Resurrecting Bethany

Update on Bethany (3/31): IL Facilities Planning Board public meeting

Bethany is believed by Christians to be the hometown of Lazarus, a man Christians believe Jesus (peace be upon him) raised from the dead. It is a town not far from Jerusalem and in Christian history is also associated with other important events in the life of Jesus (peace be upon him). Today the site is called Al Ayzariyah, Arabic for "the place of Lazarus."

Today, Advocate Bethany Hospital is at the center of a brewing controversy in Chicago, over Advocate's plan to convert Bethany from a hospital to a long-term acute-care facility. The 150-bed hospital is on Chicago's West Side and serves a primarily indigent minority population in the Lawndale neighborhood.

I did a pediatrics rotation at Bethany in my third year. The attending ran a very busy outpatient clinic at the hospital and we got to see kids come in with all the usual complaints (runny noses, fevers, strep throat, hernias, immunizations) as well as things one tends to see more of in the inner city (asthma, lead poisoning from paint chips, developmental delay from maternal substance abuse during pregnancy). We also got to see newborns in the nursery and frequent lectures on various pediatric topics. It was a great hands-on experience with an excellent attending and I'd love to see the hospital stay open.

Advocate officials, however, expect Bethany to lose over $20 million this year and it may continue to lose money over the next three years. Advocate claims that economic realities have forced them to find new ways to utilize the hospital in a sustainable manner. This led them to the plan to convert the site into an long-term facility that provides acute care for chronically ill patients, making it the first such facility in the area. They also plan to establish a Bethany Community Health Fund to promote health and wellness.

The question, however, that opponents of the plan, led by the Service Employees International Union (SEIU), have is whether or not Advocate allowed Bethany to wither away by failing to invest enough resources into it. Advocate is the largest hospital network in the Chicago area and quite profitable, making over $140 million last year. Local community activists argue that the bulk of such money is put back into Advocate hospitals in more affluent, suburban locations and that Advocate isn't doing enough to serve the indigent, in keeping with its nonprofit status and mission. Essentially, they blame Advocate for "racial redlining" by not investing in its city hospitals that largely serve uninsured black patients.

Cook County Commissioner Forrest Claypool, who is challenging John Stroger for the Democratic nomination to Cook County Board President, has called for hearings and asked for Governor Blagojevich to intervene. Claypool argues that, "Advocate's precipitous decision will leave a huge gapping hole...It will send hundreds of patients to already overtaxed hospitals."

Activists also argue that Advocate was trying to circumvent state authority by shutting down certain services without state approval. In addition, they feel betrayed by Advocate because it made comments, prior to approval of a $200 million plus expansion project at Lutheran General, suggesting it would continue to invest in its city hospitals.

As a result of all the controversy, Advocate is planning to hold a public hearing on Tuesday, March 21, at 10 a.m. at The Bilandic Building, 160 N. LaSalle in Chicago. Some are upset, however, by Advocate's decision to hold the meeting in the Loop, and not the West side neighborhood, which would have enabled more area residents to attend. Moreover, it is being held on the same day as the primary elections, which would require people to take even more time out of their workday to attend.

I'm against Advocate's plan, both because it limits options for the underserved and because it takes away an important teaching site for our medical school. Moreover, Advocate is well-known for aggressive collection practices from its patients and a "for-profit" mindset despite its nonprofit status and mission. It is not a particularly generous nonprofit, all things considered.

And has it really exhausted all options in saving the hospital? Could better partnerships with local community and religious organizations have helped improve things? Could reinvestment in Bethany have made it attractive enough to attract higher income patients moving into the near-West Side?

I realize it is hard to tell someone to continue running a facility that is losing $20 million per year. And there are other questions that complicate this discussion. For instance, do nonprofits have a duty to provide charity care and, if so, to what extent? Doesn't the state have a greater duty to provide for the care of the uninsured?

In the meantime, what do you tell the over 60,000 residents of the area that they will lose their hospital? Join the long lines at Stroger? Hope the heart attack/stroke/ketoacidosis doesn't kill you in the meantime?

Additional Sources:
1. It's My Mind blog - where I got the Crain's link