Clinical Trial
OHSU pits saving money against saving lives.
July 16th, 2008
Cover Story • Lean, Mean Meat-Free Machine | Portlander Robert Cheeke is the face of vegan bodybuilding.83 comments
July 16th, 2008
A Delay In Wheel Time | The city kills a long-planned bike-sharing project with no timeline for its return.1 comment
July 16th, 2008
Eat, Drink And Be Wary | WWire’s courthouse column makes a rare print appearance1 comment
July 16th, 2008
Murmurs • News as hot as a driver-cyclist fight.1 comment
July 16th, 2008
Rogue of the Week • John McCain | Give the money back, senator.5 comments
July 16th, 2008
Accounting 101 | University advocates to state: hands off our millions.1 comment
July 16th, 2008
Second Life | A teenager’s real 7,500-mile journey from a Southeast Asian refugee camp to Southeast Portland.5 comments
July 16th, 2008
Pour-tland | The city spends another $119,000 to train baristas even though the program isn’t meeting its goals. 5 comments
July 16th, 2008
Food Fight | Multnomah County wants chain eateries to provide calorie counts. Restaurateurs say hold the meddling.14 comments
July 16th, 2008
The Score • Signs of the Apocalypse8 comments
 ORAL COMMITMENT: Gregory Fowler gets his teeth cleaned at Russell Street Dental Clinic last week. IMAGE: Vivian Johnson |
[February 6th, 2008]
For Gregory Fowler, dental care isn’t a routine visit. It’s a life-saving measure.
And for the 651 other HIV-positive patients who—like Fowler—turn each year to Russell Street Dental Clinic in North Portland for care, low-cost alternatives simply aren’t available. Not in Portland. Not in Oregon. Not in the entire Pacific Northwest.
“We’ve been really lucky in Portland to have Russell Street Dental,” says Fowler, 49.
But the crucial services the clinic has provided HIV-positive Portlanders and other high-needs and low-income residents for 30 years are now threatened.
That threat comes from Oregon Health&Science University’s reaction to a Dec. 28 decision by the Oregon Supreme Court.
The case involved Jordaan Clarke, a 3-month-old boy who, in 1998, suffered permanent brain damage in an OHSU recovery room after successful brain surgery. In December 2007, the court determined that injured patients at OHSU could seek unlimited liability claims against the hospital, which had been protected by a $200,000 liability cap because it is a public institution.
OHSU said eliminating the $200,000 cap would drive up its insurance rates to the point that it would require $30 million in cuts elsewhere.
One piece of those potential cuts would be closing the Russell Street clinic, which is affiliated with OHSU’s School of Dentistry.
Now the impending closure is alarming the small but vulnerable community of patients who depend on the clinic for low-cost dental care, crucial services that are subsidized by federal grants, the Oregon Health Plan and Medicaid.
Though OHSU owns the building and land at 214 N Russell St., it doesn’t charge the clinic rent or fees for utilities. The clinic is otherwise financially independent from OHSU; it pays all 30 of its employees.
For people with HIV, an oral infection can lead to death if the body can’t fight the bug. And many anti-retroviral medications promote tooth decay, undermining patients’ quality of life and making them susceptible to those infections.
“With a compromised immune system…oral care is paramount,” says Dr. Bob Johnson, a dentist who is also the clinic’s director. “You simply cannot afford an oral infection.”
A final decision about the clinic’s fate won’t be made for several weeks. The uproar, however, is already huge.
Jean Ann Van Krevelen, executive director of Cascade AIDS Project, says her group has pledged to help the clinic stay alive, because the alternative would be “disastrous.” In 2007, the clinic served a total of 4,000 patients. But it also recorded 14,000 visits, including 3,025 emergencies.
Story continues belowadvertisement
At the same time, the clinic served as a training ground for 100 dental students from OHSU and 60 hygienists-in-training from local community colleges.
“We can’t let a resource like this go,” Van Krevelen says.
Adding to the frustration is the fact that some of Russell Street’s supporters don’t trust OHSU’s motives for threatening to close the clinic. They say the warning could be a political maneuver to force the Legislature during its current one-month session to speed efforts to re-impose a limit on liability claims.
OHSU denies that.“This is not a public-relations ploy,” says Dr. Joseph Robertson, president of OHSU.
Instead, OHSU says the decision is purely a financial one. “We have an obligation to the state and the rest of our patients to maintain a sound chassis,” Robertson says.
A spokesman for OHSU says the clinic runs a deficit of $600,000 a year, about 0.04 percent of OHSU’s annual $1.4 billion budget.
That figure, too, is a source of contention. The number is an estimate from OHSU based on a small operating window. In other words, it’s an extrapolation, not actual accounting. “If you’re looking at a $600,000 shortfall, that’s hard to make up,” says Johnson, the clinic’s director. “But if you’re looking at a $50,000 to $100,000 shortfall, that’s a manageable amount. That lends itself to a financial solution. And that’s where I believe we are.”
Robertson earned more than $1 million with bonuses in 2006, according to an annual report from Oregon Health News . His base pay in 2008 is $780,000—more than half the entire annual $1.5 million budget for the Russell Street clinic.
“We have been discussing executive compensation with human resources as recently as yesterday,” Robertson said last Friday, Feb. 1 when asked if he would accept a pay cut.
Closing the Russell Street clinic shouldn’t be an option, supporters say. “The safety net system in Portland cannot possibly begin to absorb the services offered at Russell Street Dental,” Johnson says.
