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Signature Signed (student author) _Redacted ______Signature Redacted Signed (faculty advisor) _···_·----~------

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Thesis title

Date , ,,_ --,~ 1 ,.,

Signature Redacted ~~~:~~~c~:y: Date: ~(tLL/ )f I JD;?-- t I rev. March 2010 1

Negotiating Health Care at the South Bronx’s Lincoln Hospital

by Taisha Rodríguez

Carmen Teresa Whalen, Advisor

A thesis submitted in partial fulfillment of the requirements for the Degree of Bachelor of Arts with Honors in Latina/o Studies

WILLIAMS COLLEGE Williamstown, Massachusetts

Monday, May 21, 2012 2

Acknowledgments

I would first like to thank Professors Ondine Chavoya and Mérida M. Rúa for sparking my interest in Latina/o Studies, and even making me consider the future possibility of a senior thesis as a first-year student. Having both of you as my readers was the perfect way to conclude the Latina/o Studies concentration. A special thanks to

Professor Mérida M. Rúa for your insightful feedback and encouragement throughout the thesis process, as well as during the past four years.

My deepest gratitude goes to my advisor, Professor Carmen T. Whalen, for your unfailing support, advice, and understanding. Thanks to our weekly meetings and your feedback, I was continually reminded of my focus and motivation for pursuing this project. Thank you also for the extensive proofreading, even while trying to balance your own busy schedule.

Many thanks to the Office of Special Academic Programs for their support through the MMUF fellowship. I would also like to extend my gratitude to Professor

Laurie Heatherington for your support, guidance, and helping me to concretely plan a strategy to complete my thesis—all for the sake of maintaining my mental health.

Thank you to my friends for being understanding and willing to listen, especially

Rigo Ruiz-Bonilla and Gracia Manzanares. Special thanks to Joel T. Clemmer for your constant reassurance, support, and making me laugh during times when I wanted to cry.

Last, but certainly not least, I would like to thank my family, especially my parents and grandparents. Aunque no hayan entendido el proceso de la tesis, no saben cuanto les agradezco su apoyo y oraciones. Gracias por siempre recordarme de la importancia de no solo trabajar, pero sobre todo de descansar y de disfrutar. 3

Table of Contents

Introduction ...... 4

Chapter 1: Community Control or Professional Control: Defining Health Care

Debates in 1970 ...... 16

Young Lords Party Perspective on Health Issues ...... 19

The New York Times Enters the Debate ...... 27

Chapter 2: The “New” Lincoln Hospital: Continuing Health Care Issues and

Framing Alternative Discourses ...... 36

Transitions: From the “Old” Lincoln to the “New” Lincoln . . . . . 37

Continuing Health Care Issues at the “New” Lincoln Hospital . . . . 43

Continuing Alternative Discourses ...... 52

Conclusion ...... 60

4

Introduction

“Welcome to the People’s Hospital,” read a banner hung on the exterior of the

South Bronx’s Lincoln Hospital on July 14, 1970. It epitomized the core of the demands that the Young Lords Party, a Puerto Rican activist group with a socialist and nationalist agenda, presented to Lincoln Hospital administrators. During their twelve hour takeover of the medical center’s administrative building, the group demanded community control of the facilities and that services meet the needs of community residents. More specifically, their demands included: preventative health care, continuation of services, training and employment for community residents, and a grievance table where both patients and employees could voice their complaints. After negotiations with Lincoln

Hospital’s administrators, hospital director Dr. Antero Lacot, a Puerto Rican gynecologist and the first non-white person to occupy a high-ranking management position, granted the Young Lords’ demand for a complaint table and the group voluntarily exited the building without having caused any physical damages to the property. 1

The next day, on behalf of the Lincoln Hospital administration, Dr. Lacot announced that the administration agreed to ensure no cutbacks in jobs or services, to implement preventative programs, and to continue with discussions for the construction of a new Lincoln Hospital.2 With their continued advocacy, the Young Lords Party members remained an active presence at Lincoln Hospital, by assisting staff with interpreting and paperwork, by manning a complaint table, and by using an x-ray truck

1 Alfonso A. Narvaez, “Young Lords Seize Lincoln Hospital: Offices are Held for 12 Hours—Official Calls Points Valid,” New York Times, 15 July 1970; Martin Gansberg, “Abortion Death Reported by City: Victim is First Here Since State Law was Relaxed,” New York Times, 21 July 1970; Alfonso A. Narvaez, “Doctors at Lincoln Hospital Threaten to Resign: Charge Harassment in Clinic by Young Lords and Other Activist Community Units,” New York Times, 29 July 1970. 2 Alfonso A. Narvaez, “Lincoln Hospital Hears Demands: Officials Meet with Young Lords to Discuss Problems,” New York Times, 16 July 1970; Narvaez, “Young Lords Seize Lincoln Hospital,” New York Times, 15 July 1970. 5 for tuberculosis screening.3 Consistent with their goals for community control and self- determination, the Young Lords not only advocated for community residents to attain employment and training opportunities at Lincoln Hospital, but also sought to ensure that hospital employees, who served predominantly low-income patients, be attentive to the needs of the community and treat them with dignity. Through the distribution of information and rallies, the organization asserted the community’s rights, and hoped that patients would demand adequate services, rather than become complacent with poor, indecent treatment.

More than 40 years later, on December 27, 2011, Mayor Michael Bloomberg

“gushed with pride” as he delivered a speech at Lincoln Hospital’s maternity ward announcing that the life-expectancy for 2009 babies had increased in New York City, and even surpassed the national average. According to the New York Times, the Bloomberg administration had made public health one of the “top policy priorities,” and for this reason, they had engaged in numerous “high-profile campaigns against smoking, obesity, and salt consumption.”4 In fact, Mayor Bloomberg described the administration’s efforts to improve public health as one of the greatest accomplishments within the last ten years.

To account for the city’s improved life-expectancies, Mayor Bloomberg offered the following as possible explanations: individuals are making healthier choices; better access to HIV treatment, screening, and prevention; and effective health campaigns. With these various explanations, Mayor Bloomberg underscored city residents’ decisions and

3 Narvaez, “Doctors at Lincoln Hospital Threaten to Resign,” New York Times, 29 July 1970; Alfonso A. Narvaez, “Lincoln Doctors to Aid Militants: Action is Taken to Insure Peace in Hospital,” New York Times, 30 July 1970; Charlayne Hunter, “Community Dispute Cuts Service at City Hospital: Dispute Cripples Lincoln Hospital,” New York Times, 26 August 1970; Esli Ramon Gonzalez, “Creo que me Equivoque con los ‘Young Lords’: Dr. Lacot,” El Diario-La Prensa, 30 agosto 1970. 4 Corinne Lestch, “The Livin’ is Longer: Life Expectancy in City Rises Sharply and Now Exceeds the National Average,” New York Times, 28 December 2011; Kate Taylor, “Life Expectancy for Babies Climbs to Record Level in City,” New York Times, 28 December 2011. 6 motivations to live healthier, which he presumed and promoted as contributing to these promising statistics. Mayor Bloomberg stated, “It’s the people in this city that have really done the work, with some help from city-government.”5

Praising New York City residents for making healthier choices might be empowering; though, solely crediting city residents for the improved statistics failed to account for neighborhoods where healthy options may not be available. Despite Mayor

Bloomberg’s best intentions to commend city residents for improving their life expectancies, this explanation misrepresents poor communities and implicitly blames them for the inability to achieve the same optimistic results. The mayor’s explanations do not account for the effects of socioeconomic status and the reality that healthy dietary options and lifestyles are often unavailable, scarce, or unaffordable in low-income communities. Whereas the Young Lords emphasized the needs of the community, Mayor

Bloomberg spoke at Lincoln Hospital without considering the specific context of the

South Bronx neighborhood where it was located.

