Brave (Old) New World: UPMC Braddock and the Rise of Class-Based Health Care

Brave (Old) New World: UPMC Braddock and the Rise of Class-Based Health Care

A western Pennsylvania post-steel town like many others, Braddock has become relatively famous for at least two reasons: first, the famed documentarian Tony Buba, who still lives in Braddock and creates his oeuvre dramatizing the individuals who have lived through economic crisis there; and second, Braddock Mayor John Fetterman, whose tattooed white body has brought the town national recognition in Atlantic Monthly, Rolling Stone, and on The Colbert Report. But even the young Fetterman seems unable to rescue this town or any other from corporate policies that alienate the poor. No one person could. The site of many bitter labor struggles, Braddock is now the center of what can only be called a corporation’s criminal disregard for the health of a community. What’s scary: that corporation is the University of Pittsburgh Medical Center, the mission of which is to serve the community’s health.

Since 1996, UPMC acquired at least a dozen community hospitals under the guise of bringing “new models of health care delivery.” [1] In the cases of UPMC Southside, which the corporation relocated across the river in 2009, UPMC Aliquippa, which was sold back after it didn’t make enough money, and UPMC Braddock, which was closed outright with less than three months notice, the more accurate statement would be “new models of profit delivery” – delivered to UPMC, of course. With fourteen hospitals now part of its “integrated system” in western Pennsylvania, UPMC exerts almost total control over access to and the cost of its product. In April of 2009, West Penn Allegheny, a trying-to-compete hospital system, filed a federal lawsuit accusing UPMC and the Highmark health insurance company of restricting competition in the region. David McClenahan, West Penn Allegheny board chairman, stated: “We believe that for several years UPMC and Highmark have engaged in mutual back-scratching designed to preserve Highmark’s monopoly in health insurance and to permit UPMC to build a monopoly in sophisticated tertiary and quaternary health care in this region.” [2] The lawsuit failed, and the mergers go on. The case of Braddock in particular reveals just how dangerous monopolies are: manipulation of access to healthcare is not only unethical, but actively imperils the quality-and length – of our lives.

UPMC Braddock: “Juking the Stats.”

On the TV show The Wire, characters make frequent reference to “juking the stats” to make crime levels seem lower or to satisfy No Child Left Behind test score requirements. Many residents of the borough of Braddock, including former UPMC nurses and staff, report just such juking of the stats by the hospital system. The corporation has claimed that Braddock hospital was under-utilized, but health department reports based on data given by UPMC show that Braddock’s occupancy rate in 2007-08 was 72.4 percent – higher than six other Allegheny County hospitals. In fact, reports show that from 2000 until its closure, Braddock hospital never averaged below 69 percent occupancy and was slightly above the countywide average. [3] These figures suggest that UPMC was not in a money sinkhole at all, although its profitability probably failed to meet some internally-generated bar. But we have seen wolf cried a lot this year: CEOs taking bailouts for economic distress, then offering themselves personal bonuses. At the time of this article, three quarters through FY 2010, UPMC has earned $6 billion in operating revenue and $3 billion in returns on investments. [4] It calls itself “an $8 billion enterprise with facilities in Italy, Ireland, the UK, Cyprus, and Japan.” CEO Jeffrey Romoff received $4,448,181.00 in compensation and $72,367.00 in contributions to his employee benefit plan in 2008.

But “We’re not making enough money off the elderly and poor” wouldn’t fly as an official exit strategy, so UPMC had to juke the stats even lower. Management chose not to include Braddock’s behavioral health beds used for drug and alcohol, sober living and detoxification programs. Yet, patients from all over the region came to Braddock hospital for these services: surely it would not have been difficult to keep those services at Braddock, rather than relocate them to another hospital, thereby keeping UPMC Braddock financially secure.

