Michael T. Regan
BYE-BYE BABY: Northeastern survived yellow fever and influenza epidemics, but the current health-care crisis may prove fatal.
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On a winter's morning, with a thick sky and snow falling, everywhere is northern light, and all the colors are true. A mother waits with her son for the 60 bus; deliveries arrive at Johnny B's pizza. A bulldozer beside a small hole in a massive asphalt parking lot is still, lonely as the adjustable basketball hoop in the side yard on Memphis Street.
Across the way, Northeastern Hospital, too, waits, its fragile financial state a matter of a national health-care system in crisis, its fate in the hands of a Temple University hospital "task force," names unrevealed, documents sealed. "I think they have no idea what they're doing," says state Rep. John Taylor (R-177) last Tuesday night to a bristling group of community activists, union organizers, doctors and nurses in the basement of the Samuel Recreation Center on Gaul Street in Port Richmond. "Only they feel like they have to do something drastic." Rumors have been circulating for a month that Temple will close the hospital or cut the number of beds from 231 to 40 or 50, or the O.R. and/or the maternity ward will be shuttered.
Northeastern, a restrained piece of neoclassical civic architecture with the look of a small city's high school, was erected while many doctors and nurses were in Europe treating the victims of World War I. In 1918, as the American war effort decisively expanded, workers completed a third floor addition. It was just in time and not nearly enough. By October, the flu that had made eight million Spaniards sick had migrated to Philadelphia. On October 10, a week into the influenza epidemic, there were 5,531 new cases of the flu, 361 deaths; doctors prescribed whiskey and hospitals like Northeastern overflowed. With 12,191 deaths and almost 50,000 reported cases, Philadelphia would be hit the hardest of any city in the U.S.
Influenza traveled particularly efficiently through Philadelphia's intimate alleys and working-class streets. It wasn't supposed to be that way. Indeed, Philadelphia was designed as an act of public health. To avoid fire and epidemic disease Penn's original city provided space for generous squares and side gardens. A century later, a much more crowded and dirty city was thought (wrongly) to be the cause of a widespread epidemic, yellow fever. Prodded by the outspoken and willful physician Benjamin Rush, the civic response was forceful. A hospital was created for victims; a Board of Health was formed. Still, yellow fever claimed nearly one-tenth of the city's population.
The present public-health crisis that threatens Northeastern isn't an epidemic. The worry isn't the city's capacity to respond to disease. Rather, it's the opposite: the prophylactic care of pregnant women and newborn babies. In 2008, doctors at Northeastern delivered 1,753 babies, nearly one in 10 born in Philadelphia. Since 1997, 12 neighborhood hospitals or maternity wards have closed, leaving Northeastern as the last community hospital in Philadelphia to provide maternity care.
It's a "disaster waiting to happen," says Albert Pizzica, the outspoken director of Northeastern's newborn nursery. Pizzica, who also runs five pediatric practices in the city, is a latter-day Benjamin Rush, who sees a medical emergency in the abandonment of maternity care. "This community needs obstetrics," he says, explaining that when Temple closed the maternity wards at Episcopal Hospital (in 2001) and Jeanes Hospital (in 2007), they claimed the university's main hospital on Broad Street would absorb them. It didn't; those families went to Northeastern, where Pizzica says births have tripled since 2003. (Attempts to reach Northeastern's CEO John Buckley were deflected to a public relations specialist who had not returned a phone call by press time.)
"I'm very, very concerned," says City Councilwoman Maria Quiñones-Sánchez, "we're a community with only one hospital." Though the hospital is located in Councilman Frank DiCicco's district, many of Northeastern's patients live in Quiñones-Sánchez's 7th District. "This is very important," she says, in part because her district's population is growing.
"It's a public-health question that needs to be answered by Temple," says Pizzica. "If Northeastern closes, where are deliveries going to go? Who is going to take public-health responsibility?"
The answer, left to a patchwork of medical centers and teaching hospitals, private insurers and government programs, is that maternity care doesn't rate. (Einstein Medical Center says it loses $2,000 per birth.) "We're coming up short at the state level paying for the delivery of babies," says Taylor.
Indeed, reimbursements are poor compared to other specialties, explains Letty Thall, public policy director for the Maternity Care Coalition, a group formed in the 1980s in response to Philadelphia's high infant mortality rate. The Coalition runs the "MOMobile" service for low-income women.
Thall says the Northeastern crisis is only part of a larger health care landscape that favors technological intervention over well care. Philadelphia lacks maternal-including prenatal services; there are no nonhospital birthing centers, for example, even though 70 to 80 percent of births are low risk. "There's an assumption that babies should always be delivered in hospitals. Really, it should be a wellness service," says Thall.
But Northeastern's patients are disproportionately poor and therefore less likely to have accessed prenatal care. A high percentage of obstetric patients end up in the operating room. Some, according to Pizzica, wouldn't make it to a hospital far away.
Temple, which receives state and federal funding for serving a low-income population (so-called "disproportionate share" allowances, worth $120 million to Temple since 2004), has an obligation to the community, according to Jerry Silberman, whose union, the Pennsylvania Association of Staff Nurses and Allied Professionals (PASNAP), represents the nurses of the Temple health system. Silberman, who has run two "save Northeastern" strategy meetings, including the one last Tuesday in Port Richmond, explains that despite Northeastern's fragile financial state, Temple has received enough extra funding to turn a net, subsidy-enhanced profit eight years straight, about $19 million a year. He carefully notes their investment in new corporate offices and other nonpatient projects. And he reminds community members that when Temple wanted to purchase adjacent land in 2005 to expand Northeastern, they gave their support. Now, he says, "We want respect — a seat on the task force, transparency and for Northeastern to remain a full-service hospital."
"We have a chance to drag Temple into something that's for their own good," he proclaims, meaning that if given the chance, doctors and nurses, community members and advocates like the Maternity Care Coalition who are currently shut out of the discussion, can help improve the hospital's financial standing.
In 1918, as influenza spread down Allegheny Avenue and nearly every-where else in Philadelphia, The Philadelphia Inquirer questioned the atmosphere of fear and panic. They recoiled against the public-health regulations prohibiting crowding into streetcars and gathering in unventilated rooms. To Philadelphians they wrote, "Do not even discuss influenza. ... Worry is useless. Talk of cheerful things instead of disease." To Silberman and the other organizers of the campaign to save Northeastern, Temple's posture is just that: Don't worry — and anyway, stay out of our business.
Pizzica, the neonatalogist, says that makes this the time for the city to assert its native concern for public health. He points to the city's Department of Public Health, the bureaucratic descendent of Benjamin Rush's Board of Health, and addresses his "friend" Donald Schwarz, Philadelphia's public health commissioner. "Why aren't you saying what Al Pizzica is saying? What are you doing, creating Calcutta here? This is not bullshit anymore. This is people's lives."
