José R. Sánchez, President and CEO of Norwegian American Hospital, said he was blindsided when Dr. Lee Francis, President and CEO of Erie Family Health, informed him of the decision to terminate the Family Medicine residency training program with Norwegian American Hospital. The program, which provides post-graduate training program for doctors following medical school, is the final step in the physician training process and is critical in shaping the future practice goals of new physicians. Community leaders in Humboldt Park and NAH administrators are extremely upset by this decision to relocate a critical healthcare services and training program from the hospital which has served the community for more than 120 years. The surprise move has set off a chain of events by Norwegian American Hospital, including a letter writing campaign to elected officials as well as two community forums where community leaders, elected officials, and NAH’s leadership and board spoke out to Erie Family Health executives about their opposition to the move. Erie Family Health’s plan is to relocate the hospital component of the Family Medicine residency training program to Swedish Covenant Hospital because of the uncertain financial commitment by Norwegian American Hospital. However, the hospital has made it clear that it was never approached by either of the partners with the opportunity to match the financial terms offered by Swedish, and that several attempts by Norwegian to meet with Erie and Northwestern to discuss the program’s future were canceled or rescheduled. History shows that Norwegian American Hospital has raised concerns with the other partners, Erie Family Health and Northwestern University, about the lack of fairness and equity in the distribution of the federal grant funds which are the predominant funding source for the residency. To date the program has received in excess of $15 million dollars in grant funds, of which Norwegian has received a total of just $80,000 despite their incurring program related costs of $300,000 annually, including malpractice liability coverage for all residents. In total, Norwegian American Hospital has provided more than $2 million dollars of net support to the program in addition to the federal grant. “This is a definite insult to Norwegian American Hospital and the community it serves,” said Maria Muñoz, M.D., obstetrics and gynecology, Norwegian American Hospital. “Erie Clinic and the Family Practice Residency have reaped both clinical and financial benefits from the benevolence of Norwegian and its medical staff for the past five years. It is pretty obvious that the population served by Norwegian was not part of the equation used by Erie when making their decision.” Dr. Muñoz went on to state that taking the patients out of this community doesn’t make sense and the community is the one that is going to suffer. She gave an example of the revamped birth certificate process implemented by Norwegian, which is now used statewide. Norwegian patients provide the data for this process and moving the program will basically eliminate this critical data from the community. This decision, executed by Dr. Francis and Rob Christie, Senior Vice President of External Affairs and Communications, Northwestern Medicine, was communitcated only after Norwegian American Hospital ensured sufficient funding for the recruitment of the fall 2015 class of residents by making available a separate source of funding outside of the federal grant should it be needed. The plan to relocate the program was never shared with Sánchez by Erie or Northwestern until the decision had been finalized. “Since I arrived in 2010, Norwegian American Hospital has consistently supported Erie Family Health’s efforts to grow in our community. We included them in the formation of MyCare, an Accountable Care Entity which now has more than 60,000 lives, and supported their application to take over the city clinic at Western and Division. When Erie took over that clinic, their first action was to sever the longstanding Nurse Midwife practice for Norwegian at that site, decreasing our deliveries by 33% .” Sánchez said. “As far as I’m concerned this is not the behavior of a trusted partner in our community. Their real interest is not in meeting the health needs of the Humboldt Park community, but economically growing their bottom line.” The health disparities of Humboldt Park and Lincoln Square run along two different paths. In a community comparison Lincoln Square’s Hispanic population is 18%, a large contrast to Humboldt Park’s 51%. 35% of Humboldt Park’s population is below the poverty level verses 12% in Lincoln Square. The per capita income in Lincoln Square is $35,500 substantially higher than the $13,000 in Humboldt Park. The deaths per 1000,000 residents from diabetes: 20 in Lincoln Square and 40 in Humboldt Park, stroke, 31 in Lincoln Square and 59 in Humboldt Park, Coronary Heart Disease, 138 in Lincoln Square and 160 in Humboldt Park. Not only does Norwegian American Hospital draw patients from Humboldt Park, but it is also one of the largest employers in the community. This decision will have repercussions for both the local economy and the future of healthcare delivery. “Erie Family Health says their intent is to look for longterm stability, but past history is a strong indication that Norwegian American Hospital has been an unwavering partner and