More Than Medicine. Jennifer Nelson
they believed their competence was being questioned. At the same time, many staff supported the action as a way to better serve patients in an extremely busy and understaffed hospital.138
A group of pediatric interns and residents, including Mullan, who had specifically chosen to work at Lincoln because of his interest in community medicine, also sided with the Think Lincoln activists. This group of doctors called themselves “the Lincoln Collective” and had connections with both the Medical Committee for Human Rights and the Student Health Organization. The newly minted doctors believed the Think Lincoln tables provided “a ready-made political role for the Collective” as supporters of Think Lincoln community activists.139
Despite support from this group of young doctors on the house staff at Lincoln, as protests escalated at the hospital, divisions increased between the activists demanding greater community control and the Lincoln Hospital administrators who had no real interest in significant reform of health care delivery or community control. Without significant collaboration among health care activists, hospital administrators, and federal or local funds to sustain innovative programs, reform efforts were short-lived at Lincoln. Yet, even short-lived reforms revealed a demand for community involvement in health care delivery in the South Bronx that, while not met, clearly carried weight among young activist physicians, members of the Young Lords, and other members of the South Bronx community. One Young Lord, Carl Pastor, wrote of community control in the Young Lords publication Palante, “Who can better determine what’s best for ourselves than us? If this is the richest country in the world, why is it that this country is 13th in the world in health care?”140 I focus in some detail on these particular protests at Lincoln Hospital to demonstrate that demands for community control thrived outside of programs sponsored by established physician-reformers and their federal government supporters at the NHCs.
The first escalation of demands for reform at Lincoln Hospital occurred on July 14, 1970, about a month after the complaint tables appeared in the lobby. This action involved a Young Lords’ occupation of the Nurses’ Residence (a former nursing school) at Lincoln Hospital for about twelve hours. The Lords presented a list of demands to hospital administrators that included a community preventive medicine program, a free day care center for children of patients and workers, a free breakfast program for children, health education classes, and a community-worker board to run the hospital. They asked why tuberculosis and lead poisoning, both preventable, were rampant in the South Bronx, suggesting that the hospital neglected the basic health needs of the community. The occupation garnered attention immediately. Police surrounded the building and the press flocked to publicize the Young Lords’ challenge to a city-run institution.141 Mullan recalled the experience from the perspective of a physician who lent his support to the community takeover: “The Nurses’ Residence suddenly had the fantastic, intoxicating air of a liberated zone. . . . The Lords had risen up and were telling the stories of the women and children waiting endlessly in the clinic, the old folks dying for lack of a Cardiac care unit, the humiliations of the Emergency Room, the flies, the pain, the degradation.”142 After police ordered the building cleared, the Young Lords and the interns and residents supporting the action left the building peacefully, ending the occupation. Permanent staff physicians at Lincoln generally did not support the action.143
The next protest and escalation of tension between activists and hospital administrators and permanent staff physicians revolved around the abortion death of a young Puerto Rican woman, Carmen Rodriguez. Sometime in the middle of July, Rodriguez had been diagnosed with rheumatic heart disease and told that a pregnancy endangered her life. She was scheduled for an elective abortion at the end of the month. The gynecologist performed a saline abortion, which ended tragically. Rodriguez died four days after the procedure. When it became apparent that a mistake might have been made at the level of medical malpractice, Think Lincoln and the Young Lords began to publicize the death as a murder. In response to the uproar over the Rodriguez death, Lincoln Hospital administrators announced that they would hold an open meeting with the community. The interns and residents involved in the protest called the meeting the “first People’s Clinical-Pathological Conference” (CPC) in reference to the medical school practice of analyzing difficult cases collectively. Mullan recalled the success of this People’s CPC: “At the least, it was a real and significant instance of physicians being called to account by community people. . . . [It] stood as a victory for community participation in the hospital.”144 Activist residents and interns shared Rodriguez’s autopsy records at the “People’s CPC” in order to assert the community’s right to access medical information that is usually kept by medical staff.145
At the CPC, the Young Lords, Think Lincoln, and other South Bronx residents asked questions of the senior staff physicians, including the director of the Department of Obstetrics and Gynecology. They wanted to know why a saline abortion had been performed on a woman with a disease that contraindicated the procedure. Think Lincoln and the Lords concluded that Rodriguez’s death, while not malicious, did stand as strong evidence that Lincoln Hospital provided insufficient and even dangerous medical care. They argued that the pivotal failure in this case had been lack of continuity of care, a common problem in an urban hospital catering to poor people without access to private physicians. Although Rodriguez had been treated for a drug addiction at the hospital and referred to ob/gyn for an abortion because of her pregnancy and heart condition, her case was unknown to the ob/gyn department. Better communication would have saved Rodriguez’s life. Think Lincoln and the Lords called for the ouster of the director of the Department of Obstetrics and Gynecology and for a worker-community board that would help design and oversee hospital policy. As a result of the protest, the director of ob/gyn resigned and an interim director took his place. Ultimately, however, the hospital retaliated against the activists, filing an injunction against the Young Lords and Think Lincoln that forced them to remove their complaint tables from the lobby.146
After the Rodriguez death, the hospital administrators took no actions to increase community control over hospital decisions although the Young Lords and Think Lincoln continued to organize around health care reform. The supportive residents and interns in the Department of Pediatrics experimented with increasing community involvement in their department. Mullan, another physician, Paul Bloom, and some former members of Think Lincoln helped organize a Pediatric Parents Association that would function like a Parent Teachers Association, allowing parents of young patients to have input in hospital policy. The group recruited parents in the hospital emergency room waiting area and in the pediatric clinic. A group of about ten parents met biweekly for several months to attend lectures about community health issues such as lead poisoning and to meet with physicians and staff. The parent group opposed budget cuts at the hospital and helped select the new house staff (interns and residents). After interviewing applicants, with particular attention paid towards candidates’ attitudes towards blacks and Puerto Ricans, the parent group made hiring recommendations to Dr. Helen Rodriguez, the new director of the Pediatrics Department and a strong advocate of community involvement in health care design and delivery. Less successfully, activist residents and interns also attempted to integrate worker input into the Pediatric Department. Nurses, secretaries, aides, and clerks, however, were suspicious of the physicians’ motives since they had never before been asked for their input. The nonphysician staff also brought their own hierarchy and disagreements among themselves to meetings, which inhibited free discussion. Unsurprisingly, many staff felt uncomfortable speaking freely among doctors in a workplace that had long operated along rigid lines of hierarchy and power. All of these factors contributed to a failed attempt to level hospital hierarchy.147
The physician residents and interns and the community activists, which included the Young Lords, pitted themselves against an intransigent group of hospital administrators who, in the end, stood in the way of any real transformation of Lincoln Hospital’s services, although they did succeed on a few fronts. Dr. Harold Osborne, an MCHR activist and intern at Lincoln, recalled that the interns were more successful at reforming the internship process than ending poverty-related health problems in the South Bronx.148 It was impossible to implement these sorts of reforms without some support from entrenched powers, even when those in powerful positions were also targeted for change. NHCs, with their federal mandate, congressional support, and national scope, were much more successful at bringing those with some entrenched interests in sustaining medical hierarchy—but also with interest in delivering quality