Monday, October 25, 2004
Levy vote puts in question Drake's long-term prognosis
By Cindi Andrews
Enquirer staff writer
HARTWELL - Drake Center's request for a tax levy Nov. 2 is turning into a referendum on its leadership - and its very existence.
Most agree the long-term, acute-care hospital has come a long way since a nurse's aide admitted killing 25 patients there in the late 1980s.
The debate is over whether hospital leaders have taken the most cost-effective route - and where Drake goes from here.
Hamilton County voters will make the call on Election Day, when they decide whether to pass Issue 43. The measure is a tax levy that would raise $80 million over the next five years. Of that amount, $68 million is expected to go to Drake. The rest would go to county programs for drug and alcohol treatment.
The tax levy would cost the owner of a $100,000 home about $25 a year, up from $24 a year now. It would replace one approved in 1999 with 60 percent of the vote.
Retired University of Cincinnati President Joseph Steger is leading the pro-levy forces as chairman of Drake's Board of Trustees. County Commissioner Phil Heimlich is leading the Drake Wastes Money Committee to defeat the levy.
Steger and other proponents say Drake is a world-class facility and a safety net for all Hamilton County residents who might be felled by a health calamity that requires long-term, intensive care and therapy.
Paul Sittenfeld knows about that firsthand.
The 57-year-old from East Walnut Hills spent weeks in intensive care at University Hospital earlier this year after a severe reaction to a medication caused extensive internal bleeding. When he moved to Drake on June 22, he was unable to use the bathroom, walk or even sit up in bed unassisted.
When Sittenfeld was released 17 days later, he could walk with a cane. He is back to work full time as managing director of the investment firm Robert W. Baird & Co. while continuing outpatient therapy.
"I worked very hard," he said. "But an awful lot of people worked hard with me. They had some reasonable and frankly unreasonable expectations, and I felt incredibly sustained and supported by the staff."
Sittenfeld estimates he dealt with more than 100 Drake employees during his stay, and found just three to be "disappointing" - a ratio he calls impressive.
Hospital leaders also trumpet statistics that attest to their medical successes, such as the 70 percent of patients who get to go home and the 75 percent of patients who get off ventilators and are able to breathe on their own. Drake is also the only facility of its type in the state that has its own levy.
"It's a unique institution," Steger said. "A lot of the people here don't like to celebrate unique."
Drake, which first opened in 1851 as the City Infirmary, operated as a county nursing home and infirmary for the poor starting in the 1920s. Renamed Daniel Drake Memorial Hospital, it has been supported by tax levies at least since 1951.
The hospital's focus began shifting to long-term care and rehabilitation in the 1960s, but by the mid-1980s, management and quality problems were brewing. Drake hit bottom in 1987, when nurse's aide Donald Harvey pleaded guilty to killing 25 patients.
The hospital was hemorrhaging money, staff and patients when the county commissioners struck an agreement with the University of Cincinnati in 1989 to turn Drake over to an independent Board of Trustees.
The 50-year deal - renewable for an additional 50 years - put UC in control by giving the university two-thirds of the appointments on the Drake board. The commissioners appoint the other third.
The bottom line
The commissioners' Tax Levy Review Committee first began questioning the hospital's spending and strategic plans a year ago, when Drake requested a levy on the March 2004 ballot.
Drake agreed to delay its request until the Nov. 2 election to give the levy committee more time to study the hospital's operations.
The committee hired Howard, Wershbale & Co., a Cleveland-based consultant, for an in-depth review of Drake's finances and operations. The resulting 70-page report echoed the committee's concerns that there's flab in Drake's $71.5 million annual budget.
The report said Drake pays too much for salaries, pharmacy services, kidney dialysis, nursing facilities and therapy services.
Drake's staff and facility are top-notch, Wershbale said, and its results are good. Inspectors found more problems than average in the hospital's skilled-nursing facility, but Drake also has sicker patients than most nursing homes.
"We believe the level of care, given resident acuity, is in the average to above average range," the report said.
However, the consultant concluded that the community could survive without Drake: "The vast majority (of services) could be provided in settings not currently subsidized by Hamilton County tax levy funding."
Drake disputes that, saying their skilled-nursing patients require more care than other nursing homes want to provide. They also say that without Drake, their patients - people like Sittenfeld - would have to spend more time in costlier, overcrowded hospitals such as University Hospital.
