Questions raised by Forum's restructuring

Our March 28 column in The Vindicator about Forum Health and issues of class and race drew attention to the community's stake in the restructuring of health care in the Mahoning Valley. We want to raise a few additional questions that community leaders should consider as the area wrestles with this issue.
Who will provide health care for low-income people in the Mahoning Valley?
According to the 2004 audits of charity care in the Mahoning Valley, 75 percent of charity care in Youngstown ($36 million) was provided by Humility of Mary Health Partners (HMHP), which runs St. Elizabeth's Hospital. Forum Health provided only $12 million in charity care. This raises two significant questions. First, how has Forum Health managed to avoid providing its share of charity care? Have they been "dumping" low-income patients onto St. E's? And second, how would restructuring at Forum affect the availability and quality of care at St. E's? How much more can HMHP provide in charity care every year?
Could the two systems serve the community better through collaboration?
A few years ago, Forum and HMHP explored the possibility of working together to expand their competing health care networks while preserving the urban hospitals. That effort failed, and Forum appears to have decided to focus on expanding into areas with lower demands for charity care and greater opportunities for profit. Meanwhile, St.E's remains committed to urban and charity care.
Why has HMHP's restrained restructuring worked while Forum Health claims it must "radically restructure"?
The mergers and acquisitions that formed HMHP and Forum Health have evolved very differently. What could Forum's board learn from St. E's approach? Instead of looking for a quick fix, HMHP has achieved economies of scale and reduced its staff within its system gradually while pursuing more modest suburban expansion. No doubt, as everyone -- including the Forum Health unions -- understands, Forum must do the same. The only questions are what process will be used and will the community and local officials be involved?
How are our donations and tax exemptions being used by Forum Health?
Many members of the local community have donated money to help Forum, especially in campaigns to support Tod Children's Hospital, and local governments have provided significant tax breaks to support the hospitals. Despite those efforts, conditions at Tod have been declining for several years. The hospital has had difficulty retaining pediatric specialists, and more and more serious cases are now being moved from local hospitals to other children's hospitals in the region, such as Rainbow Hospital in Akron. So what has become of local donations? Have they been used to subsidize Forum Health's expansion of operations to serve wealthier suburban clients?
Finally, where is Youngstown Mayor Jay Williams?
Public health is a central responsibility of local government. As mayor, his job is not only to stand up for the needs of his citizens (including healthcare access and delivery) but also to promote economic development. In the Youngstown 2010 plan, Williams argued that economic development around the city's hospitals was a key to re-energizing the city. Further, the job of a mayor is to provide leadership when the community faces difficult challenges. Many voted for Jay Williams because they believed he would be a strong advocate for this community. It is time for him to display the kind of leadership he promised during the election.
We hope that Mayor Williams will join us in proposing that the regional Boards of Health from Mahoning and Trumbull County work with local health care providers to develop a comprehensive community healthcare network. Such a project would require HMHP and Forum Health to collaborate and work with government agencies and community groups. The process would not be easy, but the result would help us all. A regional community healthcare network could serve all residents of the Mahoning Valley - rich and poor, young and old, black and white -- and those with and those without health insurance.
Sherry Linkon and John Russo are authors of "Steeltown, U.S.A.: Work and Memory in Youngstown" and "New Working-Class Studies" and are the co-directors of the Center for Working-Class Studies at Youngstown State University.