President Debbie White advocates for greater investment in University Hospital at NJ DOH budget listening session

Testimony of
Debbie White, RN
President of the Health Professionals and Allied Employees
Thursday, 6 February 2020
Before the NJ Department of Health

Good morning Commissioner Persichilli and thank you for the opportunity to provide recommendations for the FY 2021 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 bring HPAE’s top budget priorities to you with the goal of improving the quality and access to healthcare services, oversight, and patient safety in New Jersey.

Funding for University Hospital:

As the only public acute-care hospital in New Jersey, and one of three Level One trauma centers in the state, University Hospital (UH) has the monumental task of addressing the public health needs of the greater Newark community. For decades University Hospital has maintained a reputation as a well-respected, premier teaching hospital with the inclusion of such departments as New Jersey’s first liver transplant center.

The majority of UH payers are governmental – Medicare, Medicaid, and health care subsidies make up almost three-quarters of total patient revenue. In addition, New Jersey has ranked as the fifth highest receiver of Federal Medicaid Disproportionate Care Hospital (DSH) allotments in the country at least since 2008. Despite having the second highest median household income nationally, New Jersey has a significant portion of residents in need of health care assistance. University Hospital takes care of tens of thousands of patients that are uninsured and underinsured, with 93,951 visits to the emergency room in 2018 alone.

In FY 2020, UH requested $10M for its ER renovations and modernization and was only awarded $2M, not enough to make any major improvements in care delivery or services. Given the high volume of patients through the ER, the State needs to respect the demand placed on services at UH and fund it adequately. The physical health of the hospital and its ability to serve the community effectively is dependent on funding – UH state appropriations have essentially stayed flat since FY 2016, a shoestring budget for the hospital. Adding to the financial insecurity of UH is the fact that the DSH reductions, in compliance with the ACA, begin in this year and New Jersey will see a 34 percent decrease in DSH payments. We request that the Legislature and Governor increase the line item funding.

Enforcement of patient safety laws and facility oversight

As front-line healthcare workers, we cannot overstate the need for better enforcement of patient safety laws. Nurses and health professionals rely on the Department of Health to uphold its mission of ensuring access to safe, quality health care for all New Jerseyans. In order to do that, DOH needs better funding. If the Legislature and Governor fail to increase appropriations, there is an increased likelihood of a major viral or bacterial outbreak happening as it did at Wanaque Nursing & Rehabilitation in 2018, when 11 young patients died.  Similarly, University Hospital had a bacteria outbreak that killed three babies and prompted the appointment of a monitor.

Under previous administrations, the DOH was reduced to inconsistent monitoring of facilities and enforcement of conditions placed on sales or mergers that would protect patients and the community.  It is critical the FY 2021 appropriations make it possible for the DOH to reinstate transparency and a pro-active enforcement agenda for the benefit of all New Jerseyans. We request that DOH demand funding that will allow the Department to staff up in order to conduct thorough inspections, monitor hospital finances so that we avoid another CarePoint Health situation, and to enforce health and safety laws effectively.

It is fundamental for NJ DOH to be the advocate for our communities and for taxpayers when hospitals are sold, merged, or recommended to close, or when hospitals desperately need regular department inspections and enforcement of regulations. In these challenging times for health care, New Jersey needs and deserves a Department that will be a real advocate for its patients, communities, and workforce.

Substance use and addiction treatment

Opioid deaths decreased by 3 percent in 2019 but still accounted for 8.3 deaths per day in New Jersey. The number of prescriptions written for opioids declined by 6.5 percent and Naloxone administrations decreased by 6 percent as well.  While Naloxone is available without a prescription in certain pharmacies across the state, HPAE recommends that DOH push to have it available without a prescription in every pharmacy. Studies are showing that prescription-free access increases pharmacy-dispensing rates astronomically: in Ohio Naloxone dispensing increased by 2,300 percent.  Last year a Rutgers New Jersey Medical School study found that pharmacies in bigger, poorer cities in New Jersey hardest hit by the opioid crisis often do not even have Naloxone in stock. New Jersey should do whatever it takes to increase access to Naloxone: every administration is a life saved and better access will save the lives of many New Jerseyans.

Several years ago under a 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.  Restoring funding for Medicaid-eligible detox beds and services for those who are unable to afford treatment is a necessity for New Jersey to confront fully with opioid addiction for all its citizens.

Health care disparities

New Jersey has one of the highest rates of maternal mortality in the country, ranking 45th in the nation, with a maternal death rate 84 percent higher than the national rate.  The maternal mortality rate among black women in New Jersey is 394 percent higher than the national average and 241 percent higher than the New Jersey rate for white mothers.  Black mothers make up 46.5 percent of all maternal deaths in the state, while white mothers make up 12.8 percent of maternal deaths. Black infants in New Jersey have a 223 percent greater chance of dying before their first birthdays than white babies do.

HPAE requests the DOH demand greater funding for infant and maternal health from the Legislature and Governor in an effort to combat this glaring inequity in health outcomes. To quote former Commissioner of Health Shereef Elnahal, it is time to end shameful health care disparities in New Jersey. We are better than this.

Thank you for the opportunity to bring our DOH budget priorities to you today.

 

References available upon request. Contact Heidi Hansen at hhansen@hpae.org.