Social ills that were inadequately addressed in the 1980s have turned urban hospitals into “catch-all social services agencies,” crowded with victims of AIDS, drugs, gang violence and the ravages of homelessness at a time when hospitals can least afford to expand their traditional role, a coalition of urban hospitals reported today.
The coalition--the Urban Health Issues Group of the Conference of Metropolitan Hospital Assns. (CMHA)--called for coordinated efforts by public agencies and political leaders to help alleviate the burden on hospitals. The alternative is continued decay of the urban hospital system, as evidenced by the closing of trauma centers and curtailment of other services by financially strapped hospitals.
“People see the rising crime statistics, they hear about the problem of homelessness,” said Allan N. Johnson, chairman of the Urban Health Issues Group and an author of the report. “What they don’t understand is the linkage between these social problems and increased health care costs for which there is no one around to pay.”
Orange County hospitals cope with the same troubles--major social problems and uncompensated care, said David Langness, vice president of the Hospital Council of Southern California.
“In the past no one would have thought of Orange County as an urban area. Today it is,” Langness said. “And it has all the problems all the urban areas in the country have--crime, violence, drugs, all the social ills that are winding up on the doorsteps of hospitals.”
The report, titled “The Health of 1990 Urban America,” was written to quantify the effect of these social ills on the health care system in hopes of finding solutions. The report is being distributed today to members of Congress and political and civic leaders in the 35 metropolitan areas whose hospitals form CMHA.
Johnson said the coalition’s next step will be to sponsor a series of seminars in Washington for congressional and community leaders.
The study relied on data from hospitals in the nation’s major urban centers, including Orange County, Los Angeles, New York and Chicago. Washington, San Francisco and San Diego hospitals also contributed.
Among the report’s findings:
Acquired immune deficiency syndrome has grown from 295 cases reported to the federal Centers for Disease Control in 1981 to an estimated 57,000 new cases this year. In Orange County, more than 1,400 people have been diagnosed with AIDS since the county began keeping statistics in the early 1980s. Most of the cases tend to be concentrated in urban areas, with a disproportionate impact on the hospital system. For example, in New York, nearly 10% of the hospital beds are filled by AIDS patients, few of whom have health insurance.
More addicted mothers mean more babies born with the consequences of addiction, including low birth weight, physical deformities, mental limitations and inadequate development. At least 1,248 drug-exposed children were born in Orange County last year and experts here fear the problem is much larger, with many “drug babies” going undetected at birth. At Hutzel Hospital in Detroit, where 7,000 of 20,000 babies born in the city are delivered, random testing of mothers and babies showed that nearly 40% were exposed to cocaine or heroin during the pregnancy.
The U.S. rate for violent crime rose 16% during the 1980s; the victims inevitably end up in the nation’s hospital emergency rooms. Los Angeles has the worst problem, with the highest rate of gang- and drug-related violence, according to David Langness of the Hospital Council of Southern California. The volume of violence-related injuries, combined with inadequate payment for the medical care required, led four hospitals in Chicago to drop out of the trauma network and has contributed to the closure of seven hospitals there since 1985, according to the report. In Los Angeles County, 13 of 23 hospitals have pulled out of the trauma system. In Orange County, Fountain Valley Regional Hospital and Medical Center quit the system last year, leaving just three hospitals--none in northwestern sector of the county--to cope.
Hunger, malnutrition and exposure to harsh weather drive many of them to hospitals for medical care as well as shelter, food and warmth. In Los Angeles, Ronald Dahlgren, president of Queen of Angels-Hollywood Presbyterian Medical Center, says he regularly sends memos to the staff asking for contributions of clothing for homeless patients about to be discharged back to the streets. “We are not just talking adult males, but also women and children,” Dahlgren said. “Some of their health problems resulted directly from inadequate protection against the cold.”
An estimated 37 million Americans lack health insurance or other means to pay for their health care, a 22% increase since 1981. In Los Angeles County, one in four cannot pay. And in Orange County, several hundred thousand of the county’s 2.3 million residents lack insurance. The inability to pay prompts people to put off low-cost preventive health care and places a greater burden of serious illness on hospitals. Between 1980 and 1988, the burden of uncompensated hospital care grew from $3 billion to $8.3 billion, according to the report.
Late Monday, several Orange County hospital officials said they had not seen the report. But those who did comment said it appeared to assess their problems correctly.
“It sounds to me like it’s telling it like it is,” said Becky Barney-Villano, director of public relations at Coastal Communities Hospital, a small Santa Ana hospital which on Monday announced it was downgrading its emergency room to “standby status” because it could not find neurosurgeons and other doctors willing to be on call 24 hours a day. Instead, the hospital will provide “urgent care” for most emergencies.
Also applauding the report was Barbara Patton, assistant administrator at Fountain Valley. “It was worse when we were a trauma center,” with people brought in from the street after knife and gun fights who also had no health insurance. But though the trauma center closed last December, the emergency room still sometimes copes with cases like those, she said.
“And we have a compounded problem in OB (obstetrics) where sometimes the mothers without prenatal care are also drug abusers,” Patton added.
Doctors and nurses have to deal with these pregnant woman carefully because they are at high risk for having AIDS, Patton said. “And we have to watch the baby carefully because he is at high risk for multiple problems,” AIDS, drug-exposure, other problems. In addition, Patton said, many of these mothers have no health insurance, so the hospital is left with their bills.