This thesis, organized into two chapters, looks at important shifts in the framing of health care debates. The Young Lords represented a collective response to health care disparities that focused on systemic causes and defined health care as a social justice issue. In the absence of social movements, Mayor Bloomberg’s speech 40 years later represented an emphasis on individual responsibility and personal choice that de- emphasized the significance of social structures and of community voices. The result has been the continued inability of Lincoln Hospital to meet the health care needs of the

South Bronx’s community.

5 Lestch, “The Livin’ is Longer,” New York Times, 28 December 2011. 7

Lincoln Hospital, the Bronx, and Health Care Activism

Located in the South Bronx, Lincoln Hospital’s abilities to serve the health care needs of the community shifted with changes in the neighborhood’s demographics and its economy. When it originally opened in 1839, the hospital was located in New York

City’s Manhattan borough and known was known as the “Home for the Colored Aged.”

In 1898, the hospital relocated to 141st and Concord Avenue in the South Bronx, and in

1902 it was renamed “Lincoln Hospital.”6 Between 1880 and 1930, the Bronx became an increasingly prosperous New York City borough. At the time, the Bronx provided an opportunity to escape crowded East Harlem and Lower East Side tenements, thus attracting second-generation European immigrants, who were predominantly Irish and

German. However, during the 1950s and 1960s the demographics of the populations living in the South Bronx shifted dramatically. Much of the white population left, and the

South Bronx became mostly Puerto Rican and African American.7 This was part of the increased migration of Puerto Ricans and African Americans to New York City and other urban areas.8 Urban renewal programs under Robert Moses, New York City’s controversial master planner of public works, privileged the construction of high-rise public housing units and federal highways that crossed through several Bronx neighborhoods, in the process segregating communities and ethnic minority populations.

As a manufacturing sector, the deindustrialization that occurred in the South Bronx

6 “History: A Bronx Legacy,” Lincoln Medical and Mental Health Center, accessed April 12, 2012, http://www.nyc.gov/html/hhc/lincoln/html/about/history.shtml. 7 Murray Forman, “‘Welcome to the City’: Defining and Delineating the Urban Terrain,” in The ‘Hood Comes First: Race, Space, and Place in Rap and Hip-Hop (Middletown, CT: Wesleyan University Press, 2002), 35-67. 8 Carmen Teresa Whalen and Víctor Vázquez-Hernández, eds., The Puerto Rican Diaspora: Historical Perspectives (Philadelphia: Temple University Press, 2005); Gabriel Haslip-Viera, Angelo Falcón, and Félix Matos Rodríguez, eds., Boricuas in Gotham: Puerto Ricans in the Making of Modern New York City, (Princeton: Markus Wiener Publishers, 2004). 8 during the 1960s and 1970s contributed, to what scholars Evelyn Gonzalez and Murray

Forman have alluded to as the “downfall” of the borough.9 The deterioration of Lincoln

Hospital’s facilities, health services, and reputation coincided with the changing demographics and economy of the South Bronx.

In 1970, Lincoln Hospital became a focal point for debates over health care, with issues centering on inadequate health services and patient care. Numerous protests, the

Young Lords’ “takeover,” an abortion-related death, changes within the hospital’s administration, and doctor walkouts positioned Lincoln Hospital at the forefront of health care debates among the Young Lords Party, the New York Times, and medical professionals. For the Young Lords, Lincoln Hospital was part of their larger, on-going health care initiatives. In advocating an explicitly socialist agenda, which the Young

Lords termed as “socialist medicine,” the organization promoted “community control” and “self-determination.”10 For the Young Lords, community control and self- determination meant that community residents could feel empowered within their local hospitals through employment opportunities and by voicing residents’ concerns and needs.11 The Young Lords’ takeover of the administrative building at Lincoln Hospital commenced the negotiating processes between community members and hospital administrators.

Inspired by civil rights and anti-war movements in the United States, as well as by anti-imperialist and decolonization struggles in Latin America, the Caribbean, and Africa, health care activism was only one aspect of the multifaceted agenda of the Young Lords

9 Evelyn Gonzalez, The Bronx (New York: Columbia University Press, 2003). 10 Carl Pastor, “Socialist Medicine,” Palante, 5 June 1970, in The Young Lords: A Reader, ed. Darrel Enck- Wanzer (New York: New York University Press, 2010), 192-193. 11 Hunter, “Community Dispute Cuts Service at City Hospital,” New York Times, 26 August 1970. 9

Party. “Bridging homeland and barrio politics,” as historian Carmen T. Whalen described, the Young Lords Party created an agenda that included the following: advocacy for healthy, clean neighborhoods, sovereignty for the island of Puerto Rico, liberation of oppressed populations, and community control of institutions—such as housing, churches, and schools. According to Whalen, the Young Lords “linked the colonization of Puerto Rico to the poverty of Puerto Ricans in the United States and defined the issues as imperialism, capitalism, and racism.”12 The Young Lords underscored the negative implications of Puerto Rico’s colonial condition on the island and in the diaspora—poor education, housing, and health conditions—to condemn the status quo and to endorse the independence movement.13 Established within three main

U.S. cities—Chicago, New York City, and Philadelphia—the Young Lords’ attempts to decentralize institutional power relations was a means through which they hoped to liberate “Third World People” from the oppression of capitalist entities.

Some of the most notable actions by the Young Lords Party took place in

Manhattan’s El Barrio community, located in the East Harlem section of the borough.

These initiatives included the 1969 garbage offensive—during which East Harlem streets were filled with protestors complaining of the “city’s failure to collect trash in the neighborhood”—and the takeover of an East Harlem Methodist church—which occurred after failed attempts to negotiate with church leaders to use the vacant space on weekdays for “a free breakfast program, clothing drives, health services, and Puerto Rican history

12 Carmen T. Whalen, “Bridging Homeland and Barrio Politics: The Young Lords in Philadelphia,” in The Puerto Rican Movement: Voices from the Diaspora, eds. Andrés Torres and José E. Velázquez (Philadelphia: Temple University Press, 1998), 107-123. 13 Lorrin Thomas, Puerto Rican Citizen: History and Political Identity in Twentieth-Century New York City (Chicago: The University of Chicago, 2010), 241. 10 classes.”14 Still, the Young Lords were an active presence in the Bronx since 1968 through community control in schools, anti-poverty programs, and health care activism.

Since the 1960s, the Health Revolutionary Unity Movement—a “city-wide committee of hospital workers”—and the Think Lincoln Committee—a patient-worker committee of

Lincoln Hospital—facilitated collaborative activism between patients, hospital workers, and community leaders to address concerns at Lincoln Hospital and other Bronx hospitals.15

Whereas historian Lorrin Thomas has argued that the “high-profile seizure of the hospital [Lincoln] obscured [this] longer history,” I would suggest that the takeover actually built upon the Young Lords’ earlier initiatives.16 Prior to their increased involvement at Lincoln, the Young Lords had worked to improve health care at another

Bronx hospital, Prospect Hospital. However, the July 1970 takeover at Lincoln Hospital received significant media coverage, thus diverting much of the attention and focus on the Young Lords’ health care activism to this location. Because most of the scholarship on the Young Lords emphasizes their political activism against colonialism and liberation movements of Third World People, my focus solely on the Young Lords activism within the South Bronx’s Lincoln Hospital allows to me present a distinct and localized perspective from the traditional literature on the Young Lords Party.

