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Hospitals in Older Cities Close Down, Blacks Worst Affected

Riverview is a community hospita l in Detroit with 285 beds, specializing in general medical and surgical services, such as treatment of congestive heart failure, diabetes and obstetrics.

Detroit is the largest city in the state of Michigan in US Midwest, supposedly a prosperous region.

But Riverview is all set to close down.

The hospital last week said it was losing too much money and already stopped accepting inpatients, though the emergency room will remain open for now.

Because roughly 90 percent of its 11,000 annual inpatients are covered under the Medicare or Medicaid public assistance programs, Riverview has struggled economically, said Bob Hoban, a senior vice president for St. John Health, Riverview's parent company.

Riverview employs 1,511 workers at the hospital on East Jefferson, many of whom live in Detroit.

"Everybody is frustrated," said Dr. William Anderson, a Riverview surgeon. "They are despairing about their futures."

"Our psychiatric intervention program is swamped already," said Ben Carter, chief operating officer of the Detroit Medical Center, one of the health systems that would be most affected.

The Detroit area already has a shortage of mental health beds, and the 25 to 30 at the DMC's Detroit Receiving Hospital are "at full capacity," Carter said.

Both Detroit Receiving and Henry Ford hospitals have busy emergency departments that will be hard-pressed to treat all of Riverview's 30,000 annual emergency patients, officials with the two systems said.

The Ford system serves more than 90,000 emergency patients a year and is expanding because visits have grown 5% to 7% recently, officials said.

Detroit Receiving serves 85,000 emergency patients a year. And St. John Hospital and Medical Center, on Detroit's east border with Grosse Pointe Woods, serves 80,000 emergency patients.

Experts say River view's decision to close fits a distressing, decades-long pattern of hospital closures in older cities across the nation. The trend has left large swaths of predominantly poor, black neighborhoods in cities such as St. Louis, Philadelphia and Cleveland underserved.

Many say the loss of medical facilities for low-income patients is increasingly leaving overcrowded emergency rooms to double as primary-care centers.

"This hasn't been happening in the suburbs and it isn't happening in Phoenix, Arizona, where they can't build hospitals fast enough," said Bruce Siegel, a research professor at the George Washington University Medical Center in Washington, D.C. "This is occurring in older, urban inner-city areas."

New York City, Philadelphia and parts of New Jersey have seen waves of hospital closings in inner-city neighborhoods, said Siegel, who directed a 2004 report examining the phenomenon for the Robert Wood Johnson Foundation.

But few cities have been hit as hard as Detroit.

The number of hospitals in the city has dwindled to seven or eight from 42 in 1960, said Alan Sager, director of the Health Reform Program at Boston University's School of Public Health. Hospitals that are larger, have major medical school-affiliated teaching programs and more money in the bank tend to survive.

Siegel's report warned that Detroit's safety net was already in a "fragile" state and could collapse entirely with further hospital closures. It said Detroit had lost more than 1,200 hospital beds with the closure of four hospitals since 1998.

"Some of it is population shifts and declines," Siegel said. "There's (also) more and more people without health insurance and Medicaid payments that don't keep up with the cost of providing care."

Riverview finished its last fiscal year with a nearly $9.5 million deficit and expects to end this fiscal year $23 million in the red.

Medicare payments to ho spitals averaged 92 cents for every dollar spent providing care in 2005, the most recent figures available, according to the American Hospital Association. Medicaid's reimbursement rate was lower, at 87 cents per dollar.

Officials at other area hospitals have complained that Riverview's closing will burden them.

"We're 90 percent full on average and there are many days where we're 100 percent full," said Nancy Schlichting, president and chief executive of Henry Ford Health System, which has a trauma center hospital in Detroit.

Karmanos Cancer Institute plans to spend $20 million to renovate the 20-year-old Riverview and reopen it as a clinical center next year.

While waiting for a bus after a physical therapy appointment, Mary Sanders said Riverview is the closest hospital for residents of the east side, including many disabled senior citizens.

The 54-year resident of the neighborhood said she doesn't know where she'll go once the clinic closes.

There are hundreds like her, but nobody seems to heed their desperate pleas for keeping the hospital open.


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