Hospital officials say that with so many poor patients, doctors earn very little from insurers' payments for the services they provide. So Bon Secours, like many other hospitals, pays them more just to keep them on staff. That subsidy - which cost the hospital $13 million last year - makes up the biggest portion of the hospital's losses, hospital officials say.
At the same time, the neighborhood around Bon Secours has virtually no primary care practices. Patients clog the emergency room as if it's their private doctor's office.
"If we want to stop the madness, we need to come up with a more effective model that people want to embrace," Ross said. "There is no easy fix."
This month, Bon Secours officials will start meeting with neighboring hospitals, health care leaders and community advocates to discuss a new health care model for the community. Ross said he doesn't know what a new Bon Secours might look like, but it needs to focus on the community's biggest needs: primary care and helping patients with chronic medical problems manage their diseases.
Ross says the process will be similar to an effort the hospital launched a decade ago, when it established a foundation that provides a web of social services to the community. In addition to the 125-bed hospital on West Baltimore Street, Bon Secours runs community centers that offer parenting and GED classes, and it operates a bank called Our Money Place. In addition, the foundation rehabbed crumbling rowhouses into solid low-income rentals.
The hospital itself has deep roots in a community whose institutions have vanished. Bon Secours took over West Baltimore's failing Liberty Medical Center in 1996. Liberty was the outgrowth of what used to be Provident Hospital, an institution in black Baltimore and once the only city hospital that trained black nurses and doctors.
Located on a desolate corner, Bon Secours lies in the midst of Baltimore's most vexing urban problems. Its residents include some of the city's sickest, with high rates of heart disease, diabetes, AIDS and infant mortality.
In the emergency room, doctors see it all - from people with chronic diabetes, renal failure and asthma to drug addicts, psychiatric patients and the homeless, who flood the waiting room seeking a warm, safe place to escape the winter. The staff knows many of them by name.
On a recent afternoon, the ER is full, mostly with elderly patients reclining in beds, hooked up to various beeping machines. The scene is orderly, as charge nurse JoAnn Behounek makes rounds.