The New York Times, previously inattentive to Lincoln Hospital, was rather dismissive of the Young Lords’ efforts and actions. The newspaper coverage often presented the organization as one that promoted militant, racialized nationalism. It also

14 Thomas, Puerto Rican Citizen, 232; Yoruba, “Young Lords Block Street with Garbage,” Young Lords Organization, 1969, in The Young Lords: A Reader, ed. Darrel Enck-Wanzer (New York: New York University Press, 2010), 185. 15 Narvaez, “Lincoln Hospital Hears Demands,” New York Times, 16 July 1970. 16 Thomas, Puerto Rican Citizen,233. 11 juxtaposed the Young Lords’ vision for community control at Lincoln Hospital as contradictory to its own notions of professionalism. The doctors and administrators at

Lincoln Hospital who promoted professionalism advocated for hospital employees to be completely in charge of the decisions, actions, and services.17 Other doctors and staff at

Lincoln Hospital supported the Young Lords’ calls for change. Although the New York

Times presented community control and professionalism as contradictory ideals, the

Young Lords instead attempted to work with Lincoln Hospital employees to ensure that patient needs remained at the forefront of patient care. The Young Lords expanded the definition of professionalism to include providing dignified and humane care, along with a commitment to meeting the needs of the community.

After years of debates, conversations, and tensions, the long-awaited “new”

Lincoln Hospital welcomed patients for the first time on March 1976 in its new location on 149th Street and Park Ave. However, the hospital opened on the heels of the New

York City fiscal crisis of 1975, a time of significant reductions in public services and institutions.18 While public agencies were deeply affected as a result of the fiscal crises, urban studies scholar William Sites describes how the severity of the crisis even positioned prominent banks at risk for significant losses.19 In fact, the “new” Lincoln

Hospital opened earlier than expected due to the closing of two other Bronx Hospitals,

Fordham and Morrisania. Since municipal hospitals relied heavily on city funding to operate, they were among the numerous agencies that struggled to find the resources to

17 Edward Hudson, “Doctors Stay Out at Hospital Here: Injunction Fails to Influence 27 on Staff at Lincoln,” New York Times, 28 August 1970. 18 William Sites, Remaking New York: Primitive Globalization and the Politics of Urban Community (Minneapolis: University of Minnesota Press, 2003); Janet L. Abu-Lughod, New York, Chicago, Los Angeles: America’s Global Cities (Minneapolis: University of Minnesota Press, 1999); Ida Susser, Norman Street: Poverty and Politics in an Urban Neighborhood (New York: Oxford University Press, 1982), 203. 19 Sites, Remaking New York, 37-38. 12 support their health care services. As a municipal hospital, Lincoln faced decreased funding, which made it difficult to provide basic care and upkeep equipment for specialized services. Although scholar Ida Susser’s book, Norman Street: Poverty and

Politics in an Urban Neighborhood examined Brooklyn during the 1975 fiscal crisis, the ways in which Brooklyn’s poor and working class suffered the negative consequences of the fiscal crisis are also relevant to the South Bronx community.20 The increased reliance of poor residents on the services at Lincoln Hospital during a time when the municipal hospital struggled with its limited resources and tried to absorb the patients of the two other closed Bronx hospitals made the South Bronx residents vulnerable to inadequate services and treatments.

At the “new” Lincoln Hospital, tensions emerged between providing specialized services and meeting the basic health care needs of the South Bronx community. Despite being a municipal hospital, the new Lincoln was designed as a “sophisticated, tertiary- care hospital” intended to provide specialized care, which would extend beyond primary services.21 According to a November 26, 1978 New York Times news story entitled,

“Lincoln Hospital’s Chaos Traced to ‘Battle’ Conditions in Bronx,” “Politician leaders described it as a magnificent, technically advanced, $250 million municipal gift to an impoverished population with severe medical problems.”22 Although the relocation and opening of the “new” Lincoln Hospital did not receive significant media coverage, the

New York Times soon turned its attention to continuing health care issues at the hospital.

20 Susser, Norman Street, 11. 21 Ronald Sullivan, “Lincoln Hospital’s Chaos Traced to ‘Battle’ Conditions in Bronx,” New York Times, 26 November 1978. 22 Sullivan, “Lincoln Hospital’s Chaos Traced to ‘Battle’ Conditions in Bronx,” New York Times, 26 November 1978.

13

In spite of the advances in specialized medical care and services, the struggle for Lincoln

Hospital to provide access to basic, primary health care has remained, echoing many of the concerns that the Young Lords and others had raised about the “old” Lincoln

Hospital. The recurrence of issues regarding access to primary health care services and understaffed facilities revealed that the physical and structural changes of Lincoln

Hospital could only attempt to conceal the underlying issues and the concerns of the local residents. As a result, local residents and some Lincoln Hospital staff continued to press for adequate services and access to those services, as well as for dignified and humane care.

Alternative discourses have continued to emerge, although not with the activist visibility that the Young Lords brought to these issues in 1970. When Mayor Bloomberg attributed New Yorkers’ longer life expectancies to individual responsibility in a 2011 speech at Lincoln Hospital, local residents instead used the opportunity to challenge

Mayor Bloomberg’s explanation and publicize their concerns for the South Bronx community. In contrast to Mayor Bloomberg, local residents formulated a discourse that emphasized health care disparities and the social circumstances in their community that shaped their health and their health care needs.

Outline of Chapters

“Negotiating Health Care at the South Bronx’s Lincoln Hospital” begins with an exploration of how the health care debates were framed in 1970, drawing mostly from primary documents of the Young Lords Party and the New York Times. In this chapter, I examine the health care debate that emerged from the actions and rhetoric of the Young 14

Lords Party and the responses of the New York Times. While the Young Lords focused their socialist activism on community control and self-determination, the New York Times emphasized the medical staffs’ notion of professionalism. Through a close reading of these discourses, I argue that rather than competing perspectives on health care, the

Young Lords hoped to integrate community control, self-determination, and their definition of professionalism within their agenda for Lincoln Hospital.

Anchored in the opening of the ‘new’ Lincoln Hospital in 1976, Chapter 2 examines the continuing health care issues that plagued Lincoln Hospital and the ongoing discussions that sought to explain and offer remedies for those issues. My analysis is based on newspaper articles from the New York Times, New York Daily News, New York

Amsterdam News, and El Diario-La Prensa, as well as statistical reports from the New

York City Department of Health.23 In this chapter, I examine the health care issues at

Lincoln Hospital that remained despite the construction of new facilities. Concerns of an understaffed, underfunded, and over-utilized Lincoln Hospital continued to negatively affect patient care. Still, alternative discourses that sought to both improve services and preventative care at Lincoln Hospital emerged, some of which echoed the Young Lords’ vision of community control.

In my conclusion, I address the continuing struggles faced by a municipal hospital in the low-income community of the South Bronx. I consider the benefits and importance of new faciliites, while also recognizing what it could not accomplish. While local

23 Although identified as a national newspaper, I rely on the local coverage of the New York Times to gain insight into the multiplicity of perspectives on a specific hospital and Bronx community. Although I hoped to draw more extensively from the Spanish-language newspaper El Diario-La Prensa, the lack of coverage regarding the situation at Lincoln made it difficult to do so. I searched its coverage of the 1970 events, but found minimal information on Lincoln Hospital after this year. Still, I had expected greater coverage of Lincoln Hospital from El Diario-La Prensa considering that the hospital served a predominantly Puerto Rican neighborhood. 15 residents described ongoing struggles to achieve adequate, respectful care, they also hoped for political leaders to understand the societal circumstances of the South Bronx as an important aspect of their health.