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Perhaps most damning of all is that even these misreported numbers were engineered to be artificially low. Residents in the UPMC Braddock service area report that for several years prior to the hospital closing, they were typically transferred to another hospital en lieu of admission to Braddock. After its acquisition of Braddock hospital, UPMC removed oncology and obstetrics services, so pregnant women and anyone with a cancer diagnosis would have no choice but to use another hospital. Braddock Council President Jesse Brown, active in the fight to keep health care in Braddock, testifies to frequent referral to other hospitals for his prostate cancer and heart condition treatments: “Even if you’re walking in off the street and they’ve admitted me, they’ve kept me for two or three days then shipped me out [to another hospital]. If you do that, then definitely you’re not going to have enough people.” [5]

Why would UPMC funnel patients away from a hospital that is, for some, literally right next door? Two former UPMC Braddock nurses, who must remain nameless for fear of losing their new jobs at another UPMC hospital, report that they were told not to admit patients who walked into Braddock hospital, but to refer them elsewhere in the UPMC system. In a recent article, “Pennsylvania: Braddock Hospital Closes its Door for Good,” Braddock resident James Perrin offered testimony to the familiar scenario: “They say they can’t fill beds, but all they do is when someone comes in is to send them to Pittsburgh.” [6]

“Pittsburgh” refers to UPMC hospitals that are significantly farther away from Braddock. Most seniors in the UPMC Braddock service area say they won’t go to another hospital for blood work or check-ups or pain symptoms because they don’t know how they will get home. When UPMC announced in October of 2009 that it would close forever in just three months, public relations rationalized the decision by saying patients could go to “a number of UPMC facilities…easily accessible to residents of Braddock.” [7] The words easily accessible must ring hollow in the ears of Mon Valley residents. 35% of Braddock residents live below the poverty line and do not have cars, and surrounding communities report similar income levels. [8] The facilities UPMC speaks of are all at least a 30 minute drive by car in low traffic, but here is how long it really takes many residents to access these hospitals:

  • UPMC McKeesport: requires four buses and at least two hours commute time roundtrip, not including extensive wait time as buses run irregularly. [9]
  • UPMC Shadyside: four buses round trip, two hours minimum commute time.
  • UPMC Monroeville: As one resident stated in a community survey: “I’ll tell you this, I’ll never go to Monroeville for medical, that’s three buses for me. In case of an emergency, my only option would be to call an ambulance, to go to Oakland.” [10]
  • UPMC Presbyterian (Oakland): two buses roundtrip and two hours minimum commute time.

These locations could not by any standard be considered “easily accessible” even for those in perfect health, and the already-sizable difficulties of access increase dramatically when pain, weakness, and injury – the reasons we go to hospitals – are factored in. If preventive care is their number one goal, as UPMC claims on its insurance mailers, why do they make it impossible for Mon Valley residents to take preventive steps for a longer, healthier life?

In a study commissioned to assess the needs of the community and possible reuses of the hospital building, Braddock residents universally proclaimed that the only reasonable reuse would be to put in an Emergency Room – STAT. “Since I’ve been here, I’ve had two strokes – what happens to me if I have another? If you’re sick, you can’t take a bus, you have to call ACCESS the day before, you could ask a neighbor to take you, but not all the way to Presby,” one resident stated. These residents’ fears and concerns about what will happen to their bodies is real. Below is a list culled from the pages of testimony, all public record. [11]

  • “I don’t know how many buses you’d have to take to get to any replacement hospital. It’s just disgusting.”
  • “I’d like to see somebody from Port Authority [Pittsburgh’s public transit system] standing there at the corner when they’re sick waiting for a bus. And ambulance-do people have money for an ambulance all the time? No.”
  • “Just a four minute ride to Braddock hospital they want about $400 for an ambulance. Who can afford even that? And they want you to go to Shadyside or McKeesport!”
  • “The more difficult a health facility is to get to, the more likely it is to be avoided. People who need to get to the lab will not do so as often. If they don’t get it, if they don’t get their blood tests done on a regular basis, they won’t get the health care that they need.”
  • “I think that I could get to the Monroeville facility – but that’s provided that it’s not an emergency situation, and I can get there because I know the backroads.”
  • “In terms of employment and access to healthcare, it just pulls the heart of that community.”

