198 More Sundays: Best Care Anywhere

Well, I'm not sure if this is appropriate to employ in the struggle for healthcare reform, but perhaps a kind of social intervention, Method 175. Overloading of facilities, could work:

Overloading facilities involves the deliberate increase of demands fo services far beyond their capacity, so that the operation of the institution (government department, business, social service, and so on) is slow down or paralyzed.  Such overloading may be initiated by customers, the public, or employees of the institution.  The objectives may vary and may include improved services, wage increases and political ends.

In 1965 at the Los Angeles County Hospital in California, for example, interns protesting pay policies initiated an overloading of facilities by admitting far more patients to the hospital than existing facilities could accommodate--even persons not needing hospitalization were admitted.  This was called a heal-in.  The interns' aim was to obtain a better bargaining position with the hospital administration.  The hospital was filled with patients within four days, and the action cost the city around $250,000 in increased costs.

[The Miami News reported at the time:

Representatives of resident physicians and interns at Los Angeles County General Hospital, miffed by a pay raise of less than $10 a month, said they would flood the huge facility with patients. They called it a "heal in."

County Supervisor Kenneth Hahn called it "a deliberate plan to disrupt good hospital service." Ho said a delegation of three doctors claiming to represent the 200 interns and 350 resident physicians said their strategy was to admit as many patients as possible and, at the same time, retain present patients longer.

Hospital administrators said there was a 25 per cent increase in admissions yesterday and a 40 per cent drop in discharges. The doctors had asked fot $400 monthly for interns and a sliding scale foi resident physicians from S510 to $713 a month Interns now get $330 to start and $337 after six months — plus room and board. Resident physicians receive from $435 to $645 a month.]

A similar case occurred in Massachusetts at the Boston City Hospital in 1967, where it was called an "around-the-clock heal-in."  This action was begun by 450 residents and interns at Boston City Hospital on Tuesday, May 16, 1967.  The purpose of the heal-in was to dramatize salary demands by doctors at Boston teaching hospitals; at that time the take home salary of an intern was only sixty dollars per week.  The doctors felt that it would be in violation of their oaths to go on strike, so they chose instead to practice "ultra-conservative medicine in order to overcrowd the hospital.  Dr Philip Caper, President of the House Officers' Association, said: "Everyone gets the best of care," which was ensured by having all the interns and residents work twenty-four hours a day.  "Every patient who might benefit from hospitalization will be admitted, and no-one will be discharged until he is completely well."

The heal-in was patterned after the similar action at the Los Angeles County Hospital eighteen months previously.  The Boston City Hospital doctors began their heal-in as an unannounced experiment on Saturday, with 874 patients in the hospital.  On Sunday there were 890, on Monday 924, and on Tuesday at 7am (after the main action was begun) there were 982.  An unidentified doctor stated; "With 1200 or more patients in the hospital the laundry will not be able to keep up, the kitchens will have trouble getting the food out, the X-ray and laboratory departments will be swamped, and people will begin to listen to our demands..."

By Wednesday morning there were over 1000 patients, and 1075 on Thursday.  The heal-in was supported by private doctors and house officiers at the other major Boston hospitals.  Action was taken only at Boston City Hospital because house officers there had full responsibility for medical procedure, unlike the private hospitals.

Countermeasures by the administration began Tuesday afternoon with an announcement that there were no more beds for male patients, which was disproved that evening by the admission of two more patients.  They next tried to influence the chiefs of services to override the admittances, which these doctors refused to do on the grounds that these patients were indeed getting the best of care.  The administration's final effort was to deny their competence to make salary changes.  On the evening of Thursday, May 18, they relented and promised to make salary adjustments.  The doctors ended the heal-in voluntarily that night.  Observers felt that it was a "safe, effective way of backing up demands for higher wages."

[An LTE in Psychiatric News, 2001:

I was at the time a chief resident in psychiatry on what was then a Harvard service. I recall no mention of proposed union affiliation or concern about compensation, since the vast majority of residents felt privileged to be training under such notable clinicians as Dr. Derek Denny-Brown.

At issue were deplorable conditions for patient care such as grimy, open-bay wards with water-filled grapefruit juice cans filled with cigarette butts, an absence of bed linen, and no assistants to transport patients for X-ray studies or other procedures, such that interns had to push the gurney stretchers themselves.

The city administration had turned a deaf ear to the repeated pleas of the interns and residents. The “heal-in” was a last-ditch effort to draw public attention to the plight of the patients, who were, many of whom were poor and African Americans. We were determined during the heal-in to provide superior round-the-clock care. I recall being on duty for 36 hours straight. There were no “nonpatients” admitted, as described in Dr. Avram’s article. Rather, the decision was made not to discharge patients until every outstanding laboratory or X-ray study result was on the chart—this was had also been a significant problem in the precomputer era because of an absence of lab result dispatchers.

The Boston Globe was contacted in advance, emphasizing that superior care would be provided to patients during the heal-in. Thus, there was widespread public sympathy and support for this effort.

As I recall, the patient census soared from 800 to the full 1,200-bed capacity in two days. This required that some patients seeking admission were temporarily deferred to Massachusetts Memorial and Massachusetts General, New England Medical Center, and other area hospitals.

The city of Boston finally got the message, and the necessary patient care improvements were initiated.

This was not an action taken lightly and indeed only as a last resort. The interns and residents at Boston City Hospital felt totally vindicated by these positive results.]

I wonder if, with a majority of healthcare practitioners supporting single-payer, this would be an action they could take to make a point?  Order enough expensive tests that insurance companies would have to pay out or deny, create administrative bottlenecks, etc.  Even insurance employees of conscience could assist.  Dunno.

Anyway, I've just been trying to think of other ways people involved in delivering care can get involved somewhere between sidewalk summits and civil disobedience.

ntodd

Comments

[Barbara O' Brien]

Dear Pax Americana,

I just have a quick question for you but couldn't find an email so had to resort to this. I am a progressive blogger and the owner of the mahablog. Please email me back at barbaraobrien@maacenter.org when you get a chance. Thanks.

Barbara