Seize the Hospital to Serve the People

This text is the first few pages of chapter 7 from Fitzhugh Mullan's White Coat, Clenched Fist: The Political Education of an American Physician which was republished in 2006 as part of the University of Michigan Press series Conversations in Medicine and Society. It is lightly edited for clarity. The rest of the chapter is online at http://socialmedicine.info/index.php/socialmedicine/issue/view/15/showToc

Two insurrections

In July of 1969 a cabal of angry workers in the Lincoln Community Mental Health program [at Lincoln Hospital, in the South Bronx] took over their service and demanded the ouster of its leaders---two psychiatrists---and a series of reforms making the program more accountable to the community. The immediate result of the uprising was the arrest of twenty-two persons and the firing of sixty-seven more. Eventually, most of the workers were reinstated and the psychiatrists in question were removed. The most important outcome of the "mental health strike" was not the changes in the department but the drawing together of a group of people who were to be instrumental in subsequent events at Lincoln. These individuals were for the most part young, black or Puerto Rican community mental health workers whose political outlook and grievances were varied. Following the mixed outcome of the strike they began to work more intimately with the Black Panther party and the Young Lords organization. This experience developed both their own internal discipline and the breadth with which they defined the problem; that is, they saw the situation at Lincoln not simply as a badly run city hospital but as part of a larger health struggle, part of the way that white, well-to-do bureaucrats dealt with black and Puerto Rican people. They began to talk increasingly of community-worker control of Lincoln and Third World leadership in health actions.

A second, unrelated insurrection took place at Lincoln in April of 1970. At that time the position of Hospital Administrator was vacant, a post always occupied by a white professional appointed by the Commissioner of Hospitals, and a group of community people decided to challenge the tradition. Their candidate was Dr. Antero Lacot, a middle-aged Puerto Rican gynecologist with a master's degree in public health and experience running a community maternity center---hardly a radical choice. The Commissioner of Hospitals refused to support him and the Committee for Lacot swung into action. With the press in heavy attendance, they sat-in in the hospital lobby in a show of determination to get their man appointed. Twenty-two were arrested and carried out to police vans. Significantly, the groups backing Lacot were neither Lords nor Panthers. They were representatives of forces totally different from those activated in the mental health strike. Mostly they were members of Puerto Rican community organizations or political clubs that existed in the orbit of Ramon Velez, a local political boss of considerable power who hoped to extend his influence within the hospital with a director chosen by him. But the demonstrators had real grievances against Lincoln---grievances important enough to make them willing to be arrested for them. And in the end they were successful. The mayor overruled the hospital commissioner and Lincoln had its first Puerto Rican administrator.

Community Advisory Board

During this same period in 1970 plans were afoot for the establishment of a community board for Lincoln. The Department of Hospitals recognized that there was growing unrest concerning the hospital in the increasingly political South Bronx. Part in cunning, part, perhaps, in fear, they moved to appoint their own Community Advisory Board for Lincoln. The Commissioner of Hospitals selected the members of the board and, virtually without exception, chose individuals representing established interests in the South Bronx---established businesses or political factions, churches, poverty programs, and so forth. Few if any of the appointees actually received their medical care at Lincoln. The hospital's staff and workers had no representation on the board. Moreover, the board had no real duties or powers that related to the day-to-day management of the institution. Finances, hiring, medical policy, planning, and grievances all remained in traditional channels, unaffected by the existence of a community board. Meetings of the board were irregular and, generally, ill-attended. Rather than establishing a legitimate tension between the community and the forces that ran the hospital, they served to rubber stamp hospital policy and insulate the Department of Hospitals and Einstein College of Medicine from growing demands for change taking place in various segments of the community.

Both at its inception and later, Lincoln's Community Advisory Board was flawed in many ways. One activist critic called it "too little too soon," implying that a much sounder, more legitimate board could have been established if events had been allowed to generate a grass roots demand for a community board. Yet the formation of the board in early 1970 was another proof that the powers downtown recognized that the community was restive and that they were not going to accept broken-down medical care in the decade to come as they had in the decade past.

