Hospital (17 page)

The bed managers asked for and were granted an overflow unit, a grouping of rooms that could accommodate patients with a variety of illnesses. But every morning the infectious-disease team patrolled looking for “Contact P,” as in pan-resistant, patients requiring isolation because they carried bacterial infections that had become resistant to commonly used antibiotics. The special precautions had begun in 2004, when there was a noticeable increase in patients infected with these supercharged bacteria.

“They’ll call up to four P.M. and say, ‘This patient is now Contact P. You have to move this patient,’” said Romanelli. “These biology majors ruin the bed manager’s day. You think you have everything right, you think you can predict, you know what surgery is going on, then you get a call—‘We have four new Contact P patients’—and it’s chaos.”

Romanelli often felt overwhelmed. “Sometimes I feel responsible, if someone is waiting in the emergency room for a day, waiting for a bed, [and] despite bed management, despite overflow, despite everything else, we just don’t have the space, we don’t have the room,” she said. “You can have ten discharges planned, and within minutes ten discharges can be canceled. Things just happen.”

When things just happened in health care, someone found a moneymaking opportunity. A company called TeleTracking Technologies created software to deal with the bed-tracking problem. In 2005, frustrated by its inability to speed up the flow, Maimonides management decided to spent the money— $408,000—for an automated system from TeleTracking Technologies.

The company’s Web site explains how it is supposed to work:

Maria Ferlita was impressed by the new system, which had just been put in place. “Oh, my God, I’m going to go blind there with all these colors,” she said. “But now we can look at that board in a snapshot and see which bed is empty, which one is being cleaned, which one is male, which one is female, and it will allow us in one view [to see] what is going on [on] each particular floor and everything else. This will help us produce the system electronically. This will help show us where the problems are. I think long-term what it’s going to do is reduce the amount of dead bed time tremendously.” She was willing to be hopeful.

A few months later, I checked in with Olendorf, who said the flow was better but the smooth transitions described by TeleTracking Technologies were still elusive. “I can be accused of a lot of things, but I won’t be accused of kidding myself,” she said. “If you want to fix things, you have to admit they’re broken.”

They had learned that for the bed-tracking system to work, someone at the nurses’ station had to let the system know that a patient was ready to be discharged. This required punching a bunch of numbers into a telephone line. The job fell to the “information specialists” on the unit, who already had a long list of responsibilities. None of these duties involved clinical expertise, but they were the jobs that could make a hospital stay pleasant (that is, at least tolerable) or a nightmare.

The job description listed twenty-six tasks that included being receptionist and traffic cop for patient and visitor questions and needs; taking care of charts; notifying physicians, nurses, and dietary staff of arrivals and departures (via admissions, discharges, death); distributing mail; overseeing patient property; running errands. Now managing the bed-tracking system had been tacked onto the load of the lowest-paid people on the nursing staff, annual salary about $23,000.

“You have to be reasonable about what you can expect for what we’re paying them,” Olendorf said. Yet she was willing to raise expectations, hers and theirs, and made plans for yet another new training program. “People have to change their process to be watching instead of waiting for someone to call them or beep them. If we change that, it will greatly reduce potential errors. I think it’s going to work, but you can’t kid yourself about the implementation. You have to keep changing, and people have to change their practice.”

The term “dead beds” had additional meaning in the hospital world in New York State. While Maimonides was overflowing with patients, about twenty other hospitals in the state had closed in the previous five years, for various reasons, including mismanagement and not enough demand, but all related to business. St. Mary’s, for example, the hospital in Crown Heights that catered mostly to poor people, had been operating at about 57 percent capacity when it stopped operations in October 2005. A group called the Berger Commission, named after Stephen Berger, the former government official and investment banker who headed it, had been circling over the state’s hospitals like the angel of death and eventually would announce its hit list.

About two and a half miles from Maimonides, another hospital was in trouble—Victory Memorial, whose very name now seemed like a portent of its own doom. This 250-bed hospital, which also had a 150-bed nursing home, situated across the street from a golf course and from the bucolic campus of Poly Prep Country Day School, conveyed the placid feeling of a hospital in a small city. Founded in 1900, Victory had not adjusted to the changes in hospital finances brought about by managed care; it had been operating in the red for the past two years. A number of doctors affiliated with the hospital had moved their practices; the hospital was generally running at 75 percent occupancy.

State and local politicians did not want the hospital to close; the institution employed 1,000 people and delivered 2,500 babies each year. But obgyn was a money loser. Reimbursements were low, malpractice premiums enormous. The only thing that might keep Victory alive was the fact that it had a middle-class constituency with political clout—unlike St. Mary’s, located in Crown Heights, a poor neighborhood. Martin Golden, state senator for the Twenty-second District in Brooklyn, had been born at Victory. After a couple of failed attempts at partnerships with other Brooklyn hospitals, the state had asked Maimonides to get involved.

Brier was eager to do so. Victory and Maimonides entered into an uneasy partnership, overseen by state officials, under which Maimonides invested $5 million in Victory, mainly to cover payroll and other expenses. Maimonides was supposed to help Victory increase admissions and improve its finances, a task that fell to Fraidkin, Cunningham, and Robert Naldi, the chief financial officer. The return to Maimonides was murkier; the commitment was made in part to curry favor with public-health officials who wanted Victory to survive and also to fend off competition from other hospitals.

Victory became a major preoccupation for the senior staff, though most everyone else at the hospital was oblivious to the machinations involved. Like applying for Magnet status, trying to work out a deal with Victory was part of the hospital’s big ambition, regarded with admiration by some and as overreaching by others. For Naldi, who had to shoulder much of the burden of the Victory deal, it was worth the effort. “As long as they’re needed,” he qualified. “If they aren’t needed, they shouldn’t be there.”

