UPMC, a $10 billion health care giant, closed its financially troubled Braddock hospital in 2010.
Cleveland Clinic, a $6.5 billion health care giant, closed its financially troubled Huron Hospital in 2011.
UPMC left behind a struggling community health center, a family social services center, a dental clinic that operates out of a retrofitted RV a couple days a week and one van for getting people within an approximately 2-mile radius of Braddock to health care facilities. It declined a request by community officials to create an urgent care center in Braddock.
Cleveland Clinic built a $25 million, 50,000-square-foot health center adjacent to the hospital’s former location. It expanded beyond primary care to add some specialties, an Express Care center, navigation teams, a pharmacy, a dialysis center, behavioral health services, health education programs, a kitchen to teach healthy cooking and an expanded transportation system with 10 vans for door-to-door service for anyone within 5 miles to any one of four hospitals, including Cleveland Clinic’s main campus.
Two paths after closure
UPMC and Cleveland Clinic did what health systems across the country have done in the face of millions of dollars in losses and dwindling patient bases at financially troubled hospitals operating in poor communities — they closed them.
UPMC said that the hospital was being “underutilized” and that other UPMC facilities would provide care to patients in the community after the closure. But 41⁄2 years after the Mon Valley borough lost its hospital, health care options there are meager. The economically depressed borough, devastated by the collapse of the steel industry, lost a local institution, doctors, jobs and easy access to health care.
“Health care for poor people is a guaranteed loser” for a health system, said Braddock Mayor John Fetterman. “But you have to ask, is health care a right or a privilege? Do some people deserve it and some people don’t?”
About 150 miles northwest of Braddock, a different scenario unfolded.
When the Cleveland Clinic closed Huron Hospital, a struggling community hospital in East Cleveland, it angered the community. Like UPMC Braddock, Huron had an emergency room that was used heavily for primary care by residents, who opposed the closure.
“A lot of people were disappointed when it closed,” said Michael Wiggins, 61, a retired phone installation and repair manager who lives in East Cleveland. “It is where everyone who didn’t have a primary care doctor, like my parents and me growing up, went for health care.”
Cleveland Clinic had been planning a family health center nearby to address chronic diseases in the neighborhood, but decided to expand the plans in light of the closure.
The Stephanie Tubbs Jones Health Center opened in 2011 and is operated on the principles of oncologist Harold Freeman. Dr. Freeman created the Patient Navigation Institute in New York, and believes that to address chronic diseases in poor communities it’s crucial to tear down any and all barriers — from education, to learning to prepare healthy food, to transportation.
“We’re trying to promote preventive measures to improve the health of the community,” said Nana Kobaivanova, the Tubbs Jones health center’s medical director who, like much of the staff, used to work at Huron. “And if we’re consistent and we are working on that, it’s going to be multidisciplinary work.”
But why keep a medical facility in East Cleveland at all? Why not just have people find their way to Cleveland Clinic’s main campus just 3 miles away? UPMC said at the time of the Braddock closure that many residents already were using other hospitals.
“A lot of times the distance creates a challenge to get health care,” said Dr. Kobaivanova. “Having this here creates convenience and the familiarity with staff makes people more comfortable and likely to come back.”
Three years after the center’s opening, Dr. Kobaivanova said she believes it is making an impact on the health of the neighborhood, and has begun to win back the trust of its neighborhood.
The health center, which has the equivalent of about 100 full-time staff, has grown its monthly visits from about 3,100 when it opened to more than 4,000.
“If you talk to our patients you’ll get so many stories about how they transitioned from not trusting us with the closure of the community hospital, to now, they look at this center as their medical home,” she said.
Back in Braddock, Mr. Fetterman said he wishes UPMC had treated his town the way Cleveland Clinic treated a similarly poor neighborhood in its region.
UPMC has never thought it was fair that its October 2009 decision to close 106-year-old UPMC Braddock became linked by the public with its announcement 19 months earlier that it was going to build a $250 million hospital in wealthier Monroeville, 8 miles to the east.
Trading an old hospital that served a lot of poor people for a new one that would serve wealthier people looked like a classic case of modern-day hospitals chasing a better, more lucrative, “payer mix.”
Not so, says UPMC.
“They are not at all related,” said spokesman Paul Wood.
