Hadassah and Hubris, part 1

Abroad, the two Hadassah hospitals at Mt. Scopus and Ein Karem are generally regarded by American Jews as being tremendously good institutions, as is only right since "everyone" knows that Jewish doctors are the best, and Israel, of course, is a "light unto the nations".

Well, it is all coming apart at the seams.  Hadassah Medical Organization is bankrupt, with debts currently estimated at close to $400 million, and probably a lot more.

What happened?  And why do I care?

My husband's family has been a kind of mini-Mafia in Hadassah.  At one time my husband and four of his brothers all worked for it, my husband at Mt. Scopus, and the others in Ein Karem.  Now, only one does [two left when they reached pensionable age, my husband and one other brother left for other reasons].  So we know a lot of the stuff that doesn't reach the newspapers.

Hadassah, like all the hospitals in Jerusalem, is a private hospital, although it accepts patients from all the kupot holim, and only patients [foreigners and/or Palestinians] who don't have insurance have to pay cash. [This, incidentally, is why Hadassah's patient population is more than half non-Israeli. The kupot can take over a year to pay a bill; cash is paid in advance or soon after discharge].  See Part 3 for an analysis of what this means.  In previous years, compared to other Israeli hospitals, the two Hadassahs were awash with money, and Israelis perceived the nice American Hadassah ladies as rather gullible, and so the internal politics of Hadassah were always rather more cutthroat than in other hospitals: it could pay very well to stick the knife in someone's back to step up the ladder.  I've worked in US, UK, and other Israeli hospitals and while there is always intrigue, I never experienced anything as ruthless as what went on in Hadassah, btw.  Even when my husband worked there [1973-1985], contracts for maintenance and renovation were let without any real oversight, money passed under the table, and the resulting work was often shoddy.  There was a lot of waste.  But the sums provided by the American donors were enough to hide most of it.

In 2001, after years of mismanagement and outright theft, the small, mostly maternity hospital where I worked, Misgav Ladach, went belly-up.  Also private, the collection of men who constituted the governing body [amuta] were indifferent to the machinations of the hired administration. Once yearly, they'd meet with the Administrator, ask if everything was OK, and when, without providing any documentation about the financial state of the hospital, he said it was, they would leave, satisfied.  Meanwhile, he, and his deputy [who was also his nephew] was siphoning off as much as they could, including the money in the employees' pension funds [which is why, today, I have no pension]. This only came to light when an outside investigator was appointed by the receiver.  Many people I talked to were shocked: "But there are laws!"  And, yes, there are laws.  But the bottom line is, no money, no one gets paid anything.  Misgav Ladach's debts were estimated at $120 million; the building and equipment was eventually sold for $10 million.  The suppliers never received anything more than a fraction of their bills, and the workers, after 6 years of court wrangling, received partial compensation from the National Insurance Institute [Bituach Leumi]

What is happening now at Hadassah is what happened at Misgav Ladach, and currently also in the still-functioning Bikur Holim Hospital, another private Jerusalem hospital [all hospitals in Jerusalem are private; Shaare Tzedek is currently administering BH]  Only, ML had 180 employees, not 6000, and it wasn't a teaching hospital.  My brother-in-law, in what could be described as "middle management" of a particular department of Hadassah, will almost certainly lose his job in any restructuring; hopefully his pension is safe [Hadassah uses a different sort of pension fund from my old hospital], but at this point no one really knows.  He's never worked at any other place, and his job cannot be replicated outside of the medical world, so, at age 50 or so, he is likely to be permanently unemployable if fired.  His wife, who he met at Hadassah, is a skilled radiation therapy technician, so her job is probably safer, but she has so much seniority that she could be pushed out for a new graduate who is much cheaper.  In Israel, all sorts of workers in hospitals, apart from the doctors, are covered by collective wage agreements which are almost impossible to break unless the position a worker fills is eliminated [doctors work on individual contract, which is why they are being pressured to make "voluntary" contributions of large parts of their salaries]

In subsequent parts of this post, I've quoted articles from Haaretz, which are all very good.  The reason I'm reproducing them in full is because they can't be accessed without membership or subscription, and I think they need to be widely disseminated for the public good.  While it's true that today's "Hadassah ladies" are a pale shadow of their mothers and grandmothers, they still work hard, and for an excellent cause, and don't really deserve to have their efforts wasted as they have been -- but the time has come for a really hard look at the way hospitals are managed in Israel.  The free lunch has ended.  But the tragedy is not that an institution might fail, but that 6000 families, as well as the patients the hospital has served will pay a much higher price than the donors who created and maintained Hadassah.