Chapter 33: It's Going to be Ugly

June 28, 1990, McKinley, Ohio

Loretta was compelling, and I was happy she didn't try to play on emotions; she simply explained the value of the new ED and surgical wing. All things considered, she was absolutely the best choice, considering she'd been at the hospital for six years and was the longest-serving doctor in the ED, having been a PGY2 when I had my first Preceptorship.

She was asked a number of questions, and she acquitted both herself and the hospital quite well. The arguments were so strong, I didn't see how anyone could oppose the spending unless they were so ideologically wedded to not increasing taxes that they were willing to sacrifice core public services. And in the end, I felt that would cost them more votes than reneging on their promises.

Once Loretta was finished, the members of the public who had signed up to offer opinions were called in the order they had registered. The first three were adamantly opposed to any tax increases for any reason, and stated quite clearly they expected major cuts to County spending. To me, that was untenable, as that would mean cuts in the Fire Department, the Sheriff's Department, schools, road maintenance, and a host of other things.

The next two members of the public both supported the hospital, and then it was Shelly's turn. She spent her time discussing the need for additional ORs and emphasized that the money had already been secured and could only be used for that purpose, and that the County was paying interest on the bonds that had been issued. I felt she made some good points, and then it was my turn.

I'd thought about whether or not I wanted to speak, and if I did, what I might say. Some things one of the first three speakers had said grated on me, and really pushed me to take my turn, despite my aversion to politics. I got up and moved forward to the lectern.

"My name is Doctor Michael Loucks," I said. "I would like to address two things said by previous speakers to clear up some misconceptions. First, while it is true that the most senior physicians do make very good salaries, the bulk of the work done in a hospital is by Residents, that is, junior doctors.

"I am a PGY2 — a second-year Resident — in trauma surgery. My responsibility is to save the lives of people who have suffered traumatic injuries, had heart attacks or strokes, or are otherwise at severe risk for death. I work on average, seventy hours a week, and my hourly wage works out to around $7.00 per hour, or about half what a journeyman electrician makes. I'm not eligible for overtime pay, while a tradesman is. My hourly wage won't surpass that of a typical electrician, plumber, carpenter, or mechanic for another six to seven years.

"That is not a complaint by any stretch of the imagination, because I knew the pay scale when I first committed to being a doctor and vowed to serve my community. I could have easily gone to medical school at Harvard, Yale, Stanford, or another top-tier school, but I chose to attend McKinley Medical School. I could have served my Residency at a big-name hospital, including the ones I mentioned, or University of Chicago Hospital, but I chose to Match with Moore Memorial Hospital to serve my community.

"And that leads me to the second point that a previous speaker mentioned about raising fees — it simply is not possible, at least in the way he suggested. First of all, we are a public hospital, which means we have an obligation to serve our community and receive all patients transported by the Fire Department or an ambulance service.

"In addition, we are obligated by a new Federal law — EMTALA, or the Emergency Medical Treatment and Active Labor Act — to assess and treat anyone who presents themselves in our Emergency Department for any reason without respect to their ability to pay. That is a requirement for hospitals that take Medicare patients, which we do.

"Medicare determines the proper reimbursement rate for services we provide to seniors, and as Doctor Anderson explained, their reimbursement rates do not cover the cost of services provided, and there is little or nothing that can be done about that. When you combine that with patients who cannot afford to pay, there is little room for the hospital to raise revenue, and certainly not in the amount needed to fund a Level I trauma center.

"To address the final point that the hospital is 'fine as it is', it actually is not. As Doctor Anderson pointed out, patient loads are increasing, and EMTALA has caused them to increase faster. That means we need the planned expansion simply to meet the basic needs of the County in the future.

"Ultimately, if the expansion is not completed as planned, the people of the County will suffer, and people will die. Is an intemperate pledge of not raising taxes for any reason, ever, sufficient cause to accept the deaths of men, women, and children that could otherwise have been prevented? I certainly don't think so, and a small increase in property taxes to fully fund the hospital is the moral and ethical thing to do. Thank you."

I rose and returned to my seat as the next speaker took their place at the lectern.

"Not bad, Petrovich," Clarissa observed.

"Yeah, but those first three citizens were adamant in their support for the members who don't want to raise taxes."

"I bet that was on purpose," Tessa said. "They were forced to call the meeting, so they stacked the deck, so to speak, with people opposed."

"And those people would be the first to sue if their loved one died or could not be treated due to resource shortages," Shelly observed.

"They're engaged in magical thinking," I replied. "None of this — medical care, fire protection, police protection, roads, and so on — comes without cost, and the only way to pay those costs is through property taxes. Well, the only way established and accepted here. Kris would have other ideas, and I actually agree with her that more should be funded through income taxes."

"Bite your tongue!" Shelly exclaimed in a loud whisper.

"Somebody's got to pay," I said. "And that somebody is the taxpayer, in one way or another."

There were three further speakers, then each Board member had two minutes to give their views. I detected a slight change in one member's opinion, but one wasn't enough, and I wasn't even sure the one who had modified their views slightly had modified them enough to change their vote.

"What do you think?" I asked Clarissa when the meeting ended.

"They're not going to budge, and I suspect that means they aren't going to budge on the nurses' contract, either."

"I agree."

"So do I," Shelly interjected. "I'd say the strike is certain now."

"Excuse me, Doctor?" a woman about my mother's age said.

"Yes, Ma'am?"

"You really only make $7.00 an hour?"

"Yes, Ma'am," I replied. "We work about 4000 hours in a year, and last year I earned $27,800. This year, I'll earn about $30,000 for those same hours. And just to make it clear, during our final two years of medical school, trainee doctors work between sixty and eighty hours a week at no pay."

"No pay?" she asked. "That can't be right!"

"Not only no pay, but we pay tuition for the privilege of working. That's how medical education works. Contrary to what the first speaker said, doctors are not getting rich. Now, if I practiced plastic surgery in California, or if I went to a prestigious private hospital and performed elective surgery, I could make far more money once I completed my Residency. Residency salaries are effectively determined by the Federal government."

"I had no idea."

"Most people don't."

"Would you be willing to talk to my bridge club about how being a doctor in a hospital works?"

"Do it, Petrovich," Clarissa encouraged before I could even answer.

"Yes, Ma'am, I'd be happy to," I said. "We'll just need to work around my schedule, which is going to be challenging if the nurses go on strike on Sunday."

"Are they paid as badly as doctors?"

"As trainees, they have the same situation — they pay for nursing school and work around sixty hours a week for no pay, then when they start their jobs, they make around $20,000 a year, which, when you take their hours into account, works out to about $8 an hour. They do make more as they gain experience, but it tops out around $20 an hour for the most experienced nurses in the most challenging specialties."

"And the County Board believes that's OK?!" she asked.

"So it would seem."

"My name is Patricia Bachmann," she said. "How do I get in touch with you?"

"Simply call the hospital any weekday and ask for the Emergency Department. A clerk or nurse will answer, and you should ask to speak to Doctor Mike. If I'm busy, I'll call you back."

"Thank you, Doctor."

"You're welcome."

Clarissa, Tessa, and I left the building and headed towards our cars.

"I was going to say 'yes', Lissa," I said. "You didn't need to prompt me."

"You? What changed?"

"Hearing my fellow citizens saying stupid things, at least partly out of ignorance. I also remember from civics class that local politicians like to meet with bridge clubs, garden clubs, book clubs, and so on, because that's the easiest way to gain support. I also remember that car dealers are very important to local politicians because the car dealers tend to be very politically active and make significant campaign donations."