President's Page

President's Page
July 2004

Summer Vacation?
Unfortunately, the issues never take a day off.

by Warren E. Lichliter, MD
2004 DCMS President

It’s clear that the recent problems with Parkland have not gone away, but summer vacation, kids, and other activities have taken over, and we’re in the summer mode. I’d like to keep our members apprised of the Parkland board’s actions and our continued efforts to impact the direction of the Dallas County Department of Health and Human Services. Both areas are of critical importance to us.

The newly constituted Parkland Board has had its first meeting, and the meeting was important for what it did not do. It deferred naming its board chair until the July meeting. The new board did hear an internal audit report highlighting many of the billing and financial concerns expressed to the previous board members. Although the board’s need to develop the budget for the upcoming fiscal year is of immediate concern, the selection of the next chairperson is what will be the next big political news. The board is under a great deal of scrutiny, given the minority representation issues that have been pointed out by The Dallas Morning News, DCMS, and others. Protests at the commissioners court began on June 8 and organizers say they will continue until the problem is corrected. A Dallas Morning News columnist has voiced support for interim chair Lauren McDonald, MD, to continue as chair. Further complicating the board appointment is that Dr McDonald’s current term ends in 2005. It is safe to say that the Parkland Board will continue to be a topic of discussion next year.

In an effort to ensure that Parkland Health & Hospital System is as efficient and effective as possible in patient care, the Dallas County commissioners have funded a $900,000 study of Parkland and its relationship with Dallas County. Because of input from your DCMS leadership and other interested groups, the scope of the study was broadened to include the impact of Parkland on the rest of the healthcare delivery system and the entire region. The consulting firm, Health Management Associates, has worked effectively with several major cities and their city or county healthcare delivery model in dealing with the same issues that face our region. We also are facilitating meetings with the TMA for an even broader look of this region’s problems.

HMA focuses on helping the institution implement its recommendations. HMA has begun to engage many of the stakeholders in the future of the county’s healthcare system. DCMS leadership has been impressed with initial contacts and is arranging a presentation and discussion with the DCMS leadership. This study will take almost nine months to complete. One of HMA’s initial observations is extremely positive—the positive attitude of Parkland employees in all clinical areas HMA first visited—unlike their last several projects in other county hospital systems. The second observation was that not only Dallas County but the State of Texas continues essentially to throw millions of dollars away every year by not utilizing federally matched dollars in federal programs. The Texas Legislature threw away $1.9 billion last year to balance the state budget when it cut Medicaid and CHIP funding.

Physicians are appropriately concerned about the potential disastrous results of any reduction in services or access to services in the Parkland system. The effects of any such reduction on the rest of the healthcare community have been well noted, and HMA is to quantify these concerns for the county commissioners. The latest expressed concern is the proposal by Parkland CEO Ron Anderson, MD, that requires millions of dollars to be spent on new facilities. The emphasis must be on planning for both short and long-range goals for providing healthcare services. The goal cannot be simply to build new healthcare buildings; it must be to provide the most cost-efficient and high quality service setting possible. Again, physicians also are looking at these concerns not only as physicians, but as taxpayers, as well.

DCMS has continued to work closer with the Dallas County Health and Human Services Department. DCMS leadership has met with its director, Zach Thompson, and with its medical director, David Buhner, MD, who replaced Karine Lancaster, MD, when she retired on June 22. We are encouraged by those discussions. Mr Thompson has made it clear that his focus, as well as that of DCMS, is to create a more effective health department and to rely on his medical staff to help implement changes. DCMS believes that working closer with Mr Thompson and Dr Buhner on issues important to both entities will be effective. Several initiatives being undertaken as a result of that meeting will be reviewed in next month’s column.
As with Parkland, DCHHS has a decreasing budget but must deal with an increasing list of responsibilities, including immunizations, homeland security, communicable diseases, STD/TB, West Nile virus, and bioterrorism. There is little chance of funding increases for state or county health departments unless they can be related in to bioterrorism.

Another concern relates to the need for support of the health department by physicians. The health department does little disease prevention and has almost no budget to provide treatment. DCMS members represent 80 percent of the physicians in Dallas County, and we can help develop that active basis of support that is so important. Even bioterrorism will need further cooperation with the department and physicians. I will write more about this next month. It will be you and I who provide the initial care in any biological event.

DCMS leadership will continue to work on your behalf to influence the direction of healthcare delivery. We feel strongly that our work benefits all physicians in Dallas County. We hope that our work continues to be deserving of the trust you have placed in us.

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