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Is This Healthy?

Ravenswood and Ilinois Masonic hospitals may merge, but some worry that good business isn't the same as good medicine.

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By Sergio Barreto

John Blair, CEO of Ravens-wood Hospital for the past 12 years, has been getting an earful from employees and local residents ever since he announced a proposed merger between Advocate Health Care, which owns Ravenswood, and Illinois Masonic Medical Center two weeks ago.

Employees are worried about their jobs. "Advocate says they can find us another position or we can get severance," says obstetrics nurse Eva Peroulas. "But they don't say whether we can still get severance if they offer us, like, a third-shift position and we refuse to take it."

Area residents are worried about possible service cuts. "Everything they do seems to be dictated by the profit motive," says former Ravenswood Community Council president Ralph Karsten. "Two years ago they absorbed Ravenswood Hospital so they could refinance millions of dollars' worth of debt--and now here they go again."

Blair has taken great pains to point out that this isn't just a merger between his hospital and Illinois Masonic, but that the two are the biggest hospitals in what Advocate envisions as a new "multisite health-delivery system for the north side." He explains, "The driving factor behind the deal is declining reimbursement, from federal and state government as well as HMOs and PPOs. Although we have cut our costs, we're projected to lose $24 million over the next five years. At Illinois Masonic that figure is $30 million over the same period. That's not a viable economic model."

On average only 65 percent of Ravenswood's 306 beds and 72 percent of Illinois Masonic's 542 beds are full. Hospitals around the country have been facing the same problem, and over the past few years they've been consolidating in an effort to be more efficient. Chicago, says Blair, has been lagging behind that trend. "The north side is probably the most overbedded area in the nation, except maybe for Manhattan Island. You're going to see more of these kinds of deals in Chicago in the future."

One such deal is already happening on the near west side, where Rush-Presbyterian-Saint Luke's Medical Center, the University of Illinois at Chicago Medical Center, and Cook County Hospital are mulling some kind of service consolidation. "We can't speak for other hospitals in terms of a trend, but we are looking at six or seven areas of service in which we can collaborate with the University of Illinois hospital and Cook County," says Rush-Presbyterian spokesperson Chris Martin. "It just seems that some form of collaboration makes perfect sense, with the close proximity between us and other hospitals in the medical district."

But Ravenswood, at 4550 N. Winchester, and Illinois Masonic, at 836 W. Wellington, are roughly three miles apart. The Lakeview community would lose nothing under the proposed deal, because Illinois Masonic would keep all of its current services. But Ravenswood would lose its comprehensive emergency room--which would be downgraded to a "basic" emergency room that's unable to receive 911 ambulances--and the only inpatient services it would offer would be in mental health and rehabilitation.

These proposed changes alarmed people who live near Ravenswood Hospital, which is somewhat ironic given that it's the hospital that allowed Christopher Sercye to bleed to death two years ago, saying its emergency room wasn't properly equipped to treat gunshot wounds. Hospital employees were even more upset to learn that roughly 700 staff positions would be eliminated.

The possibilty of a merger--a final decision won't be made until July 1 at the earliest--was reported in the Tribune on January 18, but nobody in the community seemed to notice. The Ravenswood Community Council found out about the deal a month later and quickly began to study its impact. "We got on the Internet to do some research," says the group's executive director, Richard Hankett. "We weren't surprised to find out that there was a lot of overlap between the services offered by the two hospitals--the only differences were that Ravenswood didn't have a trauma center, while Illinois Masonic didn't have a chaplaincy. What we were surprised to find out was that Ravenswood ranked higher than Illinois Masonic on most services."

That ranking came from HealthGrades.com, a Web site that analyzes the inpatient records of medicare recipients around the country and compares patient discharges from various hospitals. It shows that when 13 respiratory, cardiac, orthopedic, and neural-system procedures were compared, Ravenswood topped Illinois Masonic in everything but its treatment for pneumonia. The RCC concluded that people who lived near Ravenswood would not only have to travel farther to get treatment, but that the treatment they got might well be inferior.

When the merger proposal was formally announced on March 31, the RCC scheduled a community meeting for April 3 at McPherson Elementary, on North Wolcott. More than 200 people turned out. RCC vice president Harriett O'Donnell asked 12 specific questions about the deal's impact on area residents and hospital employees. Instead of answering the questions, Blair read a prepared statement. "Advocate is a faith-based, value-driven organization," he said. "I can assure you that the most financially advantageous arrangement is not what we are seeking. We are a community partner."

