Last week Gov. Bill Richardson held very still while clutching onto a carefully maneuvered shovelful of dirt. No, he wasn't burying his pride in a belated post-election realization; he was posing after breaking ground on the UNM Children's Hospital Expansion Project (or, at least, breaking through the dirt in a very symbolic sandbox atop the UNM hospital parking garage). Last week's ceremony celebrated the groundbreaking of the $233 million public works project, one of the largest in the state's history, and was aflutter with highly impressive individuals and well-crafted public relations, gathered to celebrate upgrades at the state's only teaching hospital. The project is scheduled for completion in November 2007.
Yet, while the trumpets were blasting away near Lomas and University (quite literally—the Mariachi Tenampa was belting out some splendid notes), a much more modest gathering took place earlier that morning on the other side of town. In portable 15 at La Mesa Elementary, the Community Coalition for Health Care Access hosted their own press conference, announcing a lawsuit against the very same hospital that was further down the street kicking up its heels.
The coalition is a nonprofit organization dedicated to providing quality, affordable health care to indigent people in Bernalillo County. They've worked closely with UNM Hospital administrators for the last several years, advocating an increase of translation and interpretation services at the hospital. But group organizer and spokeswoman Alma Olivas says that over the last year the coalition has been running into a slew of brick walls.
The coalition has tried repeatedly to obtain what should be public documents from University Hospital in order to assess what the administration has done in the last five years to provide health care access to indigent people. The documents requested by the group should provide information such as anonymous patient satisfaction surveys, the amount of money spent on UNM Care (the primary financial assistance program for low-income patients), summaries of how tax dollars given to the hospital for services for the indigent are used, and interpreter/translation data such as budgetary costs and the number of interpreter requests received.
According to Gail Evans, attorney with the New Mexico Center on Law and Poverty, which is the nonprofit organization bringing the case to court on behalf of the coalition, hospital administrators have refused the majority of information requests.
In response, Sam Giammo, director of public affairs for the UNM Health Sciences Center, said, "We believe that we were responsive to their requests, but responding in the way that falls within the law, and falls within what we can legally do." Giammo added that the hospital has provided the coalition with over 1,100 pages of documents since they have filed their requests.
One of the primary reasons the coalition is concerned about the hospital's indigent care policy is because the number of low-income people enrolled in UNM Care has only slightly increased in the past few years, despite the fact that the funding for the uninsured was doubled from $30 million to $62 million through a countywide mil levy property tax increase in 2000. The number of people enrolled in the program has remained around 13,000 for the last several years, said Evans, even though she estimates that 70,000 people in Bernalillo County could benefit from the program.
The coalition argues that since property tax increase went into effect in 2002, the public should be seeing a difference in the number of indigent patients enrolled in the hospital's financial assistance program. Part of this could be achieved by increasing the number and availability of translator and interpretation services at the hospital, Evans said. Currently, nonEnglish speakers have problems receiving health care upon entering the hospital. Additionally, there are communication barriers between nonEnglish speaking patients and the doctors and nurses. The hospital has hired five additional interpreters in the last year alone, and although the coalition recognizes this as progress, group leaders said that providing adequate health care for the indigent is still a big challenge, and more work needs to be done.
"There is an inadequate number of people enrolled at the UNM Care program, there's inadequate interpretation services at the hospital, the hospital has a dispractice of charging the poor 50 percent up front, so it means that poor people are not getting their medically necessary care," said Evans.
Giammo, however, responded that although all uninsured patients are required to pay a percentage before treatment at the hospital, regardless of their financial status, this does not apply to emergency medicine, only to primary care and elective services. Additionally, Giammo agrees that the hospital does not have adequate translation services, but says that they are actively recruiting trained medical translators to cope with the deficit.
"As a matter of fact, the hospital has stepped forward within the last month and said that for people who pass an oral proficiency test, we will pay tuition for them to take a class that starts in January, that's a five month class, to become certified medical translators," said Giammo.
Evans argued that since there has been no visible increase in service to the indigent since the mil levy was raised, the coalition wants to look at some of the hospital's records to monitor the indigent care budget.
"This is a public institution, and this is public information that the hospital should provide for all of us," said Evans. But Evans accused the hospital administration of stonewalling by claiming that the documents contain patient information and hospital trade secrets that should remain private, and that some of the requested records do not exist.
According to the New Mexico Inspection of Public Records Act of 1941 (amended in 2003), "every person has a right to inspect any public records of this state," with the exception of those containing trade secrets. Evans said that there is nothing within the documents the coalition has requested that could be construed as "trade secrets." Additionally, Evans stated in the petition to the court that most patient information included in the documents should be anonymous, and that which isn't could be cut out.
University Hospital countered, as stated within the petition, that the information requests are overly burdensome and the records do not fulfill the criteria of public documentation, although Evans disputed that upon further investigation the records most certainly do fall into that category.
The process of copying, cutting and pasting public documents in response to a public information request could be time intensive, and hospital administrators might fear that time could be better utilized elsewhere. Yet, the coalition argued, inconvenience does not excuse them from their obligation to county residents to openly divulge information on what they're doing with tax payers' dollars. Coalition spokeswoman Alma Olivas insisted that if adequate records do not exist, in a form that organizations, or any citizen of this state, can readily access, then the records need to be created or modified to meet the needs of the public.
In other ways, the hospital is flourishing. The Children's Hospital Expansion Project, which will bring six new floors of clinical space, including features such as a maternity center, an adult critical care center and private patient rooms is a positive step that deserves a strong, well-intentioned pat on the back. And so the message from the coalition is not to kick and scream at an institution that otherwise offers tremendous benefits to the state. Rather, Evans insisted that more can be done, and as a tax payer funded institution University Hospital needs to fully open its books. For now, that means waiting for the courts to determine how much information will be made public.
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