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Town & Gown

At Their Mercy

by Anna Johnson

An essay from the Fall 2017 issue.

by Olivia Fountain | Town & Gown | Fall 2017

Drawings by Anna Johnson

When I self-diagnosed my first UTI in July of 2014, I drank the requisite cranberry juice, felt better, and moved on. It was the summer between my sophomore and junior year, and I was living in Oberlin, working as a research assistant for the Classics Department. About a week after the first signs of my UTI, I realized that it had not been eradicated—I experienced extreme stomach pain, and made the decision to go to Mercy Allen Hospital for pain medication and antibiotics. It was after 8:00 PM and I knew I couldn’t spend the night like that, so I went to the emergency room. I took a selfie in the waiting room to send to my parents, and in it I look pale, but okay.

As I ricocheted from the front desk to the admitting nurse to the doctor who eventually saw me, I said the same things: That I hurt but I knew why and that I was pale but okay. After collecting a urine sample but before informing me of my results, my doctor told me that he was worried that I had kidney stones and that he wanted to give me a CT scan. I was scared and in pain so I consented. I didn’t have kidney stones. They’re rare, though becoming more common in nineteen-year-olds. A few weeks later, my family received a bill for nearly $1,000 of what my insurance refused to pay for, citing an unnecessary procedure. According to Mercy’s website, CT scans for outpatients cost between $1,418 and $1,954; urine samples are covered with the cost of an emergency room visit.

I felt like Mercy had taken advantage of my pain by implying that I had kidney stones and pushing an expensive procedure. I felt like my doctor had violated my trust by not believing me when I told him what I thought was wrong. In the aftermath of my emergency room visit, I talked to many Oberlin students, and it seemed like everyone had a story about Mercy. Most of them were negative. Why were so many of my peers feeling unsatisfied and underserved when they found themselves needing to receive medical attention? That question prompted this article. I wanted to learn more about Mercy and its relationship with Oberlin College and Oberlin students. To be honest, I wanted to find a smoking gun—to be able to conclude my piece with a definitive statement saying “Mercy is a predatory institution for these reasons.”

***

Spoiler: I found no smoking gun. What I did find, after talking with representatives from Mercy and Student Health, interviewing students, and combing through the Oberlin archives, is complicated, nebulous, and inconclusive. Everyone that I’ve spoken to has been kind and accommodating. I struggled—am still struggling—with how to square the stories of inadequate treatment with the earnestness of Student Health and Mercy. However, I did find some alarming information about Mercy Lorain, as well as disturbing statistics on emergency rooms in health facilities nationwide. What I hope that I’ve done here is lay out some of this information in a way that may not be conclusive but is at least coherent.

I’ll start with the history.

The city of Oberlin has 8,300 permanent residents, with the population swelling to around 11,000 during the academic year. It’s unusual for a community of this size to have a hospital, and yet Oberlin is home to Mercy Allen—a sprawling one-story health facility close to the center of town. Mercy is run by Mercy Health, a private, non-profit organization affiliated with the Catholic Church that operates in Ohio and Kentucky. Though there is no current official affiliation between Oberlin College and Mercy, the two institutions have long, intertwined histories.

The earliest iteration of the hospital opened its doors in 1907, after years of concern from the community over lack of available healthcare in the immediate area. It was also in the College’s best interest to have a hospital nearby, with Oberlin President John Barrows pointing out that college kids were highly susceptible to pneumonia, typhoid, and scarlet fever. The money to build the Oberlin Hospital came in 1906, when a group of Oberlin residents organized a campaign asking everyone to donate 5 dollars (approximately 125 dollars today) and successfully generated the funds for the facilities that the college and community both desired. In 1914, Dudley Peter Allen (Class of 1875), a doctor in Oberlin, donated $100,000 to upgrade the facilities. His wife, Elisabeth Severance Prentiss Allen, gave another $50,000 to finish the project after he passed away the following year. Their joint contribution funded the Allen Memorial Hospital, which was owned by the college and opened in 1925. The hospital passed back into the city’s hands in 1954 and stayed that way until the end of the 20th century, but Oberlin College continued to nominate and appoint members to the Board of Trustees until the late ’90s, when a major shift took place.

