Hospital reform efforts shared the goal of improving health care and its delivery within a very poor community with multiple socioeconomic problems that deeply affected health. Originally built in the nineteenth century for use by freedmen and women, Lincoln Hospital had long been considered a woefully inadequate provider of charity health care to the mostly black and Puerto Rican residents of the South Bronx. The vast majority of health care providers and staff at the hospital lived outside of the South Bronx community and did not use the services of the hospital. By the mid-1960s, senior medical staff, residents, and interns at Lincoln hospital became affiliated with Einstein Medical College, improving medical care somewhat. Yet, Einstein interns and residents who rotated through Lincoln to complete their medical educations had little commitment to the Bronx community. Most of the young physicians were foreigners from outside of the United States who were only in the South Bronx to complete their medical training. Furthermore, senior medical staff on the faculty at Einstein Medical College utilized the patient population for instructional purposes, often with little or no sense of obligation to the community.135
Health care reform activists contended that community involvement needed to be at the center of any reform effort so that Lincoln would serve the health needs of the neighborhood. Several protests occurring in 1969 and 1970 involving Young Lords and other community activists attempted to further this goal. In the first protest in July 1969, community workers who had been trained in the Lincoln Community Mental Health Program, operated out of an old nurses’ residence at the hospital, focused on gaining more community-worker control over the mental health services. Cleo Silvers, one of the staff protesters, recalled that they demanded that psychologists consider that poor people had very specific problems that could not be solved by middle-class theories of mental health care. They called for the replacement of the two psychiatrists who ran the program and for a section of the mental health unit to be devoted to welfare and poverty issues. After the protest, the worker/activists became more involved with local branches of the Young Lords and Black Panther Party.136
Nearly a year later, in June 1970, at Lincoln Hospital, another health care reform effort was organized by workers, community members, and the Young Lords. This diverse group called themselves Think Lincoln. To illustrate their demands for more community-worker input into hospital policy and health care delivery, activists staffed community complaint tables in the lobby of Lincoln Hospital. As health care reform activist Fitzhugh Mullan recalled, “The complaint table was intended as a mechanism to stimulate patient awareness and participation in the hospital.” Those who staffed the complaint table handed out leaflets and pamphlets about patient rights and community control. Signs placed near the table instructed patients to lodge grievances about the hospital at the table because it was “their hospital.”137
In many instances, activists at the table also acted as patient advocates. If a patient had complaints or questions that could be directed to a particular staff member, a Think Lincoln activist would help the patient locate the appropriate hospital worker or workers to find the answers. Often this system worked and many patients viewed the complaint table as a positive benefit that demonstrated that someone in the community cared enough to improve patient care at Lincoln. Some staff, however, felt under attack by the Think Lincoln activists in their advocacy role because 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
