Keep hospitals public, for patients’ sake

There could hardly be a worse idea than offering up public hospitals in Florida for commercial takeovers. But that’s the thrust of legislation percolating in Tallahassee.

As rubber-stamped by three insufficiently curious House committees, it appears intended to require all 26 independent hospital districts, including those that operate the major public hospitals in Broward and Palm Beach counties, to put themselves on the market.

Sponsored by Rep. Randy Fine, R-Palm Bay, the bill (HB 1421) is notably broader than one Gov. Ron DeSantis vetoed two years ago which would have enabled all 26 independent public districts to convert to nonprofit corporations — but said nothing about for-profit purchasers.

Potential loss of oversight

Going nonprofit would eliminate public oversight, reducing public access to meetings and records, and would limit their service areas and any authority to levy property taxes. Broward’s two public hospital districts are governed by political appointees of the governor.

That original vetoed legislation is back with an alarming new provision that would in effect require all 26 independent districts to advertise themselves and their hospitals for sale. It specifically opens the door to profit-seeking entities like HCA as well as to wealthy multistate nonprofits like Cleveland Clinic and Mayo Clinic.

The new provision requires each independent district to commission “an evaluation of the benefits to the residents of the district” of conversion to a nonprofit or selling itself to a commercial hospital company. The analysis would include, but “not be limited to,” a complete financial valuation of the district’s assets and liabilities.

The evaluation must be conducted by independent contractors with at least five years’ experience in such work by Dec. 31 and published on the districts’ websites within 30 days. There is no prohibition against a contractor having connections to a prospective purchaser.

Mounting opposition

“You wouldn’t ask a corporation to put out all the information necessary for a hostile takeover other than what’s already required,” said Justin Senior, CEO of Florida’s Safety Net Hospital Alliance, which opposes the bill. “It seems aimed at providing a competitive advantage to those who would lobby for the conversion.”

A similar bill in the Senate appears stalled, but if the matter reaches DeSantis he should veto it again. The full House needs to pay closer attention to the implications than its committees did.

As DeSantis noted in his 2022 veto message, “Florida’s public hospitals serve our medically indigent and support the state share of our low-income pool.”

It’s hard to conceive of any good reason to sell a public hospital to a private corporation whose primary financial obligation is to stockholders, not patients.

Red flags in North Carolina

The Legislature ought to be warned off by the conspicuous decline of the Mission Hospital system, Western North Carolina’s largest health care facility, after its nonprofit board sold out for $1.5 billion to HCA five years ago. The money was invested in a charitable trust that cannot be used at its hospitals.

Mission Hospital in Asheville faces the threatened loss of its eligibility to accept Medicare and Medicaid patients and operates under an “immediate jeopardy” warning from the U.S. Centers for Medicare and Medicaid Services (CMS) that cited the deaths of four patients from apparent neglect.

CMS accepted Mission’s plan of correction, subject to verifying that it is being carried out. But a coalition of local doctors and health advocates is objecting that it is inadequate in not requiring Mission to hire more staff. Present and former nurses had been complaining about personnel shortages ever since HCA took over. Its nurses voted to unionize, a rare event in a state notably unfriendly to unions. Local governments and the state’s attorney general have pending lawsuits against HCA over how Mission is being run.

In a letter published in the Asheville Citizen Times, former patient Charlotte Kaplan wrote about a four-day stay in the Mission Hospital Heart Center after surgery:

“My room was never cleaned. Not once,” she wrote. “The trash bins were overflowing and the bathroom became visibly grimy.

“I ended up cleaning the room myself with hand sanitizer and paper towels. Was this an oversight by housekeeping? Or the result of management cost-slashing?”

In Florida HCA’s North Florida Hospital at Gainesville recently suspended surgeries amid accusations that uncleaned instruments were provided to operating rooms.

Lobbyists tracking HB 1421 include representatives of for-profit corporations HCA Healthcare and Community Health Systems, which operates in the Keys, the Panhandle and Southwest Florida; the Palm Beach, North Broward and South Broward hospital districts; Cleveland Clinic; and the National Nurses Organizing Committee.

“Legislation seeking to privatize public-sector hospitals would negatively impact patient care and health care access in our state,” wrote Lucy Diavolo, speaking for National Nurses United, in an e-mail to the Sun Sentinel Editorial Board. “In a state with poor insurance coverage and recent Medicaid disenrollments, public hospitals providing high rates of charity care are essential to the health of every Floridian.”

The Sun Sentinel Editorial Board consists of Opinion Editor Steve Bousquet, Deputy Opinion Editor Dan Sweeney, editorial writer Martin Dyckman and Editor-in-Chief Julie Anderson. Editorials are the opinion of the Board and written by one of its members or a designee. To contact us, email at letters@sunsentinel.com.