Into America: Critical Condition
Trymaine Lee: When it comes to matters of life and death, a few miles can mean everything. They can determine who has access to healthy foods, good jobs with good insurance, and access to quality healthcare. And there are few stretches of geography in the U.S. where the gap between who lives and dies mile by mile is as pronounced as the one separating Chicago's wealthier, whiter North side from the poor, mostly Black neighborhoods on the city's South and West sides.
The gap in life expectancy in some of these neighborhoods is as wide as 30 years. In Chicago, one of the most segregated American cities, race and proximity to quality healthcare are inextricably linked. A delicate fault line that's been driven wider as COVID-19 continues to infect and kill Black people disproportionately.
At the same time, Black Chicagoans are seeing hospitals in their communities closing at an alarming rate. Since 2018, three hospitals on the South and West sides have closed and now a fourth. Mercy Hospital, the oldest hospital in the city and a South side institution that stood on South Michigan Avenue for nearly 170 years is scheduled to be shuttered as early as February.
Jitu Brown: If Mercy Hospital closes, it will create a healthcare crisis in a community that's already strugglin'.
Brown: When I say fight for, you all say Mercy. Fight for.
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Brown: When I say--
Lee: The reasons for these closures are many. A broken healthcare system shattered further by the pandemic, systemic racism and classicism, simple dollars and cents. But the impact maybe more acute.
Etta Davis: Could be a matter of losing lives or saving lives.
Lee: I'm Trymaine Lee, and this is Into America. Today we go into the fight to save Mercy Hospital and examine how a tangle of race, health and economics is leaving many Black communities on life support. I met Jitu Brown in Chicago back in 2013, on the heels of the city closing 50 public schools in mostly Black and Latino neighborhoods. At the time, Jitu was working to save Walter Dyett High School on Chicago's South Side. He helped win that fight.
Brown: I'm from the South side of Chicago born and raised, product of Chicago Public Schools. I've been a community organizer most of my adult life since I was 24.
Lee: Jitu was the national director of the Journey for Justice Alliance, a coalition of grassroots community organizations in 36 cities around the country, fighting for education equity.
Brown: I never envisioned bein' a community organizer. Thought I was gonna play defensive end for the Bears. (LAUGH)
Lee: And he could have. At 54, Jitu's about 6'3" tall, 300-plus pounds. The man's got presence. And one thing about Jitu. You know where he's from. Not just Chicago, but the South Side, the storied, historically Black South Side.
Brown: I mean, the South Side is special, man, because when our ancestors and our elders evacuated the South, Chicago was one of the main destinations. Secondly, the Bronzeville community, this was a community where Gwendolyn Brooks lived, where Ida B. Wells lived, where Richard Wright who wrote Native Son lived. Sam Cook grew up right down the street from where I work at.
Lee: What hospital were you born at?
Brown: Oh Brother, I was born at Mercy Hospital. I am the oldest of four. I have one younger brother, two younger sisters, and all of us were born at Mercy Hospital.
Lee: For Jitu and his family, Mercy was always there.
Brown: It felt like stability, right. I still remember my doctor's name. His name was Dr. Crawford, and he was a Mercy Hospital doctor. And my mother would take me there and get my checkups and all the way to when I started playin' football, right, you know, I got my physical with him. So it felt like stability. It felt like you mattered, right? You felt like you belonged in a society, because when you needed these services they were available.
Lee: Do you have memories of the hospital just bein' a part of the community growin' up?
Brown: My mama is a retired nurse, and my mom used to work at Mercy. And so there is a history of this hospital being the oldest hospital in the city of Chicago and one of the few teaching hospitals that remained in the city of Chicago. This hospital has been a staple in our community. It is on the tip of Bronzeville, so it's right next to what you would call the Southern part of downtown, but it's still part of the Black community.
Lee: So it was a respected institution in the community?
Brown: Yeah, Mercy is a safety net hospital. It is a hospital whose stated mission is to serve the poor and also to stand for justice.
