Why are so many hospitals in Pennsylvania closing?

On July 11, 2019, notably before the COVID pandemic, the Wharton School of the University of Pennsylvania published an article in its “Knowledge at Wharton” Business Journal aptly titled “Keeping the Lights

On: Why Are U.S. Hospitals Closing?” At one point the article discusses rural hospitals but the most obvious example immediately before the authors and the one they devoted the majority of their discussion to was Hahnemann University Hospital, which has a long history and which is noted to be “in the heart of Philadelphia,” and obviously not rural.

In Chester County we have Brandywine Hospital, previously operated by Tower Health at 201 Reeceville Road, Caln Township, closed in January of this year. Just one month before, another Tower Health organization, Jennersville Hospital, in Penn Township, West Grove also closed.

The loss of both hospitals in this area is incalculable and is not lost on government officials, emergency services and the public generally. Even if they would be able to reopen on some basis with new ownership, as pointed out to me by one physician, doctors and other professionals associated with the organization will have had to move on and new ones would need to be attracted.

As noted by many, Brandywine Hospital operated the only in-patient Behavioral Health unit in the county. In addition, as related to my elder law practice, it operated the only known inpatient hospitalization in the county for acute care for seniors in acute mental health distress other than dementia. Jennersville Hospital serviced southern Chester County and, as has been noted in several commentaries, its closing requires patients to travel excessive distances to other locations including Chester County Hospital, associated with Penn Medicine in West Chester, or Paoli Hospital and possibly even to Maryland.

In adjoining Delaware County, the story is similar. Delaware County Memorial Hospital has closed several of its services including its outpatient substance abuse clinic and announcement has been made of the hospital’s likely closing. Crozer-Chester Medical Center owned by the same organization, notified it is also planning to close its Inpatient Acute Substance Abuse and Addiction Unit on June 11 and its Crisis Center on June 19. Again, note that, although rural medical health hospitalization has been discussed as a problem for years, both Chester County and Delaware County are suburban, not

rural, and considered “collar counties” surrounding Philadelphia.

County Commissioners and others within county government have been actively working to solve the crisis. One question is: How does this happen?

The Wharton article, although written three years ago, discusses this at some length and describes it from a prior article as “not a seismic shift; this is more of a gradual decline…” It notes “while each hospital under threat of closure deals with problems unique to its location, their underlying problem is singular: not enough money.” That leads to another question.

Robert Field, a law and health management professor at Drexel University noted “one of the real core conflicts here, which you see at the city level and also at the national level, is we still can’t decide what health care is. Is it a commodity where you can have a for-profit company come in and make money for investors? Or is this an essential public service…?”

It could be added that, if it is an essential public service, how should this be reflected in the community where an entity can simply move on without providing adequate notice and without assuming responsibility? Who or what entities should be expected to fill the breach left by unsatisfied investors?

I recall from my law school days, discussion of environmental impact studies needed to be completed before major projects could be initiated. Should community impact studies with adequate advance notice describing the alternatives be required of investors who leave the field?

Field observed “what we’re seeing as a general trend is consolidation, and … the rich get richer and the poor get poorer…” Although major hospital systems are growing — adding gene therapy and futuristic treatments other hospitals are having difficulties. Telemedicine can fill in some gaps “but that doesn’t work if the patient is having a heart attack…”

We are fortunate in the West Chester Penn Medicine and Paoli and Main Line Health areas, but problems remain in many areas of the state including surrounding suburban and outlying rural areas.

Janet Colliton, Esq. is a certified elder law attorney recognized as a specialty by the American Bar Assn and Pa. Supreme Court. Her office, Colliton Elder Law Associates PC practices elder law, retirement planning, life care, special needs, real estate and estate planning and estate administration, with offices at 790 East Market St., Suite 250, West Chester, 610436-6674, colliton@ collitonlaw.com. She is a member of the National Academy of Elder Law Attorneys and, with Jeffrey Jones, CSA, cofounder of Life Transition Services LLC, a service for families with long term care needs.