The Hospital

Starred review from January 11, 2021
Journalist Alexander (Glass House) delivers an anguished and incisive look at the struggles of an independent community hospital in northwestern Ohio between March 2018 and August 2020. Alternating boardroom politics and financial details with heartrending stories of uninsured and disadvantaged patients, Alexander documents CEO Phil Ennen’s desperate efforts to keep Community Hospitals and Wellness Centers of Bryan, Ohio, solvent without lowering standards of care. To offer more services and draw patients from neighboring counties, hospital administrators set out to recruit medical professionals from abroad who would be willing to deal with rural Ohio’s cold winters and lack of amenities; meanwhile, CHWC doctors gave patients money for lifesaving prescriptions so they didn't have to wait until payday. Alexander delves into the complicated history of U.S. healthcare and lucidly describes how the Trump administration’s anti-immigration and pro-corporation policies impacted both the hospital’s ability to attract staff and the economic difficulties faced by locals. The story of diabetic Keith Swihart, who undergoes “two amputations, three eye surgeries, and one colonoscopy,” brings home the steep cost of not providing universal health care. Alexander’s in-depth research also makes clear why CHWC and hospitals like it have struggled to deal with the Covid-19 pandemic. This wrenching account brilliantly diagnoses the flaws in America’s healthcare system.

February 15, 2021
It's a ""Code Blue"" moment for independent community hospitals across America. Many are not going to survive. Tragically, the extinction of these hospitals is happening in areas where they are most desperately needed; the populations they serve are poorer, sicker, older, and increasingly dependent on Medicaid and Medicare. Journalist Alexander delivers an intimate portrait of a struggling small hospital, CHWC, in Bryan, Ohio. The city of 8,500 is similar to other rural Midwest communities with its cornfields, aging town square, trailer parks, and a fragile economy with low-wage jobs. Although local residents commonly refer to their nonprofit hospital as a ""Band-Aid station,"" it offers a surprisingly wide range of medical services, including heart catheterizations and cancer care. Even as the plight of the townspeople is gloomy, the hospital staff's public-mindedness and generosity are rousing. Social and economic inequity have forged a new ""American Way of Life"" in rural communities like Bryan, a culture of despair and defeat. Alexander describes the power and profit-grabbing of contemporary American medicine and the regional oligopolies that dominate the health care landscape as ""one big grift"" failing the most vulnerable among us. Alexander's scorching reportage provides a distressing, infuriating picture of health care delivery and highlights the heroic fight of a little hospital and humble hamlet to stay vital.

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Starred review from March 1, 2021

Small nonprofit hospitals in the United States faced increasing difficulties even before the COVID-19 pandemic upended economic realities for businesses of all kinds. With intimate access to a small nonprofit hospital in the community of Bryan, OH, Alexander (Glass House) spent fall 2018 through summer 2020 using it as a template for a study of health care in the U.S., the forces transforming it, and the real impact it has on people. The hospital CEO's story becomes the linchpin for the broader view, as he deals with financial and structural issues, personnel, government at all levels, local needs and wants, and the corporatization of hospitals. Alexander also spends time with health care workers, leaders of other hospitals, and many people in the surrounding community, relating their struggles to the larger picture. His clear conclusion is that the increasing disparity in health care is inextricably linked to the income and social disparities that the pandemic has made all too clear. VERDICT The time Alexander spent embedded in the community gives continuity and depth to the stories of the individuals he connected with and puts a human face on broader issues of social inequality. This expertly reported account will resonate and find a wide audience.--Richard Maxwell, Porter Adventist Hosp. Lib., Denver

Copyright 2021 Library Journal, LLC Used with permission.

Starred review from December 15, 2020
A superb account of a small-town hospital whose first priority is delivering high-quality medical care. Sadly, in today's brutally competitive free market, that means it's barely surviving. In this eye-opening investigative study, journalist Alexander takes us to Bryan, Ohio, which has mostly recovered from the 2008 recession and possesses a surprisingly good hospital for its size (pop. 8,000). The author offers vivid portraits of a dozen individuals, including the hospital's CEO, Phil Ennen, and readers will receive an expert education in his duties. Delivering care is one, but the business side is difficult. If rival medical centers steal business, customers don't pay, or income doesn't match expenses, his hospital will fail. Small hospitals have two strikes against them: Suppliers charge them more, and insurance companies pay them less (big medical systems negotiate for higher reimbursement; small ones have no clout). The free market extols efficiency above all. Once part of a larger system, Bryan's hospital would see its staff trimmed, unprofitable services eliminated, and specialists moved to bigger cities. With less to offer, the hospital would become a drag on larger facilities; if it continued down that path, it would eventually close, a process that is playing out across the U.S. As of 2020, the hospital is hanging on and may even survive the pandemic, which is proving equally disastrous to rival hospitals. However, the future looks grim. Like all hospitals, Bryan's depends heavily on government money, especially Medicare and Medicaid, but it's not adequate, and this is unlikely to change in the near future. Like many states, Ohio has been cutting taxes and social services since the Reagan years, producing stagnant wages and declining health but only scattered calls for reform--certainly not in Bryan, where "a local politician could blame problems associated with a...business on the fact the owner was 'not of American extraction' and know he wouldn't hear any disapproval." A deeply insightful and disheartening portrait of America's diseased health care system.

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