Whose Hospital Is It?

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http://www.motherjones.com/news/feature/2004/05/04_402.html

 

Whose Hospital Is It?

 

MCP Hospital didn't have any celebrity doctors or slick ad campaigns. All it had

was a 150-year history serving its Philadelphia neighborhood--and in today's

cutthroat health care industry, that's no longer enough.

By Arthur Allen

 

May/June 2004 Issue

 

Gregory Gay was born 21 years ago at the Medical College of Pennsylvania

Hospital (MCP), a venerable community hospital in Philadelphia's East Falls

neighborhood. He was shot six blocks away on January 24, not long after Tenet

Healthcare Corp. decided to close the hospital. Tenet, the second-largest

for-profit hospital chain in the United States, was in the process of shuttering

or selling a quarter of its more than 100 hospitals nationwide. As it waited for

a judge's permission to shut down MCP, the company was slowly withdrawing

services, closing floors, and letting the staff fade away through attrition.

 

 

When police and paramedics arrived moments after four bullets pierced Gay's body

that icy Friday night, he was fighting for his life and lucid enough to give the

names of two men who had shot him. But instead of zipping up Henry Avenue to

MCP, the ambulance raced to Temple University Hospital, some 20 minutes away.

MCP's struggling emergency room was on " diversion " — temporarily closed to new

patients—that night, as it had been for much of that month. Gay died less than

an hour later.

 

Gay's death, one of many in the violent North Philadelphia streets whose sick

and wounded feed the hospital, has become part of a lawsuit seeking to keep MCP

open while charging that Tenet neglected its obligations to the city. (Tenet

management refused to comment for this story.) Of course, it is uncertain

whether Gay would have survived even had the hospital been fully operational.

But the closing of MCP, a community hospital in every sense of the word, would

clearly mean more hardship for thousands of its neighbors. Symbolically, in the

minds of the hospital's defenders, Gay's death has come to stand for the deaths

to come—not only the gunshot wounds, but the asthma attacks, the strokes and

embolisms and diabetic comas that are likely to be aggravated by new delays and

complications.

 

Not that MCP's fate is unusual. Tenet has closed three hospitals during its five

years in Philadelphia; over the past decade, four other North Philadelphia

hospitals have shut down their inpatient units. Nationwide, according to data

compiled by the federal government and Modern Healthcare magazine, more than 560

hospitals have closed since 1990—clobbered by stagnant reimbursement rates from

government and the insurance industry, rising malpractice rates, skyrocketing

prices for drugs and medical equipment, and increasing numbers of uninsured

patients who can't pay their bills.

 

Still, when Tenet tried to shut MCP, it hit a particular nerve. The hospital,

whose 70,000 potential clients ranged from homeless crack addicts to the

governor of Pennsylvania, has become a local cause célèbre. This is partly

because Tenet has blossomed into the Enron of the hospital business, notorious

for creative accounting and outsize payouts to its executives. It is a corporate

behemoth whose entry into Philadelphia in the late 1990s was subsidized with

generous tax breaks because of the city's desperate need to save hospitals then

on the verge of bankruptcy. The struggle to keep MCP open, in other words,

embodies a frightening larger story about the decline of health care in the

United States.

 

By a strange paradox, we live in a time in which scientific breakthroughs are

revolutionizing American medicine, while the system for caring for the majority

of the population seems to be breaking down. " As a microdelivery system,

medicine provides increasingly exquisite molecular elegance, " says Eliot Sorel,

a professor of psychiatry at George Washington University School of Medicine and

the former president of the D.C. Medical Society. " As a macrodelivery system, it

is falling apart. "

 

All across the nation, doctors and other health care providers are battling

thick layers of bureaucracy and crushing financial burdens to deliver care.

" We're watching the meltdown of the medical system, " says Dr. Donald Palmisano,

the president of the American Medical Association. " We have a broken medical

liability system, price-fixing on Medicare and Medicaid, and managed care has

such monopoly power in many states that the physician has no power to negotiate

a contract. " Nurses have also been leaving their field, creating serious

shortages that imperil care. " I advise all my patients before they go into the

hospital, " Palmisano's predecessor at the AMA, Dr. Yank Coble, recently told

Medical Economics, " to take somebody with them. A friend or relative will

increase safety more than anything else, especially in these days of nursing

shortage. " According to a 1999 Institute of Medicine report, as many as 98,000

people die in hospitals each year as the result of medical mistakes,

making such errors—often caused by staff shortages and overwork—the eighth

leading cause of death in this country.

 

A growing number of hospitals are facing an even more fundamental crisis: They

simply cannot make ends meet. The price of a pint of blood went up 30 percent in

just one year; a CAT scan machine costs $1 million. Malpractice insurance rates

have been rising at vertiginous rates—20 to 30 percent nationally, and 40 to 50

percent in some areas, including Pennsylvania. The MCP emergency room has seen

its malpractice rates increase from $18,000 to $40,000 for each doctor in five

years.

 

And even as the cost of caring for patients has increased, a decade of payment

cuts from insurers as well as the government—especially Medicare and Medicaid,

the public programs designed to provide coverage for the elderly and the

poor—has pushed hospital finances into the red. In Philadelphia, Medicaid now

pays only 75 percent of the cost of patient care, leaving hospitals and doctors

to absorb the rest. In his fiscal year 2005 budget, President Bush has proposed

another $2 billion cut in federal funding for Medicaid, and Medicare

reimbursements are failing to keep up with costs. " Hospitals, " concluded a

recent report by the American Hospital Association, " are bearing the cumulative

impact of a series of forces that are beginning to erode the foundation of the

essential public service they provide. "

 

 

 

 

 

 

 

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