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Government and People
|March 22, 2001
Rep. John Conyers Jr.
Dear Rep. Conyers:
l am a cardiologist who has practiced in the Dover, New Jersey community for over 27 years. I understand that you are evaluating the proposed closure of D.C. General Hospital in Washington. Many years ago, while a student at the George Washington University School of Medicine, I spent a great deal of time at that fine institution, and I was saddened to hear that it might close.
You should know that hospital closures are happening frequently across the country. The situations vary from place to place. and sometimes a closure may be necessary. But sometimes closures occur for the wrong reasons, and when that occurs, healthcare for the citizens may be compromised. I have experience with a planned hospital closure in New Jersey which should not occur and which will endanger the health of the people. A corporate raider, using political influence and hiding behind a smokescreen of financial problems, has brought about this event. You may find the story of Dover General Hospital to be of interest as an example of a hospital closure which should not take place.
I am attaching for your review two documents. One is a summary of what happened here in Morris County. The second is a history of Dover General Hospital that was recently published in The Daily Record, Morristown, New Jersey.
I hope that you will be able to do something about the D.C. General situation and perhaps you might also generate some interest in our situation here in northwest New Jersey:
Lessons learned from the Dover General Hospital Closure Experience
Comments prepared for presentation at the New Jersey Medical Society Paul Goldfinger, MD 21101
Introduction: In June of this year, Dover General Hospital, an important community institution for over 90 years, will close for acute care. The physicians who practice predominantly at this hospital are opposed to the closure, which we believe is wrong from the perspective of regional healthcare planning. We have not come today to discuss the merits of our point of view, but instead to acquaint you with this situation in Morris County because you will undoubtedly see other New Jersey hospital closures in the future. We would like to tell you about our experience over the last nearly two years in dealing with this matter and to share some of the lessons we have learned. Perhaps you will conclude that The Medical Society of New Jersey should pay attention to such issues when they arise. Dr. Gabe Somjen will present the story of the Dover closure, and I will discuss the lessons.
FIVE LESSONS LEARNED FROM OUR EXPERIENCE:
LESSON ONE: Physicians need to be involve when a hospital closure is proposed, but physicians' views may be ignored:
Closing a hospital is invariably a traumatic event in a community, but if a closure is appropriate and necessary, it should be done. However, when a closure is planned for the wrong reasons, healthcare in a community may be threatened. In such situations, physicians have an ethical responsibility to defend the best interests of their patients.
Such an inappropriate closure is about to occur in Morris County where a national corporate health system (Marian Healthcare, based in Oklahoma) has decided to shut down an important and successful community hospital. Its plan to close DGS has made no sense to objective observers. St. Clare's Health System did not put the welfare of the people first and it used powerful connections in Trenton to accomplish its plan. Nearly every physician in our community was opposed to the closure of the hospital, but we were ineffective in malting our voices heard. Unless the views of physicians are respected by hospitals and/or the DOH, there is little that we physicians can accomplish in these matters.
LESSON TWO Hospital systems may claim that only a closure will save their system from financial ruin, but sometimes that is not the truth.
When hospitals are in financial trouble, there are many ways to save money, and closing a hospital is not always the best or only solution. Our consultants showed that DGH could be saved if other cost cutting measures were utilized. Other hospital systems in our area such as Atlantic health have been able to survive without hospital closures.
We physicians were unable to compel St. Clare's to divulge the data that justified the closure, and St. Clare's would not agree to a physician petition asking for an unbiased outside analysis. Similarly we could not get the Dept of Health to require such an outside analysis. The only truths that were allowed on the table were those put forth by St. Clare's, and no discussion of other ideas was permitted. These events, and others, convinced us that the hospital was using their financial problems as an excuse for their real agenda, which was to close down their competition while aggrandizing their empire in Denville,
LESSON THREE: Just because a hospital is ran by a faith based organization does not mean that patient care will be the main. motivation whets decisions are made.
St Clare's wears the mask of a religious organization, but they- are, in reality, a large corporation, and their behavior is that of a corporate raider. Physicians must not be fooled by or intimidated by religious corporations that pretend to place the best interests of patients first.
LESSON FOUR: .The Department of Health has become a champion of corporate interests and cannot be relied on to place patient care at the top of their priority list.
