The Voice of the West Village (NY)

September 05, 2011

The Politics of Life and Death

Who survives? Who doesn't? It depends on who you are—and where you live.

By George Capsis

Monday, September 05, 2011


Photo by Maggie Berkvist

Photo by Maggie Berkvist

A SAFETY NET NO MORE: Doctors at a demonstration against the closing of St. Vincent's Hospital in April 2010.



For more than a year, in the fight to return a hospital, I have found myself reading articles and learning directly from doctors and nurses about the imperfect state of medical services in this city. When Dr. David Ansell, author of “County: Life Death and Politics at Chicago’s Public Hospital," appeared on Leonard Lopate’s WNYC program on July 13, I learned that the whole country is marching in lockstep to what the doctor believes is a flawed system.

In 1978, just out of medical school and as a young idealist, Dr. Ansell went to work for Cook County Hospital, designed to take all of Chicago’s poor blacks, Hispanics, immigrants “and other undesirables.” The hospital was condemned in 1927 by the American College of Surgeons, but continued to stay open. (Dr. Ansell and a fellow young doctor took to releasing their frustration in Lincoln Park howling sessions.) As he recalled, “we were overwhelmed by the conditions we met.”

What Dr. Ansell discovered then — and what he believes is true today — is that we have a tiered health system. On the lowest level are the poor and uninsured — the result of public policies that treat poor minorities as expendable — followed by those with Medicare and then moving up through the well insured and rich, who can select their hospital, primary care doctor and specialist. He practiced at County from 1978 to 1995, what he termed “Third World patient care” — “Doctors within Borders.” In the 1980s, he ran the walk-in clinic, which in his book he admits was the “most challenging and disturbing job of my career.”

Dr. Ansell, 59, is currently vice president of clinical affairs and chief medical officer at Rush University Medical Center, a teaching hospital affiliated with the new Cook County Hospital, which opened in 2002. He warns that young medical students like his daughter are eschewing primary care for the better-paying specialties. That means that those of us on Medicare, which will be cut shortly, may not be able to find highly qualified specialists, who don’t take Medicare. And as a result, we may have a shortage of plain old GPs.

Dr. Ansell, an epidemiologist and primary care physician, gives an example of a system designed for failure: the treatment of cardiac arrest (when your heart stops beating). You have four to eight minutes to brain death. In an e-mail, David L. Kaufman, M.D. of the Coalition for a New Village Hospital, elaborated, “four to seven minutes to save muscle and avoid being a cardiac cripple.” If you can’t get to the hospital in time, or the walk-in walk-out clinic isn’t equipped “to resuscitate and properly treat you, in those six to eight minutes you have dead muscle or a dead patient,” continued Dr. Kaufman.

Dr. Ansell introduces us to a new term, “patient dumping” — getting rid of poor, sick patients by transferring them to public hospitals — which was endemic in the early 1980s across the country. He cites the case of a woman in labor, with the baby emerging, who was sent to Cook County after a “wallet biopsy” (i.e., she had no insurance). Dr. Ansell and his colleagues produced a definitive study exposing this practice, which was instrumental in ending it.

Then to my surprise, Dr. Ansell spoke of the closing of the Brooklyn Catholic hospital system that had served the poor and uninsured. Lopate jumped in, pointing out that St. Vincent's closed even though it was not in a poor neighborhood, and now it will become luxury condos. What he failed to point out, wrote Dr. Kaufman, is in fact, St. Vincent's was a safety-net hospital, where over 65 percent of the patients had Medicaid, Medicare or were uninsured.

Asked for a solution, Dr. Ansell decried that the Obama healthcare bill was deeply compromised by keeping the private insurance companies “exactly in control of things,” and we should have a single payer system. Two days later, Dr. Ansell appeared on WNYC’s “Fresh Air,” hosted by Terry Gross, and he further explained, “It falls short of equity. Take the Medicare card your parents have, give it to everybody, figure out how we pay for it and manage the cost. That would be the fairest way…it’s never been an issue of money. We are paying for it now in many different ways. It’s the cost of inefficiency, emergency care, end stage disease, not doing prevention.”

He quoted Winston Churchill on whether we would ever get it right: “You can always count on Americans to do the right thing…after they have tried everything else.”

As I was writing this, I got a call from a young woman in Assemblymember Deborah Glick’s office returning my e-mails and several calls asking for a meeting to get Glick to at last speak out and demand a return of a hospital. I found myself quoting Dr. Ansell with increasing intensity and volume. I was told in effect that Glick would not see me – ever.

Not one of our politicians has agreed to an in-person interview regarding the need for a new hospital for the Lower West Side. Politicians invite the press before they are elected and avoid them after they are elected.

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