Resident Physicians Take Action Against Increasingly Common Barrier to Healthcare: Hospital Closure
By: Lena Carleton, MD
Edited by Quincy Moore, MD
On a windy summer day in late August 2020, doctors, nurses, medical students, elected officials, and local activists gathered outside of Mercy Hospital and Medical Center (Mercy) in Chicago. Less than one month earlier, Trinity Health, the Michigan-based owner of Mercy with an annual operating revenue of $18.8 billion and assets of $30.5 billion, had announced that the hospital would close as early as February 2021 after a planned merger with three other South Side area hospitals fell through.(1) With masks on and signs raised, the crowd began a call and response chant: “They say Mercy must close - We say hell no!”
Mercy Hospital and Medical Center is a 363 bed hospital located on the South Side of Chicago. According to the 2019 Community Needs Assessment published by Alliance for Health Equity, Mercy’s service area covers over 25 square miles and includes 1.1 million people (39% of Chicago’s total population), more than 80% of whom are underserved or uninsured.(2) Founded in 1852, Mercy has become a vital institution for Chicagoans who have been systematically marginalized by the city’s laws and infrastructure with respect to housing transportation, education, and other community-sustaining institutions. For the mostly Black residents of the South Side, Mercy has been a pillar of stability in a community plagued by divestment.
Activists that showed up to fight for Mercy voiced a message of community investment. The way you build a community, they argued, is by investing in the basic quality of life institutions - schools, parks, grocery stores, and hospitals. Conversely, the way you cripple a community is by defunding those same institutions. Other speakers expressed outrage over the announcement of a hospital closure amidst a global pandemic that has disproportionately affected Black & Brown communities like the ones Mercy serves.
In an article published in Becker’s Hospital Review, Mercy Hospital President Carol Schneider was quoted as saying, “The decision to discontinue services at Mercy Hospital was not an easy one. But patients on the South Side have unmet needs within the current system...The transformation from an inpatient model to one with greater access to outpatient services will better address the disparate outcomes in health from which our community suffers today.”(3) However, to date, no detailed plan has been presented as to the scale or scope of this outpatient center. Furthermore, research regarding urban hospital closures does not support Ms. Schneider’s assertion that hospital closures, complete or partial, can lead to better access to outpatient services.
According to a 2015 study in Applied Clinical Informatics investigating patient dispersal after the closure of St. Vincent Catholic Medical Center in New York City in 2010, hospital closures can have devastating impacts on local and regional healthcare infrastructure and outcomes.(4) For communities losing their closest hospital, this not only translates into difficulty in accessing care, but has also been associated with higher rates of readmission and longer transport times to the nearest facility. This time difference can be especially important for individuals experiencing a cardiac arrest, stroke, or traumatic injury.
Hospital closures can also have regional effects that negatively impact the healthcare ecosystem of a city or county. For emergency departments, an unprecedented and sudden increase in the number of patients can lead to longer wait times and crowding, which adversely affects patient outcomes. Changes in ED volume can also affect the Emergency Medical System, as ambulances that would have gone to the closed hospital are rerouted to the next nearest hospital. This can cause a domino effect, whereby patients whose home hospital is the “next nearest” hospital are also shunted away from their home institution due to crowding. Mercy’s neighboring hospitals are already bracing themselves for a spike in patient volume.
As resident physicians from University of Illinois Chicago and Loyola University who were rotating at Mercy Hospital learned of the planned closure, they were concerned not only about the loss of a training site, but also about the devastating impact this closure is sure to have on the South Side Chicago community. Residents joined with community members to organize protests, circulate petitions, and voice their opinions at local government hearings. In reflecting on resident efforts to save Mercy Hospital, Alexia Armenta, a PGY2 at UIC Emergency Medicine and one of the resident organizers, said “Many of us went into medicine to give back to the communities we serve. We can’t do that without a hospital, so what better way to help the community than to fight for one of its pillars? As residents, we work directly with patients in this community, so we know their needs, and as physicians, we have the respect of community leaders, so it’s our duty to use that influence to advocate for our patients and the community. We are in a unique position to show the people at the top how important Mercy truly is.”
On December 15tth 2020, the fight over the proposed closure of Mercy Hospital came to a head when the issue went before The Illinois Health Facilities and Services Review Board, which must approve any hospital closure. In a surprising outcome, The Board voted unanimously to reject Trinity Health’s plan for closure, thereby delivering a win for patients, community activists, and resident physicians alike.
As of this writing, the future of Mercy Hospital remains uncertain, though closure is highly likely as Trinity Health has doubled down on their rhetoric and reiterated their intention to close. If Mercy Hospital does close, it will join 134 hospitals that have closed their doors over the last 10 years.(5) As emergency physicians, we have the unique privilege and responsibility of treating all patients who walk through the hospital door regardless of ability to pay. We also see the devastating impacts of individuals in our communities who lack regular access to healthcare. We have an obligation to advocate for greater access to care for our patients, and similarly, to protest removal of care. The battle to save Mercy Hospital represents a model of how resident physicians can work with patients, community leaders, and elected officials to fight against powerful business interests and protect access to care for hundreds of thousands of community members.
References:
https://www.mercy-chicago.org/Workfiles/CommunityNeedsAssessmentFY19.PDF
https://www.beckershospitalreview.com/finance/chicago-s-mercy-hospital-to-close-in-2021.html
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4377569/
https://www.shepscenter.unc.edu/programs-projects/rural-health/rural-hospital-closures/