I have had a long working relationship with an institution that was once the Youngstown Hospital Association (YHA), then the Western Reserve Care System and most recently Forum Health. That affiliation began in 1953 when I worked as an orderly for two summers following graduation from high school. I watched that hospital system evolve into what ultimately became the 10th largest community, teaching hospital in the nation in the 1960s; an efficiently managed facility with 1000 beds. YHA had rotating internships (numbering 25 newly graduated physicians per year) and residencies in internal medicine, surgery, pediatrics, family practice, radiology, anesthesiology, dentistry and pathology; the total intern and resident house staff numbered approximately 100. While serving as an intern in 1961 to 1962 I noted that the hospital was quite well managed by one administrator (Mr. David Endres) and a medical director (Russell Rummel, MD) who each shared a secretary between them; Mrs. Rae Moore. They spent one half a day at each unit; north and south. The place ran like a well oiled machine.
YHA became the first hospital in the state to have a virology and genetics lab run by Mr. Robert
Tamburro. Our Chief of Pathology, Dr. Arthur Rappaport, in conjunction with the local office of IBM, developed the first cybernetics laboratory in the world. He was initially able to run twelve tests on one vial of blood that was placed in his complex high tech device. Previously each of those twelve tests had to be run, one at a time, over an hour or more, by one or more lab technicians. Ultimately his design enabled the system to evaluate thirty blood chemical tests at a time plus a complete blood count; consisting of red blood cell and white blood cell counts, in addition to a packet cell volume, total hemoglobin and platelet count.
When I returned to the hospital after two years on active duty in the US Air Force in 1964, the number of administrators had tripled and with the onset of Medicare in 1965 it doubled again. In addition to the administrators, countless numbers of clerical workers were added to accomplish the reams paper work demanded by the government‘s numerous rules and regulations.
In 1967 YHA experienced the first nurse’s strike that had ever occurred in the United States. Youngstown had always been a strong union town because of the steel mills and the national nurse‘s union, took advantage of that mind set to force a work stoppage. The time and place were ripe for this walkout, though most people in the community were appalled that the nurses could do such a thing. I was chief medical resident at the time and was thus responsible for doing triage on the medical floors, deciding which patients could safely be sent home. After assessing the need for a patient’s continued hospitalization I then had to call the attending physicians and incur some of their misplaced wrath. In those days a patient with a myocardial infarction (heart attack) remained hospitalized for 30 days; now they are out in less than a week. From that time on, every three years the hospital either had a work stoppage or yielded to the union demands. It was not long before the service workers union and skilled technician unions would come in as well and threaten to shut the hospital down if their financial and other goals were not met. Across town, the St. Elizabeth Hospital
Board, not having to contend with unions, simply watched to see what our various workers settled for and they would offer an increase, but a little less, to their employees. Since their workers did not have to pay union dues, the increased pay was nearly identical to that which a YHA nurse or other worker obtained through the strike. Thus not having to incur the expense of work stoppages or the increased wages demanded by unions, St E’s always had a better fiscal bottom line than we did at YHA (later named WRCS and then Forum).
I began to sit on the Board of the Western Reserve Care System (WRCS) during my two years as President of the Attending Staff from 1985 to 1987. In 1988 I was selected by the Board to fill a full time position which I held until my voluntary resignation in 1998. It was during that time that the Medicare reimbursement dollar began to shrink and the hospital was paid at first 70, then 60 and ultimately 50 cents on each dollar billed to Medicare. It would not be very long before the hospital was also doing business with HMOs and their reimbursement soon echoed that of Medicare. The snow ball of economic insolvency continued gradually took on wieght. There were more staff hirings to cover more bureaucratic rules and regulations, more raises to meet union demands and less reimbursement from the government and HMOs. Added to that mix were a shrinking market and an effort to keep up with cross town St E’s expansion into the suburbs. Recall, that their bottom line could tolerate expansion better than ours and they were further supported by a national Roman Catholic health corporation called Humility of Mary.
In 1989 the WRCS administration had hired a consulting firm to help in the planning for the future of the WRCS. The consulting team came into Youngstown for one month and studied our hospital systems and demographics. The mills had gone down by that time and as young folks left home for college, they settled elsewhere in order to find work and build a life for themselves. Our population was suffering attrition from age related deaths as well. The consulting firm met with us over a two day retreat and told us the things we needed to hear, but vital planning information to which the future Forum Board did not take heed.
In 1989 Youngstown had four hospitals totaling 1600 beds; WRCS North and South units, St E’s and Youngstown Osteopathic (YOH). The consulting team, noting the exodus of young people and the aging of those who remained, predicted that by the turn of the millennium (2000) the Youngstown metropolitan area would only be able to support one hospital with 500 beds. Eventually YOH closed its doors; Forum closed the South Side unit and both remaining hospitals (Forum North and St. E’s) cut back on the number of their open beds. By the year 2000, the prescience of the consulting firm was verified; the town had two hospitals, each with 250 beds, competing for a shrinking market. St. Es had long since merged with Humility of Mary (HM). If they experienced a short fall the HM system would pump in funds to shore them up. They also enabled St Es to expand with less threat to their net worth. Forum could not keep pace financially with that strong national organization. The rest is history.
Before the Beeghly Women’s birthing center was sold to an Akron Hospital that plans to build a pediatric hospital, we had the only pediatric, acute care game in town: Tod’s Children‘s Hospital. I urged members of the Forum Board and the Mayor Williams (he had complained about a lack of community input) to consider combining the two hospital systems (St Es and Forum) into one and to
hold on to the best of both systems while selling off or demolishing the rest. That would have put all 500 beds in one efficient unit in Boardman, maintaining our excellent Tods Childrens Hospital, and affording, immediate and emergent inner city care through the Belmont Avenue Facility. It would have also afforded the nursing and ancillary staff workers job security. My recommendations fell on deaf ears and the Forum board continues to rearrange the deck chairs on a sinking cruise ship by selling off piece by piece, its numerous assets, such as the women‘s birthing center. The diminutive size of Forum North (200 beds) will not be a favorable sign to the residency review committees who come to evaluate our excellent internal medicine, surgery and pathology residencies; the only three now remaining. There are not a sufficient number of patients to afford a broad teaching experience to these residents. If Forum loses its residency programs the quality of health care is certain to diminish. Residents keep attending on their toes. They also provide 24/7 coverage for the patient population.
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