After my brother was admitted to Hadassah Hospital several weeks ago, my experience there leads me to believe that Jerusalem's flagship medical research facility is teetering on the brink.
After spending about 36 hours there, and whether due to massive layoffs or budget cuts or internal mismanagement, I am sad to say that neither my brother nor I would feel comfortable being admitted to Hadassah Hospital today. After informal discussions with staff and with other patients, I am satisfied that whatever the predicate issues are or were, both staffing levels and morale have made the current situation untenable and uncomfortable for accidental medical tourists. I therefore feel compelled to urge international tourists without Israeli health insurance who fall ill while traveling in Jerusalem to AVOID Hadassah Hospital at this time, except for the most serious life-threatening conditions where vital signs or mental health instability demand emergency admission.
Our unfortunate episode began while my family was on vacation in Jerusalem for Passover. My brother suffered an urgent but non-life-threatening medical issue. While we all are aware of how understaffed hospitals are in general, and how frightening medical care can be, and how brusque and dictatorial medical staff can appear, especially in Israel (and especially if you don't speak the language well), the situation for myself and my brother was somewhat different. We both speak fairly good Hebrew and we have both lived in Israel. My medical school training was actually completed in Tel Aviv, and I am a board certified public health physician, while my brother is both a Conservative rabbi and a U.S. lawyer. We both love Israel very much and invested a great deal of time and money for our once-in-a-lifetime trip to Israel for Passover.
We had a very unpleasant experience at another local hospital's ER and decided to see a Hadassah Hospital physician privately. We were fortunate to meet a terrific and dedicated physician who advised that my brother should be admitted immediately to a Hadassah surgical ward.
From the moment we tried to find our way to the private clinic, to the time we were able to secure our refund of the admission prepayment, we encountered a demoralized, beleaguered, distracted and imperious group of administrators, doctors and nurses who appeared either overworked or underpaid or mismanaged. One nurse was overheard conceding that they simply could not provide proper attention to all the patients assigned to each of them as there were simply too many patients and not enough nurses. A senior physician told me he hadn't been paid in months. Other lowlights included being asked to remove soiled laundry from the rooms ourselves.
On rounds, the residents basically treated my family and my brother as if we inanimate objects or irrational or demented. Barking orders, ignoring our requests and questions, the residents' only clear responses that I could make out occurred when they admitting without hesitation that their ward does not have access to fairly simple tests such as rapid flu or rapid strep kits - tests you should be able to find in any well run urgent care center in the U.S.
One must note that Hadassah does indeed have an impressive, sprawling campus. I was engulfed by were huge halls with little else but clean shiny flooring, a few benches, almost no information desks or kiosks, and a disastrously confusing array of signage in differing colors and font size. Wasteful, non-income generating space was everywhere. My mother and I even got no answer when we asked a security staff member in Hebrew about how to hail a cab to get back to our hotel.
Today's Hadassah Hospital has 21st century elevators, endless maws of corridors, replete with grandiosely plaqued walls. Unfortunately, the facility does not seem to have enough properly treated, trained and paid staff to provide a caring, optimal health care experience for the typical hospitalized tourist with a non-life-threatening medical problem. So much of the staff I met there appeared scowling, angry, resentful, accusatory, and intensely passionate about making sure you knew that whatever you were asking about, they could not help, or that it did not fall within their job description.
Bread and circuses and naming of towers and huge stone wings cannot replace regular rounding of well-trained, compassionate nurses, and expert physicians who are actually paid on time so that they can feed their families and take the time to adequately speak to patients and their families. The world-class dedicated and selfless surgeon that I met there at the private clinic could have been making a half a million dollars a year in the U.S., I've no doubt. He told me that his salary hasn't been paid properly in weeks. He also suggested that he loved the hospital, but based on what's been going on over the last few years, he now for the first time in his career, had regrets about turning down offers outside Israel.
Hadassah is a public service hospital, and its record of excellence in research is well-known. I have visited most of the public hospitals in NYC, and I have worked in Bellevue. I understand that there are fiscal and staffing realities, mismanagement, and political realities that plague all public hospitals.
However, if a facility cannot sustain a basic level of inpatient care because it is understaffed, and there aren't enough doctors or nurses to give basic test results or to put in and take out IVs in a timely manner, it's time to rethink the facility's raison d'etre and mission statement.
If you can't afford to pay reasonable salaries or provide modern day reimbursement levels to keep up morale and to ensure optimal day-to-day clinical care, regular nursing rounds, and the time for robotic residents to start to learn about holistic care and eye contact with patients, and to answer questions from the patient or family, then it's time to rethink what Hadassah can do best to assist the community with the resources it has or it can command in future.
It is always still the responsibility of the hospital and its sponsors to ensure that the facility operates responsibly, and is only admitting and caring for the number of patients for which it is properly staffed. We all know the community desperately needs hospitals and medical care. However, the unknowing tourist should be fully aware that at this juncture, Hadassah has internal and external challenges that suggest that it is a facility that currently seems to be heading the way of Lehman Brothers.
So, whither Hadassah Hospital? Perhaps it should be audited to assess whether the facility is financially able to continue. Other hospitals have been privatized, or converted into privately funded research, surgical specialty, medical tourism, or long-term care facilities. Indeed, the sheer size of the hospital suggests that it could become a museum, a hotel or shopping complex, an entertainment center, or a profitable home to luxury condos.
An alternative solution could be an infusion from an altruistic consortium of venture capitalists. Ideally, it would be wonderful if a consortium of female Jewish philanthropists, perhaps led by Sheryl Sandberg, might be interested in renaming the facility and giving the hospital a different strategic direction, with a tighter mission and a more cost-effective model, based on the Cleveland Clinic, with benchmarking for facility planning, space utilization, staffing and outcomes research. It would also seem reasonable for someone like former Mayor Michael Bloomberg to consider a large endowment in exchange for renaming the entire facility.
To end, allow me to add two things about my background so that Haaretz readers (and hopefully those in power at Hadassah in the U.S.), will understand that I am writing with good intentions. Firstly, I received my medical qualifications both in Israel and in the U.S. Secondly, about 100 years ago, a woman named Rebecca Aronson Brickner helped found a U.S. Jewish women's organization known today as Hadassah. She was my great aunt.
Gabriel Ethan Feldman is a graduate of Brandeis University and the Sackler School of Medicine, Tel Aviv University. He received his MBA and MHA from Georgia State University and is CASA Local Medical Director and On-site Reviewer with the New York Health Services Review Organization.
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