In this thesis, I draw on Lincoln Hospital as a case study to understand health care discourses since the 1970s. Lincoln Hospital provides a lens to examine the Young

Lords’ health care activism and how their advocacy for community control and self- determination fit within their agenda for adequate and humane health care. My focus on

Lincoln Hospital revealed the differences among doctors and hospital administrators regarding health care, as well as the changes in the discussions over time. By focusing on

Lincoln Hospital and using newspaper articles to further understand discussions and activism regarding issues of health care, I make evident the contribution of this particular discourse to broader health discussions in New York City.

16

Chapter 1

Community Control or Professional Control: Defining Health Care Debates

in 1970

In 1970, Lincoln Hospital became a focal point for debates over health care.

Reflecting the activism of the era, the year witnessed the Young Lords’ takeover and doctors’ walkouts. The New York Young Lords Party had stressed health care issues since their inception in 1969. However, the Young Lords efforts at Lincoln Hospital positioned this location at the forefront of health care debates. The centrality of Lincoln

Hospital within the Young Lords’ health care activism became salient on July 14, 1970, when members of the Young Lords Party (YLP) and their supporters—members of the

Health Revolutionary Unity Movement (HRUM) and the Think Lincoln Committee

(TLC)—occupied the hospital. That day, the Young Lords led about 150 people to occupy Lincoln Hospital’s School of Nursing building, which housed the hospital’s administrative offices. During the takeover, the Young Lords presented a list of demands and negotiated with hospital and city administrators for about four hours. Without having fully brokered a solution, the group voluntarily exited the building after twelve hours.

Outside Lincoln Hospital, their banner, which proclaimed, “Welcome to the People’s

Hospital,” remained and the Young Lords set up a complaint table for patients and staff to express any concerns. Within the hospital, they assisted staff with interpreting and paperwork and they continued using an x-ray truck for tuberculosis screening.24

24 Miguel “Mickey” Melendez, Ch. 8 “‘The Butcher Shop’—Lincoln Hospital,” in We Took the Streets (New York: St. Martin’s Press, 2003), 162-178; Esli Ramon Gonzalez, “Young Lords Burlan Policía en el Hospital Lincoln,” El Diario-La Prensa, 15 junio 1970; Alfonso A. Narvaez, “Lincoln Doctors to Aid Militants,” New York Times, 30 July 1970. 17

After the takeover, tensions persisted and intensified following the July 20, 1970 abortion-related death of Carmen Rodriguez, a Lincoln Hospital patient. Charging Dr.

Joseph J. Smith, Chief of the Department of Obstetrics and Gynecology, for the death of

Rodriguez, the Young Lords pressured the administration to remove him from his position. On August 25, 1970, twenty-seven doctors from the Department of Obstetrics and Gynecology walked out in support of Dr. Smith. The doctors, like Dr. Smith, accused the Young Lords of harassment and of creating a hostile atmosphere at Lincoln Hospital.

Frustrated with the escalating tensions at Lincoln Hospital, Dr. Antero Lacot, a Puerto

Rican doctor and head of the hospital, requested a restraining order against the Young

Lords Party and the members left Lincoln peacefully on August 27, 1970.25 Yet there is evidence suggesting that the interactions between the Young Lords and medical staff were sometimes supportive and collaborative. Not only had the city-wide committee of hospital workers, the Health Revolutionary Unity Movement (HRUM), supported the

Young Lords in their efforts at Lincoln, but on August 27, 1970, about sixteen Lincoln

Hospital doctors occupied the office of Dr. Joseph T. English, president of the Health and

Hospitals Corporation, the city agency that supported and operated the seventeen municipal hospitals in New York City. Upset with not having received an opportunity to discuss the situation at Lincoln Hospital with Dr. English, the sixteen Lincoln doctors— who supported the Young Lords’ concept of community control—demanded Dr.

English’s removal from office during their hour and a half occupation.26

25 Edward Hudson, “Doctors Stay Out at Hospital Here: Injunction Fails to Influence 27 on Staff at Lincoln.” New York Times, 28 August 1970; Emanuel Perlmutter, “Doctors at Lincoln Continue Boycott, Citing Work Load,” New York Times, 30 December 1970; Irving Spiegel, “Lincoln Doctors Asked to Return,” New York Times, 1 September 1970; Esli Ramon Gonzalez, “Médicos Hospital Lincoln Ocupan Oficina de Director,” El Diario-La Prensa, 28 agosto 1970. 26 Gonzalez, “Médicos Hospital Lincoln Ocupan,” El Diario-La Prensa, 28 agosto 1970. 18

In this chapter, I analyze the perspectives of the New York Young Lords Party and the New York Times regarding Lincoln Hospital during the late 1960s and early

1970s. These differing perspectives reflected and shaped the debates over health care.

The Young Lords Party was particularly involved in advocating for the health care rights of the poor and underprivileged beginning in 1969. Consistent with their goals for community control and self-determination, the Young Lords advocated for empowerment of community residents at Lincoln Hospital through employment and training opportunities as well as through the advocacy of patient needs. The Young Lords also sought to ensure that Lincoln Hospital employees be attentive to the needs of the community and treat patients with dignity. The organization mobilized the community with the aspiration that patients themselves would demand adequate services.

When the Young Lords occupied Lincoln Hospital, they captured the media’s attention. As the media became more interested in the Young Lords’ movement, it also made the organization vulnerable to negative publicity. The coverage of the New York

Times presented the Young Lords’ notion of community control as one focused on race, describing the organization’s actions as militant, racialized nationalism. Although some doctors supported the Young Lords’ efforts, many turned to a discourse of professionalism as an alternative, suggesting that doctors themselves should be in charge of providing the most efficient care for patients and the most efficient work environment for employees. As presented in the New York Times, professionalism and community control appeared to be contradicting strategies to address health care. In contrast, I argue that the Young Lords suggested the possibility of bringing together these two concepts to improve health services. 19

Young Lords Party Perspective on Health Issues

Established in New York City in 1969, the Young Lords Party was a militant organization of predominantly second-generation Puerto Rican men and women, many of whom were college students. They worked address social, health, education, and sanitation issues within underprivileged communities, which were largely Puerto Rican and African American.27 The Young Lords self-identified as a socialist organization. In their 13 Point Program and Platform, which outlined their overall political agenda, the

Young Lords asserted, “We want a socialist society,” explaining, “We want liberation, clothing, free food, education, health care, transportation, full employment, and peace.