Such testimony makes dramatically clear that lives and quality of lives are at stake, and yet, what has come of this $50,000 study? Many residents feel the study – like so much else that has occurred in this process – was a gimmick to create the illusion of concern for the community. After all, without that image to fall back on, UPMC can hardly continue to reap the benefits of its tax exempt, non-profit status. Early on in its flight out of Braddock, UPMC claimed it would sell the building for one dollar to anyone who wanted it: “We will gift the building to the community,” VP Paul Wood said after West Penn Allegheny bought full-page newspaper ads attacking the decision to close Braddock. Like anyone paying attention to the health care landscape in Pittsburgh, UPMC knew that no other Pittsburgh hospital could afford to operate the building. It was rumored that the neighboring Cleveland Clinic expressed interest in the space, and that at that point, UPMC rescinded its one dollar offer. Cleveland Clinic says this was just a rumor, but tit appears that were a viable competitor to have made overtures, UPMC would not have sold the building. Such a sale would obviously be at odds with UPMC’s agenda of squeezing out competitors, as it is currently trying to do by building a hospital less then two miles from West Penn Allegheny’s Monroeville facility. “I didn’t know Jeffrey Romoff was a socialist,” quipped Braddock Hills resident Jan McMannis at a Save Our Community Hospitals meeting. “Aren’t capitalists supposed to support competition?”

At the time of this article, the 13-year-old, state-of the art building waits to be razed, because the plan UPMC and Chief Executive Dan Onorato have agreed to – which is not the plan residents have agreed to – slates the building for demolition and proposes a retail space, restaurant, and senior housing be erected in its place. Residents know the town doesn’t need more empty senior housing, since housing was built next door to UPMC Braddock in 2009 for the express purpose of giving seniors direct access to a hospital. [12] The grant for the senior housing also funded a brand new entranceway to the hospital that UPMC would close six months later. [13] Did UPMC know it would soon close the facility but keep this a secret? Did the corporation accept $3 millions dollars of the Commonwealth of Pennsylvania’s money simply to delay what would be a fiery community response? What else could that money have been used for? Residents continue to cry out for an ER to be put in, which seems like an extremely sound choice, given that the necessary equipment and design are in place in the existing building, but apparently their cry falls on deaf ears. The irony – not to mention environmental waste – of tearing down the nicest building in town is highlighted by the question residents have asked in varying ways: if you walked down the streets of Braddock, past the vacant homes, weathered and in need of repair, past the empty storefronts, and past, as well, the sparkling hospital building, which building would you think was going to be torn down?

“Jeffrey Romoff Needs a Heart Transplant”

Another index of just how frightening UPMC’S corporate decisions have become is the community activism that has sprung up in response. Groups like Save Our Community Hospitals have been initiating action after public action: rallies at the hospital doorstep, zombie street theater, even a morality play with Julius Caesar standing in for the community hospitals betrayed by UPMC. Bearing hand-drawn signs like “Jeffrey Romoff Needs a Heart Transplant” and “UPMGreed,” residents have demonstrated (even in winter snowstorms) at UPMC Headquarters. Activists have made visible the campaign contributions given by UPMC to Allegheny County Chief Executive Dan Onorato, now making a run for the governor’s chair. Again, mantras from The Wire prove apt: “Follow the money,” Detective Lester Freeman says, and these angry residents have. What they have found suggests that UPMC made its great escape with the help of their elected officials. County councilman Charles McCullough has demanded a public hearing on Dan Onorato’s dealings with UPMC. McCullough states:

Correspondence this past March [2010] from UPMC to the County Executive and in turn from his administration to Braddock Borough reference an “agreement” between the County and/or the County Executive and UPMC concerning the demolition of Braddock Hospital and the re-use of the site for purposes unrelated to the healthcare needs of the greater Braddock area. This agreement was never presented to County Council for approval. Such a critical arrangement, which is intended to result in the demolition of a hospital which has provided critical and essential healthcare for the residents of the greater Braddock area for over 100 years must be aired in public before the County’s legislative body, i.e. County Council.