Lee: When did you, like, first get a clue that somethin' was goin' on, that there was a problem over at Mercy?
Brown: So we first got wind of this around March or April, and that to continue as a full-service hospital was untenable.
Lee: Untenable. We'll talk about how that decision was made in just a bit.
Brown: And this is in the beginning of COVID when Black people who make up 31% of the city of Chicago were 70% of the deaths.
Lee: Just a few months later, at the end of July, Mercy announced its intent to close. WTTW, Chicago's PBS station, covered it.
Archival Recording: Last week, Mercy Hospital and Medical Center announced plans to shut its doors by next June.
Davis: I just happened to go on Facebook, and someone had posted an article about the closin' of Mercy Hospital.
Lee: Etta Davis, to this day is still mad about how she found out.
Davis: A lotta people in my community don't even know about Mercy closin', so I tried to bring information about the closin' of Mercy Hospital to the community and post it in the different buildings down here.
Lee: Etta is 66 years old. She's a retired nurse's assistant and grew up on the South Side.
Davis: And, you know, the response I got from a lotta people was, "We didn't know that." You know, so you woulda had a whole community of people sitting here that didn't know that this hospital was gonna close. And then it woulda closed, and then what would they have done?
Lee: This isn't just another community campaign for Etta. She credits the doctors and nurses at Mercy with saving her life.
Davis: Mercy discovered, you know, that I was a diabetic, and that I had high blood pressure and, you know, a few other things, ailments that I had that I didn't realize that I had. They discovered it at Mercy Hospital. They were tellin' me, you know, I was a walkin' time bomb. You know, I was just down there the other day goin' through some different testing and ultrasounds and different things, MRIs and stuff.
Lee: How close are you to Mercy now? How long does it take you to get there?
Davis: It doesn't take me that long, maybe about 10 or 15 minutes. I'm right here at 29th and Federal, so I walk down to Mercy, because that's my exercise when I have to go. Just the thought of havin' it there and knowing that it's within walkin' distance, that's good for me. I'm thankful.
Lee: It's not just the convenience of seeing her doctors or getting an MRI. Having Mercy's emergency room nearby puts Etta's mind at ease for her and her neighbors.
Davis: I hate to even think the thought of Mercy closin', because first of all, in the community where I live, we have about 216 seniors, as well as a lotta disabled people. And so, you know, it would be hard to scramble around. Suppose these people includin' myself should have a cardiac emergency or a respiratory emergency.
Then we're talkin' about time, and time in between lapse of time could be a matter of losing lives or saving lives. My sister Laura, rest her soul, Mercy saved her life twice. They brought her back twice. And, you know, she had all kinds of health problems and respiratory problems.
So I hate to think about if they would have had to take her across town somewhere, because I was actually in the room with her in Mercy one time when she within just a matter of minutes went into respiratory arrest. And so, you know, I thank God she was right there.
Lee: So if Mercy closes, how close would be the next closest hospital for you?
Davis: Probably the University of Chicago, which is on 51st, you know. But if you don't have carfare, or if you're in a crisis, then that's a matter between time. You know, that lapse of time would save lives.
Lee: Etta's frustrated, because she's already been through this once. Before she was a patient at Mercy, Etta went to another South Side Hospital called Michael Reese. Reese closed in 2009.
Davis: To me it was like a slap in the face when they closed and tore down Michael Reese Hospital, because to me they were saying that Black healthcare didn't matter. I felt really bad, to meet new doctors and things all over again. So, you know, it's just a hassle and just a whole mess.
Lee: These hospital closures are part of a bigger trend. Dozens of hospitals across the country have closed or filed for bankruptcy in 2020. In Chicago, Mercy would be the fourth hospital on the South or West Sides, the mostly Black neighborhoods, to close since 2018 alone.
Brown: It really feels like disinvesting in Black people is always on the table.
Lee: I asked Jitu, how did it feel to learn that Mercy was planning to close?
