Grace Sotomayor
Charlotte, North Carolina, United States

At this time in the United States, there is heated debate and rancor about whether health care is a right or a privilege and how and if our country should pay for healthcare. However, some members of one American institution, the hospital, have been quietly continuing to innovate, contribute to advances in patient care, and serve people in their communities regardless of ability to pay or whether they are reimbursed for preventive services. Deeply dedicated to improving health, they have become part of the fabric of social support for our nation’s most vulnerable, and remain focused on their mission regardless of the political or economic environment.

Providing access primarily through their emergency rooms, hospitals also develop outreach centers and clinics in the most destitute neighborhoods, serving as a lifeline for residents.  For hundreds of years these “social instruments” as Dorothy Levenson described one of them in 1984, have served as home and haven for those who may have nowhere else to go for assistance.

No finer example of such an organization exists than Montefiore Medical Center in the Bronx, New York.

Established by prominent members of New York’s Jewish community, Montefiore was opened on October 26, 1884, the 100^th anniversary of the birthday of Sir Moses Montefiore. Sir Moses was an internationally respected Jewish philanthropist who used his money and influence during his lifetime to fund several health care institutions in England and the United States. Initially called the, “Montefiore Home for Chronic Invalids,” the  twenty-five bed organization initially served people with tuberculosis, leprosy, and other illnesses who were being turned away by hospitals.

By 1888 it had outgrown its beds and was moved to a 140 bed structure at Broadway and West 138th Street. Its clinicians were among the most innovative of their time; in 1890 they were among the first to test tuberculin for the diagnosis of tuberculosis, and in 1901 were among the earliest users of adrenalin chloride for the treatment of asthma.  Montefiore quickly outgrew its space, and with a goal of finding a more open environment for its tubercular patients,  moved to the borough of the Bronx. To better reflect its focus on serving people with chronic disease, in 1913 it was renamed the “Montefiore Home and Hospital for Chronic Diseases.” Inclusive and collaborative at a time when championing rights for women and racial integration was rare, Montefiore was among the first hospitals to welcome African American medical residents, and  partnered with borough leadership to provide accessible health care to Bronx residents. The medical staff was opened to women and in 1914 a woman was appointed chair of the Department of Medicine.

By 1920 the organization shifted emphasis from residential to total hospital care and was renamed the “Montefiore Hospital for Chronic Diseases.” It served as a training ground for nurses, physical and occupational therapists, and physicians. Recognizing the holistic nature of determinants of health, the first hospital- based department of Social Medicine was created in 1950. In 1963 it was established as the teaching hospital for the Albert Einstein College of Medicine and in 1964 was renamed the “Montefiore Hospital and Medical Center.” Its mission to improve health for the underserved was further advanced with the help of federal funding and the Dr. Martin Luther King Health Center was opened in the South Bronx. This was staffed by physicians and health care personnel familiar with the neighborhood and brought comprehensive health care to a community of Black and Hispanic residents that had been sorely lacking for many years.

Dedication to patient care and seeking solutions for community problems has continued to be the hallmark of this organization. Known today as Montefiore Health System, it has expanded by acquiring other struggling facilities and has become a powerful sponsor of community developments in the Bronx, helping to stave off deterioration in housing and flight of middle class families to the suburbs. It remains a compelling attraction for some of the best minds in medicine and leadership, building on a past studded with innovations that have benefited people locally, nationally, and globally.

For example, in 1905 Montefiore had established one of the first hospital departments of social work in the United States, and  in 1970 one of the first residency programs in Social Medicine. In addition to its long – standing focus on disease prevention and health promotion, Montefiore continues to foster a vibrant culture of discovery and innovation.  One of its clinicians had advanced the science of cardiac care with the development of the cardiotachometer (Boas, 1928), and in 1958 Furman and Escher pioneered cardiac rhythm management with transtelephonic pacemaker monitoring (Furman & Escher, 1975). With the advent of the AIDS epidemic in the 1980’s, Montefiore was designated one of the first comprehensive AIDS centers in the United States. Its researchers have contributed to global knowledge of the transmission of  AIDS  through their landmark study of household contacts of patients (Friedland et al, 1986). Montefiore’s legacy of contributions to patient care has continued unabated. In 1979 cancer researcher Susan Horwitz identified Taxol as an effective drug for ovarian cancer and mammary tumors (Schiff et al, 1979). Surgeons at Montefiore advanced the use of minimally invasive surgery to correct abdominal aortic aneurysms and  developed unique approaches to successfully separating conjoined twins (Stone & Goodrich, 2006).

Montefiore’s long history of dedication to its communities and ability to coordinate health care for populations achieved recognition by the federal government as a Pioneer Accountable Care Organization (ACO) in 2011. Today it is well recognized as a successful contributor to  population health, improving its provider quality year after  year as measured by the Centers for Medicare and Medicaid, and generating gross savings for Medicare since the inception of the Pioneer ACO.

What drives such an organization? At a time when hospital margins are slim and new threats to federal and private reimbursement evolve daily, some organizations hunker down and abandon unprofitable endeavors such as dental care for the uninsured or partnerships with struggling facilities. Montefiore’s mission “to heal, to teach, to discover and to advance the health of the communities we serve” is not dissimilar from that of many other medical centers and health care organizations. What makes Montefiore different  is that its mission is lived and not simply words on paper. It continues to exhibit a palpable commitment to doing the right thing for its communities and selects physician leaders who understand that this organization sees itself as the primary provider for health care in the Bronx. This leadership has enabled it to grow to become a health system, providing a full continuum of care across eleven  hospitals and  180 locations across Westchester County, the Lower Hudson Valley, and the Bronx, including an extended care facility, a school of nursing, and a school of medicine.

Sir Moses would be proud.

References

1. Boas, Ernst P. 1928. “The cardiotachometer”. Archives of Internal Medicine 41, March: 403.
2. Friedland, Gerald F.; Saltzman, Brian R.; Rogers, Martha F.; Kahl, Patricia A.; Lesser, Martin L.; Mayers, Marguerite M.; Klein, Robert S. 1986. “Lack of Transmission of HTLV- III/LAV Infection to Household Contacts of Patients with AIDS or AIDS-Related Complex with Oral Candidiasis”. Journal of Medicine 314, February: 344-349.
3. Levenson, Dorothy. 1984. Montefiore- The hospital as social instrument 1884-1984. New York: Farrar, Straus & Giroux.
4. Ohki ,Takao.; Veith , Frank J.; Sanchez, Luis A.; Cynamon , Jacob.; Lipsitz , Evan C.; Wain, Reese A.; Morgan, Jeffery A.; Zhen, Lu.; Suggs, William D.; Lyon, Ross. T. 1999. “Endovascular Graft Repair of Ruptured Aortoiliac Aneurysm”. Journal of the American College of Surgeons 189 (1), July, 102-112.
5. Schiff, Peter B.; Fant, Jane.; Horwitz, Susan B. 1979. “Promotion of microtubule assembly in vitro by Taxol”. Nature 277, February: 665-667.
6. Stone, James L.; & Goodrich, James T.2006. “The craniopagus malformation: classification and implications for surgical separation”. Brain 129 (5) May: 1084-1095.