Hospital Viability and Closures

96 Presentation HOSPITAL VIABILITY AND CLOSURES THOMAS W. CHAPMAN President Greater Southeast Community Hospital Washington, D.C. During the last several years, the debate over hospital closures continues to plague those concerned with assuring adequate medical care for the underserved, even as little concrete evidence is available about the impact of hospital closures on access to and outcome of medical care. The emphasis we place upon hospitals in contributing to human well-being is natural; hospitals are great temples of mysticism. The two greatest human events in life occur there—birth and death. This reality alone gives hospitals tremendous societal power and responsibility. During the past decade, demands and needs increased for hospitals to render primary care to the poor and uninsured. But over time, the hospital's role in providing primary care to low-income populations has become too exclusive in many communities. The fact that hospital closures have received so much professional interest and are so important to low-income populations reflects a great distortion of misplaced attention. Hospital closures are distressing symptoms of a health care delivery disease that is causing widespread debilitation in the provision of health services. My vision is that there are three phases of health care development: 1. Anarchy—the era of cottage industries, which are unsystematic and highly individualistic; 2. Competition—the era of adolescence, characterized by duplication, waste, elaborate resources, and tremendous inequities; 3. Collaboration—a period when continued limitation and reduction in resources creates a great equalizer and forces providers of health, education, social, and other human services to work together. This new combination of skills and idea will produce significant progress. When will this era of collaboration begin? After the 1990s. The 1990s will be a decade of destruction and disassembling of the current system. Signs and indicators already point in that direction. Our health care delivery system represents vast waste that we as a society can no longer afford. It makes no sense Journal of Health Care for the Poor and Underserved, Vol. 1, No. 1, Summer 1990 Chapman 97 that in any given city, one hospital makes huge profits and another ten blocks away goes bankrupt. People receiving complex life-saving procedures costing megabucks reside in communities where others have no access to $25 primarycare visits. There must be massive pain, pressure, and crisis in the 1990s to gain the attention, ethical awakening, and creativity of public and private leadership to help us take the great leap into the era of collaboration in the year 2000. A personal perspective Before I venture too far on this topic, I would like to share some background on the service area of my hospital, so you will have a better understanding of my perspective. Greater Southeast Community Hospital (GSCH) is a 450-bed, full-service community hospital located in southeast Washington, D.C. The hospital lies in the heart of Ward 8 in Anacostia, adjacent to Prince George's County, Maryland. We have a wide range of community programs available to the population in our service area. The Ward 8 neighborhood is known to television viewers throughout the nation, through the recent feature on the ABC television program Nightline and other programs, as the center of the drug and murder epidemic in Washington, D.C. The ward also has the highest levels of teenage pregnancy, school dropouts, and drug abuse in Washington. In 1986,20 Washington hospitals reported 1,521 cocaine-related emergency room admissions. One year later, in 1987, the same hospitals reported 3,380 such admissions, a 122 percent increase. PCP-related admissions climbed from 2,216 in 1986 to 4,241 in 1987, a 91 percent increase, and heroin admissions jumped from 1,199 to 1,647.* Statistics from the two police precincts that serve Ward 8 show a 107 percent increase in murder and other crimes against people in 1988.2 In addition, Ward 8 has the distinction of having: • the lowest median household income in the District of Columbia— 117,00O3; • the highest concentration of households in poverty—22 percent4; • the most subsidized housing—22 percent5; • the highest unemployment—22 percent.6 In 1987, Ward 8 had a population of 75,000, half of whom...