In 2000, the hospital had lost $6 million and was prepared to declare bankruptcy, but an eleventh-hour deal between Allen Memorial, the city of Oberlin, and Oberlin College kept the doors open. The city, which owned the land on which the hospital is located, donated it to the hospital. The hospital sold the land to Oberlin College for $2 million, and the College then leased it back to the hospital at a rate of one dollar per year until 2075. The deal provided the hospital with the cash it needed to remain functional, and came with some important stipulations. First, the hospital needed to bring in an outside contractor to manage operations—enter Community Health Partners (CHP), then-parent company of (now merged with) Mercy Health. CHP guaranteed a credit line of an additional $2 million, and in turn it was agreed that CHP would ultimately merge with Allen Memorial Hospitalafter a trial period of management (the second stipulation). Oberlin College would no longer have any presence on the Board of Trustees. The official merger came in 2003. Articles in both the Oberlin Review and the Oberlin News Tribune indicate that the larger Oberlin community was suspicious of the merger, which lacked transparency because of a series of secret board meetings, and a closed-door meeting between hospital president Ed Oley and then-president of Oberlin College, Nancy Dye. Though the college still owns the land, all official ties between the school and the hospital were severed in 2000. But as the meeting with Dye in 2003 shows, the College was still invested in the wellbeing of the hospital.

The 2000 transfer of power resulted in nearly 70 layoffs and the elimination of the birthing unit that had been operating in the hospital since its inception. Under CHP’s leadership, however, the hospital was once again financially solvent. In a 2001 Ideastream article titled “Hospital Crisis Profile: Saving the Oberlin Medical Center” (Allen Memorial was renamed in 2000, before the budgeting drama), reporter Karen Schaefer describes the hoped-for trajectory for the newly operational facilities: “The plan is to expand some revenue-generating services—like surgery, CTs and CAT scans—while at the same time offering more insurance provider options to physicians and patients.” That plan is perhaps, in part, why I found myself ushered into a wheelchair and rushed to a CT scan to check for kidney stones. My story is not the only one I have heard about the allegations of unnecessary CT scans during emergency room visits. Jordan Ecker ’17 told me about a time during his freshman year when his doctor recommended a scan after administering a muscle relaxant and a sedative to stop him from vomiting. He felt like he was too sedated to understand what was being offered.

“They gave me a muscle relaxant to stop the vomiting and a shot of something else,” he said. “The net effect of the drugs was to relax my muscles, and it did—the nausea went away right away but I also felt super sleepy. So, I was sleepy and in a bed and they left me alone for I don’t know how long… and at some point they come back, it’s a guy with a chart, he asks me a bunch of questions, I don’t really understand, and he’s like, ‘We think you should get a CAT scan.’ And at that point I was pretty much just drugged up beyond belief and really exhausted and hardly awake, so I said ‘Okay.’ And I got a CAT scan while I was coming in and out of sleep and then they wheeled me back.”

When I spoke to Sue Bowers, the president of Mercy Allen from 2006 to 2011, she also brought up the CT scan machine. Bowers has worked at different iterations of the Allen Memorial since the ’70s, and was the head of nursing at Allen Memorial during the 2000-2001 transition. After her reign as president, she now serves as Mercy’s chief quality officer. I asked her about the transition—she told me to call it a “transition,” not a “takeover” during our phone interview.

“We closed the maternity unit and then also closed what was our skilled nursing unit at the time,” said Bowers. “And then Ed Oley [hospital president] and myself [sic] and a lot of the people at Community Health Partners worked to restore the services that the community needed. We put in a new CT scan machine, and the emergency department was woefully undersized, so we constructed a new emergency department that brought a lot of physicians and surgeons.” CHP was able to bring the nearly bankrupt hospital, which plays such a crucial role in the community, back from the brink—which is undeniably a good thing. However, the influx of revenue that Oley was able to bring to the hospital came in part from expensive new procedures and the elimination of departments that were not as financially viable.

