Stroger gives on hospitals

By Mike Colias
Crain's
January 21, 2008

Cook County Board President Todd Stroger is ready to give up control of Cook County hospitals, a wellspring of the political power his family amassed over the past two decades.

Assailed on all sides for patronage, inefficiency and financial woes in the Cook County Bureau of Health Services, Mr. Stroger now favors turning over Stroger Hospital, the county's two other hospitals and the dozen or so clinics it runs to an independent agency. Most of the county's 17 commissioners agree.

"The intent is to take health services for the poor out of the sphere of politics and put it into a sphere of greater business expertise," says Lance Tyson, Mr. Stroger's chief of staff.

A group of seven commissioners asked by Mr. Stroger last fall to study the issue has drafted a bill that would create a seven-member hospital authority with taxing power and control over contracts and hiring in the health system, including the power to appoint future health chiefs. Mr. Stroger is waiting to see the bill before deciding whether he backs the tax-authority plan or another model, Mr. Tyson says. The measure is expected to be introduced in the coming weeks.

Ceding control of the largest piece of county government would remove a cornerstone of the political organization built by Mr. Stroger's father, former Board President John Stroger, who died last week. Critics say the elder Stroger used the hospital system as a font of patronage jobs. Supporters of the move say it would free the health chief to fix the system's dismal finances and the operational dysfunction that leads to months-long waits for services like mammograms.

Those problems led to intense pressure on Todd Stroger to purge politics from the hospitals by handing control to an independent body. Creation of a new tax authority mirrors a recommendation from a blue-ribbon panel of health and business leaders backed by U.S. Sen. Richard Durbin, who last year told Mr. Stroger to fix the hospital system or forgo additional federal funding. Losing federal dollars would cripple the system.

"We have every hope that our congressional delegation will go to bat for us now," says county Commissioner Gregg Goslin, a Glenview Republican and chairman of the group that crafted the proposal.

Still, any plan to reform hospital oversight could unravel amid board politics. Commissioners are sure to bicker over how an independent board would work and whether a new tax district — which would require the state Legislature's approval — would usurp too much of their authority. But 11 commissioners interviewed by Crain's say they support the idea of an independent board.

POLITICAL APPOINTEES?

A key point of contention, and a measure of how much control Mr. Stroger is willing to relinquish, will be the question of who appoints members of the new hospital board.

"If we're allowing Todd Stroger to appoint these people, that's not my idea of independent governance," says Commissioner Larry Suffredin, an Evanston Democrat who is running for Cook County state's attorney.

Mr. Suffredin submitted a plan in October, backed by dozens of community groups and unions, to turn over health bureau oversight to an independent board of trustees that would restructure the system over three years.

Mr. Stroger's camp has made it clear that no change will be considered until the county fills its $238-million overall budget gap for fiscal 2008. The issue could become a bargaining chip as Mr. Stroger tries to line up votes for his controversial bid to raise the county sales tax.

The health system accounts for roughly $100 million of the shortfall, despite cost cuts last year that eliminated almost 1,000 jobs and sapped the morale of doctors and nurses. John H. Stroger Jr. Hospital's accreditation remains in jeopardy after an inspection report identified a number of shortcomings in its operations (Crain's, May 20).

An independent board with greater health care and business expertise would better manage the health system's budget, supporters say. The tax-authority plan is modeled loosely on the Chicago Park District, which has its own taxing authority and a board appointed by Mayor Richard M. Daley.

Whichever plan emerges, county leaders seem ready to follow almost every other local government in the country that operates a large hospital system, says Anne Camper, counsel to the National Assn. of Public Hospitals and Health Systems in Washington, D.C.

"They've all determined that running a hospital system is just too big of a job to do without a dedicated governing board," she says.