We want a society where the needs of the people come first.”28 For the Young Lords and their allies, health care advocacy consisted of meeting the communities’ basic needs and of organizing and empowering those communities to demand their rights.29 Their grassroots movement emphasized the importance of community control and self- determination among “Third-World People.” The Young Lords used the term “Third

World People,” to describe underrepresented, low-income populations—particularly racial minorities, which they also referred to as “oppressed people.”30 Within their publications, the Young Lords described the importance of liberation from capitalist, businessmen who did not uphold the interest of the people. When speaking about another

27 Miguel “Mickey” Melendez, We Took the Streets: Fighting for Latino Rights with the Young Lords, XV (New York: St. Martin’s Press, 2003); Lorrin Thomas, Puerto Rican Citizen: History and Political Identity in Twentieth-Century New York City (Chicago: The University of Chicago, 2010). 28 “Young Lords Party 13-Point Program and Platform (revised November 1970),” Palante, 20 November 1970, quoted in Ch. 1 “Young Lords Platform and Rules,” in The Young Lords: A Reader, ed. Darrel Enck- Wanzer (New York: New York University Press, 2010), 11-13. 29 Carl Pastor, “Socialist Medicine,” Palante, 5 June 1970, quoted in Ch. 9 “Health and Hospitals,” in The Young Lords: A Reader, ed. Darrel Enck-Wanzer (New York: New York University Press, 2010), 192-193; Carlito Rovira, “The Fight against Prospect Hospital,” Palante. 19 June 1970, quoted in Ch. 9 “Health and Hospitals,” in The Young Lords: A Reader, ed. Darrel Enck-Wanzer (New York: New York University Press, 2010), 193-194. 30 Michael Abramson and The Young Lords Party, Palante: Young Lords Party (New York: McGraw-Hill Book Company, 1971), 11. 20

Bronx hospital, Prospect Hospital, where the organization also worked for improved health services, the Minister of Health Carlito Rovira asserted, “People are beginning to realize that the only interest that hospital heads have is how much money they will be able to make out of every patient.”31 For the Young Lords, community control meant that underprivileged groups, racial minorities, and all people of low-socioeconomic status should achieve autonomy within their neighborhoods and demand their rights for basic services. With community control and self-determination at the forefront of the Young

Lords’ health care agenda, it was important that community residents felt a sense of agency within their local medical facilities. Furthermore, the Young Lords perceived it as essential that employees working at hospitals, especially those serving poor communities, upheld a commitment to meeting the needs of patients in a humane and dignified manner.32

In addition to including health care in their 13 Point Program and Platform, the

Young Lords explicitly framed the organization’s health care activism when it published its Ten Point Health Program in January 1970, outlining their goals for achieving improved and affordable health care services among underserved communities. The

Young Lords announced, “We want free publicly supported health care for treatment and prevention…an end to all fees… total decentralization of health…‘door-to-door’ preventative health services.”33 While they recognized the broader health care issues— including sanitation, housing, and malnutrition—faced by poor communities, such as the

31 Rovira, “The Fight against Prospect Hospital,” 193. 32 Cleo Silvers and Danny Argote, “Think Lincoln,” Palante, 3 July 1970, quoted in Ch. 9 “Health and Hospitals,” in The Young Lords: A Reader, ed. Darrel Enck-Wanzer (New York: New York University Press, 2010), 194-196. 33 “Ten Point Health Program,” Young Lords Organization, January 1970, quoted in Ch. 9 “Health and Hospitals,” in The Young Lords: A Reader, ed. Darrel Enck-Wanzer (New York: New York University Press, 2010), 188-189. 21

South Bronx, the Young Lords also recognized the need for an agenda that would directly address health care issues within specific facilities. Having identified health care as one of the areas with significant inequities, the Young Lords sought to integrate health care within its broader agenda. Notions of community control and self-determination remained fundamental to the Young Lords’ movements and advocacy for the rights of

“oppressed people.”34 While health care activism implied a commitment towards universal access to basic services, the emphasis on “Third World People” suggested that the Young Lords were primarily concerned with helping groups most vulnerable to the refusal of basic health services. Although the Young Lords served predominantly Puerto

Rican communities, many African Americans lived in these neighborhoods, thus ensuring the dignity and rights of all marginalized groups was essential to their organization.35

The Young Lords’ Ten Point Health Program and their involvement at Lincoln

Hospital were highly visible embodiments of the organization’s activism in health care.

However, prior to the health movement gaining momentum and publicity at Lincoln in

1970, the Young Lords were already dedicated to several programs and health related initiatives aimed at meeting the basic needs of community residents. Between the late

1960s and the early 1970s, the Young Lords promoted free breakfast programs for children, safer abortions, they had “liberated” an x-ray truck to provide free tuberculosis screenings, and advocated for a lead poison detection center. Moreover, the Young

Lords’ stance on the proper treatment of women and an end to “machismo” was a means through which the organization also promoted good mental health and freedom from

34 Iris Morales, “Sterilized Puerto Ricans,” Palante, 28 August 1970, quoted in Ch. 7 “On Women in the Revolution,” in The Young Lords: A Reader, ed. Darrel Enck-Wanzer (New York: New York University Press, 2010), 165-166. 35 Abramson and The Young Lords Party, Palante (New York: McGraw-Hill Book Company, 1971), 11. 22 domestic violence within their communities.36 Even if the media and other populations were unaware of the Young Lords’ activism, it is evident that they were an active presence within the communities they served. Once the Young Lords undertook a more public role at Lincoln Hospital, their grassroots movement gained an additional component of promoting institutional changes. The Young Lords used political education initiatives to inform communities, reveal health care inequities, and encourage others to join their cause. Through their political education initiatives, the Young Lords managed to raise awareness about the conditions at Lincoln Hospital and gain support for demanding institutional changes.

The Young Lords’ occupation of Lincoln Hospital on July 14, 1970 exemplified the organization’s intentions to implement institutional changes. The group demanded community control of the facilities as a means to systematically ameliorate the health services provided at Lincoln Hospital. However, the presence of protestors at the hospital led to increased tensions between some of the medical staff and community activists.

While upholding Lincoln Hospital patients as central to their movement, the Young

Lords defended their actions as a means to “address community health issues” and as an act of “love for their people.”37 They demanded preventative health care, continuation of services, training and employment for community residents, and a grievance table where

36 Abramson and The Young Lords Party, Palante (New York: McGraw-Hill Book Company, 1971); Gloria Gonzalez, “Sexism,” Palante, June 1971, quoted in Ch. 7 “On Women in the Revolution,” in The Young Lords: A Reader, ed. Darrel Enck-Wanzer (New York: New York University Press, 2010), 182-183; Connie Morales, “Women’s Oppression: Cortejas,” Palante, 22 May 1970, quoted in Ch. 7 “On Women in the Revolution,” in The Young Lords: A Reader, ed. Darrel Enck-Wanzer (New York: New York University Press, 2010), 163-164; “Young Lords Party 13-Point Program and Platform (revised November 1970), 11-13. 37Melendez, Ch. 8 “‘The Butcher Shop’—Lincoln Hospital,” in We Took the Streets, 169; Alfonso A. Narvaez, “Lincoln Hospital Hears Demands: Officials Meet with Young Lords to Discuss Problems,” New York Times, 16 July 1970; Alfonso A. Narvaez, “Young Lords Seize Lincoln Hospital: Offices are Held for 12 Hours—Official Calls Points Valid,” New York Times, 15 July 1970. 23 both patients and employees could voice their complaints.38 Entering negotiations with

Lincoln Hospital’s administrator Dr. Lacot was a significant first step for initiating dialogue within the hospital about health care rights.

Immediately following the takeover, Gloria Cruz, the Young Lords’ health lieutenant, addressed a crowd in front of the hospital and asserted, “The building was condemned 25 years ago. Condemned because it was not safe for human habitation.

