Lost Hospital — Franciscan Skemp, Arcadia, Minnesota

In 1936, the Franciscan Sisters of Our Lady of the Holy Angels in St. Paul opened a six-bed hospital in Arcadia, Minnesota. Originally named St. Joseph’s Hospital, the six-bed facility originally located in a two-story house grew to 25 beds by the end of its first year.

In 1948, a 50-bed hospital (with an additional 25 nursing home beds) was completed. The Arcadia News-Leader described the hospital as “the finest hospital in the state for a city that size.” By 1960 a new wing was added that included a chapel and dining room, and five years later the hospital spent $500,000 on a new surgical wing.

In 1975, a management agreement connected Franciscan Skemp to the hospital, and by 1983 the hospital became part of the Franciscan Health System. The Franciscan Skemp clinic built in 1981 was finally connected to the hospital by a wing in 1995.

In 2011, however, this source of pride for the town of 7,000 came to an end when Franciscan Skemp closed. It was the first time in 75 years that the city was without a hospital. “This hospital was a very important part of our community, and the community showed its support for the hospital for many decades,” said Terry Madden, an Arcadia lawyer and former hospital foundation board member. “People are upset; they feel that Franciscan Skemp is deserting the community.”

Franciscan Skemp made the announcement the hospital would close five mnoths earlier, blaming financial concerns in a town with too few patients and no population growth for the decision. The nursing home, however, remained open. “It’s going to be a sad day Thursday,” said John Nemec, vice president of regional practices for Franciscan Skemp. “It will be more like a funeral atmosphere, but it’s also a day to recognize the good work that was done there.”

The hospital had an average daily census between four and five patients (1,500 a year), and lost between $1 million and $2 million annually.  According to Nemec: “We saw too few patients at a huge cost at a time when it is important to improve care and lower costs. It boils down that Arcadia did not have enough population to support the hospital. I think people can understand that we can’t run a business without volume.”

Dr. Bert Hodous, a Franciscan Skemp family medicine physician in Arcadia for eight years, explained: “Not one single person in Arcadia has not been touched by the hospital or the nursing home. Our nurses interacted and knew a lot of dimensions of the patients.”

Lost Hospital — Riverside Hospital, Jacksonville, Florida

Riverside Hospital in Jacksonville, Florida once consisted of a 240,000 square-foot acute care hospital with 183 beds and a staff of more than 400.

Today at the site of the former hospital stands a Publix Super Market and Starbucks. This 90-year transformation from wellness to wifi mirrors in many ways the transformation of health care in the United States.

Dr. Carey P. Rogers opened Riverside Hospital in 1911 (known as Rogers Hospital at the time) on Riverside Avenue between Goodwin and Margaret Streets.  By 1918, the Hospital had the first and only multi-purpose specialty medical clinic in Florida.

Over the years, Riverside Hospital catered to its community, keeping up with the changes that came with each decade. By 1968 Riverside Hospital completed a six-story patient tower, and a decade later prepared for further expansion (and at the same time angering community preservationists by razing the original George Clark residence).

By 1982, the original hospital was demolished to make room for an ancillary wing. These structural changes eventually led to a change in ownership when St. Vincent’s Health System bought Riverside Hospital in 1991.  Four years later, St. Vincent’s Health System merged with Baptist Health System, becoming at the time the area’s largest health care provider.

Before the end of the decade, however, the new system announced in 1996 its decision to close Riverside Hospital due to economic reasons. At the time, this was the largest Jacksonville hospital to close.  Shortly thereafter the nursing home across the street and Riverside clinic followed suit.  These ancillary buildings were later replaced by The Villas of St. John’s in 1999 (a 257-unit luxury apartment complex) and other community developments.

By 2000, the location of the former Riverside Hospital was demolished (at a cost of $645,000) to make way for Riverside Market Square, a community retail center.

Studying the Weight of Prayer

For by these he judges the people; He gives food in abundance.”  Job 36:31

According to a recent study from Northwestern University, participation in religious activities may increase the chances for young adults to become obese by as much as 50 percent. The research indicates that religion may lead to obesity rather than obesity serving as an introduction to prayer.

