By Anna Kirsch and Jim Anderson, AlterNet
Posted on October 17, 2007
All across the country, a new epidemic is threatening people's health -- the culprit is the closure of community hospitals and those most at risk are low-income and people of color.
"This is the hospital that I take my 94-year-old mother to. This is the hospital that I was born in ... this is the hospital that I take my nieces and nephews to, the hospital where most everyone in my community goes and where all my loved ones and family members have been and still get treated," said Jim Anderson, describing the Erie County Medical Center in Buffalo, N.Y., just one of many community hospitals across the nation that are slated to be shut down within the next year.
"This hospital is located in the heart of the black community here, and it serves any and everybody ... it has its problems, but the answer is not to shut it down," said Anderson, a New York correspondent for Poor Magazine and the PoorNewsNetwork (PNN), a grassroots media organization based in San Francisco dedicated to reframing the news and views around issues of racism and poverty.
I first heard Anderson speak in one of Poor Magazine's community newsroom meetings at the United States Social Forum in Atlanta this June, where he talked about the struggle he has faced in getting any sort of healthcare as a poor African-descendent man in this country.
As he spoke to crowd of folks struggling with poverty, racism and disability about the hospital closure crisis facing poor communities of color across the entire state of New York, one hand after another shot up in the air.
"The same thing is happening in ... New Orleans ... Nashville ... Philadelphia ... Los Angeles ... right here in Atlanta with Grady Memorial Hospital," folks from all over chimed in to share stories about their struggle to keep their community hospitals open.
Grady Memorial Hospital, which is the largest publicly funded hospital in the state of Georgia, was located just a few miles away from our meeting that day in Atlanta and is often referred to as the "only hospital that treats poor people."
Rev. Calvin E. Peterson, a formerly houseless, disabled man who was born at Grady Hospital in 1948 and also worked with the hospital on their accessibility plan, said that the entire poor, black community would be in an uproar if the state closed it down.
The hospital is facing mounting financial problems and could be closed by the end of the year if an agreement is not reached. This could leave thousands, such as Peterson, suffering and without a place to receive care.
Although Grady has been criticized by many for its inadequate services, if the state hospital could receive the much-needed funding -- that is currently being denied -- it could hire the necessary staff and make improvements.
Other folks expressed similar concerns for their own low-income communities all across the nation. Where would these people go for emergency treatment? What would happen to the hospital staff that had become an integral part of the community it served? Why couldn't a state-run "public" hospital get the necessary funding to treat residents?
As a person living without health insurance, I, like so many in this country, live in fear of facing any serious illness or accident, one that would put me in lifelong debt. Like Anderson and his family, I too am dependent on these community hospitals, and even though they are plagued with problems -- they are all we have.
Connecting the dots in Atlanta
"In Buffalo, some people are mistakenly thinking that this issue isn't touching anyone else, but in Atlanta I learned that this is not an isolated incident," said Anderson who explained that he believed the nationwide closure of hospitals serving communities of color is not a coincidence, but rather a calculated effort by the government to get rid of what it's calling a "surplus of unused hospital beds."
State governments all across the country are conducting "studies" largely behind closed doors to "restructure" healthcare facilities, which has resulted in numerous plans for closures and forced mergers.
For example, in New York, the Commission on Health Care Facilities in the 21st Century was created by the governor and is made up of 54 members, each appointed by either the governor, the senate or the speaker of the assembly. The commission was left with the task of "restructuring and rightsizing the healthcare industry" in the state and held most of tits meetings in secret -- a fact that has caused an uproar in local communities and caused two hospitals to sue.
With hardly any input from the community that would be the most affected by its decisions, such as the hospital workers themselves, the commission released dozens of recommendations in 2006 ultimately affecting the entire public hospital and nursing home system in New York. (The commission's full report can be read online.) In the Buffalo area alone, six hospitals -- almost all of which serve high needs communities of color, low-income people, disabled persons and seniors -- are slated for closure.
"Shutting down these hospitals will destabilize whole communities," said Anderson. "Smaller clinics are going to have to absorb the drop-off and they just don't have the resources to do so," he added.
Erie County Medical Center, like so many others facing possible closure in the country, definitely has its problems, including a serious lack of funding and staff. But changes, not forced closures and forced mergers, need to be made, said Anderson. The hospital has long been addressing health problems largely faced by the black community, like the high rate of heart disease, Anderson added, and has the best heart surgery survival rates in Western New York.
Hardly anyone would argue with the commission report's claim that the "healthcare system is broken and needs repair," however in the past, hospital mergers have created chaos and disastrous results in New York and other states. It's also interesting to note that the hospitals run by New York City's Health and Hospitals Corp. didn't face any closures or forced mergers under the commission's recommendations; the majority of hospitals that did are public, nonprofit providers.
Information from Health Care that Works reported that in New York City, "New Yorkers who live in predominantly minority communities face greater geographic barriers to accessing a hospital than those who live in predominantly white communities. These problems were made worse by the fact that six of the eight hospitals that closed between 1995 and 2005 were located in or near communities of color."
Most of these public hospitals are considered "safety net" hospitals, meaning they provide treatment to those who are uninsured and cannot afford to pay the full cost -- people like Anderson's family and mine. As more and more of these safety net hospitals, like Erie County Medical Center, close, it is less likely that people without insurance will be able to access any sort of medical care.
