The fight over Oak Forest Hospital: Another battle in the war for the adequate funding of public sector healthcare in Cook County, Illinois.

May 16, 2011

“Cook County’s request to convert Oak Forest Hospital into a regional outpatient center was denied Tuesday by the Illinois Health Facilities and Services Review Board. Dozens of people opposed to the county’s plan shouted with joy and hug one another after the vote was announced.”  Chicago Sun Times, May 11, 2011


A conflict has arisen over the closure of an underutilized public hospital in south suburban Chicago. Twice, community and union opposition has kept the Cook County Health System’s request to close Oak Forest Hospital from being approved by the Illinois HealthFacilities and Services Review Board. On the surface, it seemed like an open and shut case. Oak Forest Hospital, one of three hospitals in the Cook County Health and Hospital System, the third largest public health system in the US, is a conglomeration of 41 buildings located on hundreds of acres of oak forested Cook County owned land about 15 miles south of Chicago’s loop.  Originally opened as a poor farm in the 1800s it was transformed into a TB sanitarium at the turn of the 20th century. By the mid twentieth century as TB waned as a public health problem, Oak Forest was converted into a long term facility for the disabled.  More recently it became an acute care hospital for the poor and uninsured of southern Cook County.  Now it was been slated to be shuttered by the Cook County Health and Hospitals System as part of the County’s, “Vision 2015,” a strategic plan which envisions a shift from costly inpatient services to regional outpatient ambulatory care centers. With an average of only 40 patients per day (fewer patients than buildings) Oak Forest cannot run with the necessary efficiencies required of a modern hospital. So why the emotional opposition to its closing?


The Chicago region, like other urban areas of the nation, has experienced an ex-urbanization of poverty from inner-city to far-outer suburban regions.  Suburban Cook County, especially areas south and southwest of the city are home to some of the poorest communities in America with some of the worst health outcomes in the nation.  It is a region of far flung communities and a paucity of health care services.  


There are three reasons for the opposition to Oak Forest’s closing- concerns about access to health care, job loss and lack of faith in the Cook County Health System to deliver on its promises to expand ambulatory services in the south suburbs.  Let’s examine them one by one:  


There are huge unmet health needs in southern Cook County and opponents of the plan to close Oak Forest Hospital believe that many people, hard pressed and in need of healthcare will have nowhere to go.  Since Oak Forest is the only public healthcare institution in the region some view the closing of the hospital as an abandonment of the community and the growing uninsured.  A hospital represents more to a community than just patients in beds. Crucial outpatient services like radiology, physical therapy are lost as well as a hospital closes. There is also a 24 hour walk and drive in Emergency Room that fields patients with urgent and non urgent conditions alike.  With a closed Oak Forest Hospital, uninsured patients in need of inpatient or outpatient hospital care will have to go to other local hospitals or be transferred to John H. Stroger Jr. Hospital of Cook County, miles away.  This creates a burden for both patients and families to travel so far from their homes.


Second, the loss of jobs at the hospital is a critical loss not only to the individuals affected but also the surrounding communities.  In many communities, hospitals are some of the largest employers and losing a hospital means loss of jobs, and reduction in economic activity.  At Oak Forest over 250 jobs will be lost when the hospital is closed, jobs the community can ill afford to lose.


Finally, there is deep skepticism that the cash strapped Cook County Health and Hospital System will ever fulfill its promise to build a comprehensive regional outpatient center on the Oak Forest campus.  The southland region of Chicago is in desperate need for primary and specialty care outpatient services and the regional clinic, if fully realized, will address some of those needs. But whether it will get built is a concern. And the Cook County Health and Hospital System is counting on the Oak Forest closing just to balance the budget this year. This is the dilemma that the Cook County Health System Board of Directors (on which I sit) faced when we made the decision to close Oak Forest.  The Cook County Health and Hospital System and the Cook County Board of Commissioners has counted on the savings from Oak Forest Hospital’s closure to build out the clinics and hire the doctors to staff them.


The failure to close Oak Forest and build the regional clinics would be a serious blow to “Vision 2015,” the health system’s strategic plan. While many of us on the board would have preferred to have built out the regional health care centers before closing Oak Forest, there were not the dollars to do so. Some of on the board (myself included) might have preferred to actually expand, redevelop and recapitalize the Oak Forest Hospital campus, but faced with huge budget gaps, and the loss of sales tax revenues this was not an option either.


The conflict over the closure of Oak Forest Hospital is just a skirmish in a larger battle about the financing of the public health sector, not just in Chicago, but around the US.  


In 2007, the Chicago based Center for Tax and Budget Responsibility published a report entitled, Cook County’s Revenue System is Structurally Unable to Support the Public Services it Provides.”

In part, reports like this led to the creation of the independent Cook County Health and Hospital System Board to manage the revenues and expenses of a public health system in decline. But there remains this structural deficit.  Since 2008, adjusting for inflation, the Cook County Health and Hospital System has lost more than $ 300 million in revenue and almost 2000 jobs. And Oak Forest Hospital is one of the first casualties. Everyone knows you can’t cut your way to success in healthcare. Lives are at stake. Communities at risk. There needs to be new revenues to treat the uninsured who will still be with us even if “health reform” survives. 


As this battle over Oak Forest Hospital’s closing demonstrates, independent governance is not sufficient, if there is not also independent financing and taxing authority for the beleaguered Cook County Health and Hospital System. Given the rise in the numbers of uninsured (more than 800,000 in Cook County) the public health system will always be needed as the provider of last resort. But without new sources of revenues, we won’t come close to meeting the health needs of the insured. In the end, Oak Forest Hospital will likely be closed and the regional outpatient center in southern Cook County, built.  The battle lines will be re-drawn. But the structural funding deficit of public health in Cook County and elsewhere will remain until we take bold and dramatic steps to solve it.  


More on this in a future blog.


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