The study followed 2,433 men and women for 18 years. Making the proper adjustments to differences in age, race, sex, education, income, and baseline body mass index, the researchers concluded that young adults with active participation in religion were 50 percent more likely to be obese by middle age. “High frequency” was defined as participating in a religious function at least once a week.

According to Matthew Feinstein, the study’s lead investigator and a fourth-year student at Northwestern University Feinberg School of Medicine: “We don’t know why frequent religious participation is associated with development of obesity, but the upshot is these findings highlight a group that could benefit from targeted efforts at obesity prevention. It’s possible that getting together once a week and associating good works and happiness with eating unhealthy foods could lead to the development of habits that are associated with greater body weight and obesity.”

The study does not suggest an overall unhealthy lifestyle among the devout.  In fact other studies have shown religious people live longer for a multitude of reasons. This study will be presented at the American Heart Association’s Nutrition, Physical Activity and Metabolism/Cardiovascular Disease Epidemiology and Prevention Scientific Sessions 2011 in Atlanta, Georgia.

Toxoplasmosis: Some Facts Behind the Word

Toxoplasmosis is a parasitic disease caused by the protozoan Toxoplasma gondii. An estimated 25% of the world’s population carries the infection, but the most common host is the household cat.

Cats are not to blame for spreading the disease, however, as contact with raw meat is a more significant source of human infections world-wide. Animals and humans are infected by eating infected meat, or alternatively by ingesting the feces of a recently-infected cat. Toxoplasmosis is also passed from mother to fetus. Toxoplasmosis can trigger or complicate psychotic symptoms and schizophrenia in patients with such a genetic predisposition.

A new study from Johns Hopkins University provides some clues as to why toxoplasmosis can differ from person to person. The study explains that each of the three different strains sets off a unique response. These findings are published in the March issue of the journal Infection and Immunity.

According to senior investigator Robert Yolken, M.D., a neurovirologist at Johns Hopkins Children’s Center: ”We already know that toxoplasmosis can play a role in some psychiatric disorders, but up until now we didn’t know why. Working with human nerve cells, our study shows the exact alterations triggered by each strain that can eventually manifest themselves as symptoms.”

The researchers injected human nerve cells with the three most common toxoplasma strains. Cells infected with type I had the greatest impact on gene expression, altering more than 1,000 genes (including those linked to brain development and the central nervous system). Cells injected with the less virulent types II and III had low and moderate levels of gene expression (including those genes related to growth and certain hormones).

“While disease course in humans is often more unpredictable than what we see in the controlled setting of a lab, these results give us a fascinating first look into the distinct genetic cascade of reactions that each strain can unlock and may one day serve as the basis for individualized treatment of symptomatic infections,” explained lead investigator Jianchun Xiao, Ph.D., a neurovirologist at the Stanley Division of Developmental Neurovirology at Hopkins.

Most infections with toxoplasma occur early in life following exposure. Infections rarely cause symptoms, but the parasite can remain dormant in the body for years.

Respecting the Right to Health Care0

It has been almost one year since the specter of health care descended upon America and demanded at last to be recognized.  This is no ordinary ghost, however, and while its presence is felt by every U.S. citizen, there is as yet no consensus as to whether it stands as friend or foe.

Known as the Patient Protection and Affordable Care Act (PPACA), or Health Care Reform, its shape is only just beginning to emerge, and medical practitioners and patients alike are waiting to see how they will be affected.  But before America attempts to confront, classify and coexist with our new system, we as a society must first understand the machinery that lies within.

As the structure of our health care system changes, so too must our definition of an individual’s right to coverage. Make no mistake, health care is a business as well as a service, and to function at its best it must strive for efficiency. Today’s hospitals are constantly criticized for their waste of both resources and finances as they work to stem the never-ending tide of sick patients, but what of the patients themselves?  At what point does a nation’s responsibility to assist those who have become sick intersect with a citizen’s obligation to take care of his or her own body?