***

On the other end of the spectrum, I also received complaints of mis-diagnoses or under-diagnoses during visits to Mercy. After going to the emergency room with severe back pain, Kellianne Doyle ’19 told me that her doctor “just prescribed me two different types of drugs, had me [lie] in the bed for an hour, and then dismissed me. He said it was just a muscle spasm, and said I didn’t need an X-ray or anything. The pain persisted for the rest of the semester, and when I talked to my doctor at home he had me get an MRI, and we found out I had two split discs in my back.”

Maya Elany ’17 also received a very serious misdiagnosis after she got hit by a car while biking in the fall of her freshman year. The accident occurred right before she was scheduled to travel home for Fall Break, and the paramedics who arrived on the scene recommended that she go to the emergency room immediately—flying with a broken bone can lead to blood clots and other complications. In the ER, she sat for some X-rays and was released soon after with a prescription for pain medication. “They told me that it was going to hurt a lot today and even more the next day, but by the third day it was going to feel better.” She didn’t feel better. “I flew home that day, walked on it—they didn’t give me any crutches—walked on it for three days, on the third day I went to see a specialist in Boston and they told me that I was going to need to get surgery pretty immediately. Six days later I got surgery on my knee. My femur had crashed down onto my tibia and depressed it seven millimeters and also tore my meniscus. They put a plate and five screws in there and I was on crutches for four months, but I couldn’t really do anything for over a year afterwards.” Elany told me that she was happy that she had seen a specialist, not only because they were able to perform the surgery she needed, but also because she hadn’t taken her pain seriously before getting a second opinion. She had doubted what her own body was telling her because she trusted what the doctors at Mercy told her.

***

On the phone, Bowers was brisk and professional. I had emailed her in advance to give her an idea of the questions I wanted to ask, and she told me she would not answer anything related to the hospital’s revenue or specific services. She told me that people from Mercy and people from Oberlin College meet periodically about “issues.” When I pressed her on what she meant by “issues” she clarified that there were “periodic concerns for an emerging health issue,” such as flu outbreaks or potentially rowdy college events. “We had concerns after an event had occurred at the College where there was quite a bit of alcohol consumption, and a number of people ended up at the ER,” she said. “So we talked with College representatives after that to see how a similar incident could be avoided in the future.”

When I sat down with head of Student Health and Counseling John Harshbarger and Student Health Coordinator Marilyn Hamel, they confirmed the occasional meeting between College and hospital representatives. They happen at least once a year, Harshbarger said, and are a time for College administrators—including the Dean of Students—to relay student feedback to the hospital. He said Mercy has “been receptive” to student complaints, but that College representatives rarely have much information to pass on. Hamel echoed Harshbarger’s positive sentiment: “They actually have a very good rating in the hospital grading system, and the students are a part of that.” She was not wrong—according to data compiled by Medicare, Mercy Allen Hospital has four to five stars and is performing at or above the national average in eleven categories of customer satisfaction. So what am I missing? Hamel and Harshbarger have been happy and satisfied with their interactions with Mercy, but discussions with my peers have revealed something else.

Through my conversation with Hamel and Harshbarger, I learned that Mercy has a special relationship with Academic Health Plans (AHP), the Oberlin-provided health insurance. Copays on STI tests and other labs frequently requested by Student Health are covered entirely with no deductible. Student Health refers students to Mercy for blood tests, X-rays, and IV services, but doesn’t keep statistics on how many students are sent to Mercy for inpatient treatment. Hamel hazarded a guess that an ambulance is called for a student at a maximum of once or twice a month. Most of the interactions that students have, it seems, are through the emergency room facilities at the hospital. I’ll return to emergency room trends later, but Sue Bowers summed it up when she frankly told me that “emergency rooms are an expensive place to receive care.”

In April 2017, patient safety watchdog The Leapfrog Group released results of a survey of 112 hospitals in Ohio. Mercy Regional Medical Center of Lorain was the only hospital included that received an “F.” The safety grade was awarded based on five different categories—infections, problems with surgery, practices to prevent errors, safety problems, and care providers—each divided into subcategories. Of the five, Mercy Lorain scored the lowest in the subcategories grouped under “doctors, nurses, and hospital staff,” where it performed below average in every single area. The survey found that there were not enough qualified nurses on the premises, that specially trained doctors were not caring for ICU patients, and that patients consistently perceived that their nurses, doctors, and the rest of the hospital staff were not communicating well or responding quickly enough to them. In the “Practices to Prevent Errors” category, Mercy Lorain performed below average in hand washing—scoring a nine out of 30—and accurately recording patient medications. Four other hospitals run by Mercy Health across Ohio received a “C.”

