Healing Reads: The Year's Five Best Books

County: Life, Death and Politics at Chicago's Public Hospital 
by David A. Ansell

F. Martin Ramin for The Wall Street Journal

'Patients with toothaches, loose teeth, oral tumors and mouth abscesses lined up in painful silence during the dark hours of the early morning… some in wheelchairs, others with canes and crutches raced to get to the Oral Surgery clinic to win one of the 50 prized slots that guaranteed a dentist would see them.'

From his start three decades ago as a resident at one of America's oldest and most battle-scarred public hospitals, the author daily confronted the issue that plagues the nation's health care to this day: how to deliver quality medical services regardless of race and income.

One of a group of idealistic young doctors in the 1970s, he worked in an antiquated, dirty facility that was the first to serve blacks and immigrants—but was infested with rats and cockroaches and still treated patients in open wards with no air conditioning.

"We were practicing Third World Medicine in Chicago…I shudder to think how many patients I may have harmed or killed because we could not diagnose or treat them quickly enough." But the doctor is inspired to carry on by the dignity, strength and resolve of the patients who come from violent and crime plagued neighborhoods.

The hospital is often a pawn in Chicago politics, as the staff fights the dumping of patients from other hospitals who refuse to treat the uninsured, and provides care on the front lines of the early AIDS epidemic. There are some triumphs, like a new breast-cancer screening program. But Dr. Ansell, now chief medical officer at Rush University Medical Center, warns that efforts to achieve health equity still have a long way to go.

Listen to Allan Chartock, from WAMC, Northeast Public Radio, talking to Dr. Ansell about what it means to be an internist (about 50 minutes).

Posted on August 27, 2011 by pagesofjulia

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

By George Capsis

Monday, September 05, 2011

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.

Front Page - Friday, July 15, 2011 - Chattanooga, TN

The Bookworm

Terri Schlichenmeyer

Exercise. Eat right. Quit smoking. See your doctor. Your stay-well regiment is pretty easy. You’ve made those four steps into habits, you pay attention to your body, and you’ve managed to stay (mostly) well. You want to live a long, healthy life. But what if you get sick – really sick – and need serious medical care? Will your insurance cover you? Do you have insurance?

Throughout much of his career, David A. Ansell has cared for people who don’t. In the new book “County: Life, Death and Politics at Chicago’s Public Hospital” he writes about frustration, changes, triumphs, and patients he remembers.

For as far back as he can recall, David Ansell had a “soft spot” for the underdog, the downtrodden and the overwhelmed. He recalls being a young man, elated to find people that shared his beliefs on civil rights, the Vietnam War, and the environment. He became an activist.

So when he went to med school, it was with an eye to helping people who needed it. Upon graduation and in preparation of Match Day, he and a group of like-minded housemates deliberately chose Cook County Hospital in Chicago for their residency because the hospital accepted the uninsured and the underinsured, and because they believed that health care was a right, not a privilege. At County, he knew, he could make a difference. When he got there, he found “third-world medicine.” For years, Chicago’s movers and shakers tried to close County because it was underfunded, “decrepit … and depressing.”  Patients waited for care - in long lines outside or on a gurney inside – in pain and without privacy, sometimes for 12 hours or more. The very sick, men and women alike, were treated in large open wards with little thought to modesty. Medicines were hard to get and patients often did without, and diseases that were curable often went untreated because appointments weren’t accepted.

Hundreds of thousands of Chicago’s poor – most of them, Black and Hispanic – came to County… or were dumped there. Loose supervision allowed young doctors to “sink or swim,” to improvise, to buck the system, to counteract city politics. The hospital was often overwhelmed. It was the best job Ansell could ever hope for.

You could be forgiven if, upon seeing this book, you’re reminded of your favorite doctor dramas. Indeed, there’s a touch of Doug Ross and Hawkeye Pierce here, but remember - they are fictional – “County” is not.

Starting with frightening statistics, this isn’t just a memoir for a hospital. Ansell also includes a good shot of his own life story, a few dishy work tales, some shockers, and kudos for colleagues who saw problems and founded programs to eliminate them. He ties it all up with a sense of outrage: that the system is unequal and laden with racism and that, despite political wrangling in the past few decades, very little has changed.

Though it suffers from an annoying propensity for short sentences (And incomplete. Three words. Sometimes less. Made me crazy.)