Fatal System Error 

Private nonprofit hospitals, which benefit from huge tax breaks, fail to care for the East Bay's poorest residents — and now one public hospital is on the verge of collapse.


Booker Williams III hadn't missed a day of work for two years. So when the 34-year-old San Quentin State Prison correctional officer got a call on the morning of August 20, 2014 that his father was going to the hospital, he decided not to break his streak. Plus, his 62-year-old father, Booker Williams II, a lifelong Richmond resident, had been relatively healthy in recent years.

But when Williams III started getting more calls from family members about his father, he realized it could be serious. His aunt sounded worried. And an ambulance had taken the elder Williams to a different hospital than usual. In emergencies, Williams II, like most Richmond residents, would typically go to Doctors Medical Center (DMC) in San Pablo, a public hospital that serves West Contra Costa County. But thirteen days earlier, because of an ongoing financial crisis at the hospital, county public health officials and DMC executives had agreed to stop sending local ambulances to the facility.

For Williams II, a retired assembly line worker for mattress manufacturer Sealy, the trouble began at a routine appointment that morning at his primary physician's office in Hercules, just north of DMC. His doctor told him his breathing was off and his heart rate was well over one hundred beats per minute. "The doctor said he could have a heart attack in his office," recalled Betty Crater, Williams II's sister. He needed to get to an emergency room immediately. So they called 911 and an ambulance soon arrived.

But the paramedics had bad news. They weren't allowed to take him to DMC, which has a special cardiac unit and is only about seven miles away from the physician's office. He could either go to Alta Bates Summit Medical Center in Berkeley (about seventeen miles away) or Contra Costa Regional Medical Center in Martinez (about eleven miles away). Williams II, who had received a kidney transplant a decade ago, told the ambulance to take him to Berkeley, because he thought Alta Bates might have his medical records, Crater said.

Crater said it took about thirty minutes for her brother to get to Alta Bates — about twice as long as it would've taken to get to DMC. Once at Alta Bates, which is part of Sutter Health, a large nonprofit healthcare system, the hospital was crowded and the wait for Williams II was agonizingly long. Crater estimated that her brother lay in pain on a gurney, essentially in the doorway of the ER, for roughly ninety minutes with little support from hospital staffers.

By early afternoon, the younger Williams had decided to skip work after all. When he arrived to Alta Bates at 2 p.m. and saw his father, he knew something was very wrong. "He called me over and said he couldn't breathe," Williams III said. "He was huffing like a fish out of water." His father was sweating profusely, so Williams III began wiping his dad's face with a towel, locking eyes with him for what felt like a very long time. "We were staring at each other eye to eye, like we were connected."

Then the nurse shouted, "'Code blue, code blue!'" Williams III recalled. His father was going into cardiac arrest, and the staff didn't seem to be mobilizing fast enough. Doctors repeatedly tried to resuscitate the elder Williams, but just before 4 p.m., a physician told the family that, while doctors were doing everything they could to save him, it might be their final opportunity to say any last words. The family — more than 25 relatives had arrived at that point — prayed over his body.

At 4:19 p.m., Booker Williams II was pronounced dead.

It's unclear what exactly went wrong that day (Alta Bates representatives declined to comment about the patient, citing privacy policies), but Williams II's family and doctors suspect that if he had gotten help quicker, and if he had received care at DMC, his neighborhood hospital, things might have turned out differently. Crater is certain that with faster treatment, her brother would've pulled through. "He was a healthy man." Given DMC's ongoing financial struggles, Crater said she wasn't even sure if that hospital would have had the resources to save him. "But he would've had a chance," she said.

The Williams family's tragedy sheds light on what health experts say is a growing crisis in the East Bay — one that reflects a profoundly flawed healthcare system that is failing the region's low-income residents. While DMC's situation is extreme — the hospital nearly closed altogether last summer due to budget problems — the facility's financial predicament exemplifies deeply ingrained inequities in healthcare delivery. According to health advocates, public hospitals, like DMC, shoulder the burden of caring for the poorest and sickest patients while private, nonprofit hospitals fail to contribute their fair share of treatment of patients who can't afford to pay their medical bills.

And private nonprofit hospitals don't just reap financial benefits derived from serving most of the region's privately insured patients. They also profit from massive tax breaks they receive each year because of their status as tax-exempt organizations. As a result, advocates say the nonprofits are failing to meet their ethical obligation to provide both care for the poor and uninsured and meaningful benefits to the community in exchange for the tax breaks they reap.

An Express analysis of hospital data in Alameda County and Contra Costa County — an examination of where low-income patients receive care and how different hospitals devote resources to low-income patients — backs up the arguments made by healthcare advocates: Tax-exempt nonprofit hospitals serve comparatively low numbers of uninsured patients and low-income residents covered by government programs like Medi-Cal and Medicare. The hospitals also regularly promote community benefit programs that actually do little to help vulnerable populations.

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