Illinois regulators have unanimously rejected historic Mercy Hospital’s request to close.
Saying they feared that patients would have less access to medical care, especially in a pandemic, regulators on Tuesday noted that Mercy’s emergency department in particular is critical to the surrounding communities, treating nearly 60,000 patients. It’s one of the busiest emergency departments in Chicago.
“I do not believe that Mercy has made a reasonable case that their services will not have an extremely negative impact on the South Side of Chicago,” said Dr. Linda Rae Murray, a Chicago health disparities expert. “As a public health person, I am really distressed this is going on in the midst of a global pandemic.”
Murray is one of six board members on the Illinois Health Facilities and Services Review Board, which decides the fate of health care projects to prevent duplication of services.
The vote was unusual. The board rarely rejects hospital closures. That’s partly because there’s this reality: Mercy says it’s running out of money. And as staff leave, it could create patient safety issues.
Mercy could still close. The hospital has another opportunity to convince the board, and if that fails, could still pursue closure in court.
In a statement, a Mercy spokeswoman said the hospital was disappointed with the board’s decision.
“We remain committed to our transformation plans,” the statement said. “We will look forward to going before the Board again in early 2021 with our plans to discontinue inpatient services at Mercy Hospital and transition to an outpatient model to serve residents on the south side of Chicago.”
The vote came after months of protests from physicians, health care advocates and community organizers against the closure. Located in the Bronzeville neighborhood, Mercy is the first chartered hospital in Chicago. The majority of Mercy’s patients are Black, and doctors there also treat many Cantonese-speaking patients from nearby neighborhoods, including Chinatown.
During the pandemic, Black and Latino Chicagoans have gotten sick and died the most, public health data show.
Everything from the rate of infant mortality to deaths from heart disease and cancer among people who live in communities that Mercy serves are higher than the citywide average, according to a 2019 report.
Advocates say the South Side already is a health care desert. Most of the hospitals in the area are so-called safety nets for their communities. They treat mostly low-income and elderly people of color, but their mission means they struggle financially. And over the years, these hospitals have cut services, particularly obstetrics.
During the board meeting, a representative for Democratic Gov. JB Pritzker spoke on his behalf, saying the governor opposes Mercy’s closure.
In a Dec. 12 letter to review board Chairwoman Debra Savage, whom Pritzker appointed, he wrote: “Mercy Hospital is one of the jewels of the community and a critical economic driver and health care provider. It is with profound sadness and frustration that I express my objection to Trinity Health’s planned closure of this hospital.”
Pritzker said he’s urged Michael Slubowski, CEO of Trinity Health, which owns Mercy, to reconsider. The governor’s office told Trinity and Mercy leaders the state would provide “financial flexibility to avoid closure,” Pritzker wrote.
Mercy cites need to evolve
Mercy announced plans to close in July. The hospital says it’s been losing patients for years, and the money they generate. Before the pandemic, this had been happening to hospitals across the nation as advances in medicine and a push toward cheaper outpatient care means fewer people need to be hospitalized.
Mercy routinely staffs fewer than half of its roughly 400 beds. The hospital loses about $4 million a month.
During the virtual board meeting, Trinity Executive Vice President John Capasso said the health system invested hundreds of millions of dollars into Mercy’s aging building, equipment and staff, and provided new services for patients.
“But none of that stopped the inpatient volumes at Mercy Hospital from declining or stopped the migration of outpatient services to the large health systems and academic medical centers,” Capasso said.
They hired consultants to help create a sustainable business model for the hospital, and investment bankers to help sell the hospital. But they couldn’t find any buyers, Capasso said.
Mercy tried to merge with three other South Side hospitals, but state lawmakers rejected the request to help fund the billion-dollar plan. The deal folded.
So instead, Mercy’s goal is to close the hospital and its half a dozen clinics, then open one new one on the South Side with an urgent care center.
“A plan that will focus on preventive and early diagnostic services, and to help local residents avoid expensive emergency room visits and hospitalizations,” Capasso said. “A plan that will seek to treat and manage chronic disease. A plan that looks to where healthcare is going, not where healthcare has been.”
To address concerns about closing Mercy during a pandemic, Capasso said the hospital is treating fewer COVID-19 patients during the second surge compared to the first surge in the spring.