UPMC East was built because the health system needed to find a way to remove some of the demand from the emergency department and patient rooms at UPMC Presbyterian-Shadyside, he said, and doctors in the Monroeville area had been asking for a facility nearby where they could send patients.
As for Braddock, the hospital that UPMC acquired in 1996, Mr. Wood said: “The bottom line was Braddock was closed because it was being underutilized.”
Mr. Fetterman doesn’t buy it.
“The second I heard they were going to build in Monroeville [in 2008], I turned to my wife and told her: ‘You can kiss Braddock Hospital goodbye. And McKeesport [hospital] is next,’ ” he said recently.
According to a fact sheet UPMC passed out in October 2009, the health system lost $27 million at the hospital in the previous six years, and projected it would lose $50 million more in the succeeding five to six years. The patient population was declining as the Mon Valley’s population decreased by 20 percent in the previous two decades.
Ultimately, the fact sheet concluded: “UPMC must prudently examine opportunities to integrate and consolidate functions balanced against the needs of the community.”
That quote was echoed by Moody’s Investor Services when it upgraded UPMC’s bond rating from negative to stable in February 2010 as UPMC was about to issue $720 million in bonds.
“Given the weak socioeconomic indices in UPMC’s greater marketplace, we view favorably management’s fortitude to balance capacity with community needs,” Moody’s wrote, in part.
Moody’s, as well as the two other major bond rating services that also gave UPMC positive reviews then — Fitch and Standard & Poor’s — cited UPMC’s decision to close Braddock as evidence of strong management.
Moody’s also linked Braddock’s closure indirectly with the construction of UPMC East.
“After concluding that clinical and facility costs could not be supported by remaining volumes management decided to close UPMC Braddock effective Jan. 31, 2010,” Moody’s said. “Conversely, to address capacity constraints at its Oakland and Shadyside Hospitals, UPMC is currently undertaking site work for a new subsidiary hospital, UPMC East, to be located in the Borough of Monroeville.”
Mr. Wood said the timing of UPMC Braddock’s closing had nothing at all to do with the issuance of the bonds and was merely coincidental.
Like many in the community, though, David Waszkiewicz, 46, an unemployed truck operator from neighboring Rankin, wishes UPMC had done things differently.
“I just wish when UPMC had pulled out of here they’d put in a MedExpress instead of nothing,” Mr. Waszkiewicz said earlier this year after leaving the Braddock Free Clinic. Volunteer physicians from the local chapter of the Muslim Council of America founded the clinic three years ago in response to the loss of the hospital. It’s open four hours every Saturday and Sunday, except on holidays.
Mr. Waszkiewicz said he had not had any insurance for four years and had gone a couple years without seeing a doctor. He began visiting the free clinic because he needed blood pressure medicine and came that day to get a prescription for antibiotics for an ear infection.
“And I’ll keep coming here until I get [a job] with insurance,” he said.
Mr. Fetterman and others had also urged UPMC to provide an urgent care center and outpatient clinic like the one it set up when it closed UPMC South Side in 2009.
UPMC declined, but now Allegheny Health Network has stepped in with plans to open a 4,000-square-foot urgent care center on the site of the old hospital sometime this fall.
Mr. Fetterman credits Highmark — AHN’s parent company — and Dan Onorato, who was county executive when the hospital closed and now works for Highmark, with making it happen. “They stepped up when UPMC wouldn’t,” Mr. Fetterman said.
Mr. Wood points to measures UPMC took when it closed Braddock: It paid for extended night and weekend hours at the federally qualified Braddock Family Health Center, created a transportation system for Braddock-area residents to get them to local doctors or other hospitals, set up the dental clinic and a Children’s Hospital of Pittsburgh of UPMC social service center.
But the night and weekend hours at Braddock Family Health Center ended last year, even though UPMC wanted to keep them going, because the health center was trying to cover the hours with existing employees.
“After three years, they were exhausted,” said Wilford Payne, executive director of Primary Care Health Services, which runs the health center. “We just couldn’t sustain it.”
The transportation system went through multiple changes but never really addressed the transportation needs of the community, critics complain. It serves about 140 people a month compared to the 4,800 people a month served by the Cleveland Clinic.
“What we’ve learned is: To try to love something that wasn’t going to love you back is a fool’s errand,” said Mr. Fetterman.
Sean D. Hamill: firstname.lastname@example.org or 412-263-2579.