Here's a news flash for those who think Cook County has a legal obligation to maintain its huge and underutilized hospital infrastructure, which provides care to the poor: You're wrong. Cook County government operates three hospitals out of the goodness of its taxpayers' hearts.
That's the bottom line from a fascinating 2007 Cook County state's attorney's legal opinion to the County Board: "…Illinois law does not impose a legal obligation on Cook County to operate a health care system," the opinion says. "Illinois law does give Cook County the power, but not the obligation, to maintain a county hospital."
The power, but not the obligation.
So why are we telling you about this now? Because someone wants to end county care for poor citizens? No, not at all. We're reporting that opinion because Cook County Board President Toni Preckwinkle alluded to it in an April 12 letter to state regulators at the Illinois Health Facilities and Services Review Board.
In March, that board rejected the county's plan to shutter the inpatient beds and emergency room at Oak Forest Hospital and convert the facility into a regional outpatient center. The board's rejection of that sensible plan — evidently the members didn't understand the need — was a huge blunder.
The board needs to back off, something it can do as early as its next meeting May 10.
Preckwinkle wants the regulators to realize that if they keep trying to micromanage the county's hospital system — and preserve its costly inpatient care at all three hospitals — then the county's strained finances could force a reckoning: County officials could close some of those hospitals.
"It is … significant to note that while Illinois law does give Cook County the power to maintain a county hospital, it does not impose a legal obligation on Cook County to operate a hospital," Preckwinkle wrote to the health services board chairman. "Still, the county remains committed to continue to provide quality public health care to its residents, but must do so in the face of ever decreasing revenues and increasing fiscal challenges. One concern with a denial of the Oak Forest application is that it may ultimately be deemed an attempt on the part of a state agency to require Cook County to maintain certain inpatient services which are not within its budget, and, thus, would be tantamount to an unfunded state mandate."
You don't need a decoder ring to figure this one out. Preckwinkle's message to the health facilities review board is the same as ours: Get out of the way. Let the county run its hospitals as efficiently and as honorably as it can.
The independent county health panel that manages the hospital system has spent months figuring out how to improve health care for the poor while whittling costs from the system. The simple truth here is that the county's three hospitals have far more inpatient capacity than they need. The health panel has a plan to better serve patients while shifting resources into primary care. The Oak Forest overhaul is part of that plan. The county's plan would also scale back Provident Hospital to a short-stay hospital with expanded outpatient capabilities. And it would consolidate inpatient care at underused Stroger Hospital.
All of this is long overdue.
Our guess is that members of the state health services review board are under the common but mistaken notion that this hospital system is ordained by law. We hope that they take a moment to read that 2007 state's attorney's opinion. It's a brisk history that traces how people — from 17th century England through 21st century Chicago — have grappled with the challenges of providing care to the poor. Along the way, Cook County absorbed responsibility for their hospital care.
State regulators, you don't have a role in how Cook County meets that crucial need.
Back off. Let the overhaul proceed.