The Proposed Plan and Their Tenuous Future

Overshadowed by the sewer crisis and the resulting bankruptcy, county-run Cooper Green Mercy Hospital's fate still floats in the ether. With the affiliated nursing home now sold, the future of the hospital itself continues to fluctuate.

"We're just going to work every day, because we think we're going to be here forever," says Sandral Hullett, MD, Cooper Green's CEO and Medical Director since 2001.

The plan to preserve Cooper Green, presented by the hospital's administration this summer, would convert it to a healthcare authority. This would release the hospital from answering to the county directly and allow it to become governed by a board of directors as its own nonprofit.

"Just about all the public hospitals in Alabama became healthcare authorities back in the 80's," says J.M. "Mickey" Trimm, PhD, associate professor at UAB's Health Services Administration and an advisor to Cooper Green for seven years.

Alabama's Healthcare Authority Act of 1982 allowed public hospitals to incorporate. This exempted them from certain laws, so they could become competitive with for-profit hospitals. Trimm says Cooper Green remains the only community-run hospital left in Alabama as a public entity.

Cooper Green's conversion to a healthcare authority would release them from Jefferson County's bureaucratic personnel procedures. "Right now, it takes us four to six weeks to hire a nurse. Most hospitals can hire one in 24 hours," Hullett says.

Also, being released from Jeffco's purchasing department would allow Cooper Green to join with for-profit hospitals in volume discounts. "Costs for catheters, bandages, stuff they use every day, would be charged at that group rate. For example, UAB uses tons more supplies a day than Cooper Green, and that kind of volume could reduce Cooper Green's costs overnight, perhaps $2 to $3 million a year," Trimm says.

Working agreements with area hospitals could also mean volume discounts on professional services, such as radiology, that Cooper Green can't afford now or that overloads their budget at their low volume. "There's potential for a lot of innovative opportunities to do this kind of savings," Trimm says.

On October 18, Cooper Green presented its five-year business plan as a health authority to a committee of Jefferson County commissioners. Hospital administration expected the plan to go to council vote the following week and receive approval.

But the commission changed their tune. At the heart of the issue lies the county Indigent Care Fund. Currently this $45 million annual fund, earmarked by law for indigent healthcare, makes up about 50 percent of Cooper Green's operating costs. Another 40 percent derives from Medicare and Medicaid, with the remaining 5 percent arising from third-party payers or self-paying patients.

Hullett says people are trying to compare Jefferson with other smaller counties where their healthcare authorities receive only $1 million in county support. "We're the largest city in the largest county in the state, so it's a little upsetting to be compared like that," Hullett says.

She also points out that Cooper Green faces a different scenario from the healthcare authorities in Tuscaloosa and Huntsville. In Birmingham, five hospitals exist within a few miles of downtown. "Those cities have only one big hospital, so they have ways of passing along the cost of treating the poor. When they have a true indigent, their percentages are low, so they can write that off as charity and bad debt. How can you compare them to us?" Hullett says.

Should the county commissioners succeed in convincing the state legislature next February to unearmark the Indigent Care Fund, Cooper Green would close. "If the hospital closed, the county could sell the licensed beds, which would probably be attractive to some of the local hospitals," Trimm says. "The hospital building would probably be purchased by UAB for development in the future. The proceeds would be a few million."

The effect on Birmingham's healthcare landscape would firstly hit emergency rooms. "Cooper Green's ER handles about 33,000 visits per year. This could not be absorbed by the other hospitals and would create havoc for UAB's ER, which would get most of the patients searching for care," Trimm says.

He says that people working in the ERs, the free clinics, and other safety net centers would see the drastic changes. "But the sad fact is that most people in the county probably won't notice, because these people who normally use Cooper Green don't have a voice," Trimm says.

At Cooper Green, the staff continues on as always. "We're taking this one day at a time. What we do is work every day," Hullett says. "And we are still trying to work on the issue."