A model of this story appeared in CNN’s Race Deconstructed e-newsletter. To get it in your inbox each week, join free here.
For the previous 4 years, Angelina Alford was capable of stroll only a couple blocks to her neighborhood hospital every time she wanted emergency well being care.
Alford, 65, mentioned that she suffers from bronchial asthma, diabetes and hypertension, and that there have been occasions when the Atlanta Medical Heart’s (AMC) downtown hospital, previously referred to as Georgia Baptist Hospital, would hold her in a single day for monitoring.
Nevertheless, with the closure of AMC’s downtown location final week – AMC South, the sister location in East Level, shut down in Might – Alford worries that touring to a different hospital in Atlanta visitors could possibly be a matter of life and dying. She doesn’t drive, she mentioned, and in consequence should depend on rideshare companies or members of the family to get round.
In accordance with the Atlanta Journal-Structure, the choice to shut the hospital came as a shock to staff as well as residents and city leaders. The newspaper reported the pending closure on August 31.
“It’s irritating, and it’s unhappy,” Alford informed CNN. “And it provides me nervousness, as a result of if I get sick, how am I going to get to the hospital?”
Wellstar Well being System, which operated each hospitals, insists that the closures had been because of shrinking income.
“Wellstar has operated AMC since 2016, investing greater than $350 million in capital enhancements and to help sustained working losses. That features $107 million in losses in simply the final 12 months, amid reducing income and growing prices for employees and provides because of hovering inflation. The pandemic and the extraordinary monetary headwinds straining healthcare organizations proper now have solely made issues worse at AMC,” the nonprofit said in a statement.
However group advocates and well being coverage consultants say that the closures exemplify systemic inequality, and that the 2 AMC losses will disproportionately burden Black communities and low-income communities.
The closures aren’t distinctive. They’re a part of a a lot bigger sample of urban hospital closures throughout the US. (Over the previous few a long time, rural hospitals even have been disappearing.) Solely three years in the past, amenities in Chicago, Philadelphia and Washington, DC, shuttered. Residents within the surrounding poor, predominantly Black communities had been left reeling from the losses.
“We’ve had three hospital closures within the final 12 months or so, all of them Black neighborhoods,” David Ansell, the senior vp for group well being fairness at Rush College Medical Heart in Chicago, told Kaiser Health News in 2020, including that selecting to close down these hospitals was “actually legal” in his thoughts, “as a result of individuals will die in consequence.”
Very quickly in any respect, Grady Memorial Hospital, Atlanta’s solely remaining Degree I trauma middle, detected the results of AMC’s closure.
“We’ve got already seen an inflow of sufferers in our emergency division and a rise in our trauma volumes. Nevertheless, we have now taken a number of steps to assist take in the elevated quantity. We’ve got employed former Atlanta Medical Heart trauma surgeons and first care physicians to assist meet the rising want at our trauma middle and in our neighborhood well being facilities. Extra practitioners have been added to Grady’s Stroll-In Heart and our ER ready room. We’ve got added 41 new inpatient beds, and extra are forthcoming,” Grady Health said in a statement.
Georgia Republican Gov. Brian Kemp boosted funding to Grady Well being as a way to “permit Grady to soak up the affect from AMC’s closure and proceed offering high quality care to new and present sufferers.”
In an October open letter to community members, he mentioned that Grady Well being would obtain greater than $130 million in American Rescue Plan funds so as to add 185 beds to the hospital by the tip of 2023.
Nancy Kane, an adjunct professor of administration on the Harvard College TH Chan Faculty of Public Well being, summarized the precarious state of entry to care in Atlanta and past the next manner.
“When a hospital leaves, the entire community begins to break down,” she informed CNN. “It’s not simply the trauma and maternity companies. The entire care continuum begins to be affected.”
Right here’s a better take a look at the persistent problem of city hospital closures:
Atlanta-area activists have fought for years to maintain city hospitals open, noting the hardships sure residents would face with out these amenities.
Richard Rose, the president of the NAACP’s Atlanta chapter, informed CNN that city hospital closures are a difficulty of “racial inequality.” State and hospital officers, he mentioned, have failed to offer the sources crucial to avoid wasting the hospitals which have largely served town’s Black and low-income residents.
Certainly, the affect of the closures of AMC’s places in downtown Atlanta and East Level (the 2 are round 7 miles aside) gained’t be evenly distributed. Black residents and low-income residents will most acutely really feel the absence of those key suppliers of group care.
Per Wellstar figures cited by the Atlanta Journal-Constitution, of the practically 4,300 emergency room sufferers the 2 AMC places noticed in 2019, north of two-thirds (67.3%) had been Black, and greater than half (51.5%) had been Medicaid and Medicare recipients.
The closure of AMC downtown has left a gap in the neighborhood.
There are no less than three main hospitals close by – Grady, Emory College Hospital Midtown and Piedmont Atlanta Hospital – however sufferers informed CNN about lengthy strains and overcrowding in these emergency rooms since AMC shuttered. Additional, some residents, reminiscent of Alford, lack transportation to get to the hospitals.
Equally, the closure of AMC South’s hospital and emergency middle has left quite a lot of households in south Fulton County – a cluster of suburbs with a mixture of poor, middle-class and upper-middle-class residents – with no full-service hospital lower than 7 miles away.
And whereas Google Maps estimates a 15-minute drive from AMC South to Grady, that commute could possibly be many leagues worse throughout peak visitors hours within the bustling metropolis.
