(Blue Dog 27 September 2001)

Hospitals at the Edge
Part I: Buffalo’s most dangerous neighborhood

by Bruce Jackson

The Danger Zone

“You know what’s changed in Buffalo?” a doctor friend said a month ago. I know him well enough to know he had something very specific in mind, so I didn’t even try to answer.

“No. What?” I said.

“It’s a dangerous city now. It didn’t used to be a dangerous city, but now it is. It used to be, you’d tell people you were from Buffalo and they’d make wisecracks about the weather, but we always knew what a great place it was. It’s got real neighborhoods, it’s comfortable like a small town but it’s got city amenities. It’s got real seasons, the lake, no traffic jams, all that. We’d tell them how great it was and if they didn’t believe us, too bad for them. Their loss. We knew how great it was. But now, we can’t say that. What we’ve got to say now is, ‘It’s a dangerous city.’”

“Nonsense,” I said. “Buffalo’s got one of the lowest urban crime rates in the country.”

“Not that,” he said. “It’s a dangerous city if you get sick. Get sick here now and you’re in real trouble. Only a few people get mugged or robbed or whatever. Everybody gets sick sometime.”

Every physician I know has said just about the same thing. Cardiologists, pediatricians, endocrinologists, surgeons—they’re all in despair about what has come about in the past few years.

"Don't get sick enough to be hospitalized in Buffalo," an internist friend said to me. "You can't afford it."

"I've got a great medical plan," I said, "one of the best. They take care of everything."

"No doubt,” my internist friend said. "But I'm not talking about money. I'm talking about going into the hospital in Buffalo. It's not something you want to do these days."

He told me a really scary story about a rich guy I'll call Jerry who had gone into one of the Kaleida hospitals for emergency treatment because he'd all-of-a-sudden come down with a bunch of inexplicable painful and debilitating symptoms. Jerry was quickly interviewed, x-rayed, poked and prodded, and then he was parked in a room after some overworked resident decided he was just a senile alcoholic in booze withdrawal. That's why he was shaking like that, that's why his blood pressure was so low, that's why his vital signs were so dreadful.

One of Jerry’s physician friends heard he was in the hospital, went to visit him, saw him, looked at his chart, and went ballistic. For starters, the friend knew that Jerry wasn't an alcoholic. What they were doing for him wasn't helping the plunging blood pressure, the erratic pulse, the troubled breathing, the bad blood gas numbers. So far as Jerry's physician friend could tell, what the were doing to him was making everything worse. The hospital was in the process of killing him.

Jerry’s friend called a senior hospital official. The senior official came in and asked for a report on the x-rays. It turned out no one had read the x-rays because there was no staff radiologist when Jerry was admitted and there wasn't one however many hours later this was. It was still the weekend, you see. Even after significant deterioration in Jerry's condition, no one had looked at the pictures because no radiologist worked in the hospital over the weekend. Whoever was in charge of Jerry’s case, if anyone was in charge of Jerry’s case, seems to have assumed that someone would look at the pictures Monday, presuming Jerry was still alive on Monday.

Once the bigshots got involved, they found a radiologist and the radiologist said Jerry had a collapsed lung and was hemorrhaging and if they didn't inflate that lung he'd probably suffocate pretty soon and if they didn't do something about the internal bleeding he'd probably bleed to death, perhaps before he suffocated. These are all things they would have known 30 minutes after he’d been admitted, had anyone looked at the x-rays which, as I said, no one ever did.

I mentioned that Jerry was a rich guy because we've gotten used to poor people being screwed by the system, ignored by the people in power or the people in control, sent to the back of the line so the swells could have the spaces at the front. Not all the time, but surely some of the time. But if a rich guy gets lousy treatment and nearly dies because of it, if he can be nearly killed by the system that's supposed to be saving him, nobody is safe. Nobody. Not Franco Megabucks, not Josey Poorbottom. Nobody. Not ever. We're all at risk, not just from random and deliberate violence or the biological things that might attack us or the ravages of time and our own bad habits, but of the very health system that's supposed to be giving us a fighting chance.

Not one physician I told about Jerry's near-death experience was surprised. Every physician I told about it told me his or her own atrocity story more or less like Jerry’s atrocity story.

One surgeon said, "When people used to say to me, ‘I've got to have this or that procedure, where should I go?' I'd tell them, ‘‘Go to General or go to Millard or whatever.' Now I tell them, ‘‘Go to Cleveland, go to Boston, go any place but Buffalo.'"

Who’s There?

A month ago, the few remaining staff radiologists at Children's Hospital said they were quitting because of intolerable workloads, inadequate replacement hiring, and inadequate support services. Kaleida Health says it will manage: it will shift some adult radiologists around so they'll be able to take and read the pictures. But—as physicians at Children's pointed out when their support services were slashed after the merger that created Kaleida—radiologists who specialize in children aren't just radiologists who work with smaller bodies. A radiologist who works with adults can say, "I know it's hurting, but if you can just hold still for two more pictures or the time it takes for this MRI we can get around to fixing it." How do you say that to a two-year-old in pain? A six-month-old in pain? Even with all the fancy gadgets, medicine is as much art as science and that is nowhere so obvious as in the way doctors and nurses handle kids in pain.

