Putting The Poor On The Street If Detroit General Closes, Where Will People Go?

Detroit General Hospital (DGH), which has been suffering for a long time from the city's developing fiscal crisis, is now facing a serious challenge to its very existence. If that challenge is successful, the first to feel it will be the people who depend on DGH for their health care needs-namely, Detroit's poor and disadvantaged.

The current economic strain has been met in the nation's urban centers by increased taxation and cutbacks of needed services. Though one would hope that government would not make people sacrifice their health in the name of fiscal austerity, that is what the situation amounts to n the cities.

Municipal hospitals nationwide are succumbing to the dollar crunch. Four hospitals were forced to close in New York City alone; nine California hospitals have also followed suit; Philadelphia Mayor Frank Rizzo recently closed his city's only municipal hospital- the only hospital that many working people could afford.

The financial problems of Highland Park General Hospital have been well documented. Since city funding could not prevent the deterioration of services there, the city has sought to turn the reins over to a private investment company before its targeted closing date in a few weeks.

Their most recent attempt to lease the facility was foiled when the proposed investor was found to be arraigned on bribery charges in Alabama.

Why the already burdened cities should have to hustle and scheme to provide health services to their people is a puling and tragic question.

THIRD PARTY PAYERS Detroit General Hospital was established in 1915 as a charity hospital, intended for use by the city's dispossessed. The City Charter states expressly in its Declaration of Rights that "the city shall provide for the public peace and health and for the safety of persons and property in the city."

What has happened since the drafting of this charter? Why is the city now forced to cut back on health services necessary to the prolonging of life (not to mention the corresponding slashes in city police and fire department budgets)?

The answer is a familiar one. The post -World War II flight of white people to the suburbs- along with their businesses and professional services-have left the central cities with a difficult problem: survival. The city can't afford to serve its people adequately without a firm tax base.

Specifically, the problems of DGH are the result of having to rely on the vicissitudes of the third-party payers-i.e., the federal and state governments through Medicare and Medicaid, and the big health insurance concerns like Blue Cross. Any cutbacks in aid to individuals from the government must be made up for with city dollars. The inability of poor and middle-income people to afford the ever-increasing costs of health insurance must also be met the same way.

High unemployment in the central city also means that fewer people are receiving worker's compensation or other employer-subsidized health-care programs.

All of this adds up to the city's decreased ability to operate DGH up to humane standards. . Thus, when a group of seventy-five hospital workers asked the neutral Joint Commission on Accreditation of Hospitals (JCAH) to investigate DGH in August of 1975, accreditation was denied.

MATTERS OF LIFE AND DEATH Denial of accreditation does not quite mean that a hospital must immediately close its doors. The hospital is given time to make reparations to bring its facilities up to code. The real danger is that the third-party payers will refuse to subsidize patient care in these hospitals. Lack of accreditation will also force Wayne State University to withdraw their personnel from the hospital; DGH is their primary teaching facility.

The Commission did not have to look very far before a list of 43 operating deficiencies were noted. These deficiencies, all but ten of which have been withheld from hospital personnel by the administration, serve to point up the shortcomings of health care n the municipal hospitals.

The SUN has secured a copy of the elusive JCAH report, in which the following problems are a few of those listed: general supply and linen shortage; failure to provide adequate nursing coverage; lack of a back-up power generator; medical records deficiencies;and an inadequate preventative maintenance program.

Other inefficiencies were divulged by a group of residents and nurses within DGH called the Detroit Commission for Better Health Care. According to one resident, conditions are so strained at DGH that doctors must make choices that can mean life or death to a patient. In a hospital with only five beds in the intensive care unit (ICU), decisions must be made concerning who "deserves" that priority and the elderly or chronically ill are sometimes denied.

Our own visit to the hospital revealed patients on life-support systems like respirators being cared for in a 12-bed ward. The delicacy of such instruments usually demands constant attention in a hospital's ICU.

Understaffing at DGH results in overworking of personnel. Nurses are required to work five weekends out of every eight. There is also no blood team at DGH, so that doctors and nurses are forced to run their own blood tests. The net result is, again, the diminished ability to serve patients' needs.

Further budget cuts ordered by the city have forced DGH to shut down its free ambulance service. The ambulances are the only way to and from the hospital for thousands of people with no other means of travel. On the average, 50 to 90 people a day had used the service for outpatient appointments and emergency care.