McCullough has filed two lawsuits: one against Allegheny County Council for issuing a richly rewarding bond to UPMC after they announced the plan to close Braddock hospital, and the other aimed at making Onorato’s dealings with UPMC public. The possibility of Onorato’s collusion with UPMC is all the scarier since the Chief Executive pledged to advocate for Braddock residents. Another instance of local officials in UPMC’s pocket: a pleasant new job for State Senator Sean Logan into marketing for – you guessed it, UPMC – has hit the public’s radar. Logan is accused of obtaining a secret $5 million grant to help finance the new and arguably redundant UPMC Monroeville hospital. Tony Buba has called Logan’s new job his “thirty pieces of silver” from UPMC: “payoff for his work on their behalf.” [14]

There is also an undeniable racial component to the UPMC story in Pittsburgh. UPMC’s most recent flight disproportionately affects African Americans, as 66.5 percent of Braddock identifies as Black. Borough Council President Jesse Brown has filed a suit with the U.S. Department of Health and Human Services (HHS) Office of Civil Rights, arguing that UPMC’s closure of Braddock hospital creates a situation of “disparate impact” against a predominantly African American community. Rev. James McDonald, a Braddock resident active in the fight to keep medical care in the area, testified before the Allegheny County Council to the racial disparity involved in pushing the closure through:

To date, there has not been a hearing of parties involved, including residents of the Mon Valley on both sides of the river. To date, UPMC has not produced a written agreement to Braddock officials. Conversations have hinged on what the County Executive said on behalf of the County, which may or may not be known by you, the County Council. And this is contrary to what UPMC did to South Side Hospital and the County Executive’s involvement. And I ask the question, why? Because South Side Hospital is located in a predominantly white community, whereas UPMC-Braddock Hospital, while serving the residents of the Mon Valley, is located within the borders of what has become a predominantly Afro-American community.

Likewise, James Kidd offered testimony to the racial and class factors involved:

I think the real basis of this thing is that they want to put this hospital in…Monroeville-build a $250 million hospital, and there’s already a hospital there. It seems they want to go where the money is. And there’s the privilege there. The money is there. But they don’t want to serve people in Braddock who have medical cards…It really just boils down to if you’re poor and you’re underprivileged, you have to fight and scratch for every darn thing you want. It doesn’t come easily. And we’re here fighting for the things for the poor, the underprivileged and minorities.

At the time of this article, Braddock has just received news that UPMC did, in fact, enter into a voluntary agreement with HHS: that is to say, it has acknowledged culpability in a civil rights infraction. It has agreed to three years of additional van services to McKeesport hospital and Forest Hills doctors’ offices and to increasing patient outreach in Braddock. Sadly, this offer is meager in comparison to what the Mon Valley has given to UPMC and what the corporation has taken.

Déjà Vu All Over Again

When UPMC bought Braddock Community Hospital thirteen years ago, residents didn’t know it would mean the end to this vital, beating heart. After all, why would a multinational corporation with hospitals in Cyprus, Qatar, Sicily and Dublin be unable to operate a hospital that’s been around for over a century? Why would a billion dollar corporation dominating the market in Allegheny county and expanding throughout Pennsylvania, the CEO of which, Jeffrey Romoff, received $4.5 million in compensation the year before, make such egregious financial errors that they could no longer afford to operate one hospital among dozens they had purchased? [15] The parsimonious answer is that the business model favored by oil drilling, hydraulic fracturing, and mountain top removal companies, who ignore the social and environmental consequences of their decisions, is also the preferred model for those to whom we entrust our very bodies. What are the alternative models, one might ask? Well, UPMC might have used an evaluative method called a Health Impact Assessment (HIA). The World Health Organization describes the HIA as “a means of assessing the health impacts of policies, plans and projects in diverse economic sectors using quantitative, qualitative and participatory techniques.” [16] Assessing the health impact of its decisions sounds like an appropriate modus operandi for a hospital.

