By Jim DeFede
Waking up at 4 in the morning this past Thursday, I could tell that my right leg, just below the knee, had swollen to the size of a volleyball. Eleven hours earlier I was trying to make my way around some crime scene tape on Miami Beach when I slipped and fell, slamming my shin into a concrete ledge.

As I picked myself up off the ground, and feeling pretty stupid, I could see there were a few scrapes but nothing serious. When I got home an hour later I iced it, knowing I would have a pretty nasty black and blue mark on my leg in the morning, but I wasn’t expecting this. Searing pain shot through my leg when I tried to bend my knee and get out of bed.

The time for ice had passed. I had trouble standing or shifting any weight on it, so I decided I should go to the hospital and get it checked out.

And here is where our story begins.

Because in that moment I was confronted with the same choices nearly everyone is faced with at one time or another in our community: Where should I go?

My first thought was Jackson Memorial Hospital. Jackson has some of the finest — if not the finest — doctors and nurses in South Florida. I have been covering the financial problems at Jackson for months. Just a few days earlier I was at their governing board meeting where they voted to close the obstetrics unit at Jackson South.

As a reporter, I thought, going to Jackson’s ER would give me an opportunity to see, first-hand, the difficulties and problems the ER is facing amid cutbacks and layoffs. Hospital administrators have admitted that patients going to the ER could face longer wait times and that some patients are likely to eventually give up and leave the ER in frustration. My clumsiness would allow me the opportunity to see this for myself.

But as I called for a cab the pain in my leg continued to grow. And suddenly something else came to mind — it’s that billboard on I-95 and another Biscayne Boulevard — touting the short wait time for the ER at Aventura Hospital. Usually when I drive past it it says “3 minutes” or “5 minutes.”

Waiting for the cab in front of my Miami Shores house I called the hospital to see what the current wait would be and was told it was four minutes.

I had no idea how long it might take me at Jackson — which is where, all things being equal — I would have preferred to go. So when the cab pulled up I surprised myself when I said, “We’re going to the Aventura Hospital ER.”

The entire drive I felt guilty. At one stop light I even thought about telling the cabbie to turn around and head to Jackson.
I arrived around 4:30 and was tended to immediately. During my stay I had X-rays taken (no fracture), had a sonogram done on my leg to check for blood clots (there were none), had blood work done to check for an infection (white blood cell count was fine), saw the ER physician, the attending physician, had my leg bandaged, and was given a tetanus shot, as well as prescriptions for antibiotics and pain killers.

They then called me a cab. I was home by 7:30.

Now I don’t know how long it would have taken me at Jackson but therein lies one of the biggest problems facing JMH. If Jackson is to survive they have to convince people like me that Jackson is the place to go.

Now I already know that if I get shot or am in a terrible car accident, I want to be taken to the Ryder Trauma Center.

But at 4 am with my leg banged up and just wanting someone to check on it, I decided to go somewhere else. And I know that every time a decision like that is made, then Jackson’s financial problems grow. Because they need paying patients like me to come in for “routine” emergencies. I don’t know how much Aventura Hospital will make off of my visit, but I have no doubt it will be profitable for them thanks to my insurance.

But when you are hurt and you’re in pain you want to go where you know you will be treated quickly. Jackson has to find a way to convince people that you can go there. If there was a number for me to call to see what the wait time was at Jackson, I would have checked there as well. But I didn’t know how to check. And right or wrong, my impression is that by the time I got home from Aventura, I would have still been sitting in the ER waiting to be seen at Jackson.

Now I will tell you there was one moment that made me stop and regret my decision to go to Aventura. When I was being wheeled for the ultra sound, I had this terrible feeling, “Okay, what if they find a blood clot? Those can be serious.”

That’s when I started looking around. And it suddenly hit me, “Other than a short ER time, what do I actually know about Aventura Hospital? Maybe there is a reason no one is in their ER. I wonder if it’s too late to head over to Jackson?”

Luckily everything was fine.

But the same is not true for Jackson. Fewer paying patients are going to the hospital and officials believe all of the negative stories about their financial problems are playing a role in those decisions. Well, I can tell you that in my case that is certainly true.

I told my story to Martha Baker, the president of the union representing Jackson’s nurses and doctors. The entire time I was telling her I felt guilty. I have been treated at Jackson in the past and believe the staff to be amazing. But I was afraid this time I was going to get lost in Jackson’s problems.

“Well, I understand your thought process,” Baker says, slowly, but with a hint of admonishment. “Wait time have actually gotten better in the ER, but I don’t know that we would have gotten you treated and released as fast as Aventura did.”

She also noted that HCA, the company that owns Aventura, as well as Kendall Regional Medical Center, has been spending a lot of money promoting their hospitals and are trying to challenge Jackson across the county.

Baker said making Jackson easier to “navigate” is one of the areas the hospital needs to improve. “That is a common perception in the community — that Jackson is difficult to navigate,” Baker said.

The consultant the union recently hired has been focused on improving things in the ER. One of the problems often encountered at Jackson’s ER is that indigent and uninsured patients come into the ER for routine medical care.

“What we are trying to do is get those people to start going to Jackson’s clinics, where they can see primary care physicians and not have to crowd into the ER,” she said. “It’s really a broken system.”

Baker said there can sometimes be a 12 hour wait time for an ER patients to get admitted into the hospital. “We are trying to make the flow of patients better,” she said.

“We need to fix these problems and build public confidence again,” she said. “There’s a lot of room for improvement.”

Jackson President and CEO Eneida Roldan often chides reporters that it is our job to offer more positive stories about Jackson. The press, however, is not a part of the hospital’s public relations team.

I don’t know what the answer is but they might want to think about a few billboards of their own.

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