Lives on the line
It’s time to set politics aside and think about economic and social benefits of a public system
Afew months ago, while working overnight at Ben Taub Hospital, I received a page from one of the internal medicine residents I was supervising. Night shifts have their busy moments and lulls, and the resident happened to catch me during a calm spell. Over the phone, she told me that one of her patients kept ringing the nurses, telling them he was having a heart attack. The man had been admitted for a totally different problem, a urinary tract infection.
The resident quickly relayed to me the patient’s history, the quality of his symptoms — including that the pain started immediately after his last meal — and the results of the electrocardiogram and blood tests. At the end of her presentation, I asked for the assessment.
“I’m not too worried,” she concluded. Finding no fault in her reasoning, I agreed, and so the two of us quickly hatched a plan of care for the rest of the night. “I’m a few floors down in my office if you need me,” I told her. I hung up the phone and immediately turned my attention to the computer monitor on my desk at Ben Taub, from which I had been streaming an episode of “Better Call Saul.” My heels fell into their usual spot beside the monitor as I started to settle in for the rest of the night.
It’s easy in such a circumstance to sidestep your duty. My job was to be available to the resident throughout the night, which meant verifying with my own eyes and hands that the patient was receiving proper care. But in medicine, like in all jobs where you’re responsible to people, we can forget the basics, even delude ourselves. During residency, one of my colleagues told me, “You can talk your way out of things.”
Earlier this month, two Harris County commissioners, Tom Ramsey and Jack Cagle, talked themselves out of appearing at a budget meeting. By doing so, they effectively vetoed a measure that would increase the budget of our county’s public health care system, Harris Health, by roughly 2 percent. Harris Health provides more than $2 billion worth of health care locally at clinics and hospitals like Ben Taub, which serves as the public health care system’s flagship. Property taxes provide $780 million of the health care system’s budget. Commissioners Ramsey and Cagle argue that the resulting $45 million shortfall in funding wouldn’t affect patient care at Harris Health. In reality, such a drastic cut would cripple the system’s ability to provide quality care for thousands of residents who rely on it in emergencies, for routine doctor’s visits and everything in between.
We’ve been here before. In 1964, County Judge Bill Elliott, a Republican, found himself caught in a similar quandary. At the time, the budget for Houston’s charity hospitals, Jefferson Davis and Ben Taub hospitals, were split between the city and county. Neither wanted to give an inch. The conditions at the hospitals deteriorated so much that one of the volunteers at Jefferson Davis, Jan de Hartog, a playwright and former Nazi resistance fighter, wrote an exposé named “The Hospital” that chronicled the effects of underfunding.
When the terrible conditions became public — de Hartog reported staph infections in the maternity ward and a cockroach crawling around a patient’s tracheostomy tube, among other violations — Elliott could have stuck to party lines and denied that anything was wrong with the hospital. Instead, he visited himself, incognito, as a volunteer. What he saw shocked him enough to throw his support behind a new taxing authority to fund a hospital district. In 1965, after four prior rejected referendums, Houstonians voted in favor of a property tax to support those unable to afford private health care.
Much has changed since Elliott’s visit to Jefferson Davis Hospital. Our public hospitals are no longer decrepit. Harris Health has grown into one of the premier safety net systems in the country. In 2014, Ben
Taub Hospital clocked the fastest average “door-to-balloon” time nationally in the treatment of heart attacks. “Door-to-balloon” measures how long it takes a hospital to identify a heart attack in the emergency room and open the clogged coronary artery with a balloon or stent; the shorter the time, the better. The hospital has also earned plaudits for its treatment of stroke and trauma, all while having to provide care to a larger pool of patients. Houston’s uninsured rate is the highest in the country, a trend worsened by the pandemic and the state’s unwillingness to expand government-sponsored Medicaid. Add to that the increased demand and expense of nursing care during COVID and it’s clear that commissioners Ramsey and Cagle are asking the impossible: for our public health care system to provide high-level care for more people with the same amount of funding.
