A man with a horribly painful case of shingles can't get medicine. A woman suffering from an agonizingly abscessed tooth is denied care. A homeless man with pneumonia is released from the hospital with no medication and no instructions to see a doctor.
These are just a few true stories that come from the bottom of South Florida's health system. All were patients of the publicly financed North Broward Hospital District, according to the Legal Aid Service, which fields an average of about two complaints a week regarding health care for indigents. And what reaches Legal Aid likely represents only a small part of the actual cases, litigation director Sharon Bourassa says.
Bourassa says the district -- and, in some cases, private hospitals that take indigents into their emergency rooms -- have violated federal laws by failing to provide proper care. The 23-year Legal Aid veteran says that if NBHD, which is the sixth-largest public health system in the nation, doesn't fix the problems, she'll take it to federal court. To avoid a costly and embarrassing lawsuit, she's met with district CEO Wil Trower and General Counsel William Scherer to help draft rules to ensure better care. This week, they'll have their third summit. "[Scherer] told me that the district gives as good of care for indigents as it gives everyone else. I said, 'Bill, there are systemic problems that you don't know about,'" she recounts. "It's not that anybody is out there deliberately to screw the indigents and screw the taxpayers. It's that [the district] can't find the problems, which occur on the front lines."
District spokeswoman Sara Howley acknowledges that NBHD is working with Legal Aid to "address the needs of the indigent population," but she asserts that all such patients are given medication and follow-up instructions.
The Legal Aid allegations cut to the core of NBHD, which was formed to provide a safety net for indigent patients. During the past few years, the Gov. Jeb Bush-appointed district board has raised property taxes to record levels, ostensibly to pay for health care for the needy. From 2002 to 2003, the district's take from the public rose a whopping 33 percent to $200 million, an increase attributable to tax hikes and higher property values.
The district maintains that all that money is going to treat indigents. In 2002, when the district taxed the public $150 million, it claimed it provided $176 million in care for the poor. Last year, the indigent-care figure ballooned to $217 million, according to an editorial written by Trower in the Sun-Sentinel.
The NBHD CEO, who refuses to be interviewed by New Times, conveniently uses that $41 million increase to justify the tax rise. Yet the district, during the past few years, has laid off hundreds of staffers. When asked to substantiate the alleged growth in spending on indigent patients, Howley didn't respond.
In fact, there is mounting evidence that the district inflates its indigent spending in a financial shell game. The Florida Attorney General's Office, in a little-noticed report issued at the beginning of 2003, found that during the late 1990s, NBHD increased taxes at more than twice the rate that its level of indigent care grew. The study also determined that in 2001, the district received $18.7 million more in tax dollars than it gave to the poor in services and concluded that the district appeared to be profiting on care for the underprivileged.
In response to that damning report, which Howley criticized as insubstantial, the district hired a consultant called the Lewin Group to conduct another study. Under the district's guidance, Lewin reported that NBHD provided $37.8 million more in community benefits in 2002 than it received in tax dollars.
Among the community benefits listed by Lewin, however, were some $43.8 million in "physician services" -- which included the district's doctors' contracts. The problem: Many of those physicians treat insured patients. In fact, one of the highest-paid doctors at the district, cardiologist Michael Chizner, who receives $1 million a year, has a contract specifying that he treat nonindigent patients. Howley countered that Chizner isn't paid from tax funds.
Lewin also looked at the South Broward Hospital District, which serves the area south of Griffin Road, including Hollywood, Hallandale Beach, and Pembroke Pines. And the consultant's comparison of the two districts glaringly reveals how the north agency is, at best, utterly mismanaged, or at worst, massively defrauding the public.
First, the north district's tax rate is 30 percent higher than that of the south district. In 2002, the south district collected just $43 million in taxes versus $149 million for the north. Even as the north raked in $106 million more in public funds, it provided only $51 million more than the south in indigent care, according to the district-endorsed Lewin numbers.
The gap between north and south taxpayers is widening -- last year, the south district collected just $51 million versus $198 million for the north.
So where is all that NBHD money going? That's extremely difficult to determine, but it's certain the district has wasted millions of dollars on insider deals, cronyism, and conflicts of interest, much of it revealed by New Times in recent months. In response to those reports, the district board has drafted a new policy to hold NBHD lobbyists and staff more accountable. And while sapping homeowners, it hasn't even been paying its own fair share of property taxes. A Broward County Property Appraiser's Office investigation, sparked by another New Times report, found that the district has failed to pay taxes for years on office buildings worth at least $13 million.
While taxpayers have plenty of reasons to be outraged, Legal Aid is focused on patients who suffer. Bourassa says that the majority of indigents get sufficient care from NBHD but that too many slip through the net; one of these is Joan Cuomo, a 46-year-old divorcée suffering from a host of physical and psychological ailments.
Cuomo, who lives with a charitable friend in a little rented Tamarac villa, has no credit, no bank accounts, no money (she had $1.06 to her name last week) and can't work. At just five-foot-one, she weighs more than 300 pounds and suffers from spinal degeneration. She says the pain is so great that she can barely get out of bed. A victim of sexual abuse as a child, she also has severe depression, anxiety attacks, and asthma.
Until she was divorced in 1998, she had health insurance through her husband. After three years working as a cashier at Publix and Walgreens, her health deteriorated. When she applied for disability benefits, physicians backed up her claim that she couldn't work, but the State of Florida denied her. Other than $141 a month in food stamps, Cuomo is on her own.
She did qualify for free medical care from NBHD. For the past three years, she says, she's been treated almost exclusively by a clinical nurse rather than a doctor, despite the alleged $44 million in doctors' contracts. And district officials have never let her see an orthopedist for her back, though the district contracts with an orthopedic group.
Basically, the district has done little more than treat her back pain with a prescription for a weak narcotic called Darvocet that gives her little relief. "If I had something better, I could dress myself and leave the house," she says, tears streaming down her face.
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She pleads for psychological help, but the district won't provide her a psychiatrist or a counselor. "I had a terrible childhood, and now my adulthood is terrible and there is nobody to talk to," she says, sobbing. "I can't believe this is happening to me. I can't believe I can't get help."
And then there's the bureaucratic nightmare -- and not just the inevitable hours-long wait for care. In May, NBHD mistakenly failed to recertify Cuomo as an indigent -- and refused to give her care. So she went to Legal Aid attorney Louise Caro, who set out to prove to the district that Cuomo had no money.
Proving a negative is never easy, and in the middle of that process, Cuomo came down with an abscessed tooth and a raging infection. When she tried to get care at NBHD's Pompano Adult Primary Care Clinic, she was turned away. Caro then drove Cuomo to the district's Seventh Avenue Family Health Center in downtown Fort Lauderdale. "They said not only do they not take walk-ins but we're booked for three months and there was only one dentist for the whole district," Caro recalls.
So they had hit a brick wall. Finally, Bourassa's private dentist, Howard Ackerman, offered to pull the tooth free of charge. "I'm not alone -- there are lots of stories like mine," Cuomo says. "If you sit down in a clinic for nine hours waiting to be treated, you hear terrible stories. But the people are afraid to talk because they think they'll lose the care they do get."