COOK COUNTY, Ill. Cook County's top doctor is slashing spending and services in the county's ailing health system with the steely urgency of an emergency room veteran who would lose the leg to save the patient.
Dr. Robert Simon said the crisis plan he launched in January is the only way he knows to save a system that lost more than a billion dollars from 2002 to 2005, while following his mandate to cut spending by $130 million this year.
Simon, tapped by new County Board President Todd Stroger as interim chief of the county's Health Services Bureau, acknowledges his triage plan may be too late to avert a deeper crisis. But some health-care colleagues say his decisions are going to ruin a hospital-and-clinic network that serves a million people a year, many with few other medical options.
Critics have seized on his decisions that involve closing 10 community-based clinics, shrinking specialty departments and focusing on urgent care services tied to the system's three hospitals. Dr. Quentin Young, who chaired Stroger's health-care transition team, said Simon's reduction in primary and preventive care is costing the county patients and staff. "If you want to be a huge ER, he did it," Young said.
Simon says with money tight, urgent-care services must be given priority. "What Quentin Young wants long term is a good idea," Simon said. "During a crisis year you have to take from prevention and put prevention back in when you get the money."
Simon was scheduled to brief county commissioners at Tuesday's board meeting. His efforts to date have been strongly backed by Stroger, who is taking a big political risk by endorsing the wrenching overhaul.
"If this doesn't work, he's going to be a one-term president," said County Commissioner Jerry Butler (D-Chicago), a Stroger supporter. "It's the issue."
Butler, chairman of the county's Health and Hospitals Committee, said Simon deserves an opportunity to succeed. "People say he's going about this like an emergency room doctor. Well, that's what he is and this is an emergency," Butler said.
A veteran of emergency medicine, Simon ran the emergency department at the old Cook County Hospital for nearly two decades. Before that, he established International Medical Corps, which sets up clinics and hospitals in overseas war zones and trains local medics.
Before his appointment, Simon was perhaps best known locally as the personal physician to John Stroger, Todd Stroger's father, when the elder Stroger had a stroke one week before the March 2006 Democratic primary election.
A day after the stroke, Simon told reporters Stroger was doing "outstanding." Although Simon and a stroke expert significantly downgraded that assessment two days later, Simon's earlier quote is remembered by critics because it came at the height of a heated election contest.
Stroger won the primary but retired four months later. Party leaders slated Todd Stroger for the November general election.
In selecting Simon for the county post, Todd Stroger got not only a doctor who he knew and trusted, but someone who, using his experience overseas, long has focused on containing health-care costs.
By the early 1990s, Simon's work on cutting costs for out-patient asthma treatment at Cook County Hospital was being cited by then-U.S. Rep. Newt Gingrich. In 1992 he was featured on CNN talking about how doctors are overpaid -- himself included.
Simon has brought rapid change to the county in less than six months, from laying off doctors and consolidating departments to transferring Oak Forest Hospital's long-term care patients, who long have been a focal point of the hospital's mission.
At Provident Hospital, Simon determined that 40 percent of the 50,000 patients treated annually at the emergency room could be treated in a clinic. So he set one up within the hospital, staffed with less-expensive internal-medicine and family-practice doctors.
Simon also closed 10 community-based clinics around the county that he said were underused. Now people are being directed to the system's two largest clinics, at Stroger Hospital, which opened in 2002.
Simon also has placed additional emphasis on Stroger's Ambulatory Screening Clinic, doubling the number of rooms where doctors see patients. The county's busiest outpatient clinic, it is essentially a gateway to the system for non-emergency patients.
But critics contend patients now have to travel farther and wait longer for care, a reversal of the county's push in the 1990s to spread into the neighborhoods and treat people closer to home. They also dispute the shift toward the screening clinic -- where sick patients go -- at the expense of community clinics that stress prevention.
"Instead of putting the investment into the primary-care piece ... they're pulling it down to the Band-Aid effect," said Dr. Carolyn Lopez, former chair of family medicine at Stroger Hospital who briefly held Simon's position late last year.
Simon points to the challenge he was handed. The health system spent nearly $850 million last year, but his budget for this year is about $725 million, a nearly 15 percent reduction.
"If you were in Simon's position and you had to cut $130 million, where would you cut?" Simon said. "That's the real question."
Though he has worked to cut expenses, Simon said the need for more revenue is critical.
His new team has stepped up billing efforts that lagged in the past, increasing collections. But that has come at a price. The number of patients using the system has declined in recent months, and Lopez suspects that the collection effort is part of the reason. Simon acknowledges that the number of patients using the system has declined but he blames bad publicity from the budget cuts.
He has cut expenses to the bone, he said, and what the county needs now is more money to complete financial and other infrastructure changes that will help make the system self-sufficient. State officials have dangled the possibility of a cash infusion. But U.S. Sen. Dick Durbin (D-Ill.) and other lawmakers have said the county has to improve its health system if it wants more federal money.
Young worries that the cuts already made have damaged the system beyond repair.
"I am not sure they can make it," he said.