Condemned for the rich people, and opened up for poor people. That’s what always happens.”39 Although Lincoln Hospital remained open to treat poor South Bronx residents, Cruz expressed concern over how city officials perceive the poor as inferior, making it seem acceptable for poor patients to receive medical treatment in sub-par facilities. Just as it affected perceptions of poor patients, it also allowed for a sense of disinvestment in the South Bronx’s and its residents. Another Young Lords member,

Miguel “Mickey” Melendez, attributed the situation at Lincoln Hospital to an “attitude of neglect.”40 Although the movement for the construction of new facilities was important to the Young Lords, the quality of treatment provided at the facilities was as essential. The new facilities could potentially permit more up-to-date medicinal tools and methods, but it could not ensure that positive perceptions of patients. The Young Lords proclaimed,

“People dying because the ambulances that arrive late, or in emergency rooms of city hospitals while they wait for hours, happens often. The people have become used to butcher health care and resigned to the fact that they’ll never be decently treated by the

38 Gloria Cruz, “Murder at Lincoln,” Palante, 31 July 1970, quoted in Ch. 9 “Health and Hospitals,” in The Young Lords: A Reader, ed. Darrel Enck-Wanzer (New York: New York University Press, 2010), 198; Cleo Silvers and Danny Argote, “Think Lincoln,” 194-196; Connie Morales, “Lincoln Hospital Must Serve the People,” Palante, 11 September 1970, quoted in Ch. 9 “Health and Hospitals,” in The Young Lords: A Reader, ed. Darrel Enck-Wanzer (New York: New York University Press, 2010), 199-200. 39 Iris Morales, "Palante, Siempre Palante!", 48 minutes, United States, 1996 ; Narvaez, “Young Lords Seize Lincoln Hospital,” New York Times, July 15, 1970. 40 Miguel “Mickey” Melendez, We Took the Streets (New York: St. Martin’s Press, 2003), 162. 24 health system.”41 Through self-determination and community control, the Young Lords hoped that South Bronx residents would join them in fighting for access to resources and, in the process, gain a sense of agency at Lincoln Hospital.

Mobilizing South Bronx residents, so that they would not resign to indignation from medical professionals, held the potential to uplift the morale of a marginalized and stigmatized neighborhood. In the midst of the controversies occurring at Lincoln Hospital in 1970, Judith Pagani, journalist for the Spanish-language newspaper El Diario-La

Prensa, wrote about the insensitive medical treatment towards Spanish-speaking patients at city hospitals. She highlighted the language barrier between hospital staff and patients.

In regards to public hospitals, Pagani called the services there “less than mediocre.”42

Without being able to speak English well, many patients were unable to accurately express themselves well, thus leading to “superficial” treatments and health services.

Lincoln Hospital administrator, Dr. Lacot, agreed with Pagani and suggested that more

Puerto Rican personnel were needed to address this concern.

During their twelve hour takeover, the Young Lords hung their banner, “Welcome to the People’s Hospital” to represent their attempt to re-claim the hospital so that it might adequately serve the South Bronx community. Similar to their motto, “Seize the

Hospital to Serve the People,” the “Welcome to the People’s Hospital” banner emphasized the importance of community control for the Young Lords according to their understanding of health care. The Young Lords’ goal was not solely to ensure that the hospital meet patients’ needs and “served the people,” but also that the community

41 Young Lords Organization, “Revolutionary Health Care Program for the People,” Young Lords Organization, January 1970, quoted in Ch. 9 “Health and Hospitals,” in The Young Lords: A Reader, ed. Darrel Enck-Wanzer (New York: New York University Press, 2010), 189-191. 42 Judith Pagani, “Señalan Insensibilidad Médica Hacia Pacientes Habla Española,” El Diario-La Prensa, 21 July 1970. 25 residents had access to employment at Lincoln Hospital. Moreover, the protection of freedom of speech was crucial for creating a “people’s hospital.” Allowing both workers and patients to voice their concerns and desires was an important first step towards creating an environment that recognized the perspectives of the community. The Young

Lords worked to have a “complaint table” at Lincoln Hospital for these conversations to occur.43 However, it also required effort from the hospital staff and administration to act upon the concerns of workers and patients. The phrase “the people’s hospital” was intended to serve the dual purpose of promoting service to the community while also allowing the community to provide insight on the treatment and services provided.

Just a few days after the takeover, news of the abortion-related death of patient of

Lincoln Hospital patient Carmen Rodriguez intensified the sense of urgency among the

South Bronx community. After being denied abortions at several health clinics,

Rodriguez finally received approval at Lincoln Hospital. However, doctors failed to recognize her heart condition and administered a medication that proved deadly due to her illness. Doctors and the New York Times framed explanations and responsibility for

Rodriguez’s death very differently than the Young Lords, highlighting their distinct approaches to health care. While the medical staff considered Rodriguez’s death as a single incident of malpractice, the Young Lords used the opportunity to highlight the systemic issues that contributed to Rodriguez’s death. In less stark language, the New

York Times attributed Rodriguez’s death to how doctors failed to check her medical history and gave her an injection that proved fatal due to her pre-existing condition. For the Young Lords, Rodriguez’s death pointed to the inhumane services doctors provided at

Lincoln Hospital. In speeches and in Palante, the Young Lords’ bilingual newspaper, the

43 Narvaez, “Lincoln Hospital Hears Demands,” New York Times, 16 July 1970. 26 doctors at Lincoln Hospital were described as “inefficient pigs” and the hospital as a

“butcher shop.” More broadly, they argued that the health care system in New York City failed Rodriguez.

According to the Young Lords, hospitals serving the poor, such as Lincoln

Hospital, jeopardized the lives of poor, racial minority patients who did not have access to other medical facilities. For Gloria Cruz, the Young Lords’ health captain, the urgency to address the indecent and inhumane patient care at Lincoln Hospital was critical as she acknowledged that an abortion at Lincoln was the only legal option available for

Rodriguez. Speaking about another Bronx hospital, the minister of health noted, “The majority of the people in the South Bronx have never been treated or examined in this hospital [Prospect] for a number of reasons, but mainly because not so many people have

Medicaid or money, so they don’t get treated for illnesses.”44 The Young Lords argued that for numerous other poor women throughout the city, there were few legal and affordable facilities willing to perform abortions. At available public facilities, such as

Lincoln Hospital, those who received treatments and services encountered inadequate and under-resourced facilities. The Young Lords asserted, “Rodriguez died in Lincoln

Hospital because she was operated in the supply room in a hospital overrun with garbage, filth, decay, where the electrical wiring is all hanging out loose. She died because the doctor, after doing several abortions, was overtired and very fuzzy about what he was doing.”45 Nevertheless, the Young Lords believed they could empower the community to demand humane treatment as a right.

44 Rovira, “The Fight against Prospect Hospital,” 193. 45 Abramson and The Young Lords Party, Palante (New York: McGraw-Hill Book Company, 1971), 51. 27

Still, the two differing perspectives of medical staff and the Young Lords provided insight into Lincoln Hospital’s substandard care. The story of Carmen

Rodriguez brought a face to the health care debate and provided a concrete reason to improve medical services. Her story not only spoke about the inadequacies of the department of obstetrics and gynecology, but it also demonstrated the carelessness of doctors at Lincoln Hospital. The “butcher shop” became a more prominent and visible term that the Young Lords, the HRUM, the TLC, and their supporters used to describe the inhumanity of the services at Lincoln Hospital towards the poor.46 While claiming to provide services, Lincoln Hospital neglected the plight of poor, racial minority patients who could not afford to find other treatment options. The work of the Young Lords sought to ensure that doctors understood adequate and dignified health care as a right, not a luxury that only the rich could afford.47

The New York Times Enters the Debate

“Young Lords Seize Lincoln Hospital” read a July 15, 1970 New York Times news story that initiated the paper’s representation of the Young Lords Party as a radical and disruptive “militant” group. As the group exited the building twelve hours later, they encountered a “line of helmeted police,” and several protestors, suspected of carrying

“dangerous weapons,” were arrested.48 This marked a dramatic increase in the New York

Times’ coverage of the Young Lords and Lincoln Hospital. Yet news stories that reported on the Young Lords’ actions took on a dismissive tone, suggesting that the New York

Times did not agree with the organization’s actions or their understanding of health care.