During a community demonstration in Oakland, one UPMC corporate employee passing by on lunch break said, “It’s a business decision. If Starbucks wants to close one of its coffee shops, doesn’t it have the right?” Despite what Starbucks might have customers believe, we won’t die without their coffee. Without adequate access to healthcare, however, people die. Some suffer more slowly, as repeatedly-ignored symptoms worsen when logistical or financial difficulties prevent the necessary trip(s) to the hospital. Some die in tragedies that could have been avoided – an asthma attack or heart attack or diabetic coma that proves fatal in the amount of time it takes an ambulance in traffic to arrive at the hospital UPMC prefers, for its numbers game, you go to.

In “Crisis. What Crisis? Profts Soar!,” James Petras describes the great escape corporations like UPMC are making under the guise of financial peril:

While progressives and leftists write about the “crises of capitalism”, manufacturers, petroleum companies, bankers and most other major corporations on both sides of the Atlantic and Pacific coast are chuckling all the way to the bank. From the first quarter of this year, corporate profits have shot up between twenty to over a hundred percent…In fact, corporate profits have risen higher than they were before the onset of the recession in 2008…Contrary to progressive bloggers the rates of profits are rising not falling, particularly among the biggest corporations…The buoyancy of corporate profits is directly a result of the deepening crises of the working class, public and private employees and small and medium size enterprises. [17]

Enjoying significant buoyancy of profit – UPMC’s operating income is up 16 percent from last year [18] – UPMC has used financial losses to justify everything it has done.

In a British study released this month, mortality rates showed the gap in quality of life between rich and poor hasn’t been this high since the Great Depression. [19] Unchecked strategies to multiply profit and our government’s failure to limit corporate greed have brought us where we are today – a landscape that, to some, looks like a Brave New World. To those who have seen the wrong end of the American dream before, however, this is not new, but an old, familiar tale. Former steelworkers like activist Mike Stout, who fought the flight of Pittsburgh Steel in the 80s, note the familiar corporate practices and the fact that places like Braddock are in economic despair because of the overwhelming greed and underdeveloped sense of responsibility in those who employ us:

For steelworkers who lost their jobs to plant shutdowns in the 80’s, it’s déjà vu all over again. Without a strong manufacturing base that actually makes things and produces wealth, services such as health care will be swept away in the giant suck to the bottom by global capitalism, forever in search of cheaper labor and higher profits. My only question is: when are organized labor and progressives going to take these bastards and their whole rotten system on? UPMC is no different than US Steel; only the name at the top of the tower has changed.

Like UPMC, US steel used the labor force to make profits hand over fist and then abandoned the Mon Valley when a recession hit. Like US Steel, UPMC made a contract: give us your bodies-as workers (there were over 650 jobs lost when the hospital closed) and as patients – to handle and treat as we wish, and give us your insurance to pay for it. We will get rich, and you, at least, will be given medical care. Braddock hospital has been operational since 1906, but it took UPMC just thirteen years to shut it down. Honestly, who would have expected that the wealthiest corporation around would decide it couldn’t pay the bills?

Let’s follow that with another, related question: when did it become accepted practice for health care providers to choose whom they would serve based on the form of insurance (if any) their patients possess? In this increasingly disturbing model of health care, patients with privatized insurance plans receive privileged access to care; those with publically funded Medicare (for seniors and the disabled) or Medicaid (for people of low-income), are cordoned off and left without healthcare, as hospital corporations funnel their services away from the poor and elderly and toward patients whose insurance reimburses the most: companies such as Blue Cross Blue Shield, which reimburse at higher rates than Medicare and Medicaid. When actually put into words, this sounds like the plot of a science fiction novel or Jonathan Swift satire. Blatantly favoring access to care for the wealthy, however, is exactly what UPMC and corporations like it have systematically begun to do. The masses of people assembling in Pittsburgh – not for a Steelers game, but for equal access to medical care – are unwilling to forgive or forget the inequality they see around them. “The closing of the mills was the crisis of my generation,” says Tony Buba. “For today’s generation, that crisis is healthcare.” In the Mon Valley people are organizing against UPMC’s brave new world, and their numbers are growing.

