The crisis of the disappearing Black hospitals - includes related article

Ebony, March, 1992

IT'S frightening but true: the Black hospital, once the institution Black Americans relied on to heal--and save--their lives, is now fighting for its own life.

Worse, say experts, unless dramatic action is taken soon, the prognosis for the survival of one of Black America's most critical institutions is bleak.

"A valuable national resource is about to be lost, perhaps irretrievably," laments Dr. Reed Tuckson, president of the Charles R. Drew University of Medicine and Science and the former commissioner of health for the nation's capital.

Dr. Tuckson isn't overstating the crisis. The Black hospital--the institution created to serve and save people ignored by White-owned hospitals--is facing its own extinction. Fact: There were 200 private Black hospitals at the turn of the century. Between 1961 and 1988, some 57 Black hospitals closed and 14 others either merged, converted or consolidated. Today, there are a dozen. Twelve. * And many of them are operating in a survival mode, struggling daily just to keep their doors open in a valiant effort to keep serving those most in need of health care.

What happened? How did this once thriving institution go from vital to vanishing? One-way integration, reduced federal funding and skyrocketing health care costs all played a role, but the primary reason for its demise, say health care experts, is so ironic that it's almost incomprehensible. The Black hospital is vanishing, they say, because it is fulfilling a hospital's greatest mission: treating and healing the sick, no matter how ill or how poor.

"The generic problem facing historically Black hospitals is that the majority of their patients are poor," Meharry Medical College President Dr. David Satcher flatly states. "After a period of time, that situation erodes the base and makes hospitals non-competitive."

Dr. Tuckson agrees. "Each day we read stories about hospitals that turn people away because they don't have the right insurance and because they are more interested in the business of health care as opposed to being sensitive to the special needs of special people, " he says. "Black hospitals have traditionally served the neediest among us. Daily, they treat the underserved and uninsured and do the work other hospitals have been unwilling to do."

Sadly, that service has exacted a terrible price. By treating patients based on their need and not their income, most Black hospitals now find themselves without the necessary dollars to modernize, make improvements, buy new equipment, and compete with White-owned hospitals in attracting new patients.

What's more, faced with this grim economic reality, they're losing Black physicians, a growing number of whom have left Black hospitals for better-funded, better-paying non-black hospitals. "Black physicians are very often in a Catch 22 situation relative to Black hospitals because in order to maintain their skill level they have to utilize hospitals that have what they need to function with," explains Dr. james Goodman, president of the Morehouse School of Medicine. "In addition, these physicians are trying to follow the patient population because of the dispersal of Black middle-class persons, who are generally the paying patients. On the other hand, Black physicians and Black middle-class persons have a peculiar responsibility to maintain these hospitals which understand the context in which illness and diseases evolve in our community, and which are generally more responsive to the patient."

Dr. Goodman and Dr. Satcher point out that the crisis of Black hospitals can't fairly be blamed on Black doctors. "You can't point the finger at Black physicians and say they won't support our hospitals," Dr. Satcher explains. "The question is, can you run a competitive hospital if you don't have the capital? Can you expect a Black physician to admit most of his patients to a hospital that can't compete in terms of medical technology with the hospital down the street that happens to be predominantly White? We decided years ago that we weren't going to win that battle. We decided to find a way to develop a capital base so that we could be competitive. " As a result, Meharry/Hubbard began what it calls niche-marketing--exploiting niches of unmet needs where it could provide better services than others in such medical specialties as geriatrics, adolescent psychiatry, sickle cell therapy, etc. After that," Dr. Satcher adds, "we had to get public support for those patients who couldn't pay."

How did Meharry do this?

"We have a pretty nice facility," Dr. Satcher says, "and the city of Nashville has a deteriorating city hospital that will cost about $100 million to rebuild or renovate. So we proposed to the city of Nashville three years ago that it close its hospital and provide all of its health care funding through Meharry/Hubbard Hospital. That proposal has been approved. We have two years to implement it before the city hospital actually closes. "

Despite the obvious superiority of Meharry/Hubbard, the plan has generated a great deal of controversy, and some people, Black and White, have said that the basic problem is race. In an address at the Vanderbilt University Divinity School, Dr. Satcher said: "It's not Meharry on trial; we are all on trial. The merger might be Nashville's best opportunity to deal generically with issues of race in this community."