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A mission

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Florence Gray Soltys remembers when there was a plaque at N.C. Memorial Hospital (now UNC Hospitals) that read: "Operated for and by the people of North Carolina." Soltys, an associate professor in geriatrics at the UNC School of Medicine, has long been a part of that mission to serve all the state's people.

More than 15 years ago, she organized the Community Coalition for Better Geriatric Care, which led to the creation of a geriatric unit that reached across the hospital's disciplines.

Fast-forward to 2005. The geriatric unit was "falling apart," Soltys says. Fourteen social workers were laid off. As a result, elderly patients were being released and sent home on public transit without family members being informed.

Around that time, UNC Health Care began telling patients, when reminding them of appointments, that they had to make some payment up front. That scared many of them, Soltys says, and the number of no-shows at the university's clinics soared. When the coalition asked the hospital to address the problems, nothing happened. So, the group put together a petition noting its concerns about those problems and the system's emphasis on profits at the expense of the poor and uninsured, gathered 1,100 signers, went public and sent it to UNC system President Erskine Bowles. Bowles acted quickly, and the university's leaders immediately agreed the messages would make clear that care was available to all, regardless of ability to pay.

Soltys asked former UNC med school professor John Hammond to work with the coalition. Hammond had recently retired, partly out of dissatisfaction with the way healthcare was going. He joined the group in meetings with hospital leaders, heard what was being said, and read between the lines. He knew that top doctors and administrators were being offered financial incentives to improve profitability.

"The only way to do that was to reduce your care to poor patients—cut your losses on uninsured or poorly insured patients and then maximize your focus on those with insurance who can pay," he says.

Hammond went to work like an investigator, making public records requests to get lists of bonuses and other information. The results are in today's cover story; many of the documents backing it up are available online.

He expands his analysis beyond the hospital to the university itself. With rapid tuition increases, he says, "I saw on the university side the same lack of regard for the lower-middle-class student."

Hammond and Soltys both say they're after the same result. "Y'know," Hammond says, "I really like the place. It was very good to me. I just want it to be truthful to its mission, both in the university and the healthcare system."

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