Brown: Now I'm gettin' a little full when you said that. We call it institutionalized lovelessness. All we want is to be treated humanely, and every time you turn around, there's a new threat to your existence. Just like when you see a community gentrify, you see investment in those institutions.
So whether it's a Whole Foods, right, whether it's new housing, you see clear investment in the basic quality of life institutions of the people that live there. When you want to remove a population, you see elimination of those institutions.
You kill the institutions that serve the community, then those people leave. And it's amazing that we're talkin' about this in the middle of a global pandemic where folks that look like me are the ones that are dying at the highest rates. That closing a hospital could even be on the table right now is inhumane.
Lee: After the break, the back story behind why Mercy is closing and the fight to keep it open.
Lee: I'm Trymaine Lee. This is Into America, and we're back with the story of Chicago's Mercy Hospital, an institution in the city that's slated for closure early next year. Before the break, you heard Jitu Brown and Etta Davis talk about what the closure would mean for Chicago's South Side. Jitu said when he first got word that the hospital was in trouble, he heard officials say.
Brown: "To continue as a full-service hospital was untenable."
Lee: So how did the hospital staying open become untenable? The reality is, Mercy Hospital has been losing money for years. Trinity Health, a nonprofit health system that operates 92 other hospitals around the country bought Mercy in 2012. Mercy's CEO, Carol Schneider, spoke to my colleague, Antonia Hylton earlier this week.
Antonia Hylton: In your view, did Trinity properly and meaningfully invest in Mercy?
Carol Schneider: Absolutely. And over the years since the acquisition in 2012, there's been over $100 million invested here at Mercy. And again, it is not sustainable to continue to put money into an old building and to continue to take the kind of losses that we have sustained.
Lee: Trinity says Mercy is hemorrhaging $4 million a month and needs an additional $100 million in capital investments to keep its facility safe and up to date. Trinity tried unsuccessfully to sell Mercy for a year, and when that failed, Trinity and Mercy explored a new strategy.
In January, Mercy and three other struggling South Side hospitals announced plans to consolidate into one new hospital with a network of outpatient facilities. As the merger was being negotiated, word of the hospital's shaky future got out. And Jitu Brown started organizing.
Brown: I want to be clear, I don't enjoy doin' a rally in the middle of a global pandemic, you know? But also that fear can be used to change the world while we cower in the corner, right? So we had to make a decision. Okay, we're gonna be socially distant, we're gonna mask up, we're gonna have hand sanitizers, but we're not gonna just sit here and watch whoever it is manufacture our removal from a community that we love.
Hylton: Kenwood-Oakland Community Organization held a prayer vigil in front of Mercy Hospital this morning to draw attention to the issue.
Brown: Racism didn't start with COVID. And we are tired of continuously kickin' the can down the road, blaming people that are underserved, without addressing key issues that contribute to the disparities that we see that leave particular populations more vulnerable.
Hylton: The mayor's office created a new racial--
Lee: Early on, Jitu and other organizers warily considered backing the idea of a merger, as long as a new hospital would remain in the community.
Brown: We don't like this proposal, but as our grandparents said, "Oatmeal beats no meal," right?
Lee: But the group of four hospitals didn't have a location for the new site, and the plan came with a $1.1 billion price tag. The hospital asked the Illinois state legislature for $520 million over five years to help offset the cost. But the legislature didn't go for it. Illinois governor, J.B. Pritzker, a Democrat, addressed the failed plan at a press conference at the end of the legislative session in May.
Gov. J.b. Pritzker: With so many things in flux about our state budget, it was nearly impossible for the general assembly to go forward with a billion dollar program. And I know that that timing, you know, makes it very, very difficult for those hospitals.
Lee: So the coalition pushing for the merger disbanded. And that's when on July 29th, Mercy announced its plan to close.
Dr. Thomas Britt: They care, but they can't really provide the kind of care without being paid.
Lee: Dr. Thomas Britt has been a doctor in the city for decades. He teaches at Chicago State University and runs the Health Policy Institute in Chicago. He started his career at Mercy in the 1970s.