"Think Lincoln"

In June, a group calling itself "Think Lincoln" began a concerted action in the hospital. They met with the newly appointed Dr. Lacot and informed him of their intention of setting up patient complaint tables in the lobby of the hospital. Without waiting for a response they went to work. "Think Lincoln's" style was direct action. Comprised of a number of people who had been involved in the mental health strike as well as several black and Puerto Rican activists from the South Bronx community, they saw their task as hospital reform, not by petition to the established authorities---including the Community Advisory Board---but by direct appeal to the patients and the community. The complaint table was intended as a mechanism to stimulate patient awareness and participation in the hospital.

They put their table in the center of the ambulance-emergency room entrance of the hospital where the majority of patients were likely to arrive. Colorfully decorated with bilingual signs and staffed eighteen hours a day, the table was immediately obvious to everyone in the hospital---worker and patient. "Think Lincoln" stocked the table with a variety of leaflets and pamphlets discussing patients' rights, alleged hospital abuses, and community control. The signs invited grievances and reminded patients that the hospital was their hospital.

The "Think Lincoln" action was, predictably, the source of immediate tension in the hospital. Many physicians saw the tables as an act of impertinence and ingratitude. Accustomed as they were to having no feedback from their patients, the action frightened them. Hospital workers were of mixed opinions on the subject. Some were enthusiastic while others reacted defensively. For many patients the complaint tables meant little, but for a few it changed the role of the hospital in their lives. For all patients it was a symbol that someone was trying to deal with the problems of Lincoln. Complaints were handled directly and promptly. If the complaint was considered reasonable, a "Think Lincoln" member would accompany the patient to the clinic or ward in question and discuss the problem with the appropriate staff member. Most often this resulted in an explanation or rectification of the problem. Occasionally things did not go smoothly. One noonday a number of patients complained about the three-to-four hour wait in the Adult Screening Clinic, the notorious Section K. A check revealed that only one doctor was assigned and he was eating a leisurely lunch. A group of four representatives from "Think Lincoln" went to the doctors' dining room (the doctors still had sit-down service in a room of their own) and, in loud voices, demanded volunteer physicians to staff the Screening Clinic. Several doctors responded angrily and a chin-to-chin confrontation resulted which had to be broken up by the hospital Security Police.

Generally, though, the "Think Lincoln" campaign was not disruptive to hospital life. While many physicians and workers took the challenge personally and felt their individual work was being questioned, they could live with the complaint table. Others saw the campaign in perspective and concluded that anything that focused attention on the shortcomings of the hospital would benefit medical care in the long run. These staff members were friendly and supportive to the "Think Lincoln" effort.

The "Think Lincoln" action embarrassed the Community Advisory Board. They could not disagree with the demand for articulation and redress of patient complaints. Even the undertone of community control that pervaded the campaign was in keeping with some vague rhetoric of the Community Advisory Board. But they generally disliked the style and the politics of the group carrying out the action. Moreover, the complaint tables entirely upstaged their own committee. To the very considerable degree that the Community Advisory Board was wed to the system as it stood, they found the complaint tables threatening and radical. The result was paralysis. While it would have been hopelessly compromising to condemn the action, the Community Advisory Board did not have the gumption to support it. The result was official silence.

Very much the same political situation trapped the newly appointed administrator. Alleged champion of community rights, he could not condemn the action or call on the hospital police to stop it without risking loss of face. On the other hand, the pressures from the city and the college to stop the "disruptive" activity were considerable. He, too, equivocated, allowing the continuation of the complaint table campaign.

