M Health Fairview closes emergency room during COVID peak

Money appears to trump mercy in cost-saving measure

“They have closed one hospital and are trying to close another and are trying to snowball us about it during a pandemic. Nothing can detract from that very fact. [M Health Fairview] has no conscience, none whatsoever,” said Mary Turner, president of the Minnesota Nurses Association (MNA).

In a press conference two weeks ago called by the MNA to protest the closing of St. Joseph’s Emergency Department (ED), Turner called on state elected officials to “stop the closing and downsizing of hospitals during a pandemic.”

“It is irresponsible for M Health Fairview to take away health care and put it on two other systems that can’t handle it,” said Kelly Wiler, referring to (United Hospital) Allina and (Regions Hospital) Health Partners which along with St. Joseph’s are located near downtown St.Paul. Wiler is a St. Joseph hospital nurse who works on the Medical-Surgical COVID unit, she has worked at St. Joseph’s for three years after spending six years at Bethesda Hospital, which was recently closed by MHealth Fairview.

“When they bought Health East in 2016, [M Health Fairview] promised us they would be there to take care of our community, and our community is St Paul,” explained Wiler.

 According to Joe Campbell, a spokesperson for M Health Fairview, the planned December 30 closing of St. Joseph’s ED is part of the overall repurposing of that facility.

“For many, many years St. Joe’s has lost tens of millions of dollars a year, which is not sustainable. It has had major financial difficulties. The community in and around St. Joe’s is changing and needs a different kind of health service. Seventy-five percent of the people who visit the emergency room are discharged without being admitted, which tells us that they would be better cared for in what we call an upstream care environment. It’s a more financially sustainable model,” explained Campbell.

Campbell also pointed out that according to M Health Fairview statistics, 55% of St. Joseph’s patients come from outside the city of St. Paul. Wiler and others dispute Campbell’s numbers.

“Who makes up the other 45%?” asked Turner. “Aren’t they important? It’s like saying take your chances somewhere else.”

“It’s obvious they do not want to cater to that population in St. Paul. They do not want to do their share for the poor. They don’t want to do their share for the homeless. They are only interested in getting hard cash from insurance-carrying paying customers. It’s all profit driven. It’s so wrong… It doesn’t matter how glossy their excuse.”

Campbell said the corporation wants the folks coming from outside the city to use St. Joseph to know that they have hospitals closer to where they live.

“It leads to bad outcomes when they use emergency rooms as primary care doctors, and it raises costs significantly. We made commitments to improving our clinics in high-need neighborhoods in the Midway and the East Side of the St. Paul community and in the Cedar-Riverside neighborhood. We want to intervene at the clinic level, which leads to better health for our patients. We made a major investment in federally qualified health care clinics like Open Cities,” said the M Health Fairview spokesman.

 “There are too many emergency care hospitals in downtown St. Paul. We don’t treat COVID patients in our emergency room,” insisted Campbell. “It should not impact our ability to treat COVID patients.”

But Wiler says she has little faith in M Health Fairview’s word. “They didn’t make up for the beds that they lost at Bethesda. There were over 100 COVID beds, and they didn’t replace them. They opened a 25-bed ICU unit in St. Joe’s and converted two units for COVID patients, but we are still getting patients,” she said.

The emergency department is a point of contact for many seeking medical treatment, especially for those without health insurance. While M Health Fairview insists that over 70% of those who used the St. Joseph emergency room could have used one of their primary care clinics, Wiler pointed out that is not how this working-class population functions.

“Going to work because they can’t miss work—that is a priority. Making sure their kids are taken care of is their priority. Taking care of themselves is not their priority. And that is their decision to make.

“When I have to live paycheck to paycheck I am going to work and make sure I can pay the rent,” explained Wiler. “God help me if I lose this job during this pandemic. I won’t get another. So I am going to work.

“So what we are seeing when they are coming to the ER [is that] they are so sick and are scared they are going to get something else while they are there.”

Wiler said that St Joseph’s is already scaling back medical procedures and emergency services. “There is a list of services that St. Joe’s is no longer providing. So they have to get back in the ambulance and drive around until they find another hospital…to have their stroke taken care of.”

According to Wiler, St. Paul hospitals Regions, United and St. Joseph’s formerly all worked together. “Even when there wasn’t COVID we diverted patients to one another to help ease the load for one another,” she said.

Health Partners and Allina Health voiced concerns about the closing of St. Joseph’s ED.

In an email to the MSR, Allina Health wrote that “against the backdrop of an ongoing mental health crisis that is further exacerbated by the pandemic, Allina Health continues to be extremely concerned about the planned closure of the St. Joseph’s emergency department, the key access point for the sickest in our community needing hospital care, by the end of the year.

“All hospitals and emergency departments, including United’s, are already under enormous strain to meet the care needs of the community. Any reduction in access will further exacerbate an already difficult situation to ensure care for our community’s increasing emergency care, COVID-19, and mental health needs. Given the short timeframe and current COVID crisis, there has not been enough time or focus to understand and plan for the implications of a disruption of this magnitude to the community.”

Health Partners also responded to the closing. “Continuing to have St. Joe’s as part of our COVID-19 solution, including emergency room care and inpatient care, will be critical over the next several months. Longer term, we will need to work together with M Health Fairview and other health systems to address the needs of the community, including mental health,” wrote Health Partners in an email to the MSR.

When informed that the other hospitals systems viewed the closing of St.Joseph’s ED as potentially problematic MNA head Turner responded, “It tells the story. If the other two health care systems are saying our ED’s are swamped.”

“We are still getting patients. Sick people are still coming through the door. Stabbings are coming through the door. Car accidents are still coming through the door. And they are going to keep coming,” observed the nurse. “United and Regions cannot handle the full load of St. Paul without becoming strained in staff and supplies.”

According to Wiler, over a thousand people a year are coming through St Joseph’s ED. “Where are those people going to go” she asked. “Many are not going to find their way to St. John’s in Maplewood. And a lot of the former Bethesda patients will have to go to Woodbury. We take the uninsured… We always had uninsured folks.”

MNA union member Mable Sale calls the hospital and ED closing “a kind of redlining. Black and Brown people are going to be disproportionately affected by this. Hospital ER’s are still going to be needed,” she said.” The clinics are still not providing emergent services. It’s like comparing apples to oranges.”

Wiler explained that, neither doctors nor nurses know exactly how the hospital will function without an Emergency Department. “We don’t know for sure which units will stay open. We have overflow COVID patients on other units and we don’t know where they are going to go.”

“We are pissed off,” said Wiler, who takes the closing personally. “We want to take care of people. We want to take care of this community. That’s what we do. Nurses are not afraid to come to work. We respect the virus and we play by its rules. We know that there are emergencies. But we show up every damn day.”

However, according to Campbell, “The metric we should be using is available staff. We have plenty of space. What we don’t have is the people to take care of them.”

 “People are going to really feel it when St. Joe’s ED is not there. There will be a real eye-opener,” mused Turner.

 “From Bethesda to St. Joe’s, these folks are just bailing on Frogtown,” said Frogtown Neighborhood Association ED Caty Royce.

Updated 12/2/2020′ 6:25 pm: This story has been updated to correct the date of St Joseph ED’s closing to Dec. 30 and update the article with a quote from Allina Health.