It's the attitude
Despite Wershbale's findings, Drake CEO Roberta Bradford insisted to the tax levy committee that she needed $99 million over the next five years - a 39 percent increase from current funding.
Hospital leaders' unwillingness to consider wholesale changes is just one example of their arrogance, Heimlich said.
"They seem completely unwilling to put in place the kind of reforms any business out in the real world would implement to stay in business," Heimlich said.
A majority of the levy committee voted to recommend to commissioners that Drake be allowed to ask voters for $95 million. But Commissioner Todd Portune, saying Drake should be able to cut its losses, supported giving Drake only $68 million.
Commissioner John Dowlin went along with Portune, while Heimlich opposed any levy request.
Steger and Bradford say they will have to make budget cuts if the levy passes. If it fails, Steger said, the hospital might have to close.
Retorted Heimlich: "It's basically empty threats to try to pressure the taxpayers to support another levy for Drake."
Portune may be the closest thing there is to a middle ground on the levy. The Democrat has a unique perspective, having been a patient for a couple of months last year after two spinal surgeries. He continued to receive physical therapy there until recently.
He says the hospital's 166-bed long-term acute-care unit needs and deserves public support, but he also agrees with critics who say the 148-bed skilled-nursing facility and other hospital services should pay for themselves.
Portune is also concerned about the revelation last week that Drake has committed to pay up to $500,000 for the pro-levy campaign. Typically, levy committees raise private donations to pay for campaign activities, but Drake also paid $204,000 for its 1999 levy campaign.
The hospital says it uses its reserve fund - not tax money - for levy campaigns. The county, however, is expected to launch an investigation today.
The levy opponents have raised $119,000, much of it from the nursing home industry, to fight the levy.
By the numbers
The Drake Center Inc. operates a long-term acute-care unit, a skilled-nursing home and rehabilitation services at 151 W. Galbraith Road in Hartwell.
Patient capacity: 314 beds
Patients from Hamilton County: 77 percent of those in skilled-nursing home; 64 percent of those in long-term, acute-care unit.
Ventilator dependency: 75 percent of Drake patients weaned off of mechanical breathing assistance, compared with 54 percent at other long-term care hospitals.
Staffing: The equivalent of 793 full-time employees
Annual budget: $71.5 million
Levy support: 20 percent of budget
Annual loss per bed: $13,620
Annual spending on marketing: $1.4 million
Sources: Drake Center; Howard, Wershbale & Co. report
Levy pros and cons
Drake Wastes Money Committee alleges: Drake pays its 17 full-time physicians an average of $110,000 more per doctor per year than the hospital receives from insurance, Medicare and Medicaid.
Drake responds: The hospital's payments to its doctors are common practice and its rates are comparable to other hospitals.
Drake Wastes Money Committee alleges: Hamilton County taxpayers are subsidizing the 28 percent of patients who come from other counties.
Drake responds: Non-paying patients are admitted only if they live in Hamilton County. Patients from outside the county must pay for services themselves. Income from patients and their insurance companies covers the cost of direct care and contributes to - but doesn't completely cover - Drake's administrative costs.
Drake Wastes Money Committee alleges: Drake's nursing home costs are close to 70 percent more than other nursing homes.
Drake responds: Opponents are unfairly comparing Drake to regular nursing homes, which care for patients with fewer medical problems. The skilled-nursing facility costs 8 percent less than other hospital-based nursing facilities in Ohio.
Drake Wastes Money Committee alleges: Hamilton is the only county in the state and maybe even the country that has a tax levy devoted to a facility like Drake.
Drake responds: Columbus, Cleveland and Indianapolis taxpayers contribute to some of the kinds of services provided at Drake; they don't do it through a dedicated tax levy.
Drake Wastes Money Committee alleges: Drake spends $1.6 million a year on marketing, including TV ads, billboards and misleading fliers, even though most of its patients are referred by area hospitals that already know about Drake's services.
Drake responds: The hospital spends $1.4 million a year, excluding the cost of staff recruitment. These marketing efforts help expand its base of paying patients.
Drake Wastes Money Committee alleges: Drake CEO Roberta Bradford gets $370,000 a year in salary and benefits.
Drake responds: Executives' salaries are comparable to those at other local and regional hospitals.
Sources: Drake Center Inc.; Drake Wastes Money Committee
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