As the number of elderly and critical patients continues to rise as our population ages, and federal laws tax our nation’s emergency rooms to the breaking point, it is important to search for ways to reduce the burden on America’s hospitals and, ultimately, the system that funds them.  Provision of health care is a two-way street, and for the new reform to function to the best of its abilities, it must be met halfway.

This begs the question: Is health care a right or a privilege?

The first ten amendments to the United States Constitution protect certain freedoms for all citizens including those of religion, speech, and the right to bear arms, while at the same time defending against unreasonable searches and seizures, self-incrimination, and the quartering of troops. These rights exist as a contract between a nation and its inhabitants, granted at birth.

A privilege, on the other hand, must be earned.  For example, to receive a license to operate a motor vehicle one must exhibit a certain level of competence.  Just as easily, this privilege can be lost by a show of negligence or through disregard for the nature of the privilege itself.

Under the Reform Bill, health care – and emergency medical health care in particular – becomes a right, not a privilege.  There is no prerequisite granting entitlement to its benefits save that of U.S. citizenship, and even the highest level of neglect will not bar any claim to services.  Additionally, the right of health care under PPACA transcends sex, race and class.  Notwithstanding any perceived inequities in this nation’s health care system, it declares that no single individual shall have greater entitlement to the right of health care than another.  For this reason alone, health care defies the basic domestic economic principles of capitalism.

But if health care remains a right that one cannot forfeit through abuse, who is responsible for picking up the tab?  In the past, the business of health care in America has often operated outside the parameters of fiscal consideration, and this lack of financial control has threatened its very existence.  At its core, this new system seeks to address these inequities, recognizing that its survival relies on its sustainability.  Early estimates calculate that health care reform can save $1 trillion between 2020 and 2030 by changing the way the system works, as it forces providers to improve quality, eliminate waste, and place greater focus on the prevention of disease rather than simply addressing treatment.  Optimistically, the health care reform bill promises to create the necessary infrastructure to accommodate these changes, relying upon technology and innovation to forge a new system rather than trying to fix one which is beyond repair. Its goals are lofty and laudable, but at what cost?

As a nation, we do not take fitness seriously.  We eat, drink, and smoke too much, and eschew exercise.  And yet, we have clamored for universal health care as though our bodies were temples in need of constant devotion. For health care reform to succeed it needs active cooperation from the very individuals who enjoy its protection, and the truth is that a long term solution may only be possible after the abolition of unrestrained entitlement to care.  Sadly, today’s health care reform relies upon a level of individual engagement its government has no authority to require or enforce.

Establishing parameters that may one day lead to individual loss of this basic right is not presently up for consideration, and certainly was not included in our current reform package.  But it needs to be.  Otherwise, the foundation of health care will erode to such a degree that any chance to preserve it for the people will be Pyrrhic at best.  Inevitably, the success or failure of health care reform will hinge on how well we as a nation come to appreciate this right and respect the obligations that come with it.  America should enjoy its long-awaited coverage, but treat it with the reverence such a monumental step deserves.

Relationships: The Front Line of Health Care0

Chaos is the score upon which reality is written.”

– Henry Miller, American novelist and painter

This article first appeared on the PBS affiliated Website This Emotional Life.

As the Chief Executive Officer of a community hospital in the Los Angeles area, I am a big fan of the television drama “House.”  While it may on occasion stretch the boundaries of medical plausibility, it does an excellent job depicting the often tenuous relationship between doctors, nurses, administrators and patients in a hospital setting.  For seven seasons – nearly as long as I have held my current position – I have been a faithful viewer, but tonight I find myself in unfamiliar territory for a number of reasons.  First, there are zombies in this episode, which strikes me as odd for a show based in reality.  Second, there is an infant in my house, screaming as newborns tend to do.  Finally, there are two plates of fish at the table, and I am eating alone.

