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Why one Chicago hospital has been slammed with ambulances

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Ambulances

Private ambulances are seen parked at Chicago's University of Illinois Hospital on West Taylor Street, on Sept. 24, 2021. The hospital has seen a jump in ambulances since Mercy Hospital stopped receiving them.

When Mercy Hospital & Medical Center stopped receiving Chicago Fire Department ambulances earlier this year, it meant one less outlet for emergency care on the Near South Side — and it meant an overflow of ambulances heading to University of Illinois Hospital on the city’s Near West Side.

Since February, the number of ambulances going to U. of I. Hospital each month has doubled to more than 700 some months, according to city data obtained by the Tribune through a Freedom of Information Act request. Wait times in the busy emergency room routinely stretch six to 12 hours, leaving patients who arrive with symptoms such as chest pain, diarrhea and vomiting languishing, nurses say. Ambulances sometimes line up outside the hospital, waiting to bring in patients.

”We’re handcuffed. We have no ability to provide dignity or care to these people,” said Paul Pater, an emergency room nurse at U. of I. Hospital.

Staffing issues and a surge in medical care needed by patients who put off doctor visits during the COVID-19 pandemic are squeezing U. of I. Hospital’s ER, nurses say. But medical workers and local leaders say the situation also demonstrates the dangers of cutbacks at community hospitals such as Mercy.

Bronzeville’s Mercy Hospital & Medical Center — which changed ownership earlier this year and is now called Insight Hospital & Medical Center Chicago — is ramping up to take Fire Department ambulances again “in the near future,” its new owner, Insight Chicago, said in a statement. It already has enough doctors to start welcoming ambulances but is grappling with the nationwide nursing shortage, Insight said.

In the meantime, U. of I. Hospital is doing the best it can under challenging circumstances, said Dr. Lauren Smith, director of the hospital’s emergency department operations. She said the sickest patients will be treated immediately and waits of 12 hours or longer are “outliers.” All patients are triaged shortly after arrival to see who needs help most urgently.

The increase in ambulances after Mercy stopped receiving them wasn’t unexpected, she said.

”When you take away health care from the community, the patients are still there so they still need care,” Smith said.

The challenges facing U. of I. Hospital “have not significantly impacted patient care,” said Michael Zenn, CEO of the University of Illinois Hospital & Clinics, in a statement.

The spike in ambulances, and its effects on U. of I. Hospital’s ER, shouldn’t surprise anyone, say community advocates and leaders. It’s exactly the type of thing that happens when community hospitals, such as Mercy, close their doors or scale back services — an increasingly common occurrence in Illinois, especially in brown and Black communities, said Deborah Harris, former executive director of Action Now Institute, which works to empower Black families on the city’s West and South sides.

”Now you have an unbalanced system at another hospital where the resources aren’t up to the task of taking on what you have pushed onto their shoulders,” Harris said. “Where is the respect for human life?”

‘We’re just overwhelmed’

Originally, Mercy Hospital was supposed to close entirely, after more than 150 years on the Near South Side. When the closure was announced in July 2020, the facility was owned by hospital system giant Trinity Health.

Community leaders and advocacy groups mobilized to protest the proposed shutdown. They said it would leave a largely brown and Black community without access to much-needed health care.

Amid the controversy, Mercy stopped receiving Fire Department ambulances, after years of confusion over whether it had a basic level ER or a comprehensive-level ER. The Chicago Fire Department transports patients to comprehensive ERs but not basic ones.

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Mercy told the state, starting in 2018, that it had a basic level ER. But the hospital told Emergency Medical Services that it was still a comprehensive ER in 2019, said Illinois Department of Public Health spokeswoman Melaney Arnold in an email. The state Health Department noticed the discrepancy early this year, and asked the hospital to clear it up, she said. Mercy was officially designated as a basic level ER and stopped getting Fire Department ambulances.

Several months after Mercy stopped receiving Fire Department ambulances, the nonprofit organization Insight Chicago took over the hospital, on June 1, pledging to operate the facility as a full-service hospital with a comprehensive ER.

But until Insight starts receiving fire department ambulances, patients who call 911 in Bronzeville are being taken to other hospitals, including U. of I. Hospital.

Though Rush University Medical Center, Stroger and U. of I. hospitals are all within a few blocks of one another, U. of I. Hospital is technically the closest of the three to the area that was served by Mercy.

U. of I. Hospital would sometimes get 10 ambulances during a busy overnight shift before Mercy stopped receiving ambulances, said Debreshia Anderson, an emergency department nurse and union steward for the Illinois Nurses Association.

Now, the hospital is sometimes getting four or five an hour, she said.

“One day we had 67 ambulance runs,” during one 11 a.m. to 11 p.m. shift, she said. “The ambulances would not stop coming. I’m thinking why can’t they just go to Rush (University Medical Center)?”

Guidance from the Region 11 EMS Medical Directors Consortium, which oversees emergency medical services in Chicago, requires patients be taken to the nearest hospital appropriate for the medical needs of the patient, said Larry Langford, a spokesman for the Chicago Fire Department. That means that some patients may be taken to slightly farther hospitals, if those hospitals can better meet certain medical needs, such as a cardiac issue or gunshot wound. But, generally, most non-life-threatening injuries go to the nearest available hospital.

That’s meant longer waits for care at U. of I. Hospital, medical workers say.

Patients with chest pain often end up waiting, Anderson said. They’re given EKGs when they arrive to see if they’re having heart attacks, and, if it appears that they’re not, they’re often sent back to the waiting room. But bloodwork performed later sometimes finds evidence of a heart attack that didn’t show up initially on an EKG, she said.