The New York Times also featured doctors’ perspectives of the situation at Lincoln

46 Young Lords Organization, “Revolutionary Health Care Program for the People,” 189-191. 47 Carl Pastor, “Socialist Medicine,” 192-193. 48 Narvaez, New York Times, “Young Lords Seize Lincoln Hospital,” 15 July 1970. 28

Hospital, which focused on notions of professionalism to counter the Young Lords’ emphasis on community control. For these reasons, the New York Times provides an alternative framing of the health care debate.

The New York Times coverage revealed a range of perspectives among medical professionals regarding conditions at Lincoln Hospital, health care issues, and the Young

Lords’ activism. In May 1970, months prior to the Young Lords’ takeover, Dr. Antero

Lacot, himself Puerto Rican, wrote a letter to the editor of the New York Times shortly after assuming his position as an administrator at Lincoln Hospital. He promised the

“highest standards of health care” according to the philosophy of the Department of

Hospitals and the newly formed Public Benefits Corporation.49 Acknowledging that much work remained to improve health care at Lincoln Hospital, he pointed to the main contributor of the health care disparities, “Because of years and years of neglect we have been suffering and now we are trying to remedy the situation.”50 Dr. Lacot’s comments highlight how the issues that the Young Lords sought to address were not new, but rather compounded and stemmed from their history of neglect. For the Young Lords, this may have reinforced a sense of urgency to act because if left unaddressed, administrators would remain complacent. Without attempting to improve health care, services at Lincoln

Hospital and other medical facilities serving the poor may have continued deteriorating.

As a potential mediator, the New York Amsterdam News highlighted Dr. Lacot’s position as central to possibly advancing or constricting the Young Lords’ struggle.

Similarly, the New York Times often recognized the role of Dr. Antero Lacot in resolving tensions at Lincoln Hospital. In “Young Lords Seize Lincoln Hospital,” Lacot was

49 Antero Lacot, “Letter from Dr. Lacot,” New York Times, 9 May 1970. 50 Narvaez, “Young Lords Seize Lincoln Hospital,” New York Times, 15 July 1970. 29 depicted as having settled negotiations with the Young Lords. Although the article mentioned that he hoped the Young Lords would vacate the hospital’s facilities, Dr.

Lacot’s public statements suggested a rather sympathetic understanding of the Young

Lords’ observations and recommendations, as he too acknowledged “years of neglect” and the need for improved health care at Lincoln Hospital. However, the New York Times did not consistently present a gracious and efficient image of Dr. Lacot. One article specifically stated that Dr. Lacot attained his job solely through the support of “dissident staff members and militant community groups,” dismissing his credentials and instead attributing his success to external support.51 Perhaps not coincidentally, another article mentioned his ethnoracial background in its title, “Puerto Rican Doctor Appointed.”52 Dr.

Lacot could have been a mediator between the hospital staff’s and the Young Lords’ competing health care frameworks, though as the situation developed, it became evident that reconciling the diverging perspectives would prove difficult.

Although it is evident that the New York Times disapproved of the Young Lords

Party, the newspaper provides insight into the various opinions of the doctors and their viewpoint of the situation. These viewpoints sometimes contrasted with the New York

Times’ descriptions of the Young Lords, which included words like “seize,” “attacked,” and “dangerous weapons,” implying that the Young Lords may have utilized excessive and/or physical force in their takeover of Lincoln Hospital. Interviews with several

Young Lords involved suggested that they went to Lincoln Hospital in an effort to motivate hospital administrators to improve the quality of services. They hoped that

Lincoln Hospital would meet the needs of the community, rather than function as a

51 John Sibley, “Pediatrics Chief at Lincoln Hospital; Puerto Rican Named,” New York Times, 17 November 1970. 52 “Puerto Rican Doctor Appointed to 2d Highest City Health Post,” New York Times, 13 July 1971. 30

“capitalist” institution. The Young Lords were not seeking to disrupt hospital services, but instead claimed that they were at the hospital “for the love of [their] people” and refused to leave the hospital until “it starte[d] serving the people.” According to an agreement reached, “the Young Lords would be allowed to run certain programs under the supervision of staff physicians, provided that the occupation of the building would end.”53 This reinforced the notion that the Young Lords were willing to negotiate for the sake of achieving better services for the South Bronx community. Even if their involvement would be limited, it still gave the organization some control over the health care provided at Lincoln.

Some doctors responded actively, albeit not positively, to the Young Lords having some influence over health care at Lincoln Hospital. On August 25, 1970, doctors from the Department of Obstetrics and Gynecology walked off the job claiming that they felt harassed, threatened, and unable to perform their responsibilities under the presence of the Young Lords. According to the New York Times, “the physicians left their jobs to protest alleged harassment by local black and Puerto Rican militant groups.”54 These doctors blamed the Young Lords’ presence as having created disruptive work conditions.

They also boycotted in support of their Department Chief, Dr. Smith. According to the

Young Lords, Dr. Smith was “fired by the people,” because he failed to do his job and address the needs of patients.55 As the department head, the Young Lords considered Dr.

Smith an “inefficient butcher” responsible for Carmen Rodriguez’s abortion-related

53 Narvaez, “Young Lords Seize Lincoln Hospital,” New York Times, 15 July 1970. 54 Perlmutter, “Doctors at Lincoln Continue Boycott,” New York Times, 30 December 1970. 55 Charlayne Hunter, “Community Dispute Cuts Services at City Hospital: Dispute Cripples Lincoln Hospital,” New York Times, 26 August 1970. 31 death.56 For this reason, they believed that the community and concerned hospital employees deserved the right to remove Dr. Smith from his position. The phrase “fired by the people” exemplified community residents asserting greater power over Lincoln

Hospital and its doctors, as they pressured the hospital to hold Dr. Smith accountable. It demonstrated the powerful potential of the community to implement changes within

Lincoln Hospital.

When the New York Times cited the phrase, “fired by the people,” however, they often implicitly suggested that it was an affront to professionalism. For this reason, doctors who supported Dr. Smith noted that they would remain off their jobs until they felt they could resume work in what they referred to as “a non-threatened environment.”57

Dr. Smith defended the doctors, stating that “boycotting doctors would only consider returning when the atmosphere was conducive for proper professional patient care.”58 In his statement, Dr. Smith positioned professional control as the antithesis of community control, as exemplified in the phrase, “fired by the people.” This delegitimized the

Young Lords’ approach of community control, positioning the organization as disruptive and as promoting unprofessional patient care.59

Although the New York Times often mentioned the Young Lords’ demands, articles also dismissed the Young Lords as a radical, violent, and militant Puerto Rican

56 Gloria Cruz, “Murder at Lincoln,” 198; Health Ministry, “Lincoln Hospital Must Serve the People,” Palante, 31 July 1970, quoted in Ch. 9 “Health and Hospitals,” in The Young Lords: A Reader, ed. Darrel Enck-Wanzer (New York: New York University Press, 2010), 199-200. 57 John Sibley, “Dr. Smith is Back in Lincoln Post: But Return of Department Head Fails to End Dispute,” New York Times, 2 September 1970. 58 Hudson, “Doctors Stay Out,” New York Times, 28 August 1970. 59 Narvaez, “Lincoln Doctors to Aid Militants,” New York Times, 30 July 1970; Hudson, “Doctors Stay Out,” New York Times, 28 August 1970. 32 group that invaded Lincoln Hospital.60 One article stands out due to explicit suspicions about the Young Lords’ motivations. New York Times journalist Harry Schwartz positioned the takeover as merely a publicity stunt for the Young Lords Party. He dismissed the organization’s presence at Lincoln Hospital as an “experiment to see whether ghetto hospitals could be used to radicalize poor blacks and Puerto

Ricans…Lincoln Hospital became propaganda and a recruitment base.”61 Presenting

Lincoln Hospital as a “recruitment base” for the organization ignored the organization’s earlier activism for health care reforms, and was misleading, especially considering that the Young Lords instead hoped for professional staff and hospital administrators to become more attuned to the community needs. Even Dr. Lacot had conveyed similar sentiments. According to a New York City Spanish-language newspaper, El Diario-La

Prensa, Dr. Lacot said, “They [the Young Lords] came here to improve the services at

Lincoln Hospital. I took their word for it. I could be wrong. The hospital is not supposed to be here as a center to fight for power for any community group.”62 Dr. Lacot described the Young Lords’ actions as potentially disruptive in the efforts to ameliorate health care services. However, he also suggested the possibility that the organization attempted to gain political power in the community through their involvement at Lincoln Hospital.