The $1.4 billion includes $307 million in restricted grant dollars.
I'm quite familiar with OHSU and while they have fine medical practitioners, the politics reeks of profit and self interest at all cost. The prima donna complex needs to go in favor of integrity and respect, and believe me, there are managers lacking in those categories.
You mention the impact on community colleges. OHSU has lost sight of the University part of its charter, a significant part of its very name. Community college students often lack access to patient charts, frequently act as the additional help that hospital staff need due to short staffing, and now will be displaced if OHSU prevails. Community colleges can't count on OHSU anymore to help train the next generation of care providers.
When I think of OHSU, I don't think so much about medical care anymore. I think of nursing strikes, staff shortfalls, and corporate arrogance from the highest levels. How the mighty have fallen...
My experience precisely "A". Get rid of the arrogance and power enhancing and OHSU will be a much better place.
Jim Newman here from the communications office at OHSU.
I appreciate that Willamette Week allows commentary following its stories and want to take the opportunity to clarify a few issues as I worked with Beth on this story.
First, I don�t think the story places this possible clinic closure into context. OHSU went to great lengths to ensure that the $30 million impact of the tort cap loss had limited impact on patients. This is apparent if you review the entire list of proposed financial measures: increases in tuition, closure or transfer or March Wellness, downsizing of the School of Engineering, reductions in research across all of our schools and of course reduced staffing.
The story doesn�t really explain the financial picture fully. While the clinic may support its staffing, the university pays the overhead costs of maintenance, security, supplies, heat and water. The story also fails to mention that the clinic will also need to pay for a share of the costs of the tort cap ruling. When WW compares the cost of the clinic�s operation to OHSU�s entire budget (the total amount of money OHSU receives through grants, patient fees, etc) that figure fails to encompass the huge costs of providing health care: pay for nurses, purchases of medical equipment and supplies, caring for the uninsured and other expensive and important functions of OHSU. In other words, a budget is not the same as a profit and may give readers the wrong impression unless placed into context.
I also hoped the story would have detailed the efforts OHSU is undertaking to try to preserve the clinic and/or its services by revisiting the earlier financial estimates and looking for solutions.
Finally, the record shows that the financial impacts of the tort loss are very real, very urgent and long lasting. An analysis conducted by an independent risk and insurance consultant in 2006 predicted the annual losses to OHSU of tens of millions of dollars if the tort cap were lost. Even under a new tort cap, the constitutionality of the cap likely would be tested in the courts, which would probably take years. Until that time, significant financial challenges created by the lack of a court-tested tort cap will continue to exist. Therefore suggestions that OHSU�s cuts are linked to a legislative agenda are in direct conflict with the reality of the situation.
Thanks for the chance to respond.
Mr. Newman,
Thank you for your response. I do, however, have a couple of questions based on your statement.
You mention a reduction in research. Much of the research in academic medical centers is grant-funded, often by NIH. I would suspect that OHSU is not significantly different in this regard. NIH grants require statements of institutional support during the application, if I'm not mistaken. Does your statement on reducing research mean that OHSU plans on reducing institutional support for NIH funded research (such as R01, R03, and new researcher grants)? How does the university proposed to deal with the potential loss of principle investigators, research assistants, and graduate students as a result of reduced research funding? How does this fit with OHSU's construction of a biomedical research facility?
You propose reduced staffing. In light of your increased liability, how do you propose to avoid actionable mishaps due to staff shortfalls? Is it not true that inadequate staffing is a significant causal factor in medical mishaps?
Ok, it was more than a couple of questions. But I'd be interested in your public response.
Mr. Newman --
It is my understanding that the decision was made to close the clinic without adequate financial information.
If so, and OHSU is now backtracking somewhat on that decision, how can the community have trust in the outcome, considering the previous uninformed decision making process?
Is the standard by which OHSU conducts it's business?
Where has Mr. Newman gone?
Press releases or honest discourse that addresses return questions? You be the judge.
"They say the warning could be a political maneuver to force the Legislature during its current one-month session to speed efforts to re-impose a limit on liability claims."
This is a prime example of the general naivety that's breaking down an already broken system. People cheer every coverage mandate our lawmakers push through. They insist liability caps stifle our coveted right to sue and our lawmakers respond in kind. The indignant masses then raise hell over sky high insurance and health care costs they unkowingly and at the same time fervently encouraged.
Until there's a collective concept of cause and effect affordable health care will continue to move further out of reach.
Jim Newman here again. Here are answers to the questions that were posed
A,
OHSU's self-sponsored research will be impacted by the loss. The university self supports some research in all of it's schools and this will be reduced due to the shortfall.
As for staffing, the cuts will not impact the hospital or health care operations. The cuts will affect other portions of the university: services, some research areas.
GB,
When we announced the budget shortfall, we did not announce that the clinic would close. We announced that it would need to be restructured or closed. Please see the fact sheet here that we released on January 18:
(link on right hand side)
OHSU is currently looking more closely at the financials to determine what will happen.
Thanks for you responses Jim. You seem open and reasonable. I strongly feel, however, that OHSU has made some unwise decisions and that they have lost a sense of their priorities. I have seen this on a number of levels.
Just the employees slopping at the PERS pig trough would keep a thousand dental clinics open...not to mention bonuses
and all the other expensive perks.
You lost me when you disingenuously stated OHSU's budget. That number includes things that can't be routed like grants and endowed chairs. Why should I trust anything else you say?