City Hospitals Are an Incentive to Stay Well

By Sydney H. Schanberg
New York Newsday, January 16, 1987

As predictable as the annual groundhog-and-his-shadow ritual are the seasonal headlines about horrible conditions in the 15 hospitals run by the city of New York.

It almost doesn’t matter what year you tune in. The narration of miseries seems to remain constant — shortages of basic medicines, crucial equipment that doesn’t work, poorly supervised emergency rooms and staffs that are overworked and undermanned.

The only nuance that does change is our ability to be shocked by the news that the poor are not nurtured through their illnesses as we with the Blue Cross-Blue Shield cards are. It gets harder and harder to surprise a citizenry that has grown accustomed to cluster of refugees and other touches of Calcutta that here and there decorate our city’s outdoor spaces.

The latest medical-failure headlines have to do with the city’s ambulances, which — after several years of improved performance — were said to be slipping now in their response time to life-threatening cases.

These reports and charges were brought by the City Council president, Andrew Stein, who had shown skill over the years at public service announcements which simultaneously promulgate some of the reality of the municipal medical system while furthering his own career interests. In this regard, Stein is little different from others in comparable stations of the city government — except perhaps that when he denies that his efforts are tinged with self-promotion, he doesn’t really expect us to believe it.

Those who administer the Health and Hospitals Corporation say that Stein seeks to “condemn by anecdote” — by taking individual bad experiences in the hospitals and trying to make them sound so typical as to depict the entire system as one large horror story.

But the issue, in the end, is not whether purity is the force behind either the council president’s motive or the hospital corporation’s performance. It has more to do with what the public hospitals really are.

They are a place of last resort for those who cannot afford the better and more comfortable care to be found at private hospitals. They are necessary but too often unpleasant, harsh, grim.

They are the repositories for those with the mundane illnesses — alcoholism, pneumonia, drug addiction, broken limbs — that the private institutions, which are linked to medical schools and are known as “voluntary” or “teaching” hospitals, do not find useful their instruction and research.

Last August, a state-commissioned study found that death rates for patients who underwent surgery were two-and-a-half times higher in the municipal hospitals than they were in the private institutions. 

One paradox of this statistic is that the private hospitals are the very institutions that staff and run the municipal hospitals under what is known as affiliation contracts with the city government. So if the doctors from the private hospitals are also manning the city hospitals, then why are the medical results so different?

There are no neat and tidy answers. It is not because the doctors and nurses care less about the tired and poor and unwashed and ill-educated, but then sometimes it is. There are medical personnel, like cops in destroyed neighborhoods, who start out with zeal and over time get worn out, discouraged, even cynical and disrespectful about the people they are serving.

And yet, what keeps the municipal hospital system from spinning totally out of control is that most of the people who go into medicine are devoted to helping people feel better, get well, be healthy. Not all of them, but most. So there are lots of doctors, nurses and supervisors in the city hospitals working like crazy to keep people alive. Without that commitment, the death figures in these hospitals would be even more dismal than they are.

But still, the present mortality rate — more than double the private hospital rate — demands more of an explanation.

The state report that disclosed these figures suggested that the answers lay more with the victims and their lifestyles than with the quality of care they receive at city hospitals.

Because the patients who go to municipal hospitals are almost always poor, the report said, they often arrive seriously ill because of bad nutrition, limited education and difficulty getting medical care in the past. Also, the report noted, they frequently arrive as emergency cases, with critical injuries or wounds. The city’s hospital corporation endorsed this view; after all, it said, these are “high-risk” patients.

But somehow, this doesn’t quite adequately explain why Harlem Hospital ran out of penicillin at one point in 1984. Or why the “crash carts” and other emergency equipment that you see saving television lives on “St. Elsewhere” are, from time to time at city hospitals, either broken or nonexistent. And it doesn’t help us understand why poor patients are less likely to receive specialized surgery such as heart valve repair and major vessel operations.

The city gives the voluntary hospitals more than $200 million a year to run the 15 municipal hospitals. Given the results, is it wasteful and therefore too much? Or not enough to do the job properly? Probably both. Again, the answers are not tidy.

The only knowledge that is clear-cut in this situation is that if you must be poor, try not to be sick. Because the rest of us are no longer shocked at your death rates.

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