Britt: I did part of my residency at Mercy. I loved it. I was a medical student learning how to take a history, learning how to do a physical examination, and, you know, I was wide-eyed and bushy-tailed. I loved it. I absolutely loved it.
Lee: A lot has changed since then.
Britt: We have decreased availability, and with decreased availability, we also have decreased accessibility. Availability's described as a facility is there. Accessibility is your ability to utilize it.
Lee: Who are these hospitals serving? Like, are we talkin' about, you know, folks with private insurance, uninsured? Who are we talkin' about here?
Britt: You know, healthcare is not free. Someone has to pay for the healthcare. Now you may go there and you receive the healthcare, and you think it's free because you didn't pay. But somebody pays. And so the somebody's gonna be the insurance carriers. The somebody's gonna be the people who have good insurance, so their insurance goes up to cover for the bill that's not being paid by those people who receive emergent care and subsequent care after the fact.
Lee: How do hospitals like Mercy get paid normally? Tell us the number of ways that these hospitals actually make money.
Britt: A patient comes to the hospital, and so if they have insurance, their hospital will bill the insurance for the services that's been rendered. If they don't have insurance, or they have Medicaid, then they bill for the Medicaid. If they have Medicare, they bill for the Medicare. The problem with Medicaid nationwide is the Medicaid is slow, low, and sometimes they do not pay.
Lee: Slow, low, and sometimes no pay. That's how Dr. Britt describes reimbursements for Medicaid, the joint state and federal health program for people with little to no income. Medicare is a federal health benefit program available to folks 65 and over as part of Social Security. Some people can be eligible for both programs, but both pay providers less money per procedure than commercial insurance.
Britt: I had to make the decision when I first started my practice. I billed the Medicaid for service I rendered, and the service at the time was $140. It took the hospital somewhere between three and six months before they sent me a check for $12. Then you have to make a decision, "Can I continue to practice this way?"
And I made the decision that I could not. Hospitals can't survive that way. If you have a hospital that is a 500-bed hospital and you only have 100 beds, then you're paying in some fashion for the 400 beds that're not being utilized. You can't continue that way.
Lee: According to Mercy, only about 30% of their patients have commercial insurance. It's a safety net hospital after all, but that's also less money for the hospital. A Mercy spokesperson told us the hospital was carrying a debt of $165 million as of 2019. They say they've been losing patients for years.
Britt: Patients who have good insurance, they're going to hospitals that they feel will service them better. They're going to the University of Chicago, or they go to Northwestern or they go to Rush.
Lee: Huh. And so just to bring us kind of full circle, Mercy had been dealing with some financial troubles even before the pandemic. And here we are I guess ten months in, and I wonder how COVID has impacted, you know, the already dire state of what was goin' on over at Mercy?
Brown: Well, if you look at nationally what's happening with respect to COVID, about 42% of people are not being seen in the emergency room. So it's gone down tremendously. That's number one. Number two, a lot of the hospitals because they're trying to service the COVID patients, they're not seeing their private patients. A lot of the elective surgeries are not happening.
Lee: It's clear that the problems Mercy Hospital's up against are real. Patients leaving, low reimbursements, all of this in the middle of a major health crisis. Mercy admitted nearly 600 COVID patients from Chicago's South Side since the pandemic began, and they recently learned the hospital will be a vaccine distribution center. So what's the solution? Jitu Brown sees one option.
Brown: We need to find a viable solution, and we've identified a viable solution. Sell it.
Lee: But Mercy CEO, Carol Schneider, told MSNBC there are no plans to sell.
Schneider: Well, I can tell you that we've done an exhaustive due diligence over many years to try to find a partner, and that has not come to fruition.
Lee: Dr. Thomas Britt says the only way forward is to think outside the box.
Britt: If Mercy Hospital was forgiven for the amount of money they owe plus whatever they are losin' per month, what would they do day two? Day one, they were forgiven, what do they do day two? How do they get their patients back? The patients, do they have insurance?
