, providing presence from the front lines to the county oversight level, with strong community members to help keep us true to our mission. I find the physicians and other providers of HHS to be supportive of the board, which was negotiated into existence as part of the medical group practice merging with HCMC. I do not believe the board is the problem.

Hennepin County leadership is, I believe, where the trouble lies. The county commissioners are considering dissolution of the HHS board and termination of the HHS CEO. The rationale for this as I understand it is a perception/narrative (with little data to support it) of poor working conditions, poor benefits, excessive executive salaries and a lack of transparency attached to these two components of our system. We would not dispute that working conditions are challenging if not poor, but they are poor throughout health care right now, and we are among the financially poorest health care systems anywhere. While reductions have been needed, our benefits remain among the best in the state. Our CEO is among the lowest paid in the state in our sector.

As for transparency, two county commissioners are on the HHS board; this intentional design was established with this in mind. Internal transparency is not a particular concern of the medical staff. In fact, our provider group is struggling to understand what is truly motivating these actions; there is a transparency concern among my colleagues, but it involves the county commissioners and the basis of their actions. Where is the data to support them? How are conditions, pay and benefits compared to other systems? What is the board’s relationship with the Minnesota Nursing Association?

What is at stake here? It is difficult to say, but easy to say we’re worried. There is a sort of magic at HCMC, a delicate magic which drives us to provide great care to vulnerable people despite the challenges here. A disruption like this has already begun to affect that spirit. If the county takes this action, some doctors and other providers would likely stay, while others would go. None of us would be the same. I believe it is foolish to think that the economic status, working conditions and overall management will improve or even be unaffected with county leadership. Most county hospitals in the U.S. no longer exist, and I fear that this is very possible here. More fundamentally, we are worried that the impacts of this disruption could devastate our community and our state. Other health care systems do not have the capacity, or in many cases the skills, to do some of what we do. I suspect that none of them will be lining up to take on the “poor payer mix” members of our community that we serve gladly. Education will suffer, which will impact care in the future. And those on the margins will suffer the most, as is most often the case.

So, for the sake of our community, I ask our county commissioners to reconsider this action and direction, and I am asking you, our community, for help on this difficult issue. So please, if you care about how we care for the most vulnerable and often most injured in our community, consider reaching out to your Hennepin County commissioner or state representative to learn more and/or express your view. Ask questions. Be curious. Be vocal. I believe there is something precious at stake.

Dr. Thomas Klemond is president of the medical staff in Hennepin Healthcare System. Recent news coverage of the issues discussed in this article includes “New calls for county oversight at HCMC” (April 3).