Muhlenberg - Courier - OpEd of Dr. Brian Fertig

Published in the Courier News, Sunday, September 7, 2008 [not on website until 9/09/2008]

Closure of Muhlenberg demonstrates deeper crisis

By Dr. BRIAN FERTIG • September 7, 2008

Health care nationwide is in a crisis of uncoiling despondency. Half of New Jersey's hospitals are financially in the red. Inadequate insurance coverage and dramatic cutbacks in state government funding, despite a rising charity-care requirement, explain the dilemma. Hospital inefficiency related to bed inoccupancy and lower quality of care with more prolonged and complicated illnesses requiring longer lengths of stay and increasing number of procedures amplifies the dilemma.

It is plausible to restrain government spending for inefficiency. However, desultory withdrawal of funding to some of the state's most efficient facilities is a senseless instigation to this health care calamity and geometrically rising costs; Muhlenberg Regional Medical Center is a paragon precedent to this point.

"We were rearranging the furniture on the slanting deck of the sinking Titanic," was quoted by the commissioner of health, who also referred to the hospital as a "sacrificial lamb."

Muhlenberg became the topic of escalating news coverage as it was being closed. It made the front page of The Washington Post on July 7. Daniel Schorr lamented the closing on National Public Radio's "All Things Considered." A heartwarming yet discriminatory documentary will undoubtedly be done on the historic nature of this institution based on its foundational stabilizing value as the city of Plainfield's largest employer and the elite ilk of standards and delivery of health care care throughout its 130 year existence.

"Done deal" from the start has never mattered; this fight needed to be fought and the story needs to be told.

A prevailing consensus of desolate presentiment daunted any effort to preserve the vitality of Muhlenberg's acute-care facility. Nevertheless, the gravamen of common sense, political correctness and reverence for the cost-efficient and highest quality of health care delivery (including the Reinholdt report) consummated a personal decision to embrace this battle. It appeared not only possible but easy to expose the sophistry for desecration to the sanctuary of health care, basic human rights and life.

Moreover, our New Jersey state elected officials, whose decision it was to withdraw state funding for hospital charity care, after all, embody a sympathetic cord for their multicultural underprivileged constituents. In fact, there were pre-emptive intentional, conspicuous measures to lead the bereaved public down a garden path of understanding and hope. Effusive emotion, sentimentality and factually incontestable well-articulated moral indignation failed to achieve any measure of moderate retrenchment by the Corzine administration. This became the defining watershed red flag for distrust.

Befitting a similitude to a hidden twist to the theme of a detective mystery, beguile and vulpine leadership became implicit, although the motives remain murky. The only explanation can be jockeying (e.g. for broader national-scale universal health care) or other even more villianous corruption.

It is a bewildering reality sometimes to have to think of our friends or elected safeguards as foes. Several tacitly credible reports have incriminated state governing officials of collusion and political blocking designed to disrupt and diffuse any focus capable of exposing an effective generator of outrage. One source points to stealthy manipulation of isolated executive individuals for the People's Organization for Progress. Another source supportive of the loyalty and virtue of the People's Organization cite threats from government officials to such individuals (who are state employees) if their level of advocacy for Muhlenberg persisted.

This may explain the fundamentally extraneous cynosure to Solaris Health Care Systems for the impending closure of Muhlenberg's acute-care operation. We need to remember that the state funding for charity care had been voluntarily taken away by the state government. Regardless of whether Solaris sees or even planned this as an opportunity to expand JFK Medical Center, it is curious that virtually no attention had been directed to the actual fundamental cause of the problem.

Framing the vital distinction of Muhlenberg's acute care provided the tangible opportunity to destabilize the accepted sophistry of the state's administration. The spurious reasoning that closing the acute care at Muhlenberg Regional Medical Center protects the financial interest of New Jersey taxpayers or ennobles fiscal responsibility is ridiculous and outrageous.

Muhlenberg has a record of scintillating efficiency and quality of care that irrefutably translated into cost savings. Repeated vacuous demonstrations directed by the People's Organization for Progress acclaimed only blank signs of "Save Muhlenberg." There had also been the conspicuous absence of worthy statewide media coverage.

It is retrospectively predictable for the state to grant the certificate of need filed by Solaris. The animus builds along with predictable prolonged legal courses of action between the sister hospitals of Solaris; this attention fulfills the function of political blocking. For Solaris to serve as a scapegoat for our state's administration, via state denial of a certificate of need, would only translate into a sooner realization that the New Jersey state government, and not Solaris, is the elemental problem to Muhlenberg's fallout. This would logically revivify the legs of Muhlenberg's supporters by directing their focus and goals.

The value of the New York Giants as a role model for champion teams must be epitomized. They have fought for Team Muhlenberg as they did for themselves. They even likened their achievement of the 2007-2008 greatest playoff and Super Bowl run in professional football history to the accomplishment that supporters of Muhlenberg pursue.

Tiki Barber, the "Mighty Mouse": He is relatively small, but found the holes that O'Hara, the front line and team created, to produce incredible statistics and outcome. The New York Giants consummated their world champion status after consecutively overcoming three redoubtable strongly favored and probably more talented opponents. Metaphorically, Muhlenberg Regional Medical Center epitomizes Mighty Mouse as a small Giant.

Built in 1877, a 400-bed hospital at its height, it has ranked No. 1 in the entire state of New Jersey (of almost 300 hospitals) and even in the top 10 percent in the country statistically for parameters of care. These include: infection rates in the intensive care unit; emergency cardiac angioplasty time; and neonatal morbidity. This efficiency of care results in decreased mechanical ventilation, transfusions, dialysis requirements, and so on, that underscore prolonged serious illness with an incommensurably high cost of delivering health care.

Champions know who they are. Fundamentals make team Muhlenberg a betting favorite. Getting knocked down can be disorienting; getting back up coupled to a cyclopean instinct of faith for the triumph of justice reorientates focus and innately the direction of the field of play. Muhlenberg's offensive game is poised for long gains, ball control and predictably a touchdown win and renaissance for the people it serves.

Both the certificate of need filed by Solaris Health Systems and the Reinhardt Report by the commissioner of health recognize and praised the outcome, quality and safety of Muhlenberg's patient care. This small community regional medical center that served the predominantly underprivileged and racial minorities of Plainfield outperformed the care of an overwhelming majority of larger medical centers in well-to-do areas.

The game plan for Muhlenberg at this point must be to illuminate Muhlenberg Regional Medical Center so brightly that it clearly exposes the sophistry of our governor's reasoning and decision-making to withdraw charity care funding to the hospital. Evidence-based medicine and statistical validation of the highly efficient delivery of care at Muhlenberg needs to be tangibly demonstrated. This can be done. Such a sophisticated analysis endeavor is the current challenge. The depth of this analysis, as already discussed with a leader in this area of econometrics, needs to be impervious to anticipated widespread scrutiny.

Dr. Brian Fertig is an endocrinologist living in Edison.

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