http://www.freep.com/news/health/detrec30_20030630.htm

HOSPITALS IN CRISIS: Detroit health care nearing meltdown

Without money, Detroit Receiving must be shut down; the impact will be felt
statewide
June 30, 2003

BY PATRICIA ANSTETT
FREE PRESS MEDICAL WRITER

Detroit's health care meltdown is getting dangerously closer.

A month from now, if no new public money is found, six Wayne, Oakland and
Washtenaw county hospitals -- and many more around the state -- will feel
the crunch of about 60 patients transferred each day from Detroit Receiving
Hospital.

Receiving, the shiny red-and-silver building north of Detroit's downtown,
visible to the west as motorists head north on I-75, is a world-class
emergency hospital in a city with what is widely viewed as a second-rate
system of public health care for the poor and uninsured.

While many other major cities and counties help support hospitals like
Receiving, and offer dozens of clinics providing free care, Detroit has no
city- or county-supported hospital and only eight federally-funded clinics.

That leaves emergency departments -- notably Receiving -- as the main source
of health care for the poor. Forty percent of its patients are uninsured, or
have Medicaid insurance that pays much less than what the care costs.

Now the Detroit Medical Center is moving ahead with a consolidation plan to
close as many as 300 of Receiving's 320 beds, and to lay off as many as
1,000 workers at Receiving and the DMC by the end of July.

Three services would remain open at Receiving through the end of the year:
its busy emergency department; its 12-bed burn unit, one of only two in
Michigan; and its intensive care program. Anyone treated at Receiving
needing admission to a hospital would be stabilized, then transferred
elsewhere.

The DMC's Harper University and Hutzel's Women's hospitals will take some of
the transfers. Both are quickly accessible through a block-long, underground
tunnel to Receiving.

"But we are unlikely to be able to provide enough beds at Harper and Hutzel
to accommodate all the patients who need admission to a hospital," said Dr.
Brooks Bock, the longtime chief of emergency medicine at Receiving and its
affiliated Wayne State University School of Medicine. "So we'll have
patients on stretchers." Doctors and other workers then will begin calling
other hospitals to take the transfers.

Receiving and Hutzel, another money-losing DMC facility, will close Dec. 31
if a permanent solution is not found, DMC officials insist.

Six other facilities in southeast Michigan designated to provide high-level
trauma care will feel an immediate impact: Sinai-Grace, Henry Ford and St.
John in Detroit; Beaumont in Royal Oak; and St. Joseph Mercy and the
University of Michigan in the Ann Arbor area.

"We can't take the entire system down for two hospitals," said Gwen
MacKenzie, chief operating officer for the DMC. She oversees the health
system's plan to save $42 million through December by consolidating
services, laying off workers and shutting down programs.

The impact will be felt almost immediately throughout the region, and much
farther away for burn and other seriously injured patients, because no
Michigan hospital north of Flint is designated as a Level One or Level Two
trauma center by the American College of Surgeons.

"We've estimated that once you close the emergency room, the portal of
entry, you'd probably clear out the hospital in five to seven days,"
MacKenzie said. "It doesn't take much time once the decision is made."

Because pregnant women need to be assured of care at the time they deliver,
Hutzel most likely will begin telling women this fall they need to go
elsewhere if solutions aren't found. A firm date for that has not been set.
Twenty-five internal committees are working out plans for scaling back or
closing down the two hospitals, MacKenzie said.

It's anyone's guess whether state and local health authorities will find a
permanent solution by year's end. Either way, time is running out.

Solutions include:


Asking voters to approve a trauma tax, similar to those in many other
cities.

Selling or leasing the two hospitals to a regional health authority -- a
quicker, interim step.

Subsidizing Hutzel deliveries with direct payments from the state's Medicaid
program. The money now usually goes to health maintenance organizations,
which contract with the Medicaid program to provide care to pregnant women
in the program. They take a portion of the money for their own
administrative fees and Hutzel wants that money.
Promises and tentative plans won't be enough. A regional health authority
must be "up and running by Dec. 31" to keep the two hospitals open,
MacKenzie said.

'They always take good care of me'
Even on a relatively slow Tuesday morning last week, 10 people wait at 10
a.m. at Receiving's emergency department. The staff is highly trained and
conscientious. The furniture is worn and torn.