Harris Health already runs one of the tightest ships in the country . A report in the New York Times listed its hospitals as the second least expensive nationally. Asking Harris Health to cut costs further risks shooting ourselves in the foot. Take the example of kidney disease. A 2007 study performed at Ben Taub and published in “Texas Medicine” showed that dialysis treatments in the ER cost four times as much as when these were scheduled three times weekly in a dialysis center. Patients whose dialysis sessions are canceled end up visiting the emergency room to receive the treatment. They have to in order to survive. In fact, it’s their right: The Emergency Medical Treatment and Labor Act, or EMTALA, guarantees any person regardless of citizenship or ability to pay the right to receive emergency care in a life-or-death situation. Without a budget increase to offset higher costs , Harris Health says it may be forced to shut down the clinics that help prevent visits to the emergency room and save county funds. We would not only be placing these people in harm’s way, but we’d also be throwing away taxpayer money.
Ramsey and Cagle aren’t the first politicians to doubt how essential our public health care system is to the city. In 2001, then-Texas Attorney General John Cornyn criticized Harris Health for providing health care to the undocumented who couldn’t afford private health care. One year later, while visiting one of Harris Health’s clinics during his campaign for U.S. Senate, Cornyn took back his words: “It’s only humane and more cost-effective to provide preventive care in clinics like this than it would be to just have [undocumented immigrants] clog emergency rooms after they’ve gotten a lot sicker and a lot more expensive to treat.”
It’s time to set politics aside and think about the economic and social benefits that a public health care system such as Harris Health gives our community. We all have our political leanings. For instance, my wife works as a communication consultant for Harris County Judge Lina Hidalgo, who supports the increase. I happened, however, to vote for Ed Emmett in the last election, in part because he visited the medical area at NRG Center set up to help Hurricane Harvey survivors. One reason I plan to vote for Hidalgo this time around is that I’m concerned her opponent, who has a corporate finance background, might follow the lead of other local governments and sell Ben Taub and LBJ to a private equity firm. There’s no question that this budget increase impacts me, not necessarily financially — Harris Health does not directly pay me — though an increase would give me a more stable environment to practice medicine.
On the other hand, I’m also a payer of property taxes who doesn’t shirk at paying more every year. In the final calculus, I don’t mind paying more taxes to an institution such as Harris Health. I’ve chosen to work there for the last 12 years because I believe in its value to the community. I’ve witnessed its impact on lives. I know that people who can’t afford or access health care receive sound scientific and personal help at Ben Taub. Insured African American and white patients have told me they only visit Ben Taub because they trust the doctors and staff, a far cry from when Bill Elliott visited Jefferson Davis. Harris Health is exactly the type of institution that we should support with our taxes.
And so, I would like to invite Ramsey and Cagle to come with me on a tour of Ben Taub. I would take them through the nursing units so they can see how amiable and professional the staff is with one another; how clean the hospital is; how a very high standard of medicine takes place here. I’d also show them the patients temporarily boarding in the hallways and how full the emergency room gets. I’d make sure to point out for them the announcements “Code Purple” and “EC Saturation Level One,” not to mention the 10-second recording of Tina Turner’s “Simply the Best” whenever a patient with COVID leaves the hospital breathing. I’d point out the travel nurses and those who have worked seven days straight. I would take them to Riverside Dialysis Center, the busiest in the city run by Harris Health, and I’d ask them which of these patients we should ask to visit the emergency room every four days. I would let the hospital speak for itself.
And if a resident calls me to check on a patient with chest pain, I wouldn’t hesitate. “Wait right here for a second, commissioners,” I’d say, so that I can lay my hands on the person, just as I had with the patient experiencing chest pain that night. Showing up at his bedside made a difference to him, especially when I explained why I thought he wasn’t having a heart attack. Your presence, commissioners, would make all the difference to the taxpayers. That’s our job, after all. We would perform our duties together.