For over a year Dr. Robert Griffin kept saying that Advocate Health Care was driving Ravenswood Hospital toward extinction. All that time Advocate kept saying that Griffin was wrong, that it was committed to maintaining the hospital.
But last week Karen Kansfield, vice president of business development for Advocate's North Side Health Network, made it clear that Griffin was right. "Yes, the hospital's on the market," she said. "We consider this very regrettable, but Ravenswood Hospital will no longer exist."
Griffin, an internist who's been on a leave of absence for more than a year, takes no satisfaction in having been right, particularly since 650 employees will lose their jobs and yet another north-side emergency room will close. "I'm not out to prove something," he says. "I want to change the way these medical companies operate. It's become a business, not a profession. And we're seeing the results."
According to Griffin, the rise and fall of Ravenswood is symbolic. It was created in 1907, at a time when local hospitals were community cornerstones, like the local parish, parks, commercial strips, and banks. "Among the local hospitals," he says, "Ravenswood was one of the best." By the early 1990s it was certainly one of the largest, occupying 7.5 acres at the corner of Damen and Wilson. It had more than 450 beds, a nursing school, a 12-story student residence, a 6-story ambulatory-care unit, a psychiatric department, and trauma, rehab, oncology, and coronary-care units. "Ravenswood Hospital Medical Center has grown and prospered for 75 years in an admirable manner because it never has lost sight of its basic commitment--to meet the health care needs of the community and the people it serves," hospital leaders wrote in a 1982 pamphlet celebrating the hospital's 75th anniversary. "Adhering to its commitment has enabled Ravenswood to endure through four wars, the Great Depression, social upheaval, increasing government regulation of the health care industry and the explosion of medical technology."
Yet by the mid-90s Ravenswood was struggling, a victim of local and national trends. The surrounding community was gentrifying, and the new residents--with fewer allegiances to local institutions--apparently didn't mind driving across town for medical services. Ravenswood's reputation suffered a major blow in 1998 after emergency-room staff allowed a boy who'd been shot by gangbangers to bleed to death outside the hospital. HMOs also were limiting hospital stays in order to cut expenses, and the state and federal governments had cut back on medicare and medicaid payments.
That's why many doctors at Ravenswood, Griffin included, were pleased when Advocate bought the hospital in 1998. "Advocate said they would improve the services of the hospital, and I had no reason not to believe them," says Griffin. "Advocate itself was a merger of several evangelical hospitals, including Lutheran General and Christ Community. Ravenswood was the seventh hospital in their system. The purpose of the merger was to make Ravenswood better by connecting us to a larger network of services."
In 2000 Advocate made another big move, merging Ravenswood with Illinois Masonic to create the North Side Health Network. For a few months in the spring and summer of 2000 Advocate leaders met with Ravenswood residents and activists to assure them that their hospital would prosper under the new arrangement. "[We have] a genuine interest in maintaining and enhancing access to the full range of health care services for community residents," John Blair, CEO at the time, wrote in a letter to the Reader following a story on the merger. "While different inpatient services will be offered at each main campus, the full range of health care offerings provided today will be available after the proposed merger is completed....Our goal remains to serve as a viable community resource for many years to come."
But many Ravenswood doctors were skeptical, particularly Griffin. They'd seen the fall of other local hospitals, including Martha Washington and Columbus. "We needed to see more specific plans," says Griffin. "We needed a greater reassurance that Advocate was not simply intending to transfer staff and services to Masonic in order to sell Ravenswood for other purposes."
Within a few months of the merger, hospital staff began to complain about cuts. Beds were removed, floors closed, doctors shifted to Masonic. In early 2001 Griffin took a leave of absence. "There was no way I could continue in good conscience while they closed Ravenswood," he says. "I can't care for sick patients and have my mind clear enough to deal with the kind of stuff we're talking about. If this is what medicine has become, I don't want any part of it."
The courtly and soft-spoken Griffin seems an unlikely activist. But over the last few years he's been tenacious, firing off memos to residents and doctors, accusing Advocate of plotting to close down Ravenswood even as the company insisted it was doing everything possible to keep it open. "I suspect that Advocate thought that most of Ravenswood's patients would follow their doctors to Masonic," he says. "I don't think they had any intention of keeping Ravenswood open. The things they did are unconscionable. They closed the emergency room to ambulance service. Are you telling me this community doesn't need an emergency room? What happens when some of these other hospitals have to turn ambulances away?"