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[1] University of Pittsburgh Medical Center. “The UPMC Story.” UPMC.com. 2010. Web. 16 Aug 2010.

[2] Pittsburgh Business Times. “West Penn Files Suit Against UPMC, Highmark.” 22 Apr 2009. Web. 4 Sep 2010.

[3] Twedt, Steve. “UPMC Braddock Usage Rate Disputed.” Pittsburgh Post-Gazette. 31 Oct 2009. Web. 15 Aug 2010.

[4] University of Pittsburgh Medical Center. UPMC.com, “UPMC’s Strong Financial Results Through Third-Quarter Fiscal Year 2010 Allow For Growth and Investment to Benefit Patients and the Community.” 2010. Web. 4 Sep 2010.

[5] Twedt, Steve. “UPMC Braddock Usage Rate Disputed.” Pittsburgh Post-Gazette. 31 Oct 2009. Web. 15 Aug 2010.

[6] Davidson, Samuel. “Braddock Hospital Closes Its Doors for Good.” World Socialist Website. 30 January 2010. Web. 16 Aug 2010.

[7] University of Pittsburgh Medical Center. “Serving the Braddock Community.” UPMC.com. 2010. Web. 16 Aug 2010. Note: UPMC’s website incorrectly states that Braddock is the only community that used the hospital. The hospital served patients all over the Mon Valley, including Rankine, Swissvale, North Braddock and Braddock.

[8] US Census Bureau. “Table DP-3. Profile of Selected Economic Characteristics: 2000 Geographic area: Braddock borough, Pennsylvania” 2000. Web. 15 Aug 2010.

[9] Residents fear that UPMC McKeesport is itself on the verge of closure, just like UPMC Braddock. (see, Mamula, Kris. “UPMC McKeesport’s Future in Question.” Pittsburgh Business Times. 20 Nov 2009. Web. 4 Sep 2010.)

[10] Allegheny County Economic Development. “Braddock Hospital Initial Facility Reuse Study” and “Appendix” 01 Feb 2010. Web. 15 Aug 2010.

[11] Ibid.

[12] Balingit, Moriah. “New Housing for Seniors in Braddock Seen as Boost to Area.” Pittsburgh Post-Gazette. 7 May 2009.

[13] All Things Braddock. “Hospital Opens New Entrance.” 25 June 2009. Web. 4 Sep 2010.

[14] Bumsted, Brad and Mike Wereshagin. Tribune-Review. “State Sen. Logan Quitting Position to Join UPMC as VP.” 30 Jul 2010. Web. 4 Sep 2010.

[15] In 1998, Romoff defended UPMC’s acquisition of community hospitals by promising longevity: UPMC preserves “vitally important institutions…Braddock [Hospital] would have been bankrupt [without UPMC’s takeover].” And later: “Shouldn’t the issue be how the community is served rather than who’s in charge of health care in Western Pennsylvania?” Indeed, shouldn’t it? (Romoff qtd in Dickerson, Linda. Pittsburgh Post Gazette. 11 Oct 1998.)

[16] World Health Organization. “Health Impact Assessment.” 2010. Web. 4 Sep 2010.

[17]Al-Jazeerah: Cross-Cultural Understanding. 19 Aug 2010. Web. 23 Aug 2010.

[18] University of Pittsburgh Medical Center, Media Relations. “UPMC’s Strong Financial Results Through Third-Quarter Fiscal Year 2010 Allow For Growth and Investment to Benefit Patients and the Community.” UPMC.com. 2010. Web. 4 Sep 2010.

[19] Thomas, Bethan, Danny Dorling, and George Davey Smith. “Inequalities in Premature Mortality in Britain: Observational Study from 1921 to 2007.”