Only 15 percent of the 250 people who seek care daily at the hospital are
transported by ambulance. The rest arrive by car, foot and taxi. It makes
for an odd mix of patients, from those with heart attacks transported by EMS
crews to others lining up with problems insured people would take to their
own doctor.

Patricia Burns borrowed a pair of shoes and took two buses to Receiving, a 3
1/2-hour journey from her Conant Gardens apartment at Moross and Ryan on
Detroit's east side.

Several St. John Health system facilities are closer to her apartment, but
Burns says she prefers Receiving. She first went there eight years ago,
after relocating from a job in Memphis. She heard about Receiving when she
went to earn money by selling her plasma at a blood bank.

"Receiving is where the best doctors are," said Burns, 53. "They always take
good care of me."

For three months, Burns' legs and ankles have been swollen. It's gotten so
painful she can't wear her own shoes. She worries about blood clots in her
legs, or worse, amputation because of poor circulation.

Burns lives with three chronic diseases -- diabetes, asthma and high blood
pressure. She smokes 1 1/2 packs of cigarettes a week. She hasn't worked for
three weeks at her part-time job at a Home Depot store.

She has insurance through Wayne County's Plus Care program, and sees a
doctor at the Detroit Community Health Connection's East Jefferson clinic.
But the federally-funded clinic is largely limited to providing physical
exams, prescriptions and advice. Patients who need specialists or diagnostic
tests like ultrasound are referred elsewhere.

Burns' doctor told her to go to Receiving. By federal and state law, all
hospitals must evaluate any person who comes to an emergency department.
Those with true emergencies must be treated until their health is stable.

There is no similar requirement once a patient has been evaluated and
stabilized.

As surprising as it may seem, the United States, a country with the most
sophisticated health treatments in the world, relies on the goodwill of
doctors and nurses who call colleagues at other hospitals to accept
patients.

"We'll certainly try, and will find, hospitals to transfer patients for
inpatient admission," Bock said. But most will decline if a person is
uninsured or has Medicaid coverage, Bock said. "They are not any more
interested than we are in caring for patients without compensation," Bock
said.

"That's when we'll begin to have a little bit of a meltdown."

'We certainly need this one'
Bock has been with Detroit Receiving since it opened 23 years ago. He also
worked at its predecessor institution, Detroit General, a Detroit-owned
facility sold for $1 to the DMC when the late Detroit Mayor Coleman Young
decided to get out of the money-losing hospital business.

Receiving prospered for years, during a time when as many as 20 other
hospitals provided care in Detroit, and when hospitals billed private
insurance plans for payments greater than costs to offset the losses of
providing free care.

As hospitals closed and health plans put an end to cost-shifting,
Receiving's problems increased. In the past five years, Receiving, like
other DMC hospitals, has helped to make up for losses with money transferred
from an emergency account.

Bock favors a national health plan to provide basic health services to all
Americans. But given the high cost and unpopularity of the idea among
politicians, Bock prefers creation of a regional health authority to oversee
and pay for care of poor patients.

"If you go to Flint, you'll find Hurley Hospital that is funded in part by
the city," Bock said. "If you go to Chicago, Boston, New York, Atlanta,
Jacksonville, Miami, Tampa, Houston, Dallas and San Antonio, and I can keep
marching around the country, you will find that there are institutions, not
100-percent public funded, to provide resources for people without health
care.

Bock takes pride in the fact that Detroit Receiving provides the primary
medical school training for 256 new WSU medical graduates every year, more
than half of whom stay in Michigan to practice medicine. It is the place on
standby to care for visiting dignitaries, including the president of the
United States, if injured in Detroit. Receiving's Level One Trauma Center
designation also has played a role in the attraction of casinos, large
conventions and special events to Detroit. No one knows what impact the
hospital's closing would have on future events.

"I think there will be just a few too many things to pick up if we -- which
I hope and pray is not the case -- were to close," Bock said. "The community
will find an exceptionally valuable resource gone.

"This is a crisis that should have been addressed two or three years ago."

While she waits for test results, Burns echoes the same thinking. "Lansing,
Jennifer Granholm and Kwame Kilpatrick need to come up with a plan. They've
come up with a plan for everything else. Detroit needs a medical facility.
We certainly need this one."



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