Plan to close Northeastern Hospital stirs anger

After 37 years at Northeastern Hospital, mostly in its bustling emergency room, Beverly Soska jokes that she knows many patients so well, she can diagnose them without asking a question.

Now the 67-year-old nurse who grew up near the hospital is worried about how her patients will fare if the Temple University Health System sticks to its plan to close the hospital in the city's Port Richmond section by July 1.

Northeastern is the dominant community hospital between Frankford to the north and Temple University Hospital to the west. It delivers 1,800 babies and treats about 50,000 patients in its emergency room each year, making it the ninth-busiest adult ER in the five-county area, state records show.

"You can't expect these people to get on a bus to Broad and Allegheny and walk to Temple" for care, Soska said. "I wish there were something that someone could do to wake Temple [executives] up to what they are turning their backs on. . . .. These are human beings who need an ER."

Sandy Gomberg, interim chief executive officer of Temple University Hospital, said Northeastern's finances were unsustainable. The hospital lost $6 million in fiscal 2008 and is on track to lose $15 million this year.

She said the system would continue to serve the community by converting Northeastern into a walk-in clinic with specialists from 10 a.m. to 8 p.m. - the peak period for the ER it will replace.

And with ERs at Temple's main campus on North Broad Street and the Episcopal campus in the city's Kensington section, Gomberg said, "we are ready to accommodate the patients who need access to emergency care."

Some of Northeastern's doctors are unconvinced.

"I think people will die because they won't get to an emergency room in time, and there won't be good follow-up care," said pulmonologist Alan Steinbach, who directs Northeastern's intensive care unit. "Care is going to be very, very disrupted."

Many U.S. hospitals are hurting this year from falling numbers of elective surgeries and a rising tide of uninsured patients. The economic downturn has also savaged investment income, which can buffer finances in lean years.

Experts say the burden is falling hardest on smaller rural and urban hospitals such as the 189-bed Northeastern.

The hospital has been hurt by falling patient admissions and rising charity care. The latter has surged 33 percent over the last four years, reaching a projected $19.2 million in charges this year.

Another sign of distress is the hospital's overreliance on government programs, such as Medicare and Medicaid. The more money that comes from those sources, generally the worse the finances are, because "government payers don't pay for the full cost of care," said consultant Alan Zuckerman, president of Health Strategies & Solutions in Philadelphia.

Northeastern got 76 percent of its revenue from government sources in fiscal 2007, the region's second-highest total. The city's hospitals averaged 46 percent.

Those numbers don't help Temple, which faces its own fiscal malaise. The system logged a $31 million net loss in the last six months of 2008, and its board installed a new CEO, Edmond F. Notebaert, in January to replace Joseph "Chip" Marshall 3d.

Temple is making the hard decisions to survive and keep caring for Northeastern's patients, Gomberg said.

Opponents argue that the Temple health system - which last year got about $60 million in government funding to treat poor people - is abandoning the community.

"Closing this ER is going to have a devastating effect," said State Sen. Michael J. Stack (D., Phila.) whose district is near the hospital. "A huge number of people go to that ER and . . . that is life and death."

One in three residents near Northeastern is Hispanic. And nearly 40 percent fall below the federal poverty line. The poor are more likely to lack access to basic health care or have the means to travel far for care.

"The disruption of care that accompanies most hospital closings is substantial," said Alan Sager, a professor of health policy at Boston University who has studied causes and effects of urban hospital closures.

"When a hospital closes, a substantial portion of the patients drop out," he said. That happens, Sager said, even if other hospitals are close at hand and have the capacity to treat more people.

Terrie Costello, 78, who has lived in a rowhouse a block from Northeastern for 54 years and who doesn't own a car, would likely be one dropout.

Three years ago, Costello was shopping at Kmart when she felt chest pain. Still in pain on her way home, she decided to stop in the ER but didn't want to be admitted.

"The doctor said, 'If you were my mother, I would make you stay,' " Costello said. It wasn't a heart attack, but she stayed for three days, and has been seeing a cardiologist and taking heart medication since.

The most common reasons for patient admission were childbirth, chest pain, and heart failure in 2007, an Inquirer analysis of hospital billing records found.

The most common surgical procedures at the hospital related to childbirth. Losing Northeastern's obstetrics unit will leave the city with only six hospitals delivering babies.

In 2007, Northeastern surgeons also performed 140 gall-bladder procedures and 93 appendectomies.

"We are not just losing an ER," said Steinbach, the Northeastern ICU director. "We are losing a hospital for inpatient problems like gallbladders and appendixes."

Many people in Port Richmond and nearby are also angry at Temple for what they see now as dubious decisions. Much of the community stood with Temple in 2003 to fight against Wal-mart, which wanted to put a store on an empty lot beside the hospital.

The retailer would have added jobs and stability. But Temple lobbied against the project and spent millions to buy the site and clean it up. The system's grand plans of building a new hospital there never materialized.

Now it's a parking lot.

On the flagpole above Northeastern's entrance, a tattered Temple flag could now symbolize the system's relations with the neighborhood.

"We fought Wal-mart for Temple," said Maryann Trombetta, vice president of Port Richmond Town Watch. "They told us, no matter what happens, Northeastern Hospital will always be there."

Trombetta is one of the leaders mobilizing with legislators such as Stack and State Rep. John Taylor (R., Phila.) to block Temple from closing Northeastern.

Taylor said yesterday that Temple leaders had agreed to hold off making any physical changes to the hospital for 30 days. But he said Temple still planned to close the hospital to inpatients by July 1.

Ultimately, Temple executives said, patients who truly need emergency care should go the three miles to Temple University or less than two miles to Episcopal.

Trombetta, for one, is disinclined to take that advice.

"If I need my gallbladder removed, if I break a leg," she said, "I don't need to go to Temple, I don't want to go to Temple."

Patients: 10,618, down 7 percent from 2005.

Occupancy: 68 percent, down from 72 percent in 2005.

ER visits: 49,491, up 18 percent from 2005.

Births: 1,753, up 29 percent from 2005.

Inpatient surgeries:

1,721, down 14 percent from 2005.

In addition, 58 percent of patients surveyed said they would recommend the hospital to family or friends, compared with 64 percent at all Pennsylvania hospitals and 68 percent at hospitals across the country.

Also, 74 percent of patients said their room was always clean, compared with 67 percent for all the state's hospitals and 69 percent nationwide.

Source: Temple University Health System, Centers for Medicare and Medicaid Services

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