Multiple times Anderson has had to clean off patients who vomited or had diarrhea while sitting in the waiting room, she said.

People who are too sick to sit in waiting room chairs are placed on stretchers by a nurse’s station. It’s now not uncommon for half a dozen people to be waiting on those stretchers, she said.

“We have a lot of very sick patients, and we don’t have enough staff or enough beds,” she said.

Daniel Culliver-Dodd, an emergency medical technician in the hospital’s ER, called the situation “chaotic.”

“There’s no way that this can be sustained,” said Culliver-Dodd, who is also Service Employees International Union Local 73 chief steward at UI Health. “Someone because of this ... waiting in the waiting room will die or get seriously injured.”

An overflow of ambulances isn’t the only reason for backups in the ER.

The ER is also stressed when beds fill up in other parts of the hospital. When that happens, patients are “boarded” in the emergency department, meaning they wait in beds in the ER until they can be admitted to the hospital. It’s a common practice at busy hospitals, but it’s exacerbating the situation in the U. of I. Hospital’s ER, nurses say.

The ER backups and waits aren’t good for patients or nurses, said Pater, who is co-chief union steward for the Illinois Nurses Association at UI Health.

“Our patients are understandably angry about that,” he said. “As nurses, we’re put there to kind of mitigate that anger.”

Pater has been on workman’s compensation leave from the hospital for more than a month, after a patient brought by ambulance kicked him while he was trying to give her a COVID-19 test, he said. He now needs surgery to address the painful injury.

Paul Pater

Paul Pater at home on Sept. 22 2021 in Evergreen Park, Ill.

“We’re just overwhelmed,” Pater said.

Smith, with the U. of I. Hospital, said the hospital is doing all it can to address ER conditions, but it’s not a quick fix. The hospital is working to get patients discharged faster when they’re ready to go home, to free up beds for patients waiting in the ER to be admitted overnight. And it’s receiving $65 million in state funding partly to create a new clinical decision unit by the ER to rapidly screen and test incoming patients and to upgrade the 42-year-old ER.

The hospital also, occasionally, goes on bypass, meaning it tells ambulances to bring new patients elsewhere when it’s too full. But under new rules implemented during the pandemic, hospitals must now get permission from the state to go on bypass.

And even going on ambulance bypass more often wouldn’t offer complete relief, she said. Only about 20% of the ER’s patients come from ambulances, and the rest are walk-ins.

Like many hospitals, U. of I. is seeing many patients who delayed getting care during the pandemic, allowing their conditions to worsen. Now, those people are coming back, and they’re sicker than usual.

“It’s a stressful situation, I understand, for the nurses and physicians as well as our techs, but this is the situation we’re in,” Smith said. “We’re seeing some of the ramifications of COVID and patients not having care for the last year and a half, and now they’re showing up and they need care, so we’re happy to help them. The majority of our patients are walking in the door, so we can’t turn those away.”

Hospital ERs across the city are seeing more patients and longer wait times because of similar stresses, she said.

U. of I. Hospital has been trying to staff up, despite the national nursing shortage, Zenn said. Since March 2021, UI Health has hired 160 full-time nurses to fill new positions, he said.

The hiring of those nurses was part of a contract agreement reached with the Illinois Nurses Association, after the nurses went on a weeklong strike over staffing woes in September 2020.

Hospital closures have ripple effects

Other Chicago hospitals may also be dealing with fallout from the changes at Mercy — though not as dramatically as U. of I. Hospital.

Rush got 478 ambulances in July, compared with 371 ambulances in August 2020, according to city data.

The City of Chicago’s Office of Emergency Management and Communications did not respond to requests for data showing how many ambulances Stroger has received.

But Stroger is now getting about as many ambulances as it did before the pandemic, said Cook County Health spokeswoman Alexandra Normington, in an email. University of Chicago Medical Center, which is about 4.5 miles south of Insight, has also been seeing an increase in demand.

It’s difficult to know whether the ambulance traffic at those hospitals is because of Mercy, the pandemic or other factors, leaders of those institutions say.

“But the loss or closure of a single organization — or even cuts to services at a hospital — can further strain the region’s already overburdened health system,” said Tom Jackiewicz, U. of C. Medical Center president, in a statement.

Every time a hospital closes or reduces services, it creates a ripple effect on other hospitals — and Mercy won’t likely be the last Chicago hospital to threaten to close its doors or scale back services, hospital and community leaders say.

Many community hospitals have been struggling to survive, amid changes in health care. They’ve had to contend with a shift away from overnight care in favor of outpatient care, reimbursements from Medicaid that don’t keep up with the costs of care, and larger institutions attracting away more of their patients.

Westlake Hospital in Melrose Park and MetroSouth Medical Center in Blue Island closed in recent years. Many Chicago community hospitals that remain open have cut services, such as obstetrics and pediatric units.

“All of those hospitals that have closed now have patient bases that have to be absorbed by the remaining hospitals,” Smith said. “Whether they come to UIC or Stroger or Rush, every hospital, I think, is starting to feel that impact now.”

Rep. Lamont Robinson Jr., D- Chicago, who represents the area Insight serves, is encouraged that Insight expects to begin getting Fire Department ambulances again soon. But he’s concerned that patients now must take longer ambulance rides to hospitals such as U. of I. to get treatment. It’s part of a larger problem of inadequate health care on the city’s South and West sides where many Black and brown people reside, he said.

It’s important to help struggling community hospitals now, before they end up in the same situation that Mercy did, further contributing to inequality in health care, he said.

“We need to make sure that we hear their cries early,” Robinson said. “All of our safety net (hospitals) are struggling.”

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