Buffalo attorney, casino developer,  and venture capitalist Gerald Lippes, former chairman of the Children’s Hospital board and newly elected chairman of the Kaleida Health board of directors, told a Buffalo News reporter that the radiologists left Children’s "because it's easier to work on adults. In the hospital, you are on call all of the time. They left for their own convenience." He said that their leaving might be  "a blessing in disguise." No one in the medical community agrees with Lippes; many point to that statement as evidence of how out-of-touch with reality Kaleida management is.

Every hospital in the Kaleida system is hurting because of losses in radiological staff. Radiologists are still here, but they’ve left the Kaleida system; they come in when they’re called for, but they’re not always on hand, the way they used to be, the way other doctors need them to be. For many illnesses and injuries, radiologists are like ground control and radar for pilots flying in dense fog: no matter how good a pilot you are, when you can't see the ground the information you get from radar and ground control is the difference between life and death. No matter how good a doctor you are, the radiologist provides the critical information that gets you to the place where you can begin doing your work. Without that information, you're flying in a fogbank. You might get lucky; you might not. Your patient might live; your patient might die.

What's happened to Buffalo's health care system isn't just a collapse in one medical specialty. The problems are endemic. The crisis in radiology has gotten the most press, but the problems are just as grim in other specialties. John I. Lauria, a physician and board chairman of the Catholic Independent Practice Association, recently wrote the Buffalo News, “The problem with the departure of the Children's Hospital radiologists is merely the exposed tip of the iceberg. Anesthesiologists, gastroenterologists, pediatric heart surgeons, pediatric cardiologists, neonatologists and other specialists have left the Kaleida system.”

Every one of those losses is critical. Anaesthesiologists, for example, aren’t just people who knock a patient out so a surgeon can get to cutting. They work in close partnership with surgeons, they control awareness of pain and they make sure the patient isn’t being killed by the process, they work in a region of delicate balance while the most astonishing violence is being done to the patient’s body. If a surgeon can’t be perfectly confident about the anaesthesiologist’s work, the surgeon is constantly distracted. The last thing you want, when you’re split open on the table, is a distracted surgeon.

High Street

All of the medical fields in Buffalo are having difficulty hiring. “Why would anyone come here,” one surgeon said to me, “when doctors are paid less here than anywhere in the northeast. The medical plans pay Rochester doctors twice what doctors get here. What’s the difference between Buffalo and Rochester? It’s crazy. We can’t hire good people any more. Why would anyone come here, unless they have family? Why would anyone stay here, unless they had family?”

Kaleida and UB and City Hall say that if we move Children's Hospital to High Street, dollars will flow from some industrial somewhere and top people will come here and all will be well. Nobody really believes that; they just say it. Kaleida lost $22 million last year and stands to lose more this year. It is expanding Millard Fillmore Suburban and is on the brink of shutting down Millard Fillmore on Delaware. It says it is doing a feasibility study about moving Children’s to High Street, but physicians at Children’s say support and maintenance have dropped to such a low level that by the time the report comes in it will be moot because Children’s on Bryant will have been already asphyxiated.

Kaleida chief Gerald Lippes also told the Buffalo News that "There is nothing wrong with our hospitals. The system is not broken. The product is very good despite the problems. There is a lot of controversy going on, and it clouds the good things that are happening." Yeah. Sure.

A Task Force of Rich White Guys

Several weeks ago, a new Buffalo medical disaster commission was announced, the Health Care Task Force, headed by M&T bank boss Robert Wilmers. The vice chairman is Thomas Baker, executive director of the John R. Oishei Foundation. The other nine members are Louis Thomas of United Steelworkers, Assembly Majority Leader Paul Tokasz, D-Cheektowaga, Erland Kailbourne, chairman of the Oishei Foundation, Jerry Castiglia (chairman of the Catholic Health System board of directors), Gerald Lippes, UB president William Greiner, Jeremy Jacobs (chairman of Delaware North Companies and chairman of the UB Council) Patrick Lee (chairman of IMC and chairman of the board at Roswell Park Cancer Institute), and David Rutecki (vice president of M&T Bank and chairman of the Erie County Medical Center board of managers).

That is: it is a task force composed of very powerful well-meaning white men, some of whom employ some of the others, and nearly all of whom have been running the very system they're now going to look at and attempt to fix. Not a single health care professional. No women. No one out of the loop of power that administered us into this mess. No one who might bring to the table any point of view or vision that differs from the points of view or vision already at the table.

"You listen to these people," one physician said, "and it's all business. Business is what they know and what they talk about. But," she said, really serious, really sad, "you don't hear them talk about care. They don't know about care. What they care about is money, what they know about is money."

Every physician I spoke to about this was furious that Wilmers’ task force specifically and deliberately  excluded health care professionals. I asked several of them what they would say if the task force of Rich White Guys decided to include them. One said, “At this point? After I asked them why no doctors and they told me ‘We don’t need you, we know what you think.’ You know what I’d say. I’d say, ‘Fuck you. Kaleida’s dead. From suicide. If you want decent medical care here now, go to the Catholic hospitals.’”

Click here for part 2, "What the doctors say," which appeared in Blue Dog on October 4.

copyright 2001 Bruce Jackson
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