The DOH refused to open their minds to any plan other than the one offered by St Clare's, even though that plan contained many illogical elements. It is quite clear that the DOH has a preordained preference for hospital closures as a cure for hospital financial problems, and they are willing to put aside legitimate physician concerns to accomplish these goals. The Commissioner's staff met with us twice, but they would never allow any discussion of the issues. At the State Health Planning Board public hearings we were allowed 3 minutes per person, and no discussion was allowed.
LESSON FIVE: We cannot expect the Governor or other political figures to a willing to get involved in such matters.
The Governor refused to meet with representatives of the Coalition including the mayors of 10 towns. She consistently referred all. inquiries to her Commissioner of Health. It was outrageous that our Governor would not meet with citizens, physicians and elected local officials regarding an issue that concerned so many people. Our state legislators refused to get involved. They viewed the matter as a no win situation for them. Our representatives at the federal level bowed out saying that it was a state issue.
CONCLUSION: Many hospitals are closing across the country, and such closures are not always a good idea. It will happen again in New Jersey, and the Medical Society may want to get involved. The Medical Society might consider forming a committee to review situations referred to them by local concerned physicians. if the committee identifies problematic closure plans, then the Medical Society might help local physicians organize and became more effective in such situations.
I would like to conclude with a quote from a patient. Mr. Richard Blake is the CEO of an international electronics firm called Transistor Devices, based in our area. His family and many of his employees have been patients at DGH, and in a letter to me on 1/17/01 he wrote, "Hopefully society will soon recognize the true expense of sacrificing facilities such as Dover General in the name of cost savings."
Obituary for a Hospital: January 2001
Dover General Hospital was born in 1908 when a group of seven women from Dover met at the Hoagland Memorial Church and decided to start a hospital. The first building was in a mansion on Ann Street, and the hospital officially opened with 25 beds. The staff consisted of 20 doctors, 7 nurses and about 20 other employees. During the flu epidemic of 1919, there was insufficient space for those in need, and a fund drive was begun to create a new facility. The hospital then made a commitment to never turn anyone away again. In 1928 the hospital moved to its present location thanks to fundraising by the community over 8 years. The first hospital there had 65 beds, which was barely adequate for the rapidly growing community. Between 1940 and 1970, there were 4 expansion projects completed. By the 1970's, the hospital had grown to 360 beds, and the CEO then, Maj. Gen. Frank White wrote in 1977, "More and more. Dover General is becoming a referral center for the hospitals to the north and west of us". He spoke about the expertise of the various departments at the hospital and about his hopes that the institution would continue to expand and to improve. He mentioned the population boom in the region and about the importance of the hospital to these growing communities.
In 1988 the hospital celebrated its 80th birthday and the construction of the most modern facility in Morris County. At that ceremony, W. Cary Edwards, the New Jersey Attorney General said. "Dover has an 80 year history. For many years, I have watched it grow. This hospital was put together by a dream of seven volunteers and the dream has never died. I congratulate the hospital for giving medical care, not just treatment''. Wayne Schiffner, hospital president at that time said, "Our history is one of responsiveness to the community and of unselfish devotion to the less fortunate among us." .
In 1994 the Trustees of Dover General Hospital agreed to a merger with St. Clare's Hospital. After that the Dover "campus" was progressively downsized by the St Clare's Health System, and the story of the gradual demise of the hospital has been chronicled in this newspaper over the last 1 1/2 years. A group of Dover area citizen activists has tried to fight the St. Clare's closure plan, but now the New Jersey Commissioner of Health, Christine Grant, has given St. Clare's permission to finalize it, plan and to terminate the facility as an acute care hospital.
The reality of the situation is that the former Dover General Hospital has already ceased to exist. It had been known for its unique family style care, wondrous nursing, exceptional support services and an outstanding medical staff, but now it is just a ghost of its former self. It has been transformed by the current management, and. with the blessing of the State of New Jersey, has been allowed to spiral out of existence. At this point it has been replaced by "St. Clare's West" and is nearly unrecognizable to those who know how it was in the past.
The people of the Dover General Hospital service area will mourn the premature death of their community hospital once they experience the aftermath of the final closure later this year. They will wonder how our public officials could have allowed such a fine healthcare institution to be destroyed.
Paul Goldfinger, MD FACC
Quotation references: official hospital history by Robert Holterman, Aug. 12, 1977 and Healthwave - official hospital newspaper - winter 1988 edition "Dover General Hospital Celebrates 80th Anniversary"
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