It is worth noting that Mercy Allen Memorial Hospital is not the same as Mercy Regional Medical Center—the two hospitals together are part of the Mercy system in Lorain county. Leapfrog did not collect data on Mercy Allen because it is a Critical Access Hospital, meaning it is not required to publicly report its safety record. But the two hospitals are closely affiliated, and while scheduling my interview with Sue Bowers, my contact at Mercy Allen referred to Mercy Lorain as the “Lorain headquarters.” Mercy Lorain’s low grade is not only unacceptable, but likely indicative of the quality of care offered at Mercy Allen as well. Furthermore, an article published in the Journal of Health Politics, Policy and Law in 2010 by Duke University Press titled “Inefficiency Differences between Critical Access Hospitals and Prospectively Paid Rural Hospitals” shows that CAHs had higher expenses per admission and were generally more cost inefficient. Based on these sources, Mercy Allen is not only providing below-average care, but by virtue of its CAH status, it is providing it at an unnecessarily expensive rate. This is especially concerning in the context of complaints about Mercy Allen’s emergency room—in general, emergency room prices are erratic and unnecessarily high, but there is extra cause for concern in an emergency room connected to a hospital such as Mercy Allen.

A Kaiser Family Foundation and the New York Times 2016 survey of medical bills showed that for people who struggled to pay their medical bills, the biggest portion of those bills were from ER fees. A 2013 PLOS One study showed that prices for the same treatment in different emergency rooms can vary wildly—a UTI, for example, can cost anywhere between $50 and $73,002 at different facilities across the country. This huge range demonstrates the lack of transparency on how much treatments actually cost, making it easy for emergency rooms to overcharge and difficult for patients to know when they are being asked to pay more than they would pay at other ERs. When I first started writing this article, I hoped to uncover something concrete about the wrongs that myself and my peers had experienced at our local hospital. While I still know that those complaints and frustrations are valid, I am beginning to see that Mercy’s track record is a symptom of a larger, very broken system of inadequate, expensive, and inconclusive emergency room care.

But there are things that can be done. A workshop should be offered during orientation to lead freshmen through the ins and outs of emergency room visits. For instance: how a deductible works, how much certain procedures cost, and how to identify when a procedure (like my CT scan) may be unnecessary and costly. A channel should be maintained by Student Health for students to submit comments about their experiences at the hospital. This was something that Harshbarger kept returning to during our conversation. He was shocked when I told him about my own experience, and alluded to some of the anecdotes I had encountered in researching this story. He insisted that Mercy was always open to student feedback, but they rarely had any to pass along. If Student Health has Mercy’s ear like Hamel and Harshbarger suggested, creating a space for students to share stories as a way to affect productive change—or at least get some answers—should be a priority.

As my conversation at Student Health came to an end, Hamel handed me a flyer for the new Mercy Ready Care clinic. The clinic, on West Lorain, is meant for non-emergencies that require quick attention. It’s a way to divert patients away from the costly emergency room to a walk-in care center that’s open later than most doctors’ offices and has weekend hours. I haven’t been to the clinic yet (thankfully I haven’t needed it), but it seems like an important step away from students feeling overcharged and improperly cared for. It also seems like something Oberlin should be shouting from the rooftops about, so students know about this alternative resource that they can take advantage of. The flyer lists “common conditions,” such as allergies, colds and coughs, minor skin infections, sore throats… and urinary tract infections. If a urinary tract infection is a “common condition” that can be treated at a walk-in clinic, why did my doctor insist on an expensive scan to check for kidney stones? This, I suppose, was the root question that started this investigation and the question that I’ve failed to answer. But I have gained some valuable insight into a medical system obfuscated by rumors that, when researched, turned out to be largely founded and symptomatic of a national crisis of emergency room care. My advice? Stick to 􏰀􏰁􏰂the clinic—or the Cleveland Clinic.