Sunday, October 18, 2009

Braddock mythos redux

News all around is that Braddock hospital is closing.  The timing is interesting in that operating losses there just can't have been unanticipated. What else might have spurred the decision to close the facility?  For a place that has already suffered immeasurably, this latest bit if news may be the worst.  Per the PG which tracked down longtime Braddock denizen/observer/sage Tony Buba:
Tony Buba, a filmmaker who has been documenting Braddock since 1972, said his 88-year-old mother still makes daily visits to the hospital coffee shop.
"This is really a surprise," Mr. Buba said of the hospital closure. "This could be the most devastating of all the losses."
I had my say on the mythos of Braddock last year.  I could just repeat that verbatim which included a cite of continued rapid real estate depreciation there.  The point was that the popular vision of Braddock rebounding is not really matched by the facts on the ground.  If anything things are worse than they were even last year which was worse than most any time in the past.  In few cases is the popular perception so incongruous with what we can measure.

I know the New York Times had a slighly more optimistic take early in the year (also check out the NYTimes video on Braddock as well) but how far can we push that vision.  This isn't a knock on those living and working there and trying against the tide to improve the situation. Mayor Fetterman is ironically on the cover the The Atlantic's November edition even.  What nobody really wants to talk about as we continue to try to 'save' Braddock... is there a Braddock to save at this point.  After 2000 I literally calculated that Braddock had a higher year-round property vacancy rate than anywhere else in the state other than Centralia, which was purposely evacuated due to underground mine fires. That has not gotten any better since then.  This is the population trend for Braddock which is an image that is bad even by the worst of rust belt standards.  The current population estimate of 2,600 or so is probably overestimated as we will learn when the 2010 census is completed. 

Another irony is that you would think Braddock epitomized the post-industrial mill town surviving after it's defining 'mill' shut down..Except that it alone among many retains its mill and Braddock's ET plant has been churning away even through the recent recession.  Here is what the employment picture looked like in 2000 as well:

I suspect each of the industry sectors have declined since 2000 and now with the hospital closure I have to believe the entire "health and education services" sector will be gone...  Again leaving mostly employment in the mill as the major generator of income from beyond the area.. except that I doubt any of the mill employees live in Braddock at all, certainly fewer live there now than at most anytime in the past.  

It's a painful scene and again I am not knocking all those I know working on improving the situation with what resources they have.. but I do believe that all the media attention on Braddock of late gives an illusion of progress that just isn't based on much that is positive for the actual residents of Braddock or environs.  If that is true then it all gives a false impression to the rest of us of progress... that the status quo is on a vector to recovery. Some probably think we should go so far as to pat ourselves on the back for all the work focused there over the last several decades.  Go back and read what I wrote just last December.  We have collectively failed Braddock and continue to do so on a scale that is not replicated elsewhere in the western world.


Anonymous Anonymous said...

Braddock's only hope would be disincorporation... which is not allowed in Pennsylvania.

Monday, October 19, 2009 2:28:00 PM  
Blogger Jake said...

Reading this article from May makes it all the worse. A new senior center set to be right next to the hospital and hopes for revitalization. The Senior Center is already under construction, I wonder if the plans for it will shift now? Open it up for apartments?

Monday, October 19, 2009 3:09:00 PM  
Anonymous Anonymous said...

I suspect each of the industry sectors have declined since 2000 and now with the hospital closure I have to believe the entire "health and education services" sector will be gone

Not the entire sector. There are still health and education jobs in Braddock without UPMC.

Monday, October 19, 2009 3:21:00 PM  
Anonymous Anonymous said...

Sorry, but this is just wrong. UPMC is (supposedly) a not-for-profit organization. And, the UPMC entity still is making "excess revenues" in a bad economy.

So, why would a non-profit that happens to have hundreds of millions of dollars in the bank, with branches all over Pennsylvania, and a few in places like Ireland, Sicily and Qatar, be closing the Braddock facility when that individual facility lost a comparatively small $27 million over the last six years?

