Of all hospitals in Minnesota facing economic woes, Hennepin County Medical Center is the hardest hit.
Gabby Raspa showed up on the verge of a diabetic coma, so disoriented she had trouble answering simple questions.
Allison Fingerett came in with a bronchial infection. Robert Fischer, homeless, drugged-out and suicidal, "probably would have been dead" if he hadn't stumbled in one dark night.
They are just a few of the 100,000 people who show up in the emergency room at Hennepin County Medical Center each year. For 120 years, the hospital has treated more uninsured, low-income and vulnerable patients than any other hospital in Minnesota, and continues to do so even in this era of profit-driven medicine.
Now the hospital itself needs an emergency transfusion -- of money.
A wave of cost-cutting that has rippled across Minnesota's health care system, from clinics to med-tech companies to insurers, has arrived at the doorstep of this premier public institution -- a facility that treats 480,000 patients annually, trains 300 medical residents at any one time and serves as the state's leading safety-net hospital.
Already this year, the hospital has cut 200 positions and slashed overtime. It is poised to shed more jobs and services as it braces for another $43 million cut in revenue when the state terminates a key program for the indigent.
Doctors say a cut that size would threaten the hospital's very mission: treating everyone who walks in regardless of ability to pay. It would "tip this hospital over and create a crisis," said Dr. Joseph Clinton, chief of emergency medicine. "It would mean unacceptable deaths for patients who can't get care."
HCMC is not the only public hospital reeling from funding cuts.
"This is happening pretty much all over the country," said Larry Gage, president of the National Association of Public Hospitals and Health Systems. "The economic crisis has increased demand for health care at the same time state and local governments are cutting back."
In Minnesota, Gov. Tim Pawlenty has struggled to close a record state budget deficit, including cutting funds for health care. Last winter, HCMC lost $12 million of state funding in a budget process known as unallotment.
Next, the governor plans to eliminate General Assistance Medical Care (GAMC), a relatively unusual state program that covers the very poor who are not eligible for Medicaid. That program will end March 1, and most of its 36,000 recipients will be temporarily rolled into a health plan for the working poor, MinnesotaCare. But after that, advocacy groups worry that this population -- many chronically ill, with mental health and chemical dependency problems -- will fall through the cracks.
HCMC estimates it would lose $43 million in reimbursements next year and another $50 million in 2011 -- the biggest budget cuts in its history -- if GAMC disappears.
"These were difficult decisions, but they were necessary in order to balance the state budget during a time of unprecedented economic challenges,'' Pawlenty spokesman Brian McClung said Thursday. "Even with reductions to some programs, Minnesota has among the most generous publicly subsidized health care and safety-net programs in the nation.''
Across the river, Regions Hospital is facing similar problems. The former St. Paul-Ramsey Medical Center is now owned by HealthPartners, but continues to serve a significant low-income population.
Regions expects to lose $24 million next year when GAMC goes away and $26 million in 2011. Officials there have already shelved plans for a new mental health center, even though the current one, housed in 40-year-old former nursing quarters, is bursting at the seams. Next month, officials are expected to propose additional cuts for 2010.
Advocacy groups predict ripple effects across the state. GAMC patients aren't going to just disappear, said Becky Lentz, a spokeswoman for Catholic Charities. Food shelves, homeless shelters and community health centers -- as well as police -- will have their hands full with the drug-addicted and the mentally ill who will be off their medications and on the streets, she warned.
But HCMC will feel the impact more than most. The downtown Minneapolis facility opened its doors in 1887 as City Hospital. It had a free dispensary, a horse-and-wagon ambulance and, during the 1918 flu pandemic, a Contagion Building to isolate patients. Over the decades, it merged with or took over nearby rivals -- Swedish Hospital, Mount Sinai, St. Barnabas. In 1964, Hennepin County took charge and raised $25 million in a bond issue to build the current complex.
Today, HCMC is one of 39 local public hospitals remaining in Minnesota. But it plays an outsize role. It operates the state's largest emergency department and trauma unit, leading the response to major disasters such as the I-35W bridge collapse in 2007. It provides more free care -- $48 million last year -- than anyone else, and trains more new doctors than any other hospital except the University of Minnesota Medical Center, Fairview. Employees often stay for years, despite drawing salaries about 20 percent lower than at private hospitals.
The county hospital also provides unique specialized services: It has the only burn unit on this side of the river (Regions has one in St. Paul) and the only 24-hour psychiatric emergency service in the state.
"They are viewed as a safety net, but they're also hugely specialized providers," said Lawrence Massa, president of the Minnesota Hospital Association.
While the hospital boasts a new intensive care unit and other state-of-the-art facilities, officials say they've had to delay the replacement of aging equipment -- for example, the hyperbaric oxygen chamber.
Hospitals from around Minnesota and as far away as Fargo, N.D., refer patients to the chamber -- the only one in the state that treats emergencies -- for everything from carbon monoxide poisoning to "the bends" suffered by scuba divers.
But it was built in 1963 on the old campus. Patients now have to be wheeled outdoors to get there, bundling up on cold days. Recently, the main compressor and backup compressor broke down one after the other and had to be replaced. "It's like having an old car and knowing eventually it is going to break down," said senior technician Bill Gossett.
Property tax increase
Last week, the hospital took the extraordinary step of saying it will soon cut off non-emergency care to uninsured patients from outside Hennepin County. Starting in April, these patients will no longer be able to call for a clinic appointment or get pharmacy services. However, they will still be treated if they show up with a medical emergency.
The hospital also plans to cut 150 to 200 jobs next year, or 3 to 5 percent of the workforce, and close a senior care clinic and a cardiac rehab program.
"Either we go bankrupt or we have to stop being who we are," said Dr. Scott Davies, the hospital's chief of medicine.
The Hennepin County Board has pledged to raise property taxes by 3 percent to raise about $18 million for HCMC, but that only fills about a third of the hole. Meanwhile, safety-net groups are working to come up with a legislative fix for GAMC before the program ends March 1.
"I really don't think they have any clue how chaotic it's going to be," said Robert Fischer, 51, a GAMC recipient from Minneapolis. Fischer, who was homeless for three years, is turning his life around. But he worries about friends in his sober housing complex, who continue to struggle.
For the hospital's loyal, longtime medical staff, it's an ironic moment: greater demands, fewer resources.
"We are not running out of work,'' said Davies. "It's frustrating to talk about cutting when we are [working] flat-out."
Chen May Yee • 612-673-7434