NEW YORK, NY August 06, 2005 —Hospitals have steadily been closing for decades – in New York and around the country. Old-style, inpatient facilities are more costly to run than outpatient clinics. Emergency rooms often serve as primary care centers, driving up costs. As the state considers shutting more facilities, WNYC’s Fred Mogul takes a look at what happens when neighborhoods lose their hospitals.

VOICE: For quality care…Fight back!...to save St. Mary’s…Fight back!

REPORTER: Sometimes the city, county or state does it. Sometimes a private enterprise does it. But closing a hospital, like shutting a fire station, is never a popular thing to do. This summer, the Saint Vincent Catholic healthcare system announced it would shut Saint Mary’s, a 123-year-old hospital in Crown Heights, Brooklyn. Community leaders have organized protests, including this recent march and discussion forum in a church basement nearby.

VOICE: If you struggle, if you stay together, if you’re unified, they’ll hear your cry and the political will change to benefit this community.

REPORTER: Local residents and members of the city council, state legislature and healthcare unions said the neighborhood could not afford lose the hospital.

VOICE: We have a hard road ahead of us.... we have an opportunity to save this hospital.

REPORTER: They vented spleen at the hospital administrators and vowed to fight the closure…

VOICE: Whenever they close a hospital, it’s closed in the communities of color

REPORTER: Activists accused Saint Vincent’s of closing the hospital and declaring bankruptcy to get federal money – a charge denied by Spokeswoman Bernadette Kingham-Bez.

KINGHAM-BEZ: The money isn’t available to any of the hospitals. The bankruptcy doesn’t help us, and that isn’t why we did it. We did it, because we couldn’t make payroll.

REPORTER: Currently there is a temporary restraining order preventing Saint Mary’s from closing, but it might just be a reprieve. An independent panel appointed by Governor Pataki is examining private and public hospitals and nursing homes. Healthcare costs are rising, and New York pays far more for Medicaid than any other state. Albany theoretically can close even private facilities, by withholding their license, if they are deemed redundant or inefficient. Chairman Stephen Berger, speaking after the panel’s first meeting.

BERGER: We’re not a hospital-closing commission. We’re a restructuring commission, which is very different. It may mean some closing. It’ll mean some re-configuration. You will have investment dollars for upgrading some, downgrading others. I think what we’re talking about is a consistent plan and process, as opposed to a series of ad hoc decisions made by individual institutions.

REPORTER: Critics say that sounds good on paper, but the reality is this: Over the last 40 years, hospitals mostly have been closed in the poor, minority communities with the worst health conditions. Judy Wessler, from the watchdog group, The Commission on the Public’s Health System, says administrators and politicians typically promise they’ll leave something behind. Maybe a beefed-up facility nearby, or a smaller, more appropriate and cost-effective center or clinic...

WESSLER: We’re always told that when a hospital closes, there will be money available to provide services in the community. And maybe there is initially, but then that money goes away, and so those services aren’t there anymore, either.

REPORTER: The Highbridge area just above Yankee Stadium lost Morrisania Hospital in 1976, during a period when much of the South Bronx was abandoned. The neighborhood actually did get one of those promised clinics Wessler talks about -- the Morrisania Family Health Care Center, around the corner from the deactivated hospital that shares its name. Sylvia Shiwnath goes there for day-to-day medical needs.

SHIWANTH: It’s close and comfortable, because we can’t able to walk. I had surgery on my knee. Any pain -- my diabetes, my high blood pressure – I go here.

REPORTER: Shiwnath sits in a beach chair on the sidewalk, chatting with a friend. Up and down the block children play in opened fire hydrants and men slap dominoes on boards and joke in Spanish. An unscientific survey suggests residents here are satisfied with the Morrisania clinic and other healthcare services nearby.

WOMAN 1: If you don’t have medical insurance, you come here, and they bring attention to you. WOMAN 2 : Everything is okay. I got, they got good help, you know? They have what I need. I ain’t got no problem. WOMAN 3: It’s very good for me. I get time with my doctor, sometimes half an hour...two times a month I go to the psychiatrist nurse, he takes care of me, too.

REPORTER: And yet, clinic or no clinic, this community’s health, like that of the Crown Heights neighborhood near Saint Mary’s, is a disaster. The mortality rate from cancer here is 50-percent higher than the city average. Death rates from diabetes, homicide, accidents, pneumonia or flu are 200 percent higher. For AIDS -- 350 percent higher. Nancy Biberman is the president and co-founder of the Women's Housing and Economic Development Corporation, or WHEDCO. It occupies the former Morrisania Hospital, which was vacant and dilapidated for 20 years. She says the local clinics and slightly farther away hospitals serve the community well, but people still don’t get the healthcare they need.

BIBERMAN: It’s not that there’s an absence of healthcare facilities. The problem is poverty. People don’t eat as well as they could or should, don’t exercise as much as they could or should, and things that are silent killers – diabetes or hypertension or one of these diseases -- go untreated.

REPORTER: Economists concur. They say health has much more to do with how much money you have and how well-educated you are, than how whether or not you have a hospital or clinic in your neighborhood. The economically disadvantaged often are poorly informed about what’s available and what they need, even when they have facilities nearby. Although they need to take responsibility for their choices, advocates say the healthcare system also needs to grab their attention.

BIBERMAN: And that’s the job of many institutions. It’s the job of public schools. It’s the job of Community Based Organizations. It’s the job of public education campaigns. That’s the job of billboards. It’s the job of everyone who’s interested in a community’s health. People need to hear these messages and hear how to prevent preventable diseases in every place they go….The health issues are issues that can and must be addressed by virtually every institution in a community.

REPORTER: In the meantime, they say, the hospital emergency room is a crucial, if expensive, safety net. John Lewis recently had an allergic reaction and went to the ER near his home at Kingsbrook Jewish Hospital in Brooklyn’s East Flatbush.

LEWIS: People were waiting outside in the waiting room, and they just whisked me through. I think the care was very good, very good.

REPORTER: Lewis says both he and his 7-year-old son were kicked off Medicaid, because he makes 300 dollars a month too much. His job doesn’t provide health insurance, and he can’t afford it.

LEWIS: I had no insurance, but they took me in. You know, I received the bill just today, but I didn’t open the envelope. You gotta leave it, to settle there on the table, before you approach it [laughs]. I don’t know what the bill is like, but, unfortunately, I’m gonna have to deal with it.

REPORTER: Many such bills go un-opened – and unpaid. Healthcare-related bankruptcies are rising for patients, and uncompensated expenses are rising for hospitals. In 2003, local hospitals provided more than a billion dollars worth of procedures they didn’t get paid for, a figure that hit 25 billion dollars nationwide. So hospitals do what Lewis does. They juggle or ignore bills, trying to stay solvent. But with costs rising and political pressure mounting, they, too, can only postpone the day of reckoning for so long.