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Critical Condition: another ailing inner-city hospital



The paint on the trim outside Jackson Park Hospital, located at the corner of Stony Island and 75th Street, is peeling, and its brick exterior badly needs tuck-pointing. The front lobby is a little dingy, certainly in need of renovation. But the shabby building is the least of the problems this 75-year-old south-side hospital has.

Like other hospitals in the inner city, Jackson Park is losing money--roughly $3 million a year. If the bleak financial picture doesn't improve, the hospital, which is still highly regarded, will have to close. "We are struggling--we are under great financial distress," says Peter Friedell, a cancer specialist and president of the hospital. "For the moment we're OK, thanks to good fund-raising campaigns. But we're running at a loss--and you can't keep that up forever. My chief financial officer says we have seven years."

The problem is of course larger than Jackson Park. The average city hospital loses $255 per patient, according to a July report by the Metropolitan Chicago Healthcare Council, even though admissions overall continue to fall. In the past several years, 13 hospitals have closed in Chicago, including four on the south side--Woodlawn, Englewood, Provident, and Central Community. At the moment just four city hospitals serve the area south of Hyde Park, where nearly a million people live.

"To sum it all up, our system of health care is all screwed up," says Quentin Young, a doctor and veteran political activist. "I have talked about a time when we will have no trauma units south of Northwestern Hospital [on the near north side]. What about no hospitals south of Northwestern to the city limits? It's a frightening thought."

The neighborhoods closest to Jackson Park Hospital--Chatham, South Shore--are flourishing middle- and working-class communities. But there are pockets of poverty nearby, and many patients come from the poorer communities to the south and west. Like so many other inner-city hospitals, Jackson Park can't find money to pay for indigent patients.

The treatment of poor patients is supposed to be paid for by medicaid. But over the years the federal government has cut back these payments, even as medical costs have increased. It may be more satisfying for doctors and nurses to treat people who can't pay, but there's no money in it. Treat too many, and you can't pay your bills.

The problem is exacerbated by the fact that these patients often need better health care than most. Friedell estimates that roughly 20 percent of the women who give birth at Jackson Park are drug dependent. "We have a large and growing problem with crack babies," he says. "The drug epidemic is a serious problem in many ways, including costs. It costs us twice as much to take care of a mother who's taking crack. Babies stay in the hospital longer--often three or four weeks--to be tested for clearance. As it is, we get about $520 a day for each day the mother is in the hospital. The average mother is in the hospital for 48 hours, so we get about $1,040 for each delivery.

"If that mother is sick because of drugs, there are added expenses: IV fluid, she may need blood transfusions, the child may need resuscitation and blood tests. All of that is supposed to come out of that $520-a-day payment. We don't get any extra. When you add all the additional care, it could cost us twice what the state pays us."

Since there's little financial incentive to treat poor patients, they receive less preventive care and counseling, which means they don't usually reach a doctor until an emergency erupts. By then it's either too late to offer comprehensive care, or the health costs are exorbitant.

"For many of our patients the first visit to the hospital is when they deliver the baby," says JoAnn Matory, the doctor who directs Jackson Park's newborn nursery. "We ask them why they didn't show up earlier, and they say, 'I did it this way last time, and everything went all right. So why go now?' I tell them, 'Well, you were lucky this time. But in the future, you wouldn't want something bad to happen that could be prevented.' Reaching pregnant teenagers is one of our biggest concerns."

A cynical competition has emerged between hospitals over choice "commercial" patients--that is, patients who are privately insured. "We'd like to get commercial patients--any hospital would," says Friedell. "There is competition." But Jackson Park is at a disadvantage in this competition. Its facilities are more than adequate. Indeed, its recently completed cancer wing is better than most. But many of its facilities--particularly its obstetrics wing--haven't been renovated in years. "Our obstetrics unit was built in 1913, and we can't afford to rebuild it," says Friedell. "Without a bright, shiny unit we can't get commercial patients to help offset our deficit. They go to Saint Bernard or Michael Reese or Mercy. They come for a tour of our ob unit--and that's it. They turn around and walk away.

"We'd like to modernize it, but that costs money we don't have. There're a lot of things we'd like to do. We'd like to paint the outside of the building. I'd say there's a half-million dollars worth of repairs needed here. But that money is going to be used to take care of our patients, and it will remain that way until the building falls down."

The money crunch also hurts Jackson's efforts to recruit doctors and nurses. "A lot of doctors will go to suburban hospitals because those hospitals can pay more," says Friedell. "I would say that inner-city physicians get paid a half to a quarter of what they would get in the suburbs. Physician recruiting is one of our hardest jobs. If we had more money we could get more doctors. The rewards are high here--the people really need our services. What frequently happens is that a physician comes here to start off and then goes somewhere else."

In the meantime, the poor neighborhoods around Jackson Park face a health crisis as violent crime and drug abuse continue to rise. "The emergency room faces an influx of 'self-pay' patients, which is a euphemism for 'no-pay' patients," says Friedell. "About 35 percent of our emergency-room patients are no-pay. They are uninsured, and medicaid won't pick up the costs. Their cost for treatment comes from the rest of the building."

The larger problem is that the hospital can't afford to get services to people that need them. "We'd like to reach more drug cases, particularly the young mothers," says Friedell. "It's difficult. One nature of a chemical dependency is denial of the problem. Unless you have a program to detect every single mother, you don't know."

With more money, hospitals could do better outreach and patients could take advantage of the hospital. "There's a tremendous need for better education," says Margo Brooks, vice president of development for Jackson Park. "Many people use the emergency room as a doctor's office. They'll show up there if they have an ear infection instead of going to the doctor."

It's gotten to the point where Jackson Park's mammography van makes almost as many trips to the suburbs as it does to surrounding neighborhoods. "Why do we take the van to Northbrook? Because people there take advantage of it," says Friedell. "It's a question of demand. I'll spend 15 percent of a visit counseling a patient on the need for a mammography. At other facilities the patients demand it."

One obvious solution to the money crunch is a nationalized health-care system similar to Canada's. But this idea is fiercely resisted by private insurance companies and doctors. So the status quo persists, which means bleaker days ahead for hospitals like Jackson Park, who will have to rely on the charity of private donors or changes in the political climate.

Several local politicians have advocated spending more money on health care for the poor. But few mainstream politicians--and no president since Jimmy Carter--have endorsed this concept. "It's much easier to get the state to build a White Sox stadium than to get more money for medicaid," says Friedell. "Those things [stadiums] generate some revenue. This only generates expenses.

"Paying taxes, on the one hand, I can see all the problems. On the other hand, our health problems don't go away. They only show up later when the kids go to school. Drug-dependent children, for instance, have neurological problems. These are the kids who will have learning disabilities. Isn't it better that we reach them as soon as we can? I don't know what else there is to say. The demand for health care far outstrips reimbursement. There are no easy solutions."

Art accompanying story in printed newspaper (not available in this archive): photo/Bruce Powell.

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