Atlanta, Georgia
CNN
 — 

A model of this story appeared in CNN’s Race Deconstructed publication. To get it in your inbox each week, join free right here.

For the previous 4 years, Angelina Alford was capable of stroll only a couple blocks to her neighborhood hospital each time she wanted emergency well being care.

Alford, 65, stated that she suffers from bronchial asthma, diabetes and hypertension, and that there have been instances when the Atlanta Medical Middle’s (AMC) downtown hospital, previously often called Georgia Baptist Hospital, would hold her in a single day for monitoring.

Nonetheless, with the closure of AMC’s downtown location final week – AMC South, the sister location in East Level, shut down in Could – Alford worries that touring to a different hospital in Atlanta visitors may very well be a matter of life and demise. She doesn’t drive, she stated, and in consequence should depend on rideshare companies or relations to get round.

In response to the Atlanta Journal-Structure, the choice to shut the hospital got here as a shock to workers in addition to residents and metropolis leaders. The newspaper reported the pending closure on August 31.

“It’s irritating, and it’s unhappy,” Alford instructed CNN. “And it offers me anxiousness, as a result of if I get sick, how am I going to get to the hospital?”

Wellstar Well being System, which operated each hospitals, insists that the closures have been because of shrinking income.

“Wellstar has operated AMC since 2016, investing greater than $350 million in capital enhancements and to assist sustained working losses. That features $107 million in losses in simply the final 12 months, amid reducing income and growing prices for workers and provides because of hovering inflation. The pandemic and the extreme monetary headwinds straining healthcare organizations proper now have solely made issues worse at AMC,” the nonprofit stated in an announcement.

However neighborhood advocates and well being coverage specialists say that the closures exemplify systemic inequality, and that the 2 AMC losses will disproportionately burden Black communities and low-income communities.

The closures aren’t distinctive. They’re a part of a a lot bigger sample of city hospital closures throughout the US. (Over the previous few a long time, rural hospitals even have been disappearing.) Solely three years in the past, services in Chicago, Philadelphia and Washington, DC, shuttered. Residents within the surrounding poor, predominantly Black communities have been left reeling from the losses.

“We’ve had three hospital closures within the final yr or so, all of them Black neighborhoods,” David Ansell, the senior vice chairman for neighborhood well being fairness at Rush College Medical Middle in Chicago, instructed Kaiser Well being Information in 2020, including that selecting to close down these hospitals was “actually legal” in his thoughts, “as a result of folks will die consequently.”

Very quickly in any respect, Grady Memorial Hospital, Atlanta’s solely remaining Degree I trauma middle, detected the consequences of AMC’s closure.

“We’ve already seen an inflow of sufferers in our emergency division and a rise in our trauma volumes. Nonetheless, we have now taken a number of steps to assist take up the elevated quantity. We’ve employed former Atlanta Medical Middle trauma surgeons and first care physicians to assist meet the rising want at our trauma middle and in our neighborhood well being facilities. Further practitioners have been added to Grady’s Stroll-In Middle and our ER ready room. We’ve added 41 new inpatient beds, and extra are forthcoming,” Grady Well being stated in an announcement.

Georgia Republican Gov. Brian Kemp boosted funding to Grady Well being to be able to “enable Grady to soak up the affect from AMC’s closure and proceed offering high quality care to new and present sufferers.”

In an October open letter to neighborhood members, he stated that Grady Well being would obtain greater than $130 million in American Rescue Plan funds so as to add 185 beds to the hospital by the top of 2023.

Nancy Kane, an adjunct professor of administration on the Harvard College TH Chan Faculty of Public Well being, summarized the precarious state of entry to care in Atlanta and past the next method.

“When a hospital leaves, the entire community begins to break down,” she instructed CNN. “It’s not simply the trauma and maternity companies. The entire care continuum begins to be affected.”

Right here’s a more in-depth have a look at the persistent problem of city hospital closures:

Atlanta-area activists have fought for years to maintain city hospitals open, noting the hardships sure residents would face with out these services.

Richard Rose, the president of the NAACP’s Atlanta chapter, instructed CNN that city hospital closures are a difficulty of “racial inequality.” State and hospital officers, he stated, have failed to supply the assets essential to avoid wasting the hospitals which have largely served the town’s Black and low-income residents.

Certainly, the affect of the closures of AMC’s places in downtown Atlanta and East Level (the 2 are round 7 miles aside) gained’t be evenly distributed. Black residents and low-income residents will most acutely really feel the absence of those key suppliers of neighborhood care.

Atlanta – the so-called Black Mecca – is 49.8% Black, and East Level is 76.5% Black, based on the latest information from the US Census Bureau.

Per Wellstar figures cited by the Atlanta Journal-Structure, of the practically 4,300 emergency room sufferers the 2 AMC places noticed in 2019, north of two-thirds (67.3%) have been Black, and greater than half (51.5%) have been Medicaid and Medicare recipients.

The closure of AMC downtown has left a gap locally.

There are not less than three main hospitals close by – Grady, Emory College Hospital Midtown and Piedmont Atlanta Hospital – however sufferers instructed CNN about lengthy strains and overcrowding in these emergency rooms since AMC shuttered. Additional, some residents, akin to Alford, lack transportation to get to the hospitals.

Equally, the closure of AMC South’s hospital and emergency middle has left quite a lot of households in south Fulton County – a cluster of suburbs with a mixture of poor, middle-class and upper-middle-class residents – and not using a full-service hospital lower than 7 miles away.

And whereas Google Maps estimates a 15-minute drive from AMC South to Grady, that commute may very well be many leagues worse throughout peak visitors hours within the bustling metropolis.

