Jerusalem hospital in critical condition

Closure may be weeks away, as the government says it won’t directly aid the private Bikur Cholim.

Bikur Cholim 311 (photo credit: Marc Israel Sellem)
Bikur Cholim 311
(photo credit: Marc Israel Sellem)
Bassinets are wheeled one after another into the maternity ward at Jerusalem’s Bikur Cholim Hospital – 42, to be exact, making it quite possibly the city’s largest assemblage of infants, and two-day-old Chaya Rivka is one of them.
Little does she know that the hospital she was born in is facing financial woes that threaten to close its doors.
Nestled in the heart of downtown Jerusalem on prime real estate, the historic buildings dating back to 1925 and spanning two city blocks may be shuttered in a matter of weeks.
“Ten nurses have already left and by the end of the month all of the anesthesiologists will be gone, leaving the chairman of the department and two uncertified anesthesiologists,” Yoram Blachar, the chairman of Bikur Cholim’s board, told The Media Line. “The only one who can turn this around is Prime Minister [Binyamin] Netanyahu. Otherwise, we could close in less than two weeks. Someone has to come through within a week.”
Raphael Pollack, the hospital’s medical director for the past eight years, said a principal reason for the hospital’s problem is the system of discounts exacted from the hospitals by the health maintenance organizations (HMOs).
Hospitals pay 36 percent off the top to the HMO – an amount virtually equal to the deficit that threatens to close the hospital. In addition, Bikur Cholim has to contend with debt repayment.
“There’s no question in the 21st century it is very hard financially to maintain viability of a hospital that has only 200 beds. We are in an era today of super hospitals, of leviathans that swallow up everything,” Pollack told The Media Line.
Serving more than one million people in the Jerusalem area, Israel’s largest but second-poorest city, Bikur Cholim cares for some 60,000 patients annually. With its 700 administrators, doctors, nurses, technicians and maintenance staff, it is one of the largest downtown employers.
One-third of the physicians are Israeli Arabs, many of whom are doing residencies there.
“They told me that learning and training here was very good and the department was good, so I chose to come here,” said Louay Taha, an Arab physician doing his residency in Bikur Cholim’s cardiology department.
This community hospital is very much what its name implies: the Hebrew term for the biblical commandment and act of visiting the sick. Its primary clientele are the city’s haredi and Arab populations. Bikur Cholim first opened in the Old City in 1826, making it the ancient city’s oldest hospital.
But a series of financial issues threaten to end its generations of service as the only hospital located in the downtown area.
“I think that in almost no civilized country would the government consider closing a hospital based on an operating deficit of $5 million. These are sums of money that can easily be raised,” Pollack said. “The last thing the government should be trying to do is close a hospital that is outfitted and staffed. They’ll just have to build another hospital, and that will be more expensive.”
Ilan Gur, director of Bikur Cholim’s neonatal and intensive care unit, told The Media Line, “This hospital is in the middle of town, whereas all the other hospitals are on the outskirts of the real center. So there should be one hospital there. No city in the world – a large city like Jerusalem – doesn’t have a hospital in the middle of town.”
According to Joseph Liebman, chief of the hospital’s emergency room, many people can’t get to the other hospitals on the periphery. Bikur Cholim’s contribution to the people of Jerusalem was never more apparent than when victims of terrorist attacks during the second intifada walked to the hospital for emergency care.
“If somebody’s life is in danger and they need immediate help, realizing that the brain only has only six minutes before it’s too late, then 20 minutes is too late.
They’d be dead on arrival,” he said.
Russian-immigrant tycoon Arkadi Gaydamak purchased the building and grounds in 2007 for $32m. on condition that he would lease them back to the hospital for at least five years. He has since provided another $10m. to cover its operating deficit.
“I don’t own the medical operations,” Gaydamak told The Media Line, saying he only bought the land and building and that the hospital is a tenant. “I’ve never collected rent, which amounts to $300,000 to $400,000 a month. I’m ready to use the rent as a donation, which amounts to about $5m. annually.”
Gaydamak said he was willing to extend the agreement for a total of seven years. However, he said his offer to extend the contract and forgive rent is contingent on the Finance Ministry coming through with NIS 30m. of assistance.
The Health Ministry says its hands are tied and cannot come to Bikur Cholim’s assistance because it’s a private institution. In a statement, the ministry said it was “making great efforts in examining the option of partnership with other institutions.”
Nevertheless, a ministry spokesperson said that the deputy health minister – haredi politician Ya’acov Litzman – expressed his opposition to its closing and asked Prime Minister Binyamin Netanyahu to intervene.
Pollack said he didn’t accept the ministry’s explanation, saying that Jerusalem’s two other medical centers – Hadassah and Shaare Zedek, also private institutions – receive government funding. Pollack said a proposal for the hospital to merge with another city medical center wasn’t as simple as it seemed and could probably not be completed before Bikur Cholim’s time ran out.
Bikur Cholim’s downtown location is prime real estate, with luxury apartment towers arising on all sides of it.
But Jerusalem realtors who spoke to The Media Line said the legal status of the property is not clear. Moti Bodek, an architect who has worked for the hospital, said that some of the hospital’s older buildings were designated for historic preservation and their value hinged on whether the buildings could be converted to another use and how. Nevertheless, realtors speculated that at least part of the land could be developed, and that alone was worth tens of millions of dollars.
Ya’acov Spigelman, a government official who was party to negotiations with Gaydamak, told The Media Line that the agreement that gave him control over the hospital did not permit the facilities to be used for any other purpose for five years. It was stipulated that if Gaydamak sold Bikur Cholim, he would be subject to a fine estimated at $500,000.
But Spigelman was unclear as to whether Gaydamak could convert the property for sale in the real estate market or how. He indicated that there was room for negotiating a waiver to contractual stipulations.
Jerusalem’s other major hospitals, which are also running deficits, would have extra revenue by taking over the deliveries of 6,000 babies Bikur Cholim performs every year and its 130 neonatal cases – more than either Hadassah Ein Kerem or Hadassah Mount Scopus.
The threat of closure is compounding Bikur Cholim’s problems as nurses and other key employees seek work elsewhere. As it is, there is a national shortage of nurses; therefore, job openings at the hospital are hard to fill, which has forced the hospital to cut back services.
“I’m not sure that next month I will get paid or not,” said nurse Anna Guberevsky. “It was very nice to work here, but because of all sorts of financial difficulties, I’ve decided to leave and have already found another place to work.” Currently, there isn’t enough cash flow to pay salaries, and there have been salary cuts of 30%.
Pollack says, “We’ve reached the end of the road of this crisis. There has to be a solution here and now.
Because without a solution, we are going to have to close our operating rooms, close our delivery rooms, and all the workers, whether they wanted to accept the pay cut or not, will have to go home.”
Eliana Rosenwasser, Chaya Rivka’s mother, chose Bikur Cholim because she wanted to be close to home while in labor.
“It wasn’t such a long taxi ride from my home to Bikur Cholim to have my baby. It is really nice.”
She may not have that option next time.