Norman Otey was rushed by ambulance to a hospital. The 63-year-old was double over in pain. A grave emergency that required the resources and expertise of an intensive care unit was the result of blood tests.
The I.C.U. was closed by the hospital in the Black neighborhood.
Linda Jones- Smith said it took several hours for Mr. Otey to be taken to another hospital. He died of sepsis on the way to the hospital. The two people who cared for Mr. Otey said the delay probably contributed to his demise.
He should have been allowed to go to the hospital for treatment. The man should have been saved.
There is an emergency room and a psychiatric ward in the community. There isn't a maternity ward or a lung specialist. Two medical workers at the hospital, who requested anonymity because they still work there, said the machine broke frequently and was out of service for seven weeks this summer. An otoscope, a device used to check the ear canal, is hard to find.
According to the hospital's financial data, it has the highest profit margins of any hospital in Virginia.
Clinics in impoverished neighborhoods can buy prescription drugs at steep discounts under a federal program that allows them. Two former executives who are still working in the health care industry said that most of the profits of the hospital come from the program.
Hospitals were supposed to use the drug program's windfalls to improve care for the poor. Bon Secours, founded by Roman Catholic nuns more than a century ago, has slashed services at the community while investing in the city's wealthier, white neighborhoods according to more than 20 former executives.
According to Dr. Lucas English,Bon Secours laundered money through this poor hospital to its wealthier outposts. It was all about making a lot of money.
Hospitals that are set up as nonprofits are able to make money but not pay taxes in the US. Although Bon Secours has taken a financial hit this year like many other hospital systems, the chain made nearly $1 billion in profit last year at its 50 hospitals in the United States and Ireland. According to an analysis by the Lown Institute, it avoids at least $440 million in taxes every year.
The IRS requires nonprofits to give a benefit to their communities in exchange for tax breaks. An investigation by The New York Times found that many of the country's largest nonprofits have moved away from their charitable roots. Hospitals like to fixate on revenue targets and expand into affluent suburbs.
Many of these hospitals have slashed staffing levels, leaving them unprepared for a large influx of Covid-19 patients. The staff have been trained to squeeze payments from poor patients who should be eligible for free care.
In a statement, a spokeswoman for Bon Secours said the hospital system had spent nearly $10 million on improvements to the community hospital. She said that the chain invested nearly $9 million in the area around the hospital.
John M. Starcher Jr. made about $6 million in 2020.
The spokeswoman said that the mission was to extend the compassionate ministry of Jesus by improving the health and well-being of our communities and bring good help to those in need. Mr. Otey's case was not commented on by Bon Secours.
In interviews, doctors, nurses and former executives said the hospital had been given short shrift, and pointed to a decade-old development deal with the city ofRichmond as an example.
Bon Secours agreed to lease land to the city for far below market value if the chain expanded its facilities. Bon Secours focused on building a complex of apartments and offices. The hospital system broke ground on the medical offices next to the community this year.
A painful reminder of what has been lost is what Dr. Richard Jackson sees when he walks through the empty halls of the hospital.
The hospital was founded by black doctors who were not allowed to work at the white hospitals. In the 1930s, Dr. Jackson's grandfather helped pay for an expansion of the hospital. His father was a doctor and would take his children to fund-raisers.
There was no other hospital in the East End neighborhood at the time of the move. The building did not have a hospital. In addition to the intensive care unit, it had specialists for cancer and other diseases. Many of them were recruited from Howard University.
The hospital was in danger in the 1990s. Large insurance companies began requiring customers to use specific networks of hospitals and doctors in order to get them to lower their rates. The hospital struggled to attract patients because it couldn't compete with large chains.
Bon Secours purchased the hospital from the doctors in 1995.
Bon Secours was one of the biggest players in the city. According to a history of the community, it invested in the hospital and opened the emergency department.
Bon Secours stripped the hospital's services, including the I.C.U., as the years went by.
The removal of the I.C.U. takes meat and potatoes out of a hospital. The emergency room is a lot like an emergency room.