Their future, and that of the 20 employees who staff the service, is unknown.

WHERE WILL PEOPLE GO? The new Detroit General Hospital is under construction now in the Medical Center corridor and is slated for completion in 1978. It will specialize in emergency and trauma medicine only. The rest of the old hospital 's service load will be absorbed by the other Medical Center hospitals.

However, residents at DGH express their fear that the city's poor will find a less-than-welcome atmosphere when they invade the hallowed halls of private institutions like Harper, Hutzel, Ford, or Children's Hospital.

In fact, after the closing of DGH's pediatrics clinic, the promised absorption of their caseload by Children's Hospital is hardly a reality. A staff member in DGH told us that children in need of health care- but lacking resources to pay- are being turned away from an already crowded Children's Hospital. (The hospital says that a misplacement of records is the cause of this difficulty, and that it will soon be rectified.)

Various critics of the quality of care at DGH are suggesting that a "private benefit Corporation" (PBC) is the only answer to its woes. A PBC would disassociate the hospital from city control-both budgetary and administrative-and give over those duties to a semi-autonomous, non-profit Corporation.

Bud Brooks of New Detroit told the SUN that "there needs to be a strong movement towards extrication of the hospital from the city bureaucracy, giving it the flexibility to apply its judgment and firsthand knowledge." Brooks said that a PBC would enable hospital experts-not city administrators- to run DGH.

The main impediments to DGH's smooth functioning are the problems of budgeting and purchasing. "To acquire funds for needed supplies, the hospital administration must deal with five or six different city departments, all who have a limited knowledge of the situation," Brooks said. The same difficulties arise in hospital maintenance.

Another advantage of the PBC, according to Brooks, is that it wouldn't subject the hospital to mid-year budget freezes. The loss of ambulance service and city demands for personnel cuts are a few recent examples of that problem.

Brooks also pointed out that the incomes of other departments are controlled by the city itself - while the hospital's income is subject to the financial constraint of the third party payers. And while the Mayor and City Council alone judge the efficiency of other city ventures, DGH is evaluated by yet another standard- the Joint Committee on Accreditation.

"Furthermore, all other departments are staffed by city employees alone. The physicians in the hospital cannot be directed to do this or that," Brooks said.

A DEAFENING SILENCE Despite these administrative advantages, fears have been expressed about a PBC by concerned groups within the hospital. Their primary worry is that poor people, to whom DGH is a last refuge, will have nowhere at all to turn for health care. The PBC's possible incorporation in the Medical Center complex is no insurance against abuses of the indigent. Experience has certainly borne that out, with the closing of the pediatrics and gynecology departments of DGH.

The Medical Center complex is viewed by critics as an attractive nexus for research and investment. While the university and the individual hospitals would benefit therefrom, the patient would be- as is usually the case-the last priority.

One resident in the hospital also is concerned that civil service suffers now employed by the city will lose their job security and pensions.

"Where do you go for a job when you're sixty years old?" he asked.

Others say that civil service workers could use a jolt to their complacent working attitudes in the hospital. "All they have to do is to show up every day to hold their jobs," a DGH volunteer told us.

New Detroit has said that all of these problems can be handled if the switch to the PBC is made. But Hospital staffers remain skeptical. They are curious about the silence from the hospital administration and University officials. They fear that services will be allowed to decline to the breaking point-when the PBC will be seen as the only remaining option for DGH.

The Mayor is designated by the City Charter to have the final word on the future of Detroit General. However, the Common Council is clamoring for a voice as well. They will soon decide whether to place a Charter amendment on the ballot that will empower them to have an equal voice in the decision. As it stands now, they can only ratify the Mayor's decision, or override his veto.

Public hearings will be held in the near future on the DGH issue. Early indications seem to show a distrust of the PBC from both the mayor and the council. "The PBC is not a magic wand that would solve all of the hospital's problems," Councilman Clyde Cleveland said at a recent jurisdiction hearing.

Even if New Detroit-or anyone else comes up with a way to keep the doors open at DGH, there has still been no guarantee that patients without insurance or funds would continue to be accepted, or that other hospitals would take up the slack. The result could be that thousands of Detroiters will just have to stay sick or hurt-denied their health because the city has been denied the resources with which to care for them. And though the quality of that care at DGH may be below par, few would disagree that some health care is better than none at all.

David Weiss is the SUN 's staff writer.