National Nurses United

that lives over the hills along the water. Jim Pandazides, an RN with a 23-year RN at Doctors who was born there herself. "It's a whirlwind Chicago's Cook County system, echoed her by saying, "We can get a of things, but everything that's happened has been because of the strong will of the nurses." job somewhere else, but these patients can't go nowhere." After comparing notes, public-sector nurses agreed that they needFor some public health systems, the situation has already deteriorated so badly that nurses have had to take to the streets themselves ed to continue to fight publicly against immediate attacks to their systems, but that the only long-term solution and lobby government officials and the pubwas to support a single-payer health insurlic in order to save services or prevent a total ance system so that all patients are guaranshutdown. Like nurses with the Cook Counteed coverage and public facilities are not ty system, RNs with Doctors Medical Center stuck bearing the financial burden of caring in San Pablo, Calif. have staged rallies and for the uninsured and low income. And with a mock funerals, testified at county supervisor public agency accountable to the public meetings, and raised hell to keep the hospiadministering the funds and making choices tal's doors open. So far, the healthcare dis—Jim Pandazides, RN for public health, not profit, nurses say trict has partnered with the county and is healthcare dollars can be put to their best use. expecting matching state funds to keep run"A single-payer system would provide funding that could level the ning, but a long-term financial solution has yet to be found. The nurses were motivated by their knowledge that poor, working-class playing field and let the public sector be competitive," said Deborah residents would otherwise die or risk serious illness if the hospital Burger, RN and CNA/NNOC president. "People use the public health system. I was born in a public hospital, and when my sister was sick, didn't exist. "We started becoming political lobbyists," said Tami Roncskevitz, it was a Sacramento public hospital that saved her." I "We can get a job somewhere else, but these patients can't go nowhere." h Bureau Cuts Boils Over know, he could still be waiting in the ER right now." Or maybe he never got the x-ray. This is just one snapshot of patient care today as Cook County Bureau of Health Services RNs and other health providers struggle to cope with lack of staff and resources. And it's about to get a lot uglier if the Bureau follows through with proposed 17 percent budget cuts county commissioners approved in February. The county plans to close about half of the Bureau's 26 clinics and reduce services at its three hospitals to cover a $500 million budget deficit. According to local news reports, some 347 layoff notices have already been sent to Bureau employees. "The cuts basically mean they're going to stop primary care as we know it," said Barrett, who is active with CNA/NNOC in fighting to restore funding. "The clinics have always operated as a release valve for the system. Patients could come receive treatment in their communities and not burden the hospital. Now they're wiping that out. People are just going to die." Bureau RNs know they are the last resort for uninsured and low-income Medicaid patients, often elderly, and are outraged that the county has not more aggressively pursued other ways to increase revenue and MARCH 2007 eliminate positions that don't provide direct care. The nurses say patients are being made to suffer for years of mismanagement, waste, and even nepotism. In mid February, the Chicago Tribune reported that the Bureau does not have enough staff in its billing department and as a result often fails to collect fees from patients with insurance who can pay. The Bureau neglected to bill for $250 million in care during the last year alone. Soon after, a health adviser to the Illinois governor warned that closing so many clinics could mean that the Bureau may be risking millions in Medicaid reimbursements because it will have fewer chances to sign up members with a primary doctor as new rules require. And in early March, the County revealed that recent audits show it is missing more than $500,000 in cash. RNs are wasting no time in staging huge protests to rally the community and convince commissioners to not cut as deeply as they have proposed. Already, nurses report that reduced hours at some facilities such as the ambulatory screening clinic (ASC), which takes walk-in patients, and the pharmacy at Stroger hospital have caused longer lines and patients to W W W. C A L N U R S E S . O R G give up seeking care. Some clinics that used to accept walk-ins now operate by appointment only, a system that doesn't allow providers to see as many patients and is sometimes difficult for patients to follow. Nurses say it's hard for patients, especially the elderly and those without their own car, to travel for healthcare – particularly in Chicago's freezing winter weather. "My friend at one of the walk-in clinics said to me the other day, 'We used to see 100 a day, but now it's 40. Where is everyone going?'" said Karen Kwiatkowski, a public health RN with the Bureau. They're probably showing up in the ER sicker and sicker, said Betty Kennedy, an ER nurse at Stroger. Patients who don't get follow-up care, who can't fill their prescriptions, who don't get preventive care eventually show up at the ER's doors. "Already I have people who come in, they have a heart problem and their legs are all swollen, and we ask, Have you been taking your medication? 'I ran out.' Well how long ago? 'A couple weeks.' Why didn't you refill it? 'I couldn't get a way to come here.'" said Kennedy. "We have a lot of 70 to 80-year-old people. If they can't go to the clinic, where are they going to go?" —lucia hwang REGISTERED NURSE 13

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