Rose referred to Kemp’s pledge to fund extra beds at Grady as a “Band-Support repair on an open wound,” and defined that the closures jeopardize the well being of residents who reside close to shuttered amenities.
“In case you get shot or have an accident or a coronary heart assault on the incorrect time of day, it’s an actual downside to get from southwest Atlanta to Grady Memorial Hospital in downtown Atlanta,” Rose mentioned. “It’s an pointless wrestle.”
Kane echoed a few of Rose’s sentiments, and painted a equally sobering image of entry to care within the aftermath of city hospital closures.
“The obvious consequence is that should you’re in a low-income neighborhood, the gap to care goes to be higher. And should you don’t have a automobile, that distance could be a massive problem,” she mentioned.
Kane added, “It’s been documented within the literature that in emergency circumstances – you probably have a coronary heart assault or a gunshot wound – particularly in a low-income neighborhood, you’ve the next probability of dying, as a result of individuals can’t get to the following hospital that simply.”
She additionally highlighted that, within the US, race and poverty are associated with health disparities, together with uneven entry to high-quality docs and care.
“Diabetes, stroke, hypertension: Many issues are precipitated simply from poor health-care entry and low earnings and stress,” Kane mentioned. “The demand (for hospitals in communities of coloration and low-income communities) is greater than in different communities. So, it’s a double whammy: You’re sicker, and you’ve got worse entry.”
If the information about AMC appears acquainted, it’s as a result of the saga isn’t anomalous. Lately, city hospital closures have many different elements of the nation, too.
For example, in August 2019, Westlake Hospital in Chicago filed for bankruptcy, paving the best way to closure.
Simply two months prior, in June, Philadelphia’s Hahnemann College Hospital, which was the chief instructing hospital affiliated with the Drexel College School of Medication, announced that it’d be shutting its doors for good.
And in April of that 12 months, Providence Hospital in Washington, DC, permanently closed.
Westlake, Hahnemann and Windfall, very similar to AMC, largely served Black communities and low-income communities.
Alan Sager, a professor of well being coverage and administration on the Boston College Faculty of Public Well being who over the course of the previous 12 years has documented hospital closures in practically each main US metropolis, characterised the nation’s health-care system as “anarchic.”
“That phrase describes the forces at play: ‘Avoid wasting hospitals, shut others,’” he told US News & World Report in 2019.
Bonnie Castillo, the manager director of the union Nationwide Nurses United, expressed comparable sentiments.
“City hospital closures are extra apt to occur in racially segregated communities and particularly in African American neighborhoods,” she informed US Information & World Report.
Castillo underscored that the shutdowns’ results might be “devastating,” because the residents of those communities depend on hospitals for main care (and different care) to a level that White and rich People don’t.
When Windfall closed, emotions of misery permeated the encompassing neighborhoods.
“You’re hurting individuals. You’re actually hurting individuals. You’re messing with individuals’s lives, and you may’t do this. You actually can’t do this,” as Phillip Lee, a lifelong DC resident, told the CNN affiliate WUSA in 2019.
Usually, Kane questions claims that shutdowns happen as a result of hospitals are shedding cash.
“Declining income isn’t an occasion that comes from Mars. It comes from under-investment within the facility,” she defined. “That’s a part of the issue. It’s not that individuals say, ‘Let’s not go there anymore.’ It’s that they will’t get in or the companies they want aren’t there anymore or the constructing’s previous and they also select to go elsewhere.”
Put one other manner, income decline is an consequence.
“Amenities get years of neglect,” Kane added. “Then, the neglect will get to a degree the place you may’t preserve the buildings, or the physicians say, ‘We’re not getting in there anymore. The elevators don’t work.’ So many issues occur which can be dangerous that firms say, ‘We’ve got to shut the hospitals. Nobody desires to come back right here anymore.’ Effectively, no kidding.”
Notably, city hospital closures shine a lightweight on the significance of native management over well being programs – on the devastation that may comply with when that authority atrophies.
“In case you look broadly throughout the nation, there are massive chains buying hospitals. They may have greater than 100 hospitals. The headquarters is in St. Louis. The chains might need hospitals in 9 or 10 states. And the chains not have a way of dedication or loyalty to the local people,” Kane mentioned. “And so, should you’re a hospital that has a lot of Medicaid sufferers or a lot of uninsured sufferers, or should you’re a hospital that doesn’t get a lot authorities help, you find yourself trying like a poor performer in a portfolio the place nobody is aware of what’s beneath.”
Briefly, as a result of chains aren’t essentially conversant in the group, they won’t have a dedication to it, and state governments aren’t demanding that they concentrate.
Todd Greene, previously a member of Wellstar’s group board for AMC, can’t assist however fear in regards to the latest closures.
He defined that they could additional chip away on the well being outcomes of Black residents, as a result of they relied on main and specialty care docs affiliated with shuttered hospitals.
Greene mentioned that a number of AMC medical places of work – together with household drugs, neurosurgery and orthopedic practices – should both shut or relocate. And a few are transferring out of town altogether, to Whiter and wealthier Cobb County.
The outcome: Quite a few residents will wrestle to safe appointments, as a result of metro Atlanta doesn’t have a sturdy transit system that may get them to different counties.
Greene was forceful in his condemnation of firms and chains.
“They’re placing earnings over individuals,” he informed CNN. “We already know that Black individuals have a decrease life expectancy, and endure from continual sicknesses (at the next price). It’s going to be very troublesome for these individuals to entry fundamental companies.”