consistent funder on two separate occasions. The rationale behind the decision to move the residency program is not in the best interest of the program, not to mention it would disrupt a long-standing medical education program that brings vital health care to this community,” said Billy Ocasio, Chairman of the Board of Trustees, Norwegian American Hospital. “It is extremely obvious that Erie Family Health and Northwestern did not give any consideration to the medical needs of the residents of Humboldt Park before making this decision. Dr. Francis may not even realize that this small move for Erie Family Health will have a big effect in the future given the health disparities of this community.” For NAH board member David Hernández, it’s an issue of trust. “Personally, I feel like we were led down a path. It takes the trust out of the relationship,” he said. “This also demonstrates a complete inconsideration for Norwegian American Hospital, their patients and the Hospital’s role as the economic anchor for Humboldt Park.” The training program made a substantial impact on Norwegian American Hospital and the entire community of Humboldt Park, producing extremely high caliber physicians with an interest in serving the community. A number of residents remained in the community upon graduation and continue to provide care for Norwegian’s patients every day. The program met the goals of the HRSA Teaching Health Center (THC) grant by improving access to primary care and addressing health disparities in local medically underserved areas such as Humboldt Park and East Garfield Park. Three healthcare providers, who sat side by side for years, made training in a true safety-net hospital a national model for improving the health of an underserved population andprovided critically needed access to primary care services with a focus on the clinical and cultural needs of our community. The success of the program was even recognized and supported by our Congressional representatives. “For the last five years, Norwegian American Hospital has been Erie’s biggest supporter and we’re taken by surprise that this has happened,” said Raiza Mendoza, Board member, Norwegian American Hospital Foundation. “A community hospital is a jewel in the community where residents can go and see physicians who they trust and receive quality healthcare close to home. Referring patients to doctors in a different community can be an overwhelming and shocking experience for many of these community members. Why would you want to be further away from the people you are helping?” José E. López, a well-respected community advocate has spent his life fighting for the rights of Puerto Ricans in Humboldt Park. He has built two community centers and a mental health facility, and the Erie Family Health move has sparked resentment. “We’re going to fight for our residents and make sure they have access to the very best health care services available,” he said. “Why do you want to be further away from the people you are helping? Humboldt Park residents will have to travel too far for care and it will limit care for many poorer residents, especially those dependent on public transportation. Erie Family Health obviously hasn’t considered all that is at stake here.” López went on to say that Norwegian serves a predominately minority community with an unemployment rate of 12% with 34% of the population living below the federal poverty level. Neighborhood residents experience significant chronic health disparities such as diabetes with 12% of adults having diabetes compared to the national benchmark of 8%. 36% of adults are obese with a national benchmark of 28%. Local political leaders also blame Erie Family Health for creating this issue. They feel that Erie is disrupting five years of collaboration to gain a strategic advantage, and the proposed move to Swedish Covenant Hospital in Lincoln Square is all about increasing the bottom line. “To move this program out of the community that I represent is really distasteful,” said Cynthia Soto, State Representative, fourth district. “We want high quality physicians to come to Norwegian American Hospital and to stay here and to serve the community. Norwegian American Hospital has served this community for generations, and it is our intention to continue to meet the needs of our patients, in their own community, for years to come.” “This training program has been located at Norwegian American Hospital, in my ward, since its inception and should remain here for the foreseeable future due to significant community need,” said Alderman Roberto Maldonado. “Dr. Francis and Erie completely ignored my letter requesting them to keep the program here in Humboldt Park. I think they are putting profit motivations over the mission of serving our at-risk population. I am extremely disappointed.” “I want to tell Dr. Francis and Dean Harrison to stop ignoring the impact that the absence of this program will have on Norwegian American Hospital and the patients and community we serve. The battles lines are clear. Lives depend on it,” said Sánchez. “Dean is one of the most influential leaders in healthcare in Chicago and Illinois. The decision to prioritize financial benefits for wealthy institutions over improving the health and wellbeing of a community with great need is a failure of that leadership.” Picture of Ald. Santiago and CEO Sánchez originally from Our Urban Times.