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Vol. 66, No. 2 2015
Northeast Florida Medicine
From the Executive Vice President’s Desk
First, do no harm. This is a meaningful philosophy that is
often (incorrectly) attributed toHippocrates.While your Hip-
pocratic Oath does include the promise “to abstain fromdoing
harm,” the philosophy of Primum non nocere is meaningfully
different. It implies that before you begin an undertaking,
you must understand
that the outcome must
be to do no harm. As a
result, sometimes doing
nothing is better than
doing a thing which
will cause harm. This
philosophy is applicable
to all walks of life, not
just the medical field.
One that immediately
jumps to mind for me
is politics. One of the
most perplexing aspects
of politics, from the
Elementary School PTA
to the U.S. Senate, is that there is a seemingly unavoidable mo-
mentum that at all times you must be doing SOMETHING.
You have been there: a meeting where there is no obvious threat
or action which needs to be taken, yet the group decides to
debate and initiate a policy or rule that seems either rushed or
short-sighted. Whether it’s a factor of a single leader pushing
a specific agenda or a matter of the group needing to justify its
existence, I know you’ve seen this happen. The result is often
ill-advised policy which actually does more harm than good.
Let’s look at the flip-side to the argument. There are legiti-
mately times when doing nothing is the thing which can cause
harm. In these instances, you are obligated to do SOMETHING
in order to help prevent the harm… if you believe in the
Pri-
mum non nocere
maxim.
So how do you know which scenario you are in? Physicians
spend years in medical school and clinical training in order to
be able to make these critical determinations with patients. The
clinical expertise of a trained physician is the most important
factor in a patient’s treatment that determines the course of
action which does no harm.
Politicians don’t get this same level of training. In fact, with
term limits in effect in Florida, often lawmakers are forced to
align themselves with powerful factions before they even are
sworn into office. They sign “pledge cards” to leaders who they
will vote into leadership years into the future. The result is that
individuals can have tremendous power…enough power to do
very real harm.
That’s what happened in May when the Florida House of
Representatives shut down more than three days early over a
$5 billion budget impasse. The core issue of the budget dispute
is healthcare funding. The Senate budget included the Florida
Health Insurance Exchange (FHIX) which would expand
Medicaid by $2.8 billion in the next fiscal year, utilizing state
regulations for Medicaid Managed Care. The Senate proposal
also includes $2.2 billion in Low Income Pool (LIP) funds
from the federal government. This money is distributed to
hospitals to help offset the cost of uncompensated care, specif-
ically in safety net hospitals and teaching hospitals which have
legitimate reasons for being less efficient (training, population
demographics, etc).
The House budget refuses to expand Medicaid or to ac-
cept federal LIP funds. House leaders say they refuse to take
“Obamacare” money. To make matters even more complicated,
Gov. Rick Scott, once opposed toMedicaid expansion, changed
his mind in 2014 to support Medicaid expansion. However,
just weeks ago he changed his mind again to say he is opposed
to the expansion. He’s also suing the federal government for
the release of the LIP funds.
The Centers for Medicare and Medicaid Services (CMS)
have refused to expand the LIP program in Florida without
the expansion of Medicaid. A Navigant Health study of
Florida’s hospitals shows that, in actuality, both sources of
income will be needed to care for Florida’s uninsured and
underinsured populations.
The issue is of critical importance in Northeast Florida. UF
Health Jacksonville stands to lose $95 million from its budget
if the LIP funds are not renewed. Hospital CEO Russ Armi-
stead has stated in several news reports that if the funding is
not received, the hospital will be forced to close or dramatically
reduce services within six months.
What’s good for UFHealth Jacksonville is good for the entire
Northeast Florida Medical community. UF Health is the only
Level One trauma center in the region. If the hospital were to
close, those 1.2 million ambulatory visits, 90,000 emergency
room visits, 35,000 admissions and 4,000 serious trauma
cases, many of which are uncompensated, would go to other
facilities in town. We would also stand to lose the 360 medical
residencies at UF Health.
The closure would have a dramatic impact on the Jacksonville
economy as well. UF Health is home to more than 5,000 jobs
and is the largest minority employer in the city.
One would hope that each of the parties involved in this
political mess would understand
Primum non nocere
, but their
actions don’t seem to reflect that knowledge. Choosing not to
take care of these patients will cause harm. Choosing not to
support our safety net hospitals will cause harm. Forcing tax-
payers to face higher hospital costs and insurance premiums to
cover higher uncompensated care will cause harm.
As the special session gets underway, I hope our leaders will
choose to believe that they, too, are charged with
Primum non
nocere
, and that they will work together on a compromise to
ensure they are, in fact, doing no harm.
v
Bryan Campbell
DCMS Executive Vice President
Primum non nocere (A Plea for Politicians)
