President's Page

President's Page
April 2004

What will happen to Parkland?

by Warren E. Lichliter, MD
2004 DCMS President

Over the last month, healthcare issues have been common in the news. My colleagues have questioned me on multiple occasions, with “What’s going to happen to Parkland” being the most frequent. We have seen controversy involving the Dallas County commissioners, the Parkland Board of Managers, the budget, and the future of Dr Ron Anderson. Parkland Health & Hospital System has caught the attention of large numbers of people as the ramifications of decisions involving its future impact the community. I would like to update the physician community because it is important to know the causes of the problems.

One must keep in mind Dallas’ top national reputation when it comes to health care. Parkland hospital is widely considered to be one of the finest urban hospitals in the country and is looked upon as an example of how a system can be run successfully. More babies are delivered at PH&HS than in any hospital in the nation. Its burn center, trauma program, neurosurgery, and other centers of excellence are highly regarded.

Ron Anderson, MD, Parkland’s CEO for more than 20 years, is nationally acclaimed, as well, and will be presented an award in May at the national meeting of hospital administrators. He, like Parkland, serves as an example of how to be successful in the difficult environment of health care today.
Parkland is the primary teaching institution of UT Southwestern, which physicians know is one of the finest medical schools in the country. Almost 50 percent of physicians in this area did some or all of their training at the medical school or in one of its residency programs.

When all these facts are considered, it is no wonder that the medical complex that is Parkland is a jewel in the city. This is why the controversies surrounding Parkland have caught the attention of even those physicians who usually are apathetic toward local politics. We know that Parkland plays a pivotal role in the accessibility of care to our patients.

The county commissioners have a problem that none of us would envy. Among the many responsiblities of their jobs is managing the budget and determining the tax rates for Parkland through a county taxing district. There are county commissioners who strongly believe that the county taxpayer is maxed out and that further needs of the county must be met by reduced spending, not increased taxes. Other commissioners also believe in maximizing the value of taxes collected, but recognize that to meet increased demand for services will require an expansion of Parkland’s operations, and that translates to increased taxes. All commissioners recognize that decisions will need to be made in the next few weeks before the next budget cycle. They also are aware of the increased need for regional, state, and national funding for the delivery of health care to the uninsured.

This conflict is apparent by the behavior of the Parkland Board of Managers. The members are appointed by county commissioners, and the managers’ opinions at least in part reflect the opinions of their respective county commissioners. The board repeatedly has cut Parkland’s budget this year to meet budget deficits. Some board members have been accusatory toward Dr Anderson and his inability to meet the budget cuts, however draconian. Many budget shortfalls for the present fiscal year are out of the control of Ron Anderson, the county commissioners, or the Parkland board. To blame are the economy, new resident work hour limits, and the legislators’ balanced budget at the cost of drastic cuts to Medicaid funding and the Children’s Health Insurance Program.All these factors have helped create a Parkland Board of Managers that is increasingly dysfunctional. We have an administrator of tremendous capability who is the focus of personal attack, instead of the focus on the real problems. We have Parkland management that faces gridlock because of the demands of its board.

Much has been made of the fact that, despite the financial shortfalls, clinical services haven’t been cut. Let there be no mistake, however, that demands for care increase, but availability of care does not, then real access to care and resultant services indeed are being cut. Those of us in clinical practice also see the “no reduction in services” people at our ERs. The March 7 Dallas Morning News points out the inadequacy of the Parkland clinic system with current funding. In an environment with a clear increase in demand for services, the discussion of Parkland’s budget and its scope of services becomes even more difficult. It will take only one or two additional crises to occur before access to care in Dallas is at risk.

So, what’s going to happen to Parkland? Its future is on the line and we are working to secure it. Your medical society leadership is meeting with county commissioners, business leaders, the medical school, and hospital systems to better define the importance of Parkland and its role in the community, and the need for Ron Anderson’s continued presence in the management of Parkland during these trying times. We are delivering a message that an increase in services will have to lead to an increase in the Parkland budget, not a decrease. We also are delivering the message that Parkland board members must work together or the board makeup must change. We are encouraged by Dallas County Judge Margaret Keliher’s attempts to be more involved with the board activities and in her efforts to bring board members back to a functional environment. Finally, we are working with the commissioners and other critical parties to better define the message to the residents of Dallas County and members of the Legislature and Congress that the funding needs of health care in Dallas must be met or the health of the entire community is at risk. We are trying to make outside parties understand what physicians and hospitals already know, and that is whatever is bad for Parkland is bad for the county as a whole. If Parkland can’t handle its patient load, the patient load at the private hospitals increases triggering a potentially catastrophic domino effect.

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