Without the I.C.U., the hospital couldn't treat critically ill patients. Bon Secours didn't replace them. A group of doctors left a few years later. Bon Secours specialists who were part of the network rarely treated patients at the community.
Bon Secours argued that patients could still receive care at the chain's other hospitals even after the I.C.U. was closed.
Black and low income residents in the East End were disproportionately affected by the coronaviruses. According to the Virginia Department of Health, the Covid death rate has been 81 percent higher than the city's overall rate.
In the summer of 2021, as the Delta variant surged through the city, a woman in the emergency room with Covid declined and needed an I.C.U.
The staff couldn't get her to a different hospital. She died after being transferred to the Memorial Regional Medical Center. Some people who cared for her at Community wondered if she would have survived if she had shown up at a different hospital.
Bon Secours wouldn't say if the hospital's lack of an I.C.U. contributed to the death toll.
The problem of getting patients access to other hospitals in the Bon Secours system was made worse by the Pandemic.
Despite recent interest from real estate investors, the East End doesn't lack basic services. It got its first store in 2019.
According to research done by Virginia Commonwealth University, more than half of the households don't own a car. It takes more than an hour to get to St. Mary's from the public bus route. There is no public transportation to Memorial Regional.
The advanced heart valve clinic at St. Mary's was scaled back by Bon Secours in 2019. He said he drove some people to the clinic.
There is a small waiting room and a tan brick facade in the community. The contrast is striking.
Patients are shuttled from the lobby to their cars by golf carts at the St. Francis Medical Center.
Bon Secours began construction on a $108 million expansion of its I.C.U. and maternity ward. Bon Secours broke ground on a free standing emergency room that would be an extension of St. Francis. The news release claimed that it would offer a number of diagnostic procedures.
The disparity reminded Dr. Samuel Hunter of when he was a child in Florida, where black children were taught from textbooks that white students had already used.
He knows what it's like to have secondhand stuff.
Poor patients who were uninsured or covered through Medicaid were mostly served by the hospital when Bon Secours purchased it. The hospital's poverty was turned into an asset.
The organization seized on a federal program created in the 1990s to give a financial boost to nonprofits. The section of the federal law that authorized the program allows hospitals to buy drugs at a half-price from manufacturers. Hospitals are allowed to charge more for the same drugs.
The law was supposed to encourage nonprofits to invest the savings in their communities. The program did not have many rules. Hospitals didn't have to report how much money they made from discounted drugs. They didn't have to use the revenues to help the patients who qualified for the program.
More than half of all hospitals in the country were involved in the program in the year 2019.
Hospitals figured out how to make the program better. The idea is to build clinics in wealthier neighborhoods, where patients with generous private insurance could receive expensive drugs, but on paper make the clinics extensions of poor hospitals.
Bon Secours has opened satellite clinics in wealthier parts of the area. The outposts are subsidiaries of the hospital and can buy drugs at a discounted rate.
The Bon Secours Cancer Institute is located on the campus of St. Mary's Hospital.
According to an estimate by Sara Tabatabai, a former researcher at Memorial Sloan Kettering Cancer Center, a small amount of Keytruda can be purchased at a discounted price for the hospital.
According to a price list that hospitals are required to publish, Blue Cross Blue Shield is charged more than seven times that price. That is a lot of money on a single drug. Adults need two injections.
Hospitals that participate in the 340B program have opened clinics in wealthier areas since the mid-2000s.
Bon Secours didn't say how much money it earned through the program, but it did say that the funds would be used to address health disparity. In the last year, it provided nearly 18 million in free care to poor patients at the hospital. The hospital provided free care to low-income patients in 2020 at a slightly higher rate than the national average.
The Health Resources and Services Administration said that hospitals and clinics were audited regularly and that the Biden administration had proposed requiring them to report how they spent profits generated through the program. Congress would need to approve the change.
According to an analysis by Virginia Health Information, the highest profit margin in the state in the most recent year for which data is available is for the community hospital.