I normally think it is a cop-out when the City of Pittsburgh tries to tax non-profits and the universities, especially because the City still hasn't closed fire stations, privatized garbage pickup, or done any of the things it should have done to balance the city budget. But, when UPMC closes Braddock, it's time to rethink their non-profit status. I say, let Mayor SteelerStahl tax them.

Monday, October 19, 2009 4:35:00 PM  
Blogger Steven Bone said...

Its probably important to distinguish the woes of Braddock the community from the UPMC Braddock facility. The former has nothing to do with the latter.

One of the given reasons for closure was simply that people were not choosing to go there. That implied that patients actually get to choose where to go, which is largely incorrect. Their doctors told them to go elsewhere. It is not really UPMC's direct fault that led to it, but rather the increasing standards of care in our health care system.

Small hospitals everywhere are in decline. Large hospitals with more beds and patients are the only ones who can afford the latest and greatest equipment and specialists for both diagnosis and treatment.

In the mid 90's the standard of care for treating a heart attack was to use a clotbuster drug, followed a day or two later by cardiac catherization (angioplasty) and possible open heart surgery. Any hospital could use the drug, but only places with specific machines, technicians, and doctors can do the latter. These days, the standard of care for a heart attack pretty much bypasses the emergency room and clotbuster drug treatment and goes straight to the cardiac catherization lab. Small hospitals cannot afford to have such labs, thus the smart thing for the best possible care is to bypass them in favor of a hospital that is more appropriate. Stroke treatment has moved even faster in the direction of immediate, specialized care not possible in a smaller hospital.

Patients with cancer that are admitted require cancer treatment machines. Patients with renal failure require dialysis during admission. UPMC Braddock has none of these facilities - if admitted via the Emergency Room, you are sent somewhere else that has them.

Since smaller hospitals could not afford these rarities, they started 'specializing' in care that required low-cost equipment. I recall hearing that the cost per admitted patient at UPMC Braddock was some crazy small percentage of a patient admitted at Shadyside or Oakland. This is why many of these small hospitals (also think South Side, Forbes Metro, and Homestead) had entire floors turned into rehabilitation centers where patients needed medium-level hospital care for extended periods of time. Imagine the cost differential of a broken hip surgery when done at Braddock vs. Oakland. In this case both are equally competent to perform the surgery and post-op rehab, and one is significantly cheaper than the other to operate. The smart plan would be to use the UPMC Braddocks of the world for these purposes, and keep the specialized higher cost procedures at large hospitals where there was enough patient density to make them available and affordable.

The problem is that people didn't want this, and neither did physicians. If my physician admits to UPMC ShadySide and not to UPMC Braddock and I need a hip replacement, neither I nor my physician would want it to happen at UPMC Braddock - continuity of care is a reason, potential travel inconvenience is another. There was and is no incentive for any party to perform the surgery at the low-cost center. Insurance pays for it, not me. This gets even harder for situations where the surgery is based on a more emergent need - lets say instead of a worn out hip it is physically broken - which makes for a potentially uncomfortable ambulance ride from one place to another for no visible benefit to the patient. If the patient had to pay the difference in costs between these two medically equivalent options, you bet your ass that UPMC Braddock would be a thriving hospital right now.

The collection of tax dollars on the part of UPMC to make improvements to their Braddock facility deserves special criticism. This tax money was dispersed to assist UPMC Braddock in remaining a going concern. Through comments made by UPMC on the closure of that facility, they had no interest in keeping it open. This is fraudulent on at least a moral level, and this money should be returned or UPMC should be sanctioned from receiving future similar disbursements.

Monday, October 19, 2009 5:00:00 PM  
Blogger C. Briem said...

on disincorporation:

and recently considered at least

Monday, October 19, 2009 8:56:00 PM  
Anonymous Anonymous said...

it is tragic, but in reality, the hospital wasn't doing much for the community. it was sure using the community's "distressed" status to scoop up grants, and then allegedly redirect the funds, but other than that, not too much. we would be better served with an urgent care facility and a walk-in clinic, but that probably won't happen either.

it's still possible that a big shake up like this could have some good unintended results.

Monday, October 19, 2009 9:03:00 PM  

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