We have to change how we practice medicine. I think the hospitals of old, a thousand-bed hospital, a 500-bed hospital is kind of the way we did it in the past, but it's not working. That's why we have hospitals closing every year or so. So if it's not workin', why don't we do something different? I think one of the ways we need to do this is we need to have these healthcare centers that can handle a lot of the problems that come into the hospital.
Lee: A healthcare center is the solution that Trinity is proposing. This fall, they announced plans for a new Mercy outpatient facility slated to open next year. It'll focus on preventative medicine and offer urgent care to the South Side. Dr. Britt said, these healthcare centers aren't a panacea, but they can cut down on unnecessary expensive ER visits.
Britt: Many times when I was workin' moonlighting as a physician, a lot of patients came in in the middle of the night with diaper rash. You don't need to come to the hospital with diaper rash. The hospital should be a place where you go when you have to have surgery, and the surgery requires more than what you are able to do in a healthcare center.
Lee: A Mercy spokesperson told us they estimate the healthcare center will serve 65,000 patients a year. By comparison, Mercy Hospital had more than 350,000 outpatient visits in 2019 alone. Dr. Britt acknowledges just how messy this is. When the system is broken, it's the patients who pay the price.
Britt: If the hospital is gone, you don't have it available to see you. And so if it's not available to see you, and you have an emergent situation, you are going to suffer. You may, in fact, die.
Lee: But Mercy says, you know, there are other hospitals in the community or nearby that can absorb the outflow of patients.
Britt: You know, what we're saying now was said years ago when Michael Reese closed, okay? Michael Reese is closed. It was a thousand-bed hospital. It was world-renowned hospital. It's gone. People suffered, people passed away. When Mercy's gone, the same is gonna happen. Yes, we have other hospitals. We have other hospitals on the South Side, and they're failing.
Lee: But I do wonder, you know, when you look at the national landscape, Black folks in particular, when it comes to access to healthcare often get inferior care, right? We understand structural racism and how that works. But I wonder, on the South Side of Chicago, do folks deserve better than Mercy?
Britt: We deserve optimal healthcare, whether we get it at Mercy. Wherever we get healthcare, we deserve the best. The problem is, there is racism. There's biased and unbiased racism. And that's just a fact. And if we don't really deal with it, I mean, we really do have to deal with it. We have to discuss it and be open about it. We have to tell the truth. We have to collect the data, as if we don't already have it. We need to analyze it, and then we need to come up with strategies that got teeth in it so it works.
Lee: Are people pointing at the right force here? They're pointing at Mercy, but should they be pointing the finger somewhere else? Or is about Mercy and their actions?
Britt: They should be pointing the finger at Trinity, and they should be pointing the finger at Mercy. They should be pointing the finger at the Illinois Department of Public Aid. They should be pointing the finger at all of the systems that got us to the picture that's being painted. We're all in this mess, and it's gonna take all of us to be enlightened and to make real efforts to get out of this mess.
Lee: I asked Etta Davis, the Mercy patient we heard from earlier, for her view on the care center that's proposed to replace the hospital.
Davis: No, no. That's not gonna work, because after hours when a clinic closes, then what do you do in a crisis? We need more than clinics, because as Blacks as a whole, we have health issues anyway due to improper healthcare. So we need some kind of an emergency hospital with things goin' on. We don't just need clinics.
Lee: But I want to ask you just straight up, how much of this do you think has to do with race? That the reason the community is being treated a certain way is because you're talkin' about Black people, and you're talkin' about a huge population of Black people who are also poor?
Davis: Oh, you know racism has a lot to do with it. You know, I've been fightin' racism since I was a kid. You know, I've seen it rear its ugly head over and over again. You know, and unless you've been Black all your life, then you may not understand it or may not want to even understand it. But you know about it, you know. You do know about it. You know, we've built this nation on our backs. And we're the last people in the world to be given anything.