The Collective

The Collective arrived to begin work on July 1, 1970, in the midst of the "Think Lincoln" action. In some respects it was more than we could have hoped for. In part, we were coming to Lincoln in the hope of joining hands with the community to change and improve the hospital. The community, it seemed, had already made a move. They had articulated their criticisms and they were doing something about them. Moreover, they obviously needed allies within the hospital to legitimize their claims and help sustain their effort. Clearly there was a ready-made political role for the Collective. Yet, in other respects, the timing of the campaign was unfortunate. The month of July is a trying and even dangerous time in any hospital that relies on interns and residents for staffing because it is the traditional turnover month. Everyone has just been graduated to a new level of responsibility and is relatively slow and inexperienced at the new job. Beyond that, in July of 1970 the vast majority of the Pediatric Department at Lincoln was new to the hospital and more or less new to one another. We had barely gotten our feet wet medically or politically when we were called on to start making some hard choices about the use of time and resources. Clearly and enthusiastically our support went to "Think Lincoln" and the complaint table approach. Yet I cannot escape the conclusion that our efforts would have been better coordinated and significantly better received by the rest of the hospital staff had we had a chance to establish ourselves medically and develop our own collective discipline before we were tested politically.

But events moved too quickly. Marty and I were both on duty on the night of the thirteenth of July. Early on the morning of the fourteenth (we would later joke that it was Bastille Day) we were jarred out of our sleep by someone banging on the door of the Nurses' Residence cubicle that we shared. It was barely light. Marty asked who it was and, hearing no response, we both went happily back to sleep. The phone rang at seven to awake Marty who had to relieve the pediatrician on duty in the Emergency Room. "We've been liberated?" I heard Marty say. "What are you talking about?" He hung up and went to the window. "Fitz! Come here and look at this." I got wearily out of bed and went to the window. The ambulance ramp below was jammed with police cars. Police vans and more patrol cars filled the street beyond. Policemen wearing baby-blue riot helmets milled about the hospital grounds below. "Schipior in the Emergency Room told me we'd been liberated by the Young Lords. I thought he was kidding. But something must be happening. The cops aren't here at seven A.M. for checkups."

Takeover

In a dramatic---some would say melodramatic---early morning move the Young Lords working with "Think Lincoln" had, indeed, occupied the Nurses' Residence. About thirty Lords had taken up positions on the ground floor of the building, barricaded all but one entrance, sealed off windows, and announced plans to "run a hospital to serve the people." The early morning knock at our door had apparently been the uninspired effort of a cadre who had been assigned the task of notifying the doctors that the building had been occupied. Marty and I got dressed and went downstairs quickly. The ground floor was well occupied. It had the air of a spirited street bazaar. The place was barricaded with chairs and tables piled high at every window. The auditorium had been converted into a day care center and an infirmary for screening tests for TB, anemia, and lead poisoning. There was a press area, security checkpoints, strategy sessions, marshals with armbands, and so on. Doctors came and went freely. The Lords announced that the building was open to all hospital employees and encouraged all clerical personnel from the upper floors to staff their offices. Most stayed away. And the police massed outside unsure what to do.

The Collective supported the takeover. The Lords never requested formal backing in advance since to do so would have jeopardized the secrecy surrounding the planned action. In all likelihood, though, they counted on a fair amount of support from the hospital staff. And they got it. The Collective never met to discuss the occupation. There was no time. But Collective members visited the occupied area frequently, helped staff the day care and the health care programs, and let it be known to the press and the police that physicians backed the Lords. I, for one, couldn't stay away. The Nurses' Residence suddenly had the fantastic, intoxicating air of a liberated zone. The press was listening; the city was listening; and 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 humiliation of the Emergency Room, the flies, the pain, the degradation. It felt good, it felt right, it felt righteous. It was why we had come to Lincoln.

Life in the hospital itself went on unmolested. But both sides understood the symbolism of the takeover. For the Lords and their backers the occupation stood as a challenge to the city to account for the sloppy, cheap, unresponsive medical care they dispensed. Moreover, they demanded of the city not just the grudging provision of medical services but the initiation of community programs to stamp out clearly curable diseases, such as TB and lead poisoning. They asked that the hospital move into the community to search out problems. Midway through the morning the Young Lords held a well-attended press conference to state their aims. They were simple enough: that Lincoln establish a community preventive medical program, a free day care center for workers and patients, a free breakfast program for children of the community, and health education classes for workers and patients. Late in the morning an unknown occupier stated the argument more succinctly. He painted a bedsheet in one of the on-call rooms with the words "Seize the Hospital to Serve the People" and hung it out the sixth-floor window where it waved and flapped over the Bruckner Expressway for the rest of the day.