As a recent study conducted by a committee of interns, residents and directors of the Health Reform Program at Boston noted, "Hospital closings have harmed access to care -- particularly in underserved areas and communities of color ... the effects of hospital closings on access to care have been poorly studied and systematically downplayed by advocates of closing."
This is a fact that Anderson and other community members know all too well. When a financial crisis occurs in any industry, the poor are the first to face cuts in services. In America's longstanding trend of privatizing services that were once considered public, healthcare is the next in line. More and more, the truth is becoming that if you don't have the money, you don't get the treatment.
A nationwide epidemic
The story is the same all over the nation -- the most recent crisis occurring in South Central L.A., where the Martin Luther King Harbor Hospital will be closed. This historic hospital, which is predominately staffed by and serves African descendent folks, used to be a place of pride in the community, but has recently -- like Grady Memorial and Erie County Medical Center -- come under intense scrutiny for its care.
Now the emergency department at King has been shut down and the entire hospital is soon to follow. As Earl Ofari Hutchinson wrote for the L.A. Times:
The currently downsized King treats at least 100 emergency patients daily, nearly 1,000 in a week ... It has one of the highest emergency patient loads of any urban hospital. At one point, King provided sustained care for more than 10,000 patients, and it treated nearly 170,000 as outpatients. That equals the population of a small city. The U.S. Centers for Medicare and Medicaid Services, which cited King for deficiencies, has never stated that King was a threat to patients' lives.
Who are these patients the hospital serves? They are mainly African-Americans and Latinos who have a per capita income below the federal poverty rate. Many lack adequate private transportation. King is not one of the few options they have for medical care; it's their only option.
King served over 47,000 patients last year, now these patients will be forced to travel farther distances in life-threatening situations and overwhelm other already understaffed hospitals.
And where would these people go? Hutchinson writes:
In 2005, University of California researchers looked at hospital closures in L.A. County between 1997 and 2002. They found that the closures overwhelmed staff and facilities at the county's four general hospitals, which included King. The closures triggered a stampede of patients to doctor's offices, clinics and emergency rooms. They increased the time and distance that patients had to travel to get to a healthcare provider.
That meant that fewer patients saw doctors, fewer children had checkups, patients were less likely to seek and get preventive care, and there was a jump in the number of deaths from injuries and heart attacks. This virtually guaranteed that the number of people who suffered from acute illnesses would climb. These ailments are more costly to treat. In the case of King, there are even more deadly consequences. It treats more victims of life-threatening gunshot wounds than any other area hospital.
Across the country, the story is much the same. The hospital where I was born in Norfolk, Va., is facing serious downsizing and possible closure. Depaul Hospital, a nonprofit Catholic hospital run by the Bon Secours Health System that has been a fixture in my own community for over 150 years, is the latest target in the attack on community hospitals.
Now, in Virginia, just as in New York, a private advisory board called the Eastern Virginia Health Systems Agency, which was set up years ago, is about to release a set of recommendations early this month. The results could be disastrous for the local community, just like in Buffalo and Los Angeles.
Also similarly, the state is claiming this hospital must close or downsize to save money, yet it has been proven over and over again, by numerous researchers at places such as Boston University, that closing hospitals does in fact not save money. This fact seems to have been ignored by state governments all across the nation, as "financial reasons" is the claim most often stated by proponents of the closures.
Again, the solution does not seem to be to simply close this hospital's door, but rather provide better funding and develop more staff to meet the health needs of our citizens. As Anderson said, "We need to use these hospitals to train our own community members how to be culturally sensitive in their treatment and care of patients ... the opportunity for these hospitals to be successful exists if only we provide what's necessary. We are capable of doing our own analysis, our own studies, because in the end it's our loved ones who have been and will continue to be mis-served and underserved."
Anderson has a vision of not just preventing hospital closures but seeing a better community healthcare model.
"Imagine culturally sensitive, inclusive hospitals that are really capable of addressing healthcare needs by providing equitable quality care, diverse staffing, preventive healthcare and real community services," he said.
The possibility to save these hospitals does exist if only we, the community, refuse to be silenced and together create a vision for the future. These hospitals are meant to be for us and our communities, and we have all got to demand that the doors stay open and the facilities receive the proper and necessary funding to provide real care and service for people of all income levels.
"The real question to the public is: 'What are you prepared to do to stop these closures?' said Anderson. "We need people to share stories about what's happening in their hometowns with their own community hospital ... we need people to pay attention to reports and actions occurring in other communities, and people must challenge state and national political office holders to address this issue," he added.
It's time to demand a stop to the closures of community hospitals and, along with it, to demand a real cure for our hospitals and our healthcare system.
If a hospital is closing in your community, and you are interested in nationally organizing please email Anna (firstname.lastname@example.org) or Jim (email@example.com). Poor Magazine is an online news service dedicated to providing media access to communities of color struggling with poverty locally and globally, as well as scholarship on issues of poverty, racism, disability, immigration and youth justice from people who struggle with and resist these positions of oppression every day.
Anna Kirsch is a graduate of Poor Magazine's Race, Poverty and Media Justice Institute and is a PNN community journalist. Jim Anderson is race and poverty scholar, community activist, social justice advocate and PNN New York Correspondent.