Testimony of Debbie White, RN President of the Health Professionals and Allied Employees Thursday, January 10, 2019 Before the NJ Department of Health

Good morning Commissioner Elnahal and thank you for the opportunity to provide input into the 2019-2020 NJ Department of Health budget. My name is Debbie White, President of HPAE, NJ’s largest union of healthcare professionals representing 13,000 nurses and healthcare workers in hospitals, nursing homes, behavioral and mental health, blood collection and substance abuse facilities.

I appreciate the opportunity to share with you HPAE’s top budget priorities to improve the quality of healthcare services in New Jersey.

Funding for University Hospital

University Hospital is the only public acute care hospital in the state and one of three level 1 trauma centers in New Jersey. It is also the premier research and teaching hospital for the state.  The hospital is tasked with addressing the Newark area’s public health needs, but without the proper funding, the hospital will continue to fall short in fulfilling its mission and serving the greater Newark community. In the upcoming budget, it is imperative that the state provides University Hospital with adequate funding. The ability to provide quality care is directly connected to the financial health of the institution. The recent Monitor’s report for UH revealed a plethora of issues in the Hospital including the subpar financial health of the hospital – and other issues that can be addressed with increases in funding levels. Increased community engagement, effective emergency care and even strategic planning initiatives have costs attached to them. We would like to see the legislature evaluate the costs of improving care at University Hospital and increase University Hospital’s funding to match the need.

Since the reorganization of UMDNJ, the separation of University Hospital has had a negative impact on the financial stability, and as we are well aware, patient safety concerns have risen.

In the FY 2019 budget, funding for charity care for University Hospital remained flat from the previous year but saw an overall decrease of $30M since FY2015. Given that UH is the state’s largest public health provider, it is essential that UH have the funds to provide treatment to those that are uninsured, underinsured, and impoverished. An increase in charity care will help the hospital maintain its mission for caring for underserved populations.

The Medicaid and CHIP Payment and Access Commission (MACPAC) reported to Congress in 2016 that only ten states account for more than two-thirds of total Disproportionate Share Hospital (DSH) spending in the country.   New Jersey was the fifth highest[1] on that list of ten states in 2015; in FY 2016, New Jersey moved to fourth highest state for DSH allotments and remained in fourth place in 2017 as well.[2] New Jersey is also among the top ten states in total Medicaid services spending.[3] These grim statistics are a reminder that even with an expanded Medicaid in New Jersey our poorest citizens need more help.

 Enforcement of patient safety laws

We are grateful to see that appropriations for the Department of Health received a modest increase for FY 2019 after years of neglect under the previous administration. The nurses and health professionals in HPAE and throughout New Jersey rely on the Department of Health to uphold its mission of ensuring access to quality health care for all New Jerseyans.

Under the previous administration there was a long, steady decline in enforcement and inspections. Hospital inspections were no longer conducted regularly by the Department of Health for license renewals. Rather, renewals were made on the basis of reports made by private accreditation entities. Those reports have not been made available to the public, unlike Department of Health inspections that are subject to the Open Public Records Act.[4]

Over the past seven years, the DOH was inconsistent in its monitoring of the impact of an ever-changing healthcare landscape and in enforcing conditions on sales or mergers that would protect patients and the community.  Now, the Department of Health could reinstate transparency and a pro-active enforcement agenda for the benefit of all New Jerseyans if funding is restored. The Governor and the legislature must adequately fund the DOH so that it can carry out its mission of hospital safety for patients and workers by making it possible to hire the staff necessary to enforce current regulations, and I urge you to make such a recommendation to the Governor.

Substance use and addiction treatment

New Jersey has experienced a 15 percent increase in overdose deaths in 2018, an average of 8.7 deaths a day.   The appearance of fentanyl, a drug that was originally approved by the FDA only for use in controlling pain in cancer patients, has increased in prevalence in New Jersey for overdose deaths by 701 percent since 2014.[5] In addition, from January 2018 through October 2018, Naloxone was administered 13,614 – each of those overdose administrations is a death avoided.[6]

Under the previous administration, New Jersey lost more than 40 percent of its addiction treatment beds for the poor and uninsured while as many as 90 percent of those addicted to heroin in New Jersey have no private insurance and rely on Medicaid.[7] Restoring funding for Medicaid-eligible detox beds and services for those who are unable to afford treatment is a necessity if New Jersey intends to seriously grapple with opioid addiction for all its citizens.

We applaud Governor Murphy’s decision to expand the State’s prescription drug monitoring system last year. It has already made a difference in opioid prescriptions, but we have a long way to go with more than 4.1 million opioid prescriptions written in the state in 2018 just through October.[8] Stopping addiction where it starts for many, in the doctor’s office, is crucial for curbing the spread of addiction.

 Sustained Funding to Reduce Disparities in Birth Outcomes and Black Infant Mortality

In April of 2018, The Department of Health announced that it would provide grant monies to agencies to decrease disparities in birth outcomes and reduce black infant mortality. New Jersey’s infant mortality rate is among the lowest in the nation, with 4.7 deaths per 1,000 live births, compared to national rate of 5.9 death per 1,000 live births. But the disparity between white and black infants is stark. Many factors are known to affect birth outcomes – these include the mother’s age, education, health status, and behavior during pregnancy. But study after study show that these factors fail to explain large differences by race. Race plays a significant role in health outcomes. Because of this, we were excited to see the initial commitment by the Department of Health to reducing health disparities in birth outcomes and believe that sustained funding will allow for a continued commitment.

Thank you for the opportunity today to share our concerns and priorities.

 

[1] The Kaiser Foundation website; reporting on FY2015 “Federal Medicaid Disproportionate Share Hospital (DSH) Allotments,” http://kff.org/medicaid/state-indicator/federal-dsh-allotments/

[2] Supra, FY 2016 and FY 2017.

[3] MACPAC. “Report to Congress on Medicaid Disproportionate Share Hospital Payments.” February 2016, p. 7, https://www.macpac.gov/wp-content/uploads/2016/01/Report-to-Congress-on-Medicaid-Disproportionate-Share-Hospital-Payments.pdf

[4] Andrew Kitchenman. “Healthcare workers union accuses state of inadequate monitoring.” NJSpotlight, 26 March 2014, http://www.njspotlight.com/stories/14/03/25/healthcare-workers-union-accuses-state-of-inadequate-monitoring/

[5] NJ Cares: The Office of the New Jersey Coordinator for Addiction Responses and Enforcement Strategies, data accessed 9 January 2019, https://www.nj.gov/oag/njcares/ .

[6] Supra.

[7] Star-Ledger Editorial Board. “Christie pegs his legacy on the drug fight, but deserves a B-minus at best.” NJ.com, 24 September 2017, http://www.nj.com/opinion/index.ssf/2017/09/christie_pegs_his_legacy_on_the_drug_fight_but_des.html .

[8] NJ Cares: The Office of the New Jersey Coordinator for Addiction Responses and Enforcement Strategies, data accessed 9 January 2019, https://www.nj.gov/oag/njcares/