Rose referred to Kemp’s pledge to fund extra beds at Grady as a “Band-Help repair on an open wound,” and defined that the closures jeopardize the well being of residents who stay close to shuttered services.

“Should you get shot or have an accident or a coronary heart assault on the mistaken time of day, it’s an actual downside to get from southwest Atlanta to Grady Memorial Hospital in downtown Atlanta,” Rose stated. “It’s an pointless battle.”

Kane echoed a few of Rose’s sentiments, and painted a equally sobering image of entry to care within the aftermath of city hospital closures.

“The obvious consequence is that if you happen to’re in a low-income neighborhood, the space to care goes to be higher. And if you happen to don’t have a automobile, that distance is usually a huge problem,” she stated.

Kane added, “It’s been documented within the literature that in emergency instances – in case you have a coronary heart assault or a gunshot wound – particularly in a low-income neighborhood, you’ve gotten the next chance of dying, as a result of folks can’t get to the following hospital that simply.”

She additionally highlighted that, within the US, race and poverty are related to well being disparities, together with uneven entry to high-quality medical doctors and care.

“Diabetes, stroke, hypertension: Many issues are precipitated simply from poor health-care entry and low earnings and stress,” Kane stated. “The demand (for hospitals in communities of colour and low-income communities) is larger than in different communities. So, it’s a double whammy: You’re sicker, and you’ve got worse entry.”

If the information about AMC appears acquainted, it’s as a result of the saga isn’t anomalous. In recent times, city hospital closures have troubled many different elements of the nation, too.

As an illustration, in August 2019, Westlake Hospital in Chicago filed for chapter, paving the way in which to closure.

Simply two months prior, in June, Philadelphia’s Hahnemann College Hospital, which was the chief instructing hospital affiliated with the Drexel College School of Medication, introduced that it’d be shutting its doorways for good.

And in April of that yr, Windfall Hospital in Washington, DC, completely closed.

Westlake, Hahnemann and Windfall, very like AMC, largely served Black communities and low-income communities.

Alan Sager, a professor of well being coverage and administration on the Boston College Faculty of Public Well being who over the course of the previous 12 years has documented hospital closures in practically each main US metropolis, characterised the nation’s health-care system as “anarchic.”

“That phrase describes the forces at play: ‘Avoid wasting hospitals, shut others,’” he instructed US Information & World Report in 2019.

Bonnie Castillo, the manager director of the union Nationwide Nurses United, expressed comparable sentiments.

“City hospital closures are extra apt to occur in racially segregated communities and particularly in African American neighborhoods,” she instructed US Information & World Report.

Castillo underscored that the shutdowns’ results could be “devastating,” for the reason that residents of those communities depend on hospitals for main care (and different care) to a level that White and rich Individuals don’t.

When Windfall closed, emotions of misery permeated the encircling neighborhoods.

“You’re hurting folks. You’re actually hurting folks. You’re messing with folks’s lives, and you’ll’t do this. You actually can’t do this,” as Phillip Lee, a lifelong DC resident, instructed the CNN affiliate WUSA in 2019.

Typically, Kane questions claims that shutdowns happen as a result of hospitals are shedding cash.

“Declining income isn’t an occasion that comes from Mars. It comes from under-investment within the facility,” she defined. “That’s a part of the issue. It’s not that folks say, ‘Let’s not go there anymore.’ It’s that they’ll’t get in or the companies they want aren’t there anymore or the constructing’s previous and they also select to go elsewhere.”

Put one other method, income decline is an consequence.

“Amenities get years of neglect,” Kane added. “Then, the neglect will get to a degree the place you may’t keep the buildings, or the physicians say, ‘We’re not entering into there anymore. The elevators don’t work.’ So many issues occur which might be unhealthy that firms say, ‘We’ve to shut the hospitals. Nobody needs to return right here anymore.’ Nicely, no kidding.”

Notably, city hospital closures shine a lightweight on the significance of native management over well being techniques – on the devastation that may observe when that authority atrophies.

“Should you look broadly throughout the nation, there are huge chains buying hospitals. They could have greater than 100 hospitals. The headquarters is in St. Louis. The chains might need hospitals in 9 or 10 states. And the chains not have a way of dedication or loyalty to the local people,” Kane stated. “And so, if you happen to’re a hospital that has numerous Medicaid sufferers or numerous uninsured sufferers, or if you happen to’re a hospital that doesn’t get a lot authorities assist, you find yourself wanting like a poor performer in a portfolio the place nobody is aware of what’s beneath.”

Briefly, as a result of chains aren’t essentially accustomed to the neighborhood, they won’t have a dedication to it, and state governments aren’t demanding that they concentrate.

Todd Greene, previously a member of Wellstar’s neighborhood board for AMC, can’t assist however fear concerning the latest closures.

He defined that they could additional chip away on the well being outcomes of Black residents, as a result of they relied on main and specialty care medical doctors affiliated with shuttered hospitals.

Greene stated that a number of AMC medical places of work – together with household medication, neurosurgery and orthopedic practices – should both shut or relocate. And a few are shifting out of the town altogether, to Whiter and wealthier Cobb County.

The consequence: Quite a few residents will battle to safe appointments, as a result of metro Atlanta doesn’t have a strong transit system that may get them to different counties.

Greene was forceful in his condemnation of firms and chains.

“They’re placing earnings over folks,” he instructed CNN. “We already know that Black folks have a decrease life expectancy, and undergo from continual diseases (at the next price). It’s going to be very tough for these folks to entry fundamental companies.”