Working in a hospital, I have come to accept the fact that very few things surprise me anymore, as the unexpected and strange have long since replaced the usual and customary.  At any given day on the job I might observe the miracle of birth or the tragedy of life cut short, and on occasion even the phenomenon of life brought back from the brink. But regardless of whether art imitates life, work supplants home, or zombies magically appear in a medical TV drama, one thing remains constant – it quickly becomes clear to those involved in any emergency that the likelihood of survival rests on the stability of the relationships that are formed in the environment at hand.

As the onscreen events transition from the macabre to the surreal and the baby heads to his first bath ever, I sit eating my salmon while a small Pekingese dog stands on his hind legs, desperately begging for food.  I think of my young son, dependent on my wife to keep him clean.  I think of the dog, dependent on me to keep him fed. I think of patients dependent on House to keep them alive and House dependent on Dr. Lisa Cuddy et al. to keep him employed. And through it all I remember something else important – I really hate fish. … Read more →

Introducing, the “Diabetes Belt”

According to a new study in the American Journal of Preventive Medicine, the Centers for Disease and Prevention Control (CDC), has identified geographic region now known as the “diabetes belt” in the United States that includes 644 counties across 15 states. While 8.5% of the U.S. population has diabetes, in this new region the number is 12%. The diabetes belt also includes a population that is 32.9% obese (compared to the national average of 26.1%), and 30.6% who do not exercise regularly (compared to a national average of 30.6%).

The diabetes belt includes counties in Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia and West Virginia, as well as the entire state of Mississippi. According to Dr. Shubhada Jagasia, associate professor of medicine at Vanderbilt University Medical Center in Tennessee, the counties that make up the diabetes belt are located in regions that used to be primarily agricultural, but are no longer. “People in those states may have continued to consume high-calorie foods, which are appropriate for heavy manual labor as is involved in agriculture, but very inappropriate if people eating that diet are now very sedentary.”

According to the CDC, in the United States almost 26 million people have diabetes, and 79 million people have prediabetes.


Too Many Unseen in Hospital Emergency Departments

A recent study suggests that as many as 20% of “would-be” emergency department patients in California leave the hospital before seeing a doctor. According to the study author Dr. Renee Y. Hsia, an assistant professor in the department of emergency medicine at the University of California, San Francisco: “This is concerning to us as both providers and consumers because these are patients who decided they need care, and we’re not able to provide service to them.”

Hsia’s findings will appear in the Annals of Emergency Medicine. According to the U.S. Centers for Disease Control and Prevention, in 2007 hospital emergency departments saw 117 million visits, and from that number, 18% were seen in less than 15 minutes. California represents 12% of the U.S. population, and statewide there has been an alarming trend of patients who leave an emergency department without being seen.

The authors utilized data collected by the State of California’s Office of Statewide Health Planning and Development (OSHPD).  Emergency departments located in lower income communities had more patients leaving the hospital before being seen. Not for profit hospitals averaged 2.5%, and the figure doubled at county-owned facilities. Teaching hospitals had twice as high of a rate as non-teaching hospitals, and trauma centers had a 3.9% rate compared with the rate of non-trauma centers (at 2.5%).

Hsia continued: “What’s important to combat here is the myth that the people who leave an ER aren’t that sick to begin with. That’s certainly not true. Most people go to the ER only because they have to. Nobody really wants to go. So it’s a sad thing when they make that decision to go, and they need care, and they can’t get it.”

Dr. Marshall Morgan, chief of emergency medicine at the Ronald Reagan UCLA Medical Center in Los Angeles, also added: “I think it’s a big mistake for people to assume that the people who are leaving the ERs are people who don’t have serious problems. In fact, it’s been shown in other research that among the people who are leaving a certain percentage were seriously ill, as witnessed by their having to come back and be admitted within a few days. . . . So we’re not just talking about the people with sniffles and soar throats and sprained ankles. And this is a very big number. And whether it’s because of a general increase in overall volume at ERs across the state due to the general economic issues the country faces today, or for some other reason, it’s certainly a very big problem.”

Miniature Horses Coming to a Psychiatric Hospital Near You

Effective March 15, 2011, changes to the Americans with Disabilities Act (ADA) will expand the role of “service animals” in health care.

