Given the sunshine, low humidity and passing rain the previous day, the warm and sunny lunch hour in downtown Philadelphia on June 27 should have been serene.
Instead, alarm bells and code lights were going off at frenetic rates.
After nearly two centuries of serving the community and an exceptional legacy as an indispensable teaching hospital, Hahnemann was suddenly on life support. In the balance were 2,500-3,000 jobs, critical access to lifesaving emergency care and the medical homes of countless Philadelphia-area residents.
Around noon, Hahnemann staff would typically be trying to sneak in a bite to eat between hours of treating and saving patients at the 500-bed facility. But on this particular Thursday, hundreds of nurses, physicians, social workers and support staff rushed to City Hall’s front porch to rescue the fading establishment that so many called home.
With Hahnemann’s sunlit southern facade laid out in front of them just a thousand or so yards away, nurses, union officials and city leaders feverishly worked to infuse patient stories, local government power and city and state law into the dying institution in a desperate attempt to save it.
The mechanism of injury, in this case, was identified as private equity-financed corporation American Academic Health System (AAHS) and its CEO Joel Freedman. Just weeks before Nick Foles worked his replacement magic to lead a championship parade nearly to Hahnemann’s doorstep on Broad and Vine, the for-profit national corporation arrived in Philadelphia with big promises.
These included promises to pour money and resources into rebuilding the hospital’s worn infrastructure and commitments to a new start for employees and patients who reportedly endured years of rocky ownership and dangerous working conditions. But before Carson Wentz could begin his first full training camp healed from his initial injury, AAMS publicly declared Hahnemann as a “DO NOT RESUSCITATE” and then announced they would pull the plug.
People are going to die.
For a city struggling to battle an opioid epidemic that claims the lives of three Philadelphians a day, and a gun violence epidemic which picks its own daily victim, the fact that a Level 1 trauma center in the heart of Center City would be forced to close its doors is madness.
When Hahnemann nurse Shanna Hobson heard that her hospital would be closing, her first thought as an emergency room nurse was “this [is] going to be a disaster.”
Hobson then pointed northeast. “Kensington is right up there, we see a lot of overdoses… and if [they overdose] and someone is driving them, it’s going to take longer to potentially get drugs to reverse the agents. Unfortunately, more people will die.”
She then added, “It wasn’t too long ago we had two shootings on the Broad Street Line. We often get drop-offs by police for shootings that happened nearby. They just scoop them and bring them right to us. And now…”
Gunshot wounds, overdoses, heart attacks, strokes and aortic ruptures wait for nobody. Given Hahnemann’s proximity to the city’s major arterial roads and the Broad Street Subway, it is often the choice hospital for patients with emergencies who live closer to other institutions. Hahnemann sees 40,000 ER visits a year.
Hahnemann ER nurse Joelle Leone struggled to comprehend what Philadelphia residents faced. “It’s going to be catastrophic. Seconds count... We’re right off I-76. It’s very quick for ambulances to get to us. Now they are going to have to bypass us and go down to Penn, Jefferson, go through all of those city streets. That’s a lot of traffic, these cars can’t get out of the way. It’s going to delay care. People are going to die.”
In addition to delays getting to a hospital, Leone also pointed out that wait times for Philadelphians calling 911 would increase with ambulances driving longer distances, waiting to unload patients in more and more crowded ERs and taking longer to return to the street.
Seconds turn into minutes. Now, could minutes turn to hours?
Hahnemann's union nurses, like nurses across the country, selflessly work on the front line of these epidemics, devoting their careers, talents and care to serve our city. They also often risk significant physical harm and mental health trauma to do so. Dylan Toolajian, an inpatient cancer nurse at Hahnemann, gave a touching speech on stage about a cancer survivor who had multiple bouts with death but was saved by the outstanding care and treatment by the oncology unit.
On the day the news of the planned closing of the hospital was announced, the patient “came to visit us to say ‘goodbye’ and ‘thank you.’ He was sobbing. My heart shattered.” Despite not knowing what was in store for their future, Dylan and his team did what nurses do — they selflessly comforted their patient. During Toolajian’s speech, one distressed woman in the crowd called out that she had been served at Hahnemann for the last 40 years, as had her entire family. “Where are we going to go?” she asked.
Toolajian told me later, “We’re really worried for our patients. We know that they will get hurt, will get injured. Many of them will not be able to seek emergency services elsewhere, many of them don’t have the option of transferring care to another facility. Many of them are uninsured or underinsured. It’s a life and death matter. Without [Hahnemann’s] ER, some of them may lose their lives. Immediately.”
Hahnemann: A manufactured crisis?
After the rally, Hahnemann ER nurse Joanne Leone could not fight back the tears as she left the stage to race back to her shift at the hospital. “It’s just devastating, we feel like we had the rug pulled out from under us and our patients,” she said. “We’re just being thrown under the bus.”
None of the nurses from Hahnemann that I spoke with bought the story of financial distress portrayed by owner Joel Freedman and AAMS.
Having to close down a 171-year institution after running it for only 18 months may make Freedman one of the most hapless Philadelphia executives since Sixers president Bryan Colangelo, his high-collared shirts and his wife’s burner Twitter accounts were shown the door.