After he finished, residents asked more questions and offered comments. Representatives of the Lakeview Action Coalition and the Lakeview Ecumenical and Interfaith Clergy Association welcomed Advocate's willingness to add a chaplaincy at Illinois Masonic. "We have been very frustrated with Illinois Masonic's refusal to allow in-house chaplaincy," said James Dunkerley, pastor of Saint Peter's Episcopal Church. "We'll be very happy to work with a faith-based organization like Advocate, which will allow us to address the spiritual needs of patients." Some Ravenswood residents and community groups, including the Organization of the NorthEast, also welcomed the proposed deal.

But most speakers criticized Advocate. For a while no one answered their questions, though Blair seemed to be listening carefully and RCC directors wrote the questions on a board. After a half hour or so Eva Peroulas yelled, "When do we get some answers? There are enough questions on the board." People in the audience shouted that they too wanted specifics. What was a "basic" emergency room? What kind of rehabilitation services was the hospital planning to offer?

Hankett pointed out that the RCC had booked the school's hall for only another half hour and said it probably wouldn't be possible to get answers to everyone's questions that evening. He said all the questions had been recorded and would be answered at another meeting, to be held after Easter. That caused a lot of grumbling.

Finally Blair took the stage again and said he'd try to answer some questions. He defined rehabilitation services as physical rehabilitation for people who, for example, had had a stroke. He confirmed that 911 ambulances would have to go to Illinois Masonic. He said he couldn't guarantee that everyone would be eligible for severance pay, nor could he answer several other questions. People in the audience groaned in frustration.

"When I came to this meeting at 7:30 my goal was to be alive by 9," Blair concluded. "I think I've accomplished that. I promise this will be the first of many community meetings, and I will make an effort to answer all of your questions."

After the meeting Peroulas and a clerk at Ravenswood, Sharon Blackwell, described how the hospital staff had reacted to the announcement of the proposed merger. "They told us not to take any drastic measures, but everyone's sending out their resume," Peroulas said. "It's confusing--I love my job and my coworkers, but everyone's scared. Some people are taking second jobs at different hospitals as a backup plan; others are quitting." She said Swedish Covenant, Edgewater, and Weiss Memorial Hospital are "hearing a lot from Ravenswood employees."

"We don't think they're dealing in good faith," Blackwell said. "We think they're gonna make us quit by offering positions we don't want and then saying 'Sorry, you can't get severance because we found you a position and you turned it down.' We already had two supervisors quit."

On April 6 and 7 the hospital held six meetings at different times to accommodate employees on all shifts. During the first meeting one staff member asked Blair, "Aren't you going to apologize for what you're going to put us through?"

He replied, "I have nothing to apologize for."

Peroulas, who attended the 10 AM meeting on April 7, asked Blair how the proposed new Advocate organization would be staffed. He said that the best employees from Ravenswood and Illinois Masonic would be selected by management based on a number of criteria--customer-service skills, skills needed by the new organization, past performance reviews, and seniority. He said that staff members would not be forced to take a position they didn't want in one of the many suburban Advocate sites. "We'll be considerate of everyone's personal needs."

But he refused to guarantee that everyone would get severance pay. He tried to dispel some fears by explaining that eliminating 700 positions over five years didn't mean that 700 people would lose their jobs. "Two years ago when Advocate merged with Ravenswood, we eliminated 200 positions but only laid off six people. When we say 'eliminate positions' we mean consolidating services, not firing people."

Asked if the merger would make Ravenswood primarily a provider of mental-health and rehabilitation services, Blair said yes. "Ravenswood is the number one provider of mental-health services on the north side," he added. "The goal is to build on our strengths." He acknowledged that the plan was to consolidate all inpatient services in one of the hospital's buildings and vacate all the others. "Those buildings can then be used for senior-citizen housing, which the neighborhood so badly needs."

"You say these plans aren't final, but they sure sound final to us," complained a nurse.

"What if the plan doesn't go through?" said Blair. "What if the books aren't right, or something isn't what it looks? The deal can fall apart. And then how am I going to backtrack out of everything I've been saying? I live in fear of that. Of course I want the deal to go through, because I think it's the best thing for all of us. But there's no guarantee it will happen."

If the plan went through, he added, the eight-figure losses Ravenswood had projected over the next few years would drop dramatically. Within four years the hospital would be running a surplus that would grow to $12 million by the fifth year.

After the meeting Blair said, "I'm encouraged that community reaction to the proposed deal has been thoughtful. You heard people and groups making positive statements. This isn't about Lakeview versus Ravenswood. With employees, the issues are a lot more personal."

Asked whether the staff was really ready to quit in droves, Blair replied, "It's not happening across the board. In the weeks to come we hope everyone will agree that this move has great potential for employees and will enhance our ability to serve the community."

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

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