Vote for $2.5B bond to fix public hospitals
Thick vapor suddenly filled the air one morning when registered nurse Wroty Colekraty was in a fourth-floor patient care unit of Lyndon B. Johnson Hospital in northeast Houston. A steam pipe had burst, showering debris on the nurse’s station and releasing steaming hot water.
Colekraty jumped into action, he told a member of the editorial board, quickly moving two patients to safety and scalding his neck and back in the process. One patient was transferred to the University of Texas Medical Branch, while the other joined Colekraty and two other staff members at the LBJ emergency center to be treated for burns. The water damage, which affected all four floors, reduced patient bed capacity for the entire hospital by 25 percent.
Ask Colekraty about the event today, and he’ll humbly brush off the injuries as minor. Patient safety will always take precedence, he said. Sure, nurses are often heroic, as we were reminded at the height of the COVID pandemic, but Colekraty shouldn’t have to add “first responder” to his job duties.
It’s unacceptable for a public hospital whose mission is to save lives to instead endanger them due to aging infrastructure that’s been neglected for too long.
The pipe break was the second of three in 2020. Just weeks before, hallways in the secondfloor obstetric triage and ultrasound unit turned into streams 2-3 inches deep. Stairwells became waterfalls. Without enough isolation valves to stop the water flow in sections where the pipes had burst, the entire hospital’s water lines came to a standstill. The series of internal disasters left behind yawning ceilings, ruined equipment and peeling walls.
It took nearly two years and $13 million for the hospital to fully recover, even as it juggled routine staffing and capacity shortages that became particularly acute during the pandemic. Even now, on the screens at a command center in LBJ, the stats for LBJ and its sister hospital, Ben Taub, are stark: on a relatively calm Friday afternoon, the needle on the occupancy gauge for both was already all the way to the right — at 98 and 97%.
Plans for an expansion have been in the works for years and in the upcoming election, voters will be asked to fund them.
We think the ask is not only fair but overdue.
LBJ operates “virtually at the seams,” Dr. Kimberly Monday, associate professor of neurology at UTHealth Houston’s McGovern Medical School and former chair of the Harris Health board, said in a public comment recently. “And Ben Taub is not much better.”
Harris Health System runs more than 30 clinics and ambulatory care centers as well as LBJ and Ben Taub. In a city where nearly 1 in 4 people are uninsured, the two safety-net hospitals are critical. Each year, the system provides more than $2 billion worth of health care to nearly 300,000 unique patients, and it has earned national recognition for its treatment of stroke and trauma, as well as for its preventive care “food farmacies.”
Harris Health has long planned to expand services to accommodate the county’s growing population, which has doubled in size since LBJ and Ben Taub opened in their current locations three decades ago. However, the system’s budget is limited by its reliance on property taxes and Medicaid reimbursements.
Last year, after a bitterly partisan budget impasse in Commissioners Court led the county to default to a no new revenue rate, Harris Health was forced to scrap plans for an expansion and make drastic cuts just to maintain its operation, with a projected $43 million deficit. Though the system has so far gotten by without running a deficit, Harris Health CEO and President Esmaeil Porsa told the Chronicle he’s not optimistic it will stay that way.
A $2.5 billion bond on your ballot this November would help Harris Health make much-needed improvements. The majority of the money — $1.6 billion — would go toward building a new LBJ hospital with a Level I trauma center, which provides the most comprehensive care for injuries, near the existing LBJ north of Kashmere Gardens. That would make it the county’s third Level I adult trauma center and the first outside of the Texas Medical Center.
According to Porsa, the need for trauma care in that northeast corridor is high, as the existing LBJ hospital is currently the busiest Level III trauma center in the state, with over 80,000 annual patient visits.
The new building would expand the number of inpatient beds in that area from 215 to 390, with room to add another 60, and allow for the beds to be used for interchangeable needs. It would also add capacity for patients under observation, and include a helicopter landing pad. That extra capacity will help accommodate patients from the existing LBJ so the hospital can undergo $433 million in renovations and expand inpatient and outpatient care, including psychiatric services, which it currently isn’t able to provide. That’s despite mental health care being the primary need of many repeat patients who show up for emergency care.
A stronger-than-usual wind is enough to knock out power at LBJ right now. Should the day be reasonably warm, the hospital, which doesn’t have backup power for air-conditioning, has less than 12 hours before staff would be forced to transfer patients, an LBJ facilities manager and an engineer explained. The new LBJ will have 96 hours of backup energy, on-site solar power generation and be built above the floodplain.
Another $410 million will go toward adding 120 inpatient rooms at Ben Taub and extending the hospital’s life span by 15 years. The rest — $504.5 million — will fund three new outpatient ambulatory care centers in east, northwest and southwest Harris County.
The bond would finance the project over 10 years, with an additional $300 million in county funds and $100 million in grants and philanthropy.
While the plan has received broad support from multiple Houston health leaders, some critics worry about whether it’s the most cost-effective use of taxpayer money. As proposed, the bond would raise property tax bills for the average homeowner (homes valued at $300,000) by nearly $6 per month once the entire bond has been financed a decade from now.
Ken Mattox, a nationally recognized trauma expert who promoted indigent care in Houston and trained thousands of doctors in his three decades as chief of staff at Ben Taub, wonders why the bulk of the money couldn’t go toward retrofitting existing hospital buildings that shut down during Harvey. If we want to reach people where they are, he said, those buildings — in west, southeast and southwest Houston in particular — are a much cheaper, more effective solution.
“You don’t make a trauma center by building a hospital,” he said. “You make a trauma center by having commitments on the part of the doctors and administration saying that ‘we’re going to be here when the patients need us.’”
Mattox feels the current LBJ hospital has what it needs to become a Level II trauma center right now, and could easily become Level I, filling that gap in the northeast. Porsa argues that they’re not taking those cost-effective ideas for expanding ambulatory care centers off the table. However, he said, a new building is necessary because the current LBJ was built with design standards that aren’t up to par today. Engineers determined that it was unfeasible to entirely upgrade to those standards, and would be impossible to do without significantly disrupting patient care.
Ultimately, we’re swayed by the urgency that Porsa and the staff at LBJ consistently emphasize. A shortage of inpatient beds keeps up to 50 people waiting in the LBJ emergency room every day, he said. Meaning, the LBJ expansion is truly a matter of life and death for some. By investing in preventive care, Harris Health will also save taxpayers money that is otherwise spent on repeat ER visits.
“We call Monday ‘Crisis Day’ around here,” Porsa told us, to the many nodding heads of emergency room staff.
It’s time we take seriously the concerns of burned-out nurses, physicians, surgeons and other staff members who tirelessly pour themselves into fulfilling their Hippocratic Oath, despite dwindling resources and crumbling infrastructure.
We strongly encourage voters to approve this bond proposal.