Less than a year before, the baby-faced Freedman had doubled-down on his promise of investments into the hospital and chided the hospital’s previous steward, Tenet Healthcare, in the Philadelphia Business Journal for neglecting its workers and patients in a “highly irresponsible manner.” But just months later, when AAMS was claiming financial hardship, the mayor’s office reported that key financial details that may have saved the historic institution were consistently withheld by AAMS, derailing early city efforts to save the institution.
In a press release issued on the day of the announced closure, Lisa Leshinski, executive director of PASNAP, a union representing Hahnemann’s nursing and healthcare workers union, said, “Joel Freedman’s company has run this hospital with only profit in mind. He is creating a public health crisis.”
The nurses I spoke with at the rally were furious. One told me, “In my personal opinion, Joel Freedman did not come in here with any intention to really care for the city of Philadelphia and its poorest and sickest people who live on the streets, or those inside this hospital. He came here because he thought he might see a way to make money, and the minute that didn’t happen he’s bailing on us.”
Another nurse I talked with was adamant. “I believe Joel Freeman never intended to keep this hospital open, and he looked at it as a real-estate investment,” she said. “I used to see him telling people, ‘What a great building, great location…’ There’s a reason why you say ‘great location’ when you’re talking about a hospital.”
Colin Kellar, an ER nurse, saw the mixed signals being sent by Freeman and his team as a warning sign, despite promises to employees that they would keep the hospital open. “I think the owner knew what he was doing,” Kellar said. “He wanted to sell it for the real estate… He said all these things about helping the community. There was no attempt for them to turn the business around. They just wanted to sell it.”
Kellar left for a different hospital earlier this month. “As soon as I saw them close the outpatient clinics, I knew it was coming,” he continued. “It is awful. I spent my whole career [there].”
‘We are a family.’
Wednesday’s announcement was painful to the legions of Hahnemann’s workers, many of whom had stuck with the institution through the use and abuse of many years of inattentive owners.
“[The previous owner] Tenet ignored us because they let a lot of the infrastructure crumble and we stayed because we care about the patients,” Leone said. “We know them. We really are like a family, we really are. We all know each other... this is just sickening.”
Leone was one of many employees who focused on her fellow workers. “People have been here for 40 years,” she said. “We have new nurses, they have school debt. All the sudden we have 800 nurses that need to find jobs that don’t want to find new jobs. You have to love it to work here because it’s not an easy place to work.”
ER nurse Talia Gottesman mentioned a nursing shift supervisor who had worked at the institution for over half a century among other Hahnemann family members. “Their mothers worked there,” she said. “Just the amount of family ties that goes on there...”
Hobson could not help but think of the patients who would be affected. “We see patients all the time when they are sick, they come to us for treatment. We know them, and they know us. We’re there to serve an underserved community. The staff is like family… I love the people that I work with.”
Toolajian agreed. “Every job in the whole place goes back to the patient. Everything that every person does, except for the owner, goes back to the patient. For some patients, Hahnemann is their address.”
Just then, the Chief Nursing Officer came over and, like a caring mother greeting her children returning home, gave each of the nurses a big warm hug. “She’s our fearless leader,” Gottesman said.
Not on our damn watch.
While Joel Freedman is steadfastly on his way to becoming one of Philadelphia’s most loathed individuals, the question of what can be done remains. Some think that comfort measures are the only option, and Hahnemann cannot be saved. If that is the case, everything must be done to fill the giant healthcare void that will now exist in the heart of our city. Also, every nurse, physician, employee and student in Hahnemann’s family must be accommodated, in addition to its loyal patients, or AACN (which would still operate in the city running both Hahnemann and St. Christopher’s Hospital for Children) must be held to account.
If Hahnemann is going to be saved, an all hands on deck approach is required. “We need as much support from the community as we can get,” Toolajian said. “We need [people] to reach out to their community leaders... to come out in support. We need all the help we can get to achieve this emergency aid, so we can stay open and continue to serve this community.”
Gottesman’s vision forward for Hahnemann was for the hospital to “allow for state oversight [to] bring in millions of dollars to turn this around in the immediate phase.”
In addition to nurses and leaders from unions like 1199C, AFL-CIO and PASNAP, Bobby Henon, Helen Gym and other city officials took to the stage. They pledged to the large crowd that they would do all they could to use the city’s power to resuscitate Hahnemann and derail any plans Freedman had of flipping the historic Broad and Vine location for a quick sale. If Freedman thought he would be able to sell Hahnemann’s land for real estate, he’s out of touch.
In case there was any doubt, Helen Gym used all of the weight that her resounding recent City Council win carried. Gym carried home this point in classic Gymnasium fashion, by being swift, forceful and a champion. “I’m here for the warriors who are going to stand up to Joel Freedman,” she proclaimed. “[To] his hedge fund buddies… and Silicon Valley, to say, ‘not on our watch!’ And NOT without a fight!”
Tarik Sharif Khan is a family nurse practitioner, an associate fellow at the Leonard Davis Institute and a Ph.D. student at The University of Pennsylvania School of Nursing.