But need by whose measure? Did the community need another hospital or more assisted-living centers for an aging population? What about all those babies being born at Victory? Maimonides didn’t have room for their mothers or for them. What about turning Victory into a primary-care center, where inexpensive preventive medicine could be practiced, reducing overcrowding in emergency rooms all over the borough? I didn’t envy the Berger Commission as it worked out its assessment of waste and need.

Both Maimonides and Victory were founded following the last great wave of immigration to the United States, in the nineteenth century. For Newman Dube, the founder of Israel Zion Hospital, which would become Maimonides, need was obvious, uncomplicated, and personal. Dube, born Nehemiah Dubovsky, came to America in 1888 from Minsk, at age twenty, because he was afraid of being conscripted into the Russian army. The Dube and Bashevkin families were part of the same chapter of U.S. history, in which impoverished greenhorn peddlers became prosperous American merchants. After the turn of the century, Dube moved his family to Borough Park, a fairly new community that had no hospital.

Two incidents convinced Dube that the health-care situation in his neighborhood had to change. The first occurred in 1916, when Dube’s four-year-old son contracted croup diphtheria and barely survived the trip to the nearest hospital. The second incident, which took place almost three years later, was far more calamitous. The influenza pandemic of 1918, believed to have killed 20 to 24 million people worldwide and around 675,000 in the United States, found its way to the Dube home; the former peddler by then lived in a massive residence, with thirteen rooms to house him, his wife, and their six children. This time illness brought death. His fifteen-year-old daughter became part of the global statistic.

Would a local hospital have made a difference? It’s doubtful, but Dube chose to believe so. Grief demands explanations. So just as Steven Cymbrowitz, a century later, would raise money for a cancer center in order to give his wife’s early death some purpose, Dube the grieving father would became the primary force behind the creation of a hospital in Borough Park.

The dedication of the hospital took place in 1919, which seemed—in 2005—like a comparatively simple time. The $10,000 Dube collected was adequate seed money for an entire hospital. In 2005 that $10,000 would be worth roughly $112,890, using the consumer price index as a comparison. In adjusted dollars it would pay salary and benefits for one registered nurse, or three or four defibrillators, or 220 emergency room visits (less than a day’s worth at Maimonides), or three bypass operations.

But paying for health care was a problem even then. “By the early 1900s, the annual deficits incurred by most hospitals in New York City became a generally recognized problem among the city’s hospital trustees, administrators, and even charity workers,” wrote David Rosner in
A Once Charitable Institution,
a book full of reminders that hospitals have always struggled with finances, with management, with determining their social mandate.

Was it ridiculous to try to connect this humble story of a father trying to cope with his daughter’s premature death to present-day Maimonides—the multicultural patient flow, the feuds, the political wrangling over Victory, the cancer center, insurance reimbursements—to Mr. Zen?

Luckily—amazingly—I found a direct link, making me think that maybe it was true,
min zhong zhu ding,
“life is predestined.” One of Newman Dube’s children was still alive.

Douglas Jablon introduced me to Daniel Dube, who was about to turn ninety-seven years old when I met him in his office at Park Surgical Company, across from Moishe’s Cleaners, under the elevated subway, a few blocks from the hospital. Park Surgical (named for Borough Park) sold all kinds of medical supplies, including wheelchairs, lactation aids, prosthetic legs, hearing aids. Newman Dube started the business in 1929, another legacy for his children and grandchildren, who seventy-six years later ran the business with their Uncle Daniel, the only living reminder of the past generations.

Dube was what my mother would call a “real gentleman,” the type who stood when a woman entered the room. He was about five feet tall, had a thick, carefully trimmed white mustache, and was very natty in a sports jacket with tiny sky blue and white checks, plaid pants, and a striped tie. He spoke with the stentorian tones and elegant cadences of another era; he could have been a bit player in a Fred Astaire movie, part of the atmosphere. His precise diction was studied, not natural; he had found talking difficult as a child and eventually trained himself to speak, as he called it, “euphoniously.” Hearing his melodious use of the language would have pleased his mother; she was an immigrant from Brest-Litovsk, famous for the treaty that got Russia out of World War I, and never spoke Yiddish with her children because she wanted to improve her English.

Dube gave me a tour of the business, pointing out an old sewing machine where, he said proudly, a gifted employee made prosthetic bras for women who’d had mastectomies. Then he told me his father’s story, and his own, compressing a century’s worth of social history into one family’s memory. He covered the 1929 stock-market crash, the 1918 flu epidemic, the development of health care in southern Brooklyn, World War II, and elocution lessons. He also offered medical advice, urging me to take cod liver oil every day, as he had done for forty years, a prescription he felt certain had kept him from having arthritis. He endorsed bran powder as well, noting that too many people strain when they go to the bathroom.

As for the hospital, he told me he didn’t know much about Maimonides anymore, though he spoke warmly about it. His father stayed on the board until he died in 1966 and insisted on going to every meeting, even though he was blind for the last three years of his life and needed his son’s help to get there. Daniel Dube had been watching the construction of the new wing with interest but confessed that his company didn’t do as much business with the hospital as it used to. “Hospitals don’t pay their bills on time,” he said. “It can involve a great deal of money, and if you want to be viable in business, you have to pay your bills on time or you lose whatever benefit you have in discounting.”

I asked him how the hospital was regarded in the community. “It is well regarded, but the great difficulty is that the first contact is through the emergency room, and the wait is interminable to be admitted to the hospital,” he said. “I can understand the difficulties, and I’m sure the hospital powers that be are doing the best they can. Before, the demands of the community were not as large.”