Crisis at Boston City

HOSPITALS Like many of its patients, Boston City Hospital is old, impoverished and badly in need of rehabilitation. Paint peels from sagging walls. Windows are smashed throughout the complex of 34 buildings, and the heating system is so antiquated that some wards must be shut down entirely in winter because the temperature cannot be pushed above 40DEG. The ill-ventilated, six-story maternity wing, where 3,500 babies are born each year, does not have a single bath or shower. Sighs Staff Physician William V. McDermott: "This is a hell of a way to run a hospital."

The hospital's patient services are as inadequate as its plant. Nurses and aides are in such short supply that the gravely ill sometimes die unnoticed and unattended; fragile premature babies have missed crucial feedings. Surgery patients must wait as long as two months until operating facilities become available. In some minor cases, doctors are known to have used instruments that were just dipped in rusty sinks. On a typical Saturday, the hospital treats 500 emergency patients--nearly twice as many as all of Boston's other hospitals combined--but its scandalous state is so well known to ghetto dwellers that they use almost any excuse to get sent to some other hospital.

Clinical Details. Complaints are beginning to be voiced by the hospital's own staff. Last year interns and resident physicians became so disgruntled with their working conditions and their pay ($3,600 a year for interns and $7,500 for top residents) that they went to the unusual extreme of staging a "heal-in"--admitting far more patients than the hospital could handle. More recently, the bacteriology labs became so overloaded that they had to suspend all diagnostic services to outpatient and emergency wards. Last month, after weeks of long hours and double shifts, the badly undermanned X-ray staff simply quit work on a busy weekend and went home. That was more than the hospital's 27 hardened chief physicians and surgeons could endure. Despite their professional aversion to notoriety, they gave Boston newspapers full, clinical details of the hospital's chronic condition --a move calculated to arouse the conscience of city hall and of the entire community.

The decline of few other institutions could have wounded Boston's civic pride more. In the 1930s, during Mayor James Curley's heyday, Boston City was considered one of the nation's finest municipal hospitals. Curley kept it well staffed, often with his supporters, and made sure Boston's Irish got medical care "second to none." It still ranks as a first-rate research center, as a result of its affiliations with the Harvard, Tufts and Boston University medical schools, but that hardly helps patients with ordinary ailments.

On Probation. While extreme, the problems are not unique. They reflect the sharp rise in medical costs and the changing makeup of the nation's cities. In Boston's case, as the middle-class Irish drifted to the suburbs, Curley-style paternalism faded. The hospital was flooded with more and more poor patients, but it lacked the means to provide the increasingly expensive medical care. Faced with spreading urban decay and soaring annual deficits, a strapped city hall felt compelled to place the hospital's money requests far behind other needs, such as schools, slum demolition and downtown renewal. Three years ago, the hospital's accreditation was put on probation. Still, newly installed Mayor Kevin White, who has switched the emphasis to low-income housing and neighborhood improvement, reluctantly cut $6,000,000 from this year's $36 million hospital budget.

The doctors' outcry has already had some small remedial effect. Two weeks ago, the city council voted another $536,000 for nurses' salaries; now White is asking the council to restore a third of his budget cuts. Most of this extra money would go for emergency renovation, so that the hospital can retain at least its probationary status. Help may come from Washington, where Massachusetts' Senator Edward M. Kennedy has been plugging for federal loans to crisis-ridden municipal hospitals. But the question remains whether the financial therapy will be quick and massive enough to save Boston City.

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