And there are empty beds at other hospitals, he said. Still, it often depends on a patient’s health insurance, if they have any, where they can get medical care.
Dozens of hospitals have committed to hire Mercy employees when the hospital closes, Capasso added.
“I do not mean to imply for one minute that we can ignore the grim reality of COVID,” Capasso said. “I am just saying that we think we have accounted for the pandemic and we think that the data is showing some hope that the pandemic’s impact will continue to lessen as the months march forward.”
During the board meeting, several board members peppered Trinity and Mercy officials with questions about why Trinity, which is a giant national hospital group, couldn’t shuffle money around to help stabilize Mercy.
Trinity said that 70% of Mercy’s patients who are admitted to the hospital come from the emergency department, which set off alarm bells among the board members. And the board members noted that the COVID-19 pandemic has highlighted the need for more intensive care beds for the most critically-ill patients.
Capasso pointed to some vacant beds at nearby hospitals that could absorb Mercy’s patients — but those hospitals would have to staff them. And during the pandemic, many hospitals are fighting to hire more staff, nurses especially.
Murray questioned Mercy’s plan for a new outpatient center that doesn’t include primary care physicians. These types of doctors keep tabs on their patients’ health with annual check-ups and sick visits. Mercy plans to direct patients to primary care physicians at local clinics.
The new outpatient center would replace the hospital and other Mercy existing clinics.
“I don’t see how this adds anything, to be honest with you,” Murray said. “This really just sounds like a closure.”
Murray said she wasn’t convinced that Mercy needed to close, saying that the board didn’t receive letters of support from local clinics, or hear from big teaching hospitals about how they’re prepared to take on Mercy’s patients.
Capasso said community clinics that treat many low-income patients, like Mercy, said they need more diagnostic testing for patients, like a MRI scan.
The void Mercy would leave
Before the vote, physicians, nurses and patients testified for more than two hours about what’s at stake if Mercy closes. They mostly opposed the hospital closure.
For patients, it’s timely access to medical care if they have a heart attack or stroke, for example.
“I am disabled, and I am a senior,” said Brenda Moore, who lives near Mercy. “I’ve had two strokes and two heart attacks. If it was not for Mercy being here, I don’t know where I would go.”
Another woman testified that when her daughter was stabbed, Mercy was the closest hospital.
“It took four hours to stitch her up,” the woman testified.
Noting the void the closure could leave, a Mercy nurse pointed to Damian Turner, a young man who was shot blocks from the University of Chicago Medical Center in Hyde Park on the South Side, but was taken to a hospital downtown because U of C didn’t have an adult trauma center at the time. Turner died, and U of C later re-opened the trauma center.
If Mercy closes, patients would have to travel at least five miles to another hospital emergency department, according to a state report. And many people have issues accessing transportation on the South Side, several people testified.
Some people said the proposal was racist, noting how the majority of Mercy’s patients are black.
And there are also concerns about having enough space at other hospitals to absorb Mercy’s sickest patients. Meco Clark works at Mount Sinai hospital, about seven miles west of Mercy.
“Currently at Mount Sinai Hospital, we are literally running out of ICU beds,” Clark said.
Doctors say there’s another factor at risk: losing the trust of patients, many of whom show up to Mercy with little previous medical care. The hospital has also been a place to train physicians to treat patients.
Dr. John Picken is an obstetrician who said he spent more than 50 years at Mercy. He said last year, Mercy had 570 applications for four spots in the hospital’s obstetrics residency training program.
“We train them how to deal with patients who have never had decent medical care before, and they don’t trust the system because they do revolving door type visits in many places where they walk in, talk a few minutes with the doctor, are handed a prescription and they’re out on the sidewalk wondering what happened,” Picken said. “We train our residents how to deal with patients who have been treated that way consistently.”
Mercy wanted to close by May 31. The hospital has one more chance to win over the review board, followed by an administrative hearing if the board rejects Mercy’s bid to close a second time.
Ultimately, Mercy could take the state to court, or the hospital could just close and be fined.
The fine is $10,000, plus another $10,000 for every 30 days the hospital stays closed without permission from the board.
Kristen Schorsch covers public health on WBEZ’s government and politics team. Follow her @kschorsch.
The story has been updated to correct spelling of Dr. John Picken’s name.