jackson_pix-rehab__web.jpgMIAMI – Work has begun to draft a resolution for the Miami-Dade County Commission to create a “civilian oversight board” which will have advisory – but not veto – powers over how the Jackson Health System will spend $830 million to upgrade and expand.

The board was not mentioned in the ballot language for a referendum which voters approved overwhelmingly on Nov. 5 for a 30-year bond.
Jackson officials and county leaders, especially County Commissioner Audrey Edmonson say, insist the board will be created.
Edmonson told South Florida Times that the resolution to set up the board is being readied and will include its terms of reference and membership criteria.
“There is nothing firm as yet but I can tell you that there will be an oversight board,” said Edmonson, who spearheaded the move to put the referendum before voters.
Edmonson said the commission will look for “specific skills” in prospective members. “They will be people who can offer something to the board,” she said. “The intention is to keep politics out of it. They will be charged with analyzing everything and seeing everything is being done in a transparent way and funds are being spent in the way intended.”
The commissioner said reference to a board was not included in the ballot because of a limit on the number of words that could be included in the text.
Within Jackson’s governing structure, the board will rank third, with the County Commission still as the top decision-maker, followed by the quasi-autonomous Public Heath Trust which has general supervisory responsibility for Jackson, and employees at the bottom, according to a JHS chart.
It is not known yet how the powers and make-up of the board will compare with those of a 21-member “Citizens’ Advisory Committee” which the County Commission set up on April, 5, 2005, about five months after voters approved a $2.9 million “Building Communities General Bond Program” on Nov. 2, 2004.
“The Advisory Committee is established solely for the purpose of advising the Mayor, the Board of County Commissioners and the County Manager regarding the Building Better Communities General Obligation Bond Program,” that resolution said.
The commission did not extend any veto powers to that board and it is unlikely that it will do so for the team that will be appointed for the Jackson bond.
Generally, it is expected that the membership will track those of the Building Better Communities team. Members of that group were appointed by the mayor, each commissioner and the county manager. 
It will take time for the bonds to be floated and initial funds raised so work can start, Jackson officials have explained. But once the projects get underway, people can look forward to a comprehensive healthcare network which, its administrators expect, will be sustainable through economic efficiencies and attracting more of the lucrative business from high-paying patients.
Many of those patients currently go to rival hospitals and other medical service providers.
The plan calls for technology to get $353 million, followed by new facilities, and hospital upgrades, for which $150 million each is being set aside. A generic “other” has a $177 million budget.
Miami-Dade County has estimated that the average homeowner will pay an additional $6.20 in property taxes the first year of the bond, rising to $30.99 at the peak of the funds draw-down.
Jackson officials explained in a recent briefing with South Florida Times that the idea behind asking taxpayers for more than three-quarter billion dollars originated from an existential need to modernize the system and meticulous analysis of various components of Jackson to determine where the weaknesses and strengths exist – much like the way a business would do it.
The ballot language, which is the legal authority for raising and spending the money, specifies that it must be used for “modernizing, improvement and equipping . . . emergency rooms, children’s ambulatory pavilion and urgent care centers.” But Jackson has a lot of wiggle room in the words “but not limited to” in the ballot language, which probably explains the “other” in the system’s spending pie-chart.
In the case of the Building Better Communities bond, the referendum included eight ballot questions dealing with specific areas for which money was being sought. Voters approved all of them.
Jackson officials have promised not to spend any bond money until the advisory board is set up. When that happens, the first major project to be financed will likely be a new six- to seven-floor, 61-bed Rehabilitation Hospital costing around $70 million.
The Rehab hospital will replace the current outdated building and will be located on Northwest 12th Avenue, between 16th and 17th streets, in what is now the parking lot of the current facility which will be demolished. The new hospital is expected to open within 36 months after construction starts.
Jackson hopes it will “attract patients from across the U.S. and internationally.”
Another early big project will be a Children’s Ambulatory Pavilion to be located seven to 10 miles from the Holtz Children’s Hospital on a site still to be selected. Jackson is betting that this facility will build on Holtz’s revenues and reputation – Holtz is nationally ranked in six specialties – while helping to retain and recruit the best pediatric doctors.   
The Pavilion will take outpatient clinics, radiology and same-day surgeries for children into the community, Jackson says.
Holtz, which is located on the main Jackson campus, will remain the system’s children’s medical center. It will be expanded and the entrance will be relocated to make it more accessible and more kid- friendly.
Construction of the ambulatory facility and expanding Holtz will cost about $40 million.
Another $40 million will be used to establish an unspecified number of urgent care centers in areas where Jackson doesn’t already have them, especially near Medicare patients and also locations where patients in managed care will use them to help control costs as an alternative to expensive emergency-room visits.
Technology and equipment improvements, which will take a big chunk of the bond money, will include upgrading Jackson’s medical information system, especially for electronic medical records, that will link every patient and Jackson’s healthcare provider no matter what Jackson facility the patient goes to.
Jackson says its current software and configurations are outdated and a  project is already underway for their upgrade. The intention is to eventually install computers at every patient bed, with patients being able to use them, in addition to care providers.
“Clinicians, nurses and physicians can use the terminal to access the patient’s electronic medical record and documents in the room, rather than at the nurse’s station, and doctors can review radiological images directly with the patient throughout the health system,” Jackson says. 
Jackson will also spend about $51 million to upgrade its aging medical equipment, including cath labs where diagnostic imaging equipment is used to visualize the arteries and the chambers of the heart and treat any stenosis or abnormality found.
In addition, Jackson has already started upgrading patient floors, a project with an $85 million price tag which is being met with surpluses which the system has finally started to generate.
Modernizing the operating rooms and emergency department will cost roughly $65 million. The money will be used to improve the technology and layout of some facilities.
Less expensive plans include replacing and modernizing the decades-old building elevators, at a cost of $14 million, and using $16 million to improve and expand parking facilities as the system prepares for growth.
Jackson’s president and chief executive officer Carlos sees approval of the bond referendum as an indication that taxpayers, who own Jackson, “want to ensure the best future for our world-class health system.”
Migoya said in a comment to South Florida Times that Jackson is supporting the commission’s efforts to establish the advisory board “while starting the hard and vital work of carrying out these projects in a way that is transparent, professional and top-quality.”
“Over the next five years, Jackson will build an infrastructure that competes nationally and drives our long-term growth,” Migoya said.