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March 4, 2011
A state of critical condition
Israeli government refuses to come to Bikur Cholim hospital’s aid.
FELICE FRIEDSON THE MEDIA LINE
Bassinets are wheeled in one after another into the maternity ward at Jerusalem’s Bikur Cholim Hospital – 42, to be exact, making it quite possibly the city’s largest assemblage of infants – and two-dayold Chaya Rivka is one of them.
Little does she know that the hospital she was born in is facing financial woes that threaten to close its doors. Nestled in the heart of downtown Jerusalem on prime real estate – its historic buildings dating back to 1925 spread out over two city blocks – Bikur Cholim may be shuttered in a matter of weeks.
“There’s no question [that] in the 21st century, it is very hard financially to maintain viability of a hospital that has only 200 beds. We are in an era today of super hospitals, of leviathans that swallow up everything,” said Raphael Pollack, the hospital’s medical director for the past eight years.
A principal reason for the hospital’s problem is the system of discounts exacted from the hospitals by health maintenance organizations (HMOs), said Pollack. Hospitals pay 36 percent off the top to HMOs, an amount virtually equal to the deficit that threatens to close the hospital. On top of this, Bikur Cholim also has to contend with debt repayment.
Serving more than one million people in the Jerusalem area, Israel’s biggest but second-poorest city, Bikur Cholim cares for some 60,000 patients annually. Its 700 administrators, doctors, nurses, technicians and cleaners also make it one of the largest downtown employers. One-third of the physicians are Israeli Arabs, many of whom are currently doing residencies there.
“They told me that learning and training here was very good, and the department was good, so I chose to come here,” said Louay Taha, an Arab physician doing his residency in Bikur Cholim’s department of cardiology.
This community hospital is very much what its name implies: the Hebrew expression for the biblical commandment and act of visiting the sick. Its primary clientele is the city’s ultra-Orthodox and Arab populations. Bikur Cholim first opened in the Old City of Jerusalem in 1826, making it the ancient city’s oldest hospital, but a series of financial issues threaten to end its generations of service as the only hospital located in the downtown area of the city.
“I think that in almost no civilized country would the government consider closing a hospital based on an operating deficit of $5 million. These are sums of money that can easily be raised,” Pollack said. “The last thing the government should be trying to do is closing a hospital that is outfitted and staffed. They’ll just have to build another hospital and that will be more expensive.”
Ilan Gur, director of Bikur Cholim’s neonatal and intensive care unit, said, “This hospital is in the middle of the town whereas all the other hospitals are on the outside of the real centre. So there should be one hospital in there. No city in the world – a large city like Jerusalem – doesn’t have a hospital in the middle of town.”
According to Joseph Liebman, chief of the hospital’s emergency room, many people can’t get to the other hospitals on the periphery. Bikur Cholim’s contribution to the people of Jerusalem was never more apparent than when victims of terrorist attacks during the second intifada walked to the hospital for emergency care.
“If somebody’s life is in danger and they need immediate help, realizing that the brain only has six minutes before it’s too late, then 20 minutes is too late. It’s coming dead on arrival,” he said.
Arkady Gaydamak, a Russian immigrant tycoon, purchased the hospital in 2007 for $32 million and provided another $5 million in the first year to cover its operating deficit. But he refused to put any more money into the institution, citing disagreements with the foundation he had set up to run the hospital and because his own personal financial situation changed.
Israel’s Health Ministry says its hands are tied and cannot come to Bikur Cholim’s assistance because it’s a private institution. In a statement, the ministry said it “is making great efforts in examining the option of partnership with other institutions.” Nevertheless, it said the deputy minister of health – an ultra-Orthodox politician, Ya’acov Litzman – has expressed his opposition to its closing and has asked Prime Minister Binyamin Netanyahu to intervene.
Pollack said he doesn’t accept the ministry’s explanation, saying that Jerusalem’s two other medical centres – Hadassah and Shaarei Zedek, also private institutions – receive government funding. Pollack said a proposal for the hospital to merge with another city medical centre isn’t simple and probably couldn’t be completed before Bikur Cholim’s time runs out.
For one thing, its downtown location is prime real estate, with luxury apartment towers arising on all sides of it. But Jerusalem realtors who spoke to reporters said the legal status of the Bikur Cholim property is not clear.
Moti Bodek, an architect who has worked for the hospital, said some of the hospital’s older buildings are designated for historic preservation and their value hinges on whether the buildings could be converted to another use and how. Nevertheless, realtors speculated that at least part of the land could be developed and that alone is worth tens of millions of dollars.
Yaakov Spigelman, a government official who was party to the negotiations with Gaydamak, said in an interview that the agreement that gave him control over the hospital did not permit the facilities to be used for any other purpose for five years. It was stipulated that if Gaydamak sold Bikur Cholim, he would be subject to a penalty estimated at $500,000. Spigelman was unclear on whether Gaydamak could convert the property for sale in the real estate market, or how, but he indicated that there was room for negotiating a waiver to contractual stipulations.
Jerusalem’s other major hospitals, which are also running deficits, would enjoy the extra revenue from taking the 6,000 births Bikur Cholim now facilitates each year and its 130 neo-natal cases – more than either Hadassah Ein Karem or Hadassah Mt. Scopus.
The threat of closure is compounding Bikur Cholim’s problems as nurses and other key employees seek work elsewhere. As it is, there is a national shortage of nurses and, therefore, job openings at the hospital are hard to fill, which has forced the hospital to cut back services. “I’m not sure that next month I will get paid or not,” nurse Anna Guberevsky explained. “It was very nice to work here, but because of all sorts of financial difficulties, I’ve decided to leave and have already found another place to work.” Currently, there isn’t enough cash flow to pay salaries and there have been salary cuts of 30 percent.
“We’ve reached the end of the road to the crisis,” said Pollack. “There has to be a solution here and now. Because without a solution we are just going to have to close our operating rooms, close our delivery rooms, and all the workers, whether they wanted to accept the pay cut or not, will have to go home.”
Eliana Rosenwasser, Chaya Rivka’s mother, chose Bikur Cholim because she wanted to be close to home while in labor. “It wasn’t such a long ride in the taxi from my home to Bikur Cholim to have my baby. It is really nice.” She may not have that option next time.
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