Bankrupt Hospital Leaves Physicians, Nurses in the Lurch

Damian McNamara

July 19, 2019

Hahnemann University Hospital has been an institution for 171 years in downtown Philadelphia. The level I trauma center, medical training facility, and public "safety net" hospital has been in continuous operation since 1848.

That could all come to an end soon. For the physicians, nurses, and staff who considered Hahnemann a "second home" for years, the impending closure of the hospital on September 6 after it filed for bankruptcy has left many facing a high level of uncertainty.

The situation is having a ripple effect throughout the area and took on an even greater sense of urgency Thursday after an announcement reported by local media from Philadelphia's Drexel University — whose College of Medicine relies on Hahnemann as its teaching hospital — that it will have to eliminate about 40% of its physicians and clinical staff.

Drexel President John Fry announced in an emailed letter that Hahnemann's impending closure has created a "crisis point."

"We have been forced to make extremely difficult decisions, but please know that the long-term goal is to preserve as many clinical faculty and professional staff jobs as possible," Fry wrote.

Lifesaving Measures?

Many physicians, nurses, residents, and staff are not giving up without a fight. Many held signs and chanted "Keep it open!" during a protest July 11 outside Hahnemann Hospital's historic entrance at Broad Street and Vine in Philadelphia's Center City.

Protesters outside Hahnemann University Hospital on July 11. Damian McNamara

 

"We're trying to fight for our faculty, physicians, residents, and our nurses — because without this teaching institution, all of these lives are going to be displaced, these dreams and futures destroyed," Naitik Patel, MD, a hospitalist at Hahnemann Hospital and assistant professor of general internal medicine at Drexel's College of Medicine, told Medscape Medical News.

"We do this because we love teaching," added Patel, who has been affiliated with Hahnemann for 7 years. "We're training the next generation, and displacing this many educators is going to be detrimental to our healthcare system, which already needs more doctors."

"This is somewhere we wanted to start and end our training. For many of us and for the more seasoned physicians — some have been here 10-plus years, 20-plus years — it affects a lot of us in so many ways," said Billy Zhang, MD, an internal medicine resident at Hahnemann.

For many physicians affiliated with Hahnemann, this is a "heartfelt moment," added Zhang as he stood with a group of other clinicians wearing white coats at the protest. "I'm here to support my program and to support keeping the hospital open."

Many residents, some of whom only started training at Hahnemann a couple of weeks earlier, are looking for positions at hospitals both near and far, as Medscape Medical News recently reported.

Nurses Treating Fewer and Fewer Patients

Most of the nurses on staff at Hahnemann continue to show up to perform their clinical duties, despite a precipitous drop in the number of patients since the closure was announced.

"We come to work. Some of our units don't have patients, but we're coming to work anyway," Sue Bowes, RN, BSN, president of the Hahnemann local chapter of the Pennsylvania Association of Staff Nurses and Allied Professionals union, told Medscape Medical News.

An exception are the nurses on units that were officially closed in recent weeks, such as the mother-baby unit. "They told them not to report to work anymore," said Bowes, who has worked at Hahnemann for 14 years.

More clarity from hospital administration is needed, Bowes added. There has been no official word from leadership other than the closure announcement on June 25. The statement provided 60 days' notice of the pending closure, as required by the Worker Adjustment and Retraining Notification Act of 1988 (WARN Act).

"We're down to two floors in the hospital," she said. "They've closed three or four floors already, and consolidated all the patients." In addition, administrators combined four critical care units into one.

Bowes works in a procedural area and continues to treat patients who come in for weekly therapy. "They are still coming, but none of the inpatient procedures that we do are being done. We went from doing 15 or 16 cases a day down to two or three."

Fluid Situation

Although Hahnemann Hospital's leadership declared Chapter 11 bankruptcy and announced that the hospital would be closing within 60 days, the situation remains fluid.

On July 9, for example, Hahnemann announced cessation of all nonemergency surgeries and procedures, including the delivery of babies, by week's end. The same day, local KYW Newsradio reported that Philadelphia Common Pleas Judge Nina Padilla granted part of the city's request for an injunction. The judge ruled that Hahnemann's owners are prohibited "from closing, ceasing operations, or in any way further reducing or disrupting services" at the hospital's emergency department "without a closure plan authorized by the health commissioner."

Even if the hospital ultimately stays open, it will likely not be the same.

When asked what it is like for nurses currently at Hahnemann, Bowes replied, "We're all pretty sad. It's very depressing, and we're all scrambling to try to find employment. It's just very sad for us and for our patients."

A Hospital in Declining Health

Patel reported experiencing declining conditions at the hospital even before the filing for bankruptcy. "I've spent a lot of years working with limited resources, and the last year has just been devastating to us. We keep getting gutted and gutted to the point now where we can't function," he said.

"We've always had supplies, until recently. And now that a state regulator came in, we have supplies again," Bowes said.

"It's a shame because this institution used to stand for a lot. It was a center for a lot of education and innovation in medical education," Patel added.

"Some of our patients we call 'frequent flyers' essentially live at this hospital because they don't have adequate resources," Patel said. "A lot of our patients do not have insurance and cannot even afford electricity in their house. And this hospital was designed to take care of these types of patients."

Zhang said he also worries about what will happen to the many local residents who rely on Hahnemann for their healthcare.

Pennsylvania Governor Tom Wolf and Philadelphia Mayor Jim Kenney released a joint statement on July 11. It read, in part, "The situation at Hahnemann University Hospital, caused by CEO Joel Freedman and his team of venture capitalists, is an absolute disgrace and shows a greed-driven lack of care for the community. The hospital has $300 million in debt that is growing daily. Now the owners want a bankruptcy proceeding to protect the profits they extracted from the hospital and community."

Long History of Community Service

Established as the Homeopathic Medical College of Pennsylvania in 1848, the facility was later renamed Hahnemann Medical College after Samuel Hahnemann, the father of homeopathic medicine. The focus on homeopathic medicine was dropped in the 1920s, but the institution continued as an academic training center.

Fast forward to 1996, when the Allegheny Health, Education Research and Foundation purchased Hahnemann Medical College and the Medical College of Pennsylvania and combined them into one medical college, Allegheny University of the Health Sciences. Tenet bought the respective hospitals 2 years later, a deal that also formed the nonprofit MPC Hahnemann University to oversee the two merged medical schools.

In 2002, Drexel University bought MPC Hahnemann University, at which time it became the medical school of the Drexel University College of Medicine.

Although the prognosis for Hahnemann looks bleak, the injunction ordering the institution to stay open is buoying hope for now. The closure is gaining national attention. Vermont Senator Bernie Sanders made an appearance at the hospital on July 15 to show his support for the physicians, staff, and patients affected by the impending closure.

Bowes is more concerned for other workers at the institution than for herself. "I've been a nurse for 36 years. I'll get another job," she said.

"I just feel sad for my coworkers and colleagues who are a year from retiring," Bowes said. "It's also sad for the members of the other union, the 1199C, who are in limbo with their pensions and everything else."

District 1199C Philadelphia is part of the National Union of Hospital and Health Care Employees of the American Federation of State, County and Municipal Employees, a union that represents technicians, dieticians, and transport and environmental services.

"Nurses will find jobs. But the 1199C people are really struggling," she said.

If hospital ownership proceeds with shuttering the doors in late summer, "It's going to be sad to see this place shut down," Patel said.

Follow Damian McNamara on Twitter: @MedReporter

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