New York’s health care system has been in the news this year as communities across the boroughs fight against hospital closures and reduction of services. Most of these cost-cutting measures have targeted low-income communities, making it harder for them to access health care. This week, a particularly unsettling piece of news out of the Bronx, where prenatal and delivery services at the North Central Bronx Hospital (NCBH) were abruptly cut with no notice, diverting patients and staff alike to Jacobi Medical Center, which is four miles away.
Hospital closures don’t reduce the number of patients, but instead shift them to other locales and put pressure on remaining facilities. For people in low-income communities relying on public hospitals for services, closures can be devastating. The closest hospital may be difficult and/or expensive to reach, continuity of care can be disrupted, and when patients do arrive at one of the hospitals that remains open, a scene of chaos can await them.
As public hospitals struggle to deal with an influx of new patients in the wake of closures of other hospitals, they’re stretched to capacity, which means long waits for triage in the emergency room, difficulty finding enough beds for patients, and more problems. Patients may be crammed into rooms, for example, or may have to wait extended periods of time for equipment to be available for medical testing and treatment.
When it comes to prenatal care, disrupting continuity of care can potentially have very dangerous consequences. Low-income patients may have trouble getting to appointments as it is, and yanking a care provider and hospital out from under them can leave them flailing. Some may not follow up and establish a relationship at the new hospital, and any problems with the pregnancy will go undetected. Others may struggle to get to appointments and could find that they’re forced to wait longer for shorter sessions with care providers.
Once former NCBH patients go into labor, they’re going to be forced to travel four miles out of the way, which can make a critical difference if a crisis emerges during labor and delivery. Four miles may not seem like much to people with cars who live in areas with clear streets, but in New York, four miles can become a life and death issue. As patients in active labor arrive at a hospital they may have never been to before, the hospital’s overcrowding can cause problems with intake, getting the patient into a room, and, of course, providing support while the patient labors and delivers the baby.
NCBH used to have a pioneering midwifery program, making midwife services available to low-income women and providing full outreach and support for patients who preferred midwives to obstetricians. Those services are no longer available, which upsets continuity of care for patients who have been seeing midwives for their pregnancy up to this point, and narrows down the options for all patients. The loss of the award-winning program is a harsh blow for the any women who benefited from it.
Nurses are reporting that the situation in the wards at Jacobi is troubling. Patients are warehoused six to a room because the hospital is struggling to cope with the extra patients from NCBH, and there aren’t enough staff members to meet their needs. Some new parents are waiting 12 hours to see their children because the hospital didn’t have security procedures in place in the new units — and it’s important to make sure babies are protected from kidnapping, accidental swaps and other safety and security risks.
Such conditions wouldn’t be tolerated in a private hospital, and they shouldn’t be tolerated in a public one, either. New York’s hospitals need the support of their communities not just to stay open, but to maintain critically important departments and programs. The people of New York have shown themselves to be more than capable when it comes to defending their hospitals this summer, fortunately, but the battle is far from over.
Photo credit: christina rutz.