Lee: My colleague, Antonia Hylton, put this idea to Mercy CEO, Carol Schneider.
Hylton: This isn't the first time that a predominantly Black population of patients has lost access to a hospital. Is this evidence of systemic racism here in Chicago?
Schneider: I believe that we certainly have opportunities to improve how we provide access to care, especially on the South Side. We know that life expectancy for those that live on the South Side is 30 years less than those that live on the North Side of Chicago. So we can't deny that fact, and we need to transform healthcare on the South Side so there's accessibility and early diagnosis and treatment for the patients that live in these communities. And that's what we hope we will be able to do.
Lee: But that doesn't change the fact that Trinity and Mercy are determined to shut down the hospital. On December 15th, just a few days from now, Mercy leadership will ask the state for official permission to close. Activist Jitu Brown has been pushing his elected officials to step in. He's focusing on Chicago Mayor Lori Lightfoot and Governor J.B. Pritzker, both Democrats. Earlier this year, Governor Pritzker sent a letter to Trinity asking them to reconsider closing.
Brown: We appreciate the letter. We're strongly encouraging him to do more. And for the mayor, I think the same thing. The mayor often talks very progressive talk. She talks about racial justice all the time on her daily coronavirus updates. They released a letter saying, "It would be sad if Mercy closes." And the moment demands so much more than that.
Lee: Etta Davis shares this frustration.
Davis: Yes, I'm callin' them out. Don't come out to our communities and want to shake our hand and, you know, smile in our faces because you need a vote. It's not just about a vote. You know, it's about these communities that you're over, and it's about healthcare. To me, these people are tellin' us they don't care, it's your problem not ours. Come on.
Lee: We reached out to the office of the mayor and governor for comment. The mayor's office told us the city didn't have anything to do with Mercy's decision, but recognizes the quote "important role safety net hospitals play in our healthcare system."
In a statement, the governor's office emphasized the role of the state legislature and Trinity Health in finding a solution and said, quote, "The pandemic has only heightened the essential need for more equitable healthcare access and delivery, particularly in Black and brown communities, and for those who are uninsured and/or underinsured."
Brown: Fight for.
Brown: Fight for.
Brown: When I say fight for, you all say Mercy. Fight for.
Lee: Meanwhile, Jitu and Etta have continued their fight to save Mercy, even as the temperature drops and COVID cases remain high. This past week, they were part of a series of actions organized by the Chicago Health Equity Coalition they called Mercy Week to bring more public attention to this issue, all of it building to that important date on the 15th when Mercy Hospital will ask for official permission to close. Are you hopeful that you all will be able to save Mercy Hospital? Do you really believe that ultimately you'll be able to save it?
Brown: Yes sir. I mean, I say that in all humility. I mean, we're gonna do our level best, you know what I mean? I've been a part of winning campaigns, and I've been a part of campaigns where we didn't win, right? This will be frontline election issue come city and state elections. This will be frontline.
Who stood up, who shriveled at this moment in the middle of a global pandemic? And people will not forget this. People will not forget this. There's no sound bitin' your way outta this. You either stand up for people havin' healthcare in their community, or you demonstrate that you're not worthy of bein' in public office.
You shut down a Black hospital in the middle of a global pandemic. That is a belief statement. That is a value system at play. And so that is what we're confronted with. That's the way I view it, Brother. So no, I'm very hopeful. We are very hopeful that we'll be able to win this.
Lee: Jitu Brown is an organizer on the South Side of Chicago and the national director of the Journey for Justice Alliance. We also heard from Etta Davis, a patient at Mercy Hospital and community activist, and Dr. Thomas Britt of the Health Policy Institute of Chicago.
Into America is produced by Isabel Angel, Allison Bailey, Aaron Dalton, Max Jacobs, Barbara Raab, Claire Tighe, Aisha Turner, and Preeti Varathan. Original music by Hannis Brown. Our executive producer is Ellen Frankman. And I'm Trymaine Lee. We'll be back next Thursday.