Big Business--Bad Medicine

Individuals and communities have long been pawns in the machinations of big businesses as they pursue their best interests by downsizings, consolidations and closures. Corporate raiders have replaced the classic gangsters as the bad guys in books and film. In years past, government had been active in overseeing big business. Remember history lessons about monopolies and anti-trust? But now the trend is for government to be hands-off, to let business and the marketplace run its course.

Recently, large for-profit hospital corporations have been busy gobbling up public, charitable and other for-profit hospitals in an effort to corner health-care markets in many regions of the country. They claim to be the answer to the conundrum of out-of-control medical costs. But unlike a charitable or public hospital whose bottom-line purpose is to serve public health and use profits to lower costs and improve quality of care, a for-profit entity’s “bottom line” is the bottom line--to maximize profits and shareholder stock value. One of these new hospital corporations is Columbia / HCA Healthcare Corp., the nation’s largest for-profit hospital company. And they have come to my hometown.

When Columbia acquired Westlake Hospital in Westlake Village in 1995, they became owners of basically every hospital in an area that extends from Woodland Hills to Newbury Park, from Malibu and the rugged Santa Monica Mountains canyons to Moorpark. Today, most residents and physicians in that area have no other choice but to utilize a Columbia facility.

Westlake Hospital was a paramedic base station, a trauma center and a full-service emergency and acute-care hospital for more than 20 years. It was not a “cash cow” for its owners but, set in an affluent community, it was not a big money loser either. Then Columbia moved into town. Although they had a track record of buying up hospitals and closing them to consolidate their business, the doctors and community were optimistic. Columbia initially was upbeat in its plans for Westlake. But then they began to dismantle it. First they closed its popular labor and delivery services. Then they closed its cardiac rehabilitation unit. Then its gastroenterology services. And then, in January, they announced--wonder of wonder--that the hospital just wasn’t profitable and that they would close it all.

Another company, Salick Health Care, a provider of cancer treatments, announced it wanted to buy the hospital. Negotiations were secret for months, but rumors abounded that although Salick would be permitted to buy, it would be contractually prohibited from competing with nearby Columbia hospitals in providing emergency or acute-care services, the very services the community most needed and wanted.

Local residents, protective service agencies and government officials all urged preservation of emergency services. But on July 2, the day before Columbia was supposed to hand over ownership to Salick, Columbia closed all emergency and acute-care services at Westlake. The next day, the deal fell apart, according to Salick, because Columbia not only forbade Salick from providing emergency and acute-care services but from forever selling or leasing the hospital to anyone who would. A court ordered that Columbia maintain the hospital’s services while the haggling continued, but Columbia elected not to reopen the emergency room.

It seemed evident to me that Columbia’s business plan all along was to eliminate competition. The community rallied--with protests, petitions and letter-writing campaigns--in opposition to Columbia. People felt betrayed, and sadly impotent in efforts to affect the plans of a billion-dollar corporation.

This scenario should raise concerns for everyone, everywhere--because we all need quality health care. No business ought to be forced to stay open and lose money. But when it comes to health care, should mega-corporations be allowed to limit or prohibit someone from buying a hospital and competing? Does that serve the public good?

Deal-making between potential health care providers needs to be held under greater public scrutiny. The people are ill-served when valuable community assets are bandied about behind closed doors without citizen input. In Westlake, most residents didn’t learn about the closure of their hospital until it was reported in the newspapers. Some didn’t know until they walked through the hospital’s doors in medical distress. And we were all lulled into apathy by the big corporations negotiating behind closed doors, with whispered rumors of hope.

Governments license hospitals, local communities have representatives on boards of directors, medical staffs have rights and physicians have obligations to protect public health. But these entities are not often heard from when big businesses play Russian roulette with hospitals, and people’s lives, behind closed doors.

The public should have the right to know what is happening behind those doors, to know for what price their health care is being negotiated, what provisions are being made to protect their options and access to physicians and hospitals, and whose deep pockets are getting deeper. These corporations manipulating health care will fight tooth and nail to keep their business practices secret. But if we truly have any right to health-care options and any desire to protect our health and well-being, we ought to demand that, when it comes to negotiations that involve medical care, public and media representatives be allowed behind those “closed doors.”

A big corporation has invaded my home town. Its goals are alien to me. People in Westlake and surrounding communities will continue to fight, to try to save their local hospital. But not until all communities have the right to public knowledge will we ever be able to truly preserve the public good.