Photo: Courtesy of Cook County Health
Photo: Courtesy of Cook County Health

The 2021 Cook County budget closed a shortfall of more than $400 million with funds from the county’s general reserve, eliminations of vacant jobs, more than a hundred layoffs in the Cook County Health (CCH) system, clinic closures, and restructuring of county-run hospitals. The budget will close two South Side clinics—the Near South Clinic and the Woodlawn Clinic—eliminate twenty-six full-time positions at Provident Hospital in Washington Park, and downgrade that hospital’s emergency department to a twenty-four-seven standby ED

Unlike comprehensive hospital emergency services—which require the presence of a licensed physician, physician specialists, and fully staffed laboratory, X-ray and pharmacy services—standby EDs are only mandated by the state to have one registered nurse on duty in the hospital and one licensed physician on call.

The clinics, at 35th and Michigan Ave and at 63rd and Woodlawn, will be closed and consolidated into the Sengstacke Health Center at Provident Hospital. Nurses and activists have expressed concerns over the plan, with National Nurses United calling health care service cuts during a global pandemic “a death sentence for Black and Brown communities” in a statement. 

The changes are expected to reduce the cost of ambulatory health services, for which community health centers like the clinics provide primary care and outpatient services, by $3.3 million compared to 2020. The county cited decreases in primary care visits in 2020 as a result of COVID-19 as one reason for the clinic closures. “With the consolidation of the clinics, CCH will be able to offer the patient better access to specialty care and other improved services at the Sengstacke Health Center, which is within a ten-minute drive from both locations and has better access to transportation,” according to the budget recommendation from the office of Cook County Board President Toni Preckwinkle. 

“[The county is] shutting down the Near South and Woodlawn Clinics and condensing them into Provident, and we are being told that this is an expansion,” said Dennis Kosuth, a part-time nurse at Provident Hospital, in an interview. “On what planet are you cutting services and say you are providing more? That makes no sense to me.” 

The budget proposal also cited lower patient volume as the reason to downgrade Provident’s ED to a standby ED, replacing its comprehensive emergency treatment services. According to the preliminary budget, Provident has not accepted ambulances since 2011, and most cases seen at the ED in the past few years could be treated in a primary care setting at the walk-in clinics on the Provident Hospital campus. In addition, Provident’s ED sees few patients after 7pm, and high-acuity emergency room cases, including life-threatening medical conditions that require significant care, are usually transferred to Stroger Hospital in West Loop. As a result, Stroger Hospital becomes busy with emergency and trauma surgeries, leaving few spaces for non-emergent, outpatient services. 

“These circumstances provide an opportunity to reallocate and save additional resources as emergency rooms are one of the most expensive places to care for patients,” the CCH Preliminary Budget reads. The budget envisions turning Provident Hospital into a primary location for elective surgeries, which could be scheduled in advance, designating non-emergency and emergency services to different hospitals.

“It is true that fewer people come in [Provident], but it was their decision to stop having ambulance runs bring people to the ED,” explained Kosuth, who worked at Stroger Hospital for eight years before starting his current position at Provident. He said ambulances have “always been bringing patients” to Stroger, instead of other hospitals. 

With the clinic consolidation, more high-acuity cases might be directed to Stroger Hospital. And as two clinics are consolidated into the health center at Provident Hospital, patients who use the clinics for primary care services such as getting prescriptions filled could turn to EDs. “It’s double-edged, because on the one hand they’re going to be closing clinics, and that’s going to limit people’s ability to access their doctor and get their prescriptions filled,” Kosuth said. “On the other hand, there’s not even going to be a doctor in the ER. And that doesn’t even speak to all the other reasons people come to the ER.”

In his three years at Provident’s ED, Kosuth has also seen patients with gunshot wounds, heroin overdoses, heart attacks, and severe asthma attacks. “These are the things that need emergency care. They are not things where you can [solve] having a nurse with no doctor and no equipment.” 

In a statement, National Nurses United, the largest union of registered nurses in the nation, pointed out that the patients who seek services at Provident Hospital, Near South Clinic, and Woodlawn Clinic are primarily Black and Latinx. Moreover, the proposed changes will lead to the layoff of more than 130 workers, including Kosuth.

“With the Covid-19 pandemic, it is not the time to remove these crucial jobs and critical health care resources from the people who are most vulnerable and most at risk. We need to save these jobs and save health care!”, Debra Simmons-Peterson, the president of Teamsters Local 743, said in the statement.

On July 29, Mercy Hospital in Bronzeville announced its plan for closure during Spring 2021 after a failed attempt to merge with the four other South Side hospitals. However, an Illinois state board unanimously rejected Mercy’s proposal for closure on December 15, citing community pleas and concerns about serving the surrounding community amid the pandemic. Trinity Health system, the owner of Mercy, said that it would again propose their plan to discontinue inpatient services, including ED operations, in early 2021, due to profit losses.

If both Mercy and Provident’s ED close, the University of Chicago Medical Center (UCMC) will become the only hospital with a comprehensive emergency services capacity in the South Side, according to NNU. In a memo submitted to the Cook County Board of Commissions, NNU executive director Marti Smith noted that UCMC’s ED was already investigated last year for overuse of ambulance diversion, where hospitals send incoming ambulances to other EDs instead of taking the patients themselves. In 2019 the Tribune reported that UCMC was one of three hospitals investigated by the state Department of Public Health because it “turned to the tactic so often.” Smith wrote that if all of Provident’s and Mercy’s patients went to UCMC instead, that hospital’s ED would see a “massive increase” in patient volumes that would make it “far more likely” to rely on ambulance diversion.

“The University of Chicago is not far away, but it’s already incredibly busy,” an NNU spokesperson told the Weekly. “So the question is, where do all these folks go then? Where did the poor folks who usually go to the two county hospitals go?”

In a public hearing on October 29 about the county’s 2021 budget, Kosuth raised concerns over the disproportionate effect of the pandemic on the healthcare of the Black community. To his comment, Cook County Board Commissioner Bridget Degnen responded, “The service [at Provident] is gonna continue, I just want to make that clear.”

“We can argue over semantics if they want to and say that it’s not a closure,” Kosuth told the Weekly, but the hospital won’t be the same anymore, he said. “It’s just lying to yourself about what you are doing.”

This story is a part of the Solving for Chicago collaborative effort by newsrooms to cover the workers deemed “essential” during COVID-19 and how the pandemic is reshaping work and employment. It is a project of the Local Media Foundation with support from the Google News Initiative and the Solutions Journalism Network.

Update, January 5, 2021: This piece was updated for print in the January 6 issue.

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Yiwen Lu is a reporter for the Weekly who primarily covers politics. She last wrote about how lessons from previous pandemics informed local responses to COVID-19.

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