Still angry three years after the fact, I have some observations to offer about why we lost Muhlenberg Hospital. These conditions must be addressed before we have any chance of getting it back.
Between 1987 and 1994, I practiced law with a firm that represented 15 hospitals, of which 5 were mine. We did all their malpractice and other liability defense work. All of them were either non-profit or municipal. But then, someone got the bright idea to turn hospitals into for-profit business enterprises. And so it was that JFK Medical Center in Edison turned into Solaris Health Systems in 1997, when its owners bought Muhlenberg. Lots of money has been made in the hospital business since then, but lots of money has been lost too, at hospitals that could not stand the competition, or which bore special burdens. From my perspective as a hospital lawyer, the change was like fixing something that wasn’t broken, always an invitation to disaster.
Major changes in American medicine have caused many hospitals to go broke. Today, all sorts of surgeries and other treatments are far faster and less invasive than before. For example, people who have lumbosacral spinal procedures (as I had at JFK in 1997) go home the very next morning. Most gall bladder removals are now done laparoscopically, also reducing what were once 10-day hospitalizations (as I had at Muhlenberg in 2003) to 1- or 2-night stays. People with debilitating conditions, who are not ready to go home, and those waiting to die, no longer stay in the hospital for weeks, but are sent to nursing homes or rehabilitative centers. Numerous medical conditions do not require admission at all anymore, but are treated with medications at home, or at outpatient facilities.
And so it is that the volume of hospital usage has been reduced. But while there were small hospitals in some of our older cities that really aren’t needed anymore, Muhlenberg is not like that–it served a large area. Solaris, wanting to be more cost-efficient and thus more profitable, removed several departments and services from Plainfield and put them in JFK. What it left behind is the emergency room, which we still have–for now.
There was a second problem, and it was gigantic. The number of people who seek care, but have neither insurance nor money, has skyrocketed. Plainfield has a disproportionately huge number of them, mostly minorities, both legal and illegal.
New Jersey has an incredibly stupid law that requires hospitals to treat any and all comers, whether insured or not, and whether or not their illness belongs at a hospital. Though the State provides some reimbursement for “charity care”, it isn’t anywhere near enough. Muhlenberg became a de facto clinic, at tremendous cost, and defenseless to stave off those who should be going to a doctor’s office, or a clinic like the one on Rock Avenue.
I do not suggest that people needing medical care should be left out on the streets. I am merely saying that letting them swamp Muhlenberg created a dilemma reminiscent of the sinking of the Titanic. People in overloaded lifeboats drove off those trying to climb aboard, because if too many people did it, the boat would capsize, and everyone would die.
Hospitals must be allowed to refuse treatment to people who show up with minor or routine health issues that don’t justify going to them. The abuse of emergency rooms would stop if those seeking treatment for a child’s earache, for instance, were sent away. I don’t want to hear it that there are people who lack other options. That is a societal issue and can be handled in other ways. If excessive compassion has cost us our hospital, because Plainfield has so many poor and immigrants, then the price is too high.
None of our Plainfield elected officials have done anything to seek relief for hospitals with this problem. Assemblyman Green is certainly not leading the charge for measures that would relieve urban hospitals of their special burden: being swamped by people who should be getting their medical attention somewhere else.
If I am elected to the City Council, I won’t have the power to effect reform that has to come from the State Legislature. But I would be the first Councilman to say out loud what the real problems are, and if others join me, that would create some pressure that might filter up to Trenton and Washington and actually address the problem.
Michelson's View 