Advocate's administrators denied Griffin's charges and accused him of being simplistic. "I am aware of Dr. Griffin's lengthy memos and communications over many years, which can be generally summarized as 'Advocate deceived us, the problems impacting Ravenswood Hospital are all Advocate's fault, and we want to go back to the good old days,'" Kenneth Rojek, North Side's CEO, wrote in a March 2002 letter to the Ravenswood Community Council. "He also acknowledges little knowledge or interest in the current economics or financial realities of health care."
Last week Advocate said those realities had caught up with it. "For the past year we have been working very hard to make Ravenswood successful," says Kansfield. "Despite all those efforts, it continues to lose $1.5 million a month. In the calendar year 2001 it lost $35 million. Over the past ten years it's been well documented that there has been a decreased need for full-service hospitals. The north-side market is overbedded--there are too many beds and not enough patients to fill them. It's as simple as that."
Kansfield says Advocate hasn't decided what to do with Ravenswood. It's now renting one wing to the Chicago Institute of Neurosurgery and Neuroresearch, which has managed to build a thriving practice even in this era of health-service cutbacks. It may continue to rent to CINN and other health providers, or it may sell the whole complex to the highest bidder, or it may do a little of both. "It's confidential because the buyers aren't chosen yet," she says. "It's a bidding process. Beyond that I can't comment."
But she will say that Griffin doesn't speak for most Ravenswood doctors. "I think he's just one of many people with many opinions," she says. "I could provide you with other people with different opinions." So she had Dr. Jose Elizondo, chairman of Illinois Masonic's department of family medicine, give me a call.
Elizondo says Kansfield's right when she claims Advocate did everything it could to save Ravenswood. "It's sad to see that Ravenswood is closing its doors," he says. "But I've seen enough in Chicago with medical economics to recognize that things just need to be done sometimes. There was no alternative." He adds that Griffin is misguided: "It's admirable that he has this mission, but I think that from my perspective he should move on and try to see how he can better utilize his resources to help the community in other ways. Perhaps his energies could be targeted on projects that are doable."
Griffin says he'll continue making his case to politicians, activists, doctors, and residents, trying to persuade them to pressure Advocate to keep Ravenswood open. Last week he sat in the doctor's lounge at Ravenswood doing just that. "Advocate says they've lost $35 million," he told the doctors there. "I don't know how much they lost. In this day of creative accounting, who can argue? But I understand they did lose money. Of course they did. They took away the hospital. How can you make money out of an empty building?"
As doctors wandered in they greeted him warmly and nodded in agreement. "Bob's the only one with the courage to speak the truth," one of them said. "We can't speak openly because Advocate might retaliate, but Bob's fearless. He's Don Quixote--he's crazy, but he's the only one who's sane."
"Advocate's losing money because they mistakenly thought our patients would follow us to Masonic--and that's not happening," said another doctor, unknowingly echoing one of Griffin's lines. "A lot of patients figure, 'If I've got to go out of the neighborhood, why stop at Masonic? Why not go a little farther to Northwestern?'"
Afterward, Griffin strolled through Ravenswood's closed wards. "The hospital's in great shape--it's not leaking, it's not peeling," he said. "Are you telling me this has to go? What a waste. What are we going to do when in a few years we realize there's a need for more beds, for more emergency rooms? We will regret having destroyed this hospital."
He stopped at a room on the fifth floor that was deserted except for the folded-up metal frame of a bed. Someone had left a textbook, Human Sexuality: A Nursing Perspective, on the floor. "I don't buy any of their excuses," he said. "They say medicare and medicaid have been cut. Well, what did they do to stop that? Can you imagine what a force for good Advocate could be if they used their money and political connections to point out all the defects in our system? If you keep working within a defective system, everyone loses, particularly the patient. The things they list as reasons for their demise are what they should be fighting, not going along with."
He entered another room, which had a lovely view of the neighborhood and, in the distance, the Sears Tower. "They'll probably make a fortune selling this for real estate," he said. "They call it progress. I call it a shame."
Art accompanying story in printed newspaper (not available in this archive): photo/Jon Randolph.