She visits Mary Bishop, 66, a Bon Secours regular. Today, she's complaining of a toothache. But after more prodding, Behounek discovers Bishop has had a heart valve infection. She was likely told to visit the emergency room in the event of any serious pain.
Bishop lives in East Baltimore, but she took a taxi out of her way to Bon Secours. "I like it here," she says.
Two beds down, Kenneth Jackson, 45, is hooked up to oxygen. His lifelong asthma was so severe that morning that his girlfriend called an ambulance. Doctors concluded he had pneumonia. Jackson, who takes medication for schizophrenia, said he was treated for asthma at a health clinic for the homeless until a few months ago when his doctor left the organization.
Behounek, who has worked at Bon Secours for 25 years, says Jackson is like many patients whose health care history is murky. "They are all God's children, just like me," said Behounek, who wears a silver cross around her neck.
If Bon Secours converts to an outpatient model, no one knows where Bishop and Jackson will go for emergency care. The closest hospitals are the University of Maryland Medical Center, St. Agnes Hospital and Maryland General Hospital.
But patients will bring their financial problems with them to hospitals that are already strained, said Alan Sager of Boston University's School of Public Health, who has studied urban hospital closings. And some patients may stop seeking medical care, he said.
The state's rate-setting commission has tried to help Bon Secours by building a 3 percent cushion into its rates, which translates to roughly an extra $3 million a year for the hospital. But the commission cannot do more, said Robert Murray, its executive director. "The commission has tried to recognize the additional cost of operating in a very indigent neighborhood," he said.
Ross pointed out that beyond health care, Bon Secours is the primary economic engine in a depressed area. "It's not just us," he said. "There are vendors, small businesses and people we employ."
Brother Arthur R. Caliman, a senior executive, said the hospital cannot turn its back on a neighborhood with such great needs.
"There is no question that we want to continue some level of health care ministry," he said. "I think the problem is so great that the hospital may not be the best solution."