Service animals are individually trained to perform tasks for people with disabilities such as guiding the blind, alerting the hearing impaired, pulling wheelchairs, and alerting and protecting a person who is having a seizure. Service animals are working animals, not pets.

Now, the ADA will recognize that individuals with psychiatric, intellectual, and mental disabilities may require a service animal.  These changes both define and distinguish service animals in this context from comfort or companion animals. 

The new definition reads: “Service animal means any dog that is individually trained to do work or perform tasks for the benefit of an individual with a disability, including a physical, sensory, psychiatric, intellectual, or other mental disability.  Other species of animals, whether wild or domestic, trained or untrained, are not service animals for the purposes of this definition.  The work or tasks performed by a service animal must be directly related to the handler’s disability.  Examples of work or tasks include, but are not limited to, assisting individuals who are blind or have low vision with navigation and other tasks, alerting individuals who are deaf or hard of hearing to the presence of people or sounds, providing non-violent protection or rescue work, pulling a wheelchair, assisting an individual during a seizure, alerting individuals to the presence of allergens, retrieving items such as medicine or the telephone, providing physical support and assistance with balance and stability to individuals with mobility disabilities, and helping persons with psychiatric and neurological disabilities by preventing or interrupting impulsive or destructive behaviors.  The crime deterrent effects of an animal’s presence and the provision of emotional support, well-being, comfort, or companionship do not constitute work or tasks for the purposes of this definition.

In fact, if a sight-impaired individual is allergic to dogs, he or she may use a miniature horse (provided the miniature horse is house broken). As violators of ADA requirements may face money damages and penalties, following are some useful tips.

  • Businesses may inquire if an animal is in fact a service animal (including the specific tasks the animal can perform), but they cannot require any special identification for the animal, or inquire about the disability.
  • The service animal can go wherever the customer can go.
  • Businesses cannot charge an additional fee for people with accompanying service animals, nor can they be treated unfairly.
  • The only instances when a person with  a disability can be asked to remove his/her service animal from a location include: (1) the animal is out of control; or (2) the animal poses a direct threat to the health and safety of others.

The Centers for Disease Control and Prevention (CDC) recommends that individuals minimize contact with animal saliva, dander, urine, and feces. The CDC also suggests that nonhuman primates and reptiles should be avoided if possible as service animals.

Questions should be directed to ADA specialists at the U.S. Department of Justice in Washington, D.C.


Communicate With Your Caregivers Before You Can’t

An “advance health care directive,” also known as a living will or advance directive, provides a legal mechanism for individuals to specify what actions should be taken for their health in the event that they are no longer able to make such decisions due to illness or incapacity.

These instructions can prevent the need for anyone to “guess” what to do. By appointing a person or persons in this capacity, individuals can let their physician, family and/or friends know their health care preferences, including the types of special treatment they may want at the end of life, their desire for diagnostic testing, surgical procedures, cardiopulmonary resuscitation, and/or organ donation.

While many people go so far as to name a medical surrogate, too often they fail to provide adequate information about their health care preferences. A recent publication in the Annals of Internal Medicine concludes that the failure to provide these specific instructions to a medical surrogate in advance may lead to years of emotional distress.

In identifying several stressors that accompany the role of medical surrogate, the authors reviewed 40 studies. First on the list of stressors, according to the study, was being unsure of a patient’s preferences.  According to the authors: “We found that patients might also be encouraged to document their treatment preferences as a way of reducing the burden on their surrogates.” The nonprofit Engage with Grace has a LIST of some questions that may assist in this process, before the medical surrogate must make uninformed decisions.

Other stressors included uncertainty with a prognosis, discomfort with the hospital environment, poor communications with the health care professionals, insufficient time, disagreements with the medical staff, and feelings of uncertainty or guilt.

In conclusion, the study notes: “Making treatment decisions has a negative emotional effect on at least one third of surrogates, which is often substantial and typically lasts months (or sometimes years). Future research should evaluate ways to reduce this burden, including methods to identify which treatment options are consistent with the patient’s preferences”