Catholic, then Protestant. Protestant, then Catholic. That's the story of the founding of hospitals in Pittsburgh, a reason we have so many, often in the same neighborhood, and why there have been mergers and closures in recent years.
That ecclesiastical "formula" was described for me 37 years ago by Steve Sieverts, executive director of the then-existing Hospital Planning Association of Allegheny County. If you want to understand Pittsburgh's hospital situation, Mr. Sieverts said, know that in the 19th Century when the Catholics built a hospital, the Protestants did, too, and vice versa. Often, the impetus came not from Protestant denominations but from Protestant laymen anxious about surging Catholicism.
(Note: There is no overall history of Pittsburgh's hospitals, so I have pieced together this narrative from a 1977 talk by philanthropist Philip Hallen; Mary Brignano's histories of some individual hospitals; the invaluable resources of the Pennsylvania Department at the Carnegie Library; and interviews.)
So in Pittsburgh's central district you had Mercy Hospital, founded by the Sisters of Mercy in 1847, balanced by Passavant, a Lutheran institution first situated in 1848 on the North Side, but then moved to the neighborhood where the Mellon Arena now sits. George Breed, a Protestant businessman, led the effort to found West Penn Hospital in Bloomfield in 1853, with the Catholics following suit in 1866 with St. Francis nearby.
On the South Side there was South Side Hospital, founded in 1889, and St. Joseph's in 1904. North Siders in 1880 founded Allegheny General, whose board Presbyterians later dominated. In 1915, the Sisters of Divine Providence acquired St. John's in Brighton Heights, founded by the Lankenau Lutheran Sisters in 1896.
Not everything can be attributed to a tit-for-tat pattern. Shadyside was launched as an homeopathic hospital in 1866, fostering a repudiation of the "heroic medicine" techniques of bleeding and emetics. The Episcopalians built St. Margaret's in Lawrenceville in 1889. Presbyterian was founded on the North Side in 1895 by Dr. Louise Wotring Lyle, widow of a Presbyterian minister, alarming the Pittsburgh Presbytery, which feared any implied financial responsibility. Presbyterian moved to Oakland in 1938, with its Arch Street building taken over in 1953 by the Sisters of Divine Providence. They ran it until 1993, when it was acquired by the Sisters of Mercy.
The Jewish community founded Montefiore in 1908 because Jewish doctors were then barred from practicing in any Pittsburgh hospital.
Until well into the 20th century, the city was growing so the more hospital beds produced by interfaith rivalry the better. But in the Great Depression, with all the charity cases pouring in, hospitals were desperate for income. At the same time, business leaders were concerned about the rising costs of supporting so much medical capacity.
With Buhl Foundation funding, a series of planning organizations evolved, in 1964 culminating in the planning agency that Mr. Sieverts later headed. The federal government got into hospital planning in a big way in the Lyndon Johnson years with the Comprehensive Health Planning System, which lasted until 1986 when the Reagan Administration switched health-cost-containment efforts from government planning to private competition.
Competition has had its pluses and minuses. It has prompted numerous mergers and acquisitions by two major players -- the University of Pittsburgh Medical Center and West Penn Allegheny -- to make possible specialization in particular hospitals. On the one hand, this undoubtedly has saved local medical service for places such as Braddock and McKeesport, but, on the other hand, has led to such competition-based efforts as UPMC's new venture into the already-served Monroeville market.
The face of medicine has changed in two ways. One is new technologies -- MRIs, CAT-scans, transplants, sophisticated cancer and heart treatments, non-invasive surgery. Add in the development of ambulances with life-saving equipment, plus surgicenters and urgicenters, some launched by hospitals or physicians, some by drug-store chains.
In southwestern Pennsylvania, UPMC has spread the blessings with "telemedicine" hub-and-spoke systems. Examples: A network that links the Hillman Cancer Center with 42 community hospitals, plus two in Ireland, allowing highly trained experts to share information with radiation specialists at the satellite centers. Similarly, a Telestroke network, offering immediate diagnoses without victims having to travel to Pittsburgh.
Such developments have helped create the second great change: People are living longer, though this sometimes means three to four chronic diseases per person. It's a blessing, of course, but a bane financially, partly explaining the climb of health costs to 16 percent of GNP, highest in the world.
Health reform is all the talk in Washington, keyed to the fact that 46 million Americans still aren't covered by any health plan. My prayer is that Congress can find a way -- whether single-payer insurance or a cost-containing variation thereof -- to make available to all the kinds of benefits that in the Pittsburgh region those of us with health plans enjoy.
Clarke Thomas is a Post-Gazette senior editor ( firstname.lastname@example.org ).