According to Virginia Health Information, the hospital brought in more than $110 million in revenue. According to two former Bon Secours executives familiar with the hospital's financial operations, the majority of the profit has come from the 340B program
Bon Secours' other hospitals did not do as well. St. Mary's brought in $83 million in 2020.
Two cheerleaders for Washington's National Football League team smiled for the camera as they held a large sign between them.
The Bon Secours fleur-de-lis logo was combined with a bust of a Native American in a sign that said the training center.
The Bon Secours team and the state of Virginia were about to announce a major economic deal that would bring over 40 million dollars to the state and keep the team in Virginia for summer training.
There were three main parts. Bon Secours would get naming rights and help the team build a training camp next to the science museum.
Bon Secours had been looking for a piece of real estate that would cost them $5,000 a year. Bon Secours wanted to build medical offices and a nursing school on the parcel.
The nonprofit promised city leaders that they would build a 25,000- square-foot medical office building next to the hospital. Bon Secours plans to hire 75 local workers and build a fitness center.
At the news conference, the mayor said he thought we could accomplish it.
There is a football field at the training center.
Bon Secours had planned to build a nursing school on the west side of the city. It worked with a real estate developer to build luxury apartments on the site instead of building medical offices. The $73 million project includes a saltwater pool for residents at The Crest at Westhampton Commons. A Mexican restaurant and Drybar are on the ground floor.
Bon Secours broke ground on the complex in February of this year.
A change in mayoral administrations and a series of management changes have distracted attention from the project. The push for higher revenues was accelerated by a merger with an Ohio hospital chain.
Dr. Jones said there was a major shift from being mission-oriented to being profit-oriented.
Bon Secours spent more than $19 million on organizations and initiatives in the metropolitan area, including more than $8 million on businesses and charities in the East End. The work is expected to be done by the end of the year. Hospital executives said they plan to house a number of services there.
Doctors and nurses at the hospital have felt like they were working on a battlefield, doing their best with limited supplies and facilities.
Schnurman began her career as a physician assistant at Bon Secours and left in the middle of the year.
She said that he told her that she was learning disaster medicine.
The hospital's air-conditioning went out for several weeks in the summer of 2016 because it was so hot.
Bon Secours wouldn't comment on the lack of basic supplies at the community. The M.R.I. machine will be replaced as part of a $5.3 million capital improvement plan.
The doctor stopped treating patients at the hospital. There is a man who is haunted by his tale.
A man in his 50s showed up at the emergency room with signs of a heart attack. To prevent permanent damage, the man had to be quickly catheterized and have a balloon inserted into his blocked arteries.
The patient was transferred quickly to Memorial Regional because Bon Secours didn't have the tools for the procedure.
Memorial couldn't guarantee a bed would be ready. The patient was in the emergency room for a long time. We were only able to watch it happen.
He said that the delay damaged the patient's heart. The man will be at risk for fatigue and low blood pressure for the rest of his life.
Patients were just an ambulance ride away from hospitals when Bon Secours took away a service.
Many patients ended up like the man with the heart attack, according to Dr. Kelly. Patients who needed advanced care were often stuck with us for long periods of time.
Specialists who saw patients at other Bon Secours locations wouldn't go to the hospital.
The woman went to the community to have part of her toe removed. The toe was gangrenous due to poor circulation. She said her doctor told her that she would lose part of her toe, but that she would keep her leg.
This procedure wasn't offered by the community. It took Ms. Scarborough more than two weeks to get an appointment. She lost her toe weeks after the procedure.
Many people in poor, nonwhite communities faced the same delays in getting the procedure as did Dr. Fakorede. He said he wasn't surprised by what happened with the patient.
She has to take time off from her job every time she goes to the doctor because she doesn't drive. It would have taken five minutes to get to the community. Bon Secours did not speak to her.
There are good doctors at the hospital. There needs to be more facilities and services in that area for us.
Beachy was involved in research.