They are known in the trade as Southern Fried Hospitals, the extraordinary empire of health care facilities run by the Hospital Corporation of America. Founded by a man who made his fortune on Kentucky Fried Chicken, HCA has developed in the past decade into the world's largest hospital chain, with 343 health care facilities, about48,000 beds in 39 states and five countries and yearly profits of $81 million.
Now it is making its first move in Maryland, as the Prince George's County Council considers a plan put forward by County Executive Lawrence J. Hogan that would have HCA lease and operate the county-owned hospitals and nursing home. To Hogan, the plan is a last-gasp effort. He says the facilities suffer from inefficient management and should either be leased and run by professionals or closed.
Hogans's plan is facing strong opposition on two fronts. Despite HCA's record of success in saving a number of struggling hospitals, many of the poor and elderly in Prince George's fear loss of local control will bring restrictions on charity care there. At the same time, county council members are distressed that Hogan has written the lease in a way that would ban all abortions at the hospitals.
More than 100 citizens, mostly elderly, are expected to protest the proposal at a final public hearing on the issue tonight.
"The poor people of the county won't get what they need," said Dorothy McNeill, 69, chairman of the Hospital Emergency Action League, a Prince George's group opposd to the lease. "It's a big organization and they're going to look out for their shareholders."
The proposal calls for HCA to run the Prince George's General Hospital and nursing home in Cheverly, the Greater Laurel Beltsville Hospital and the Bowie Health Center, paying the county an annual rent of $3.4 million, plus property taxes. In addition to a down payment of $9 million, Prince George's officials estimate the county will receive yearly revenues of $8 million, plus 60 percent of any profits exceeding HCA's normal profit margin.
In contrast, notes Bill Brown, county finance director, the system lost $168,476 in the year ending in June and has asked for $3 million in extra money for the coming year.
One of the biggest selling points in HCA's proposal, and cause for concern to citizen groups, is a pledge that charity care at the facilities will cost the county no more than$500,000 annually.
This would be a large savings to taxpayers, as charity costs for Prince George's General alone, the largest provider, ran $756,071 last year.
William White, HCA's vice-president for acquisitions, says the company can limit county costs without turning patients away. This is possible, he says, because improved management will attract more private, paying patients, thus raising profits.
Mark Kleiman, director of the Washington-based Consumer Coalition for Health, questioned White's claim. "They've tightened admission requirements and kept out the poor patients that way," he said, citing a 1979 Georgia Legal Services study showing low amounts of charity care in six HCA hospitals there.
"The publics (public hospitals) got tagged with inefficiency, when it's really that they are losing money because of treating the poor," Kleiman added.
Critics of the lease cite two incidents to confirm their suspicions that HCA will give short shrift to poor patients. In one case, an Alabama HCA hospital dropped from a state certificate any reference to its promise to provide charity care in coming years. The hospital comptroller said this was an oversight that subsequently was corrected.
An attorney for Legal Services of Alabama said the correction was made only after her group discovered the ommission and threatened to make a public issue of it.
Opponents of the lease also cite the recent practice at HCA-managed George W. Hubbard Hospital in Nashville, Tenn., of charging patients $26 at the front desk before they are admitted. Members of the Nashville Black Community Forum, Urban League and NAACP described the policy as an "insensitive, anti-cultural and probably illegal practice" in a May 1981 letter of protest to the hospital.
White said the preadmission deposits were the idea of the hospital's board, and not of the director, who is the only HCA employe.
"We told them the public would resent it," he said.
White conceded his firm does carefully check the eligibility of charity cases, rejecting many who received free treatment under former managers.
"There are stories of people driving up in Cadillacs and Mercedes, coming for free care," he said.
He said that in the Prince George's lease, as with all the hospitals HCA runs, charity, Medicaid patients and low-profit hospital services like rape centers are continued.
Because of centralized purchasing, headquarters-trained managers, improved billing and cutting out the "political bureaucracy," White said, HCA is able to make money despite "these opportunities to expand our social conscience."
Councilwoman Ann Lombardi, who opposes the lease, says not all the council members have decided on the issue and several object to Hogan's eagerness to settle the issue quickly.
Hogan may have sandbagged the lease, Lombardi said, by inserting the clause prohibiting abortions at any of the hospitals.
"I did it because I believe government should not take life," asserted Hogan, who said he will "cross that bridge later" if the antiabortion clause is a roadblock to approval.
"If we don't get out of the hospital business, there aren't going to be hospitals to run," Hogan said. "It's only financial sense and it's got to be done."