Although Schwartz implicated the Young Lords’ actions as a means to attain political power, Dr. Lacot proposed that the Young Lords’ actions may have possibly served dual purposes. Perhaps Dr. Lacot agreed with the Young Lords’ efforts to improve health care and empower community residents, but disapproved of their tactics.

60 Martin Gansberg , “Abortion Death Reported by City: Victim is First Here Since State Law was Relaxed,” New York Times, 21 July 1970. 61 Harry Schwartz, “Hospital Target for a Test by Radicals,” New York Times, 6 September 1970. 62 Esli Ramon Gonzalez, “Creo que me Equivoque con los ‘Young Lords’: Dr. Lacot,” El Diario-La Prensa, 30 agosto 1970. 33

Through their demands for preventative care, dignified treatment, and community control, it is evident that the Young Lords’ actions at Lincoln Hospital were not attempts to just gain publicity for the organization, but rather, to increase awareness for their concerns. As a grassroots organization, the Young Lords may have hoped to convince others to join their efforts towards improving health care and achieving community control. This was not, however, the sole driving force of the Young Lords decision to go to Lincoln Hospital and make their demands public. Rather than just self-promotion, the

Young Lords’ actions at Lincoln Hospital and the organization’s programs were the means to politicize health care, to empower community residents and patients, and to change the system.

Despite his dismissive critique of the Young Lords’ actions, Schwartz wrote an alliance between the organization and some doctors at Lincoln Hospital not previously mentioned in the New York Times. Schwartz noted, “The Young Lords have important allies inside the hospital, a group of radical young physicians, many of whom are also white and Jewish. Some of these are revolutionaries dedicated to destroying ‘oppressive capitalism’ others have been radicalized by the hospital’s many failings.”63 Previously, the New York Times had mainly discussed the Puerto Rican membership within the organization, failing to recognize that whites too supported the cause of the Young Lords

Party. This alliance emphasized that race was not at the core of the organization, but rather that the Young Lords welcomed those who also believed in advocating for the rights of poor, underrepresented groups. It also demonstrated that some doctors recognized how Lincoln Hospital failed to meet the needs of the community, and thus saw the Young Lords as allies towards improving health care.

63 Schwartz, “Hospital Target for a Test by Radicals,” New York Times, 6 September 1970. 34

In a later article, doctors also revealed existing generational differences between medical professionals at Lincoln Hospital. Some of the younger physicians described a sense of “paternalism and malpractice” among older doctors, which had led to deteriorating treatments for the poor.64 These younger doctors complained of the circumstances at Lincoln Hospital as detrimental for interns and residents. Even though earlier articles had presented divergent interests between the Young Lords and health care professionals, this disagreement among hospital employees pointed to a complexity, which the New York Times had initially overlooked. Despite existing tensions between the Young Lords and Lincoln Hospital employees, there were also doctors who actually agreed with the Young Lords’ stance that Lincoln Hospital’s services were inadequate.

Still, the New York Times presented the Young Lords’ notion of community control as contradictory to the doctors’ belief in professionalism.

In the Young Lords’ discourse, it is evident that they understood community control as compatible with a different definition of professionalism, a view that seemed supported by some but not all doctors at Lincoln Hospital. The Young Lords hoped to work alongside with doctors, so that doctors could better understand how to adequately serve their patients. They presented community control as an additional component to the professionalism essential for providing the highest quality health services, in essence redefining and expanding the meaning of “professionalism.” For the Young Lords, professionalism meant that the medical staff should be adequately trained, provide essential primary and preventative care needed in the communities, and treat patients in a

64 Michael T. Kaufman, “Lincoln Hospital: Case History of Dissension that has Split the Staff for Last Year,” New York Times, 21 December 1970. 35 dignified manner. Through community control, or including community residents within the hospital, the Young Lords hoped that community perspectives regarding the needs of

South Bronx residents would be ensured. Incorporating both community control and professionalism, the Young Lords simply wanted well-trained doctors to also meet the needs of the community, providing services in a humane and dignified manner.

36

Chapter 2

The “New” Lincoln Hospital: Continuing Health Care Issues and Framing

Alternative Discourses

After years of debates, conversations, and tensions, the long-awaited “new”

Lincoln Hospital welcomed patients for the first time on March 1976 in its new South

Bronx location.65 Lincoln Hospital continued to serve the predominantly low-income, ethnic minority, and disadvantaged populations of the South Bronx and Harlem. The achievement of new facilities was a significant accomplishment for Lincoln Hospital. It also provided an opportunity for the hospital to construct a new image and allow for new perceptions, especially considering that Lincoln Hospital was not simply reconstructed but also relocated. Although Lincoln’s reopening should have received significant media coverage as a momentous day for the hospital, it received minimal news coverage.

Instead, discussions of the “new” Lincoln Hospital and mention of its new location and facility dealt with the continued struggles to ensure patients efficient access to medical treatments and care, echoing many of the concerns that the Young Lords and others had raised about the “old” Lincoln Hospital. The “new” Lincoln Hospital facilities and location did not necessarily eliminate its controversial history. Underlying concerns over patient care and the broader societal disparities of the South Bronx community remained an issue even after Lincoln Hospital attained new facilities.

The opening of new facilities was an important step in Lincoln Hospital’s potential to provide services as well as better access to those services. The “new” Lincoln

Hospital was designed as a “sophisticated, tertiary-care hospital” intended to provide

65 David Bird, “An Emergency Birth Marks First Day for New Lincoln Hospital in Bronx,” New York Times, 29 March 1976; “Procedure Studied in Lincoln Hospital: Analysis Follows Accidental Death of a Cirrhosis Patient, 50,” New York Times, 2 August 1978. 37 specialized care, which would extend beyond primary services.66 With time, Lincoln

Hospital managed to implement specialized care programs, some of which have even won national awards. In spite of the advances in specialized medical care and services, the struggle for Lincoln Hospital to provide access to basic, primary health care has remained. Since its new facilities opened in March 1976, Lincoln continued to contend with staffing and financial difficulties that have exacerbated the lack of necessary, adequate, and dignified access to services. Traditionally, wealthier and privileged institutions are the ones able to afford and provide access to tertiary health care. As a public, underfunded facility, it may seem unusual for Lincoln Hospital to have been created with the intention to support specialized programs. Indeed, tensions between upholding award winning specialized treatments and serving the basic need for primary care of the South Bronx’s low-income populations emerged. The recurrence of issues regarding access to primary health care services and understaffed facilities revealed that physical, structural changes of Lincoln Hospital could only attempt to conceal the underlying issues and the real concerns of the local residents. Employment of poorly trained doctors, overutilization of services, and malpractice law suits were among the circumstances that still overshadowed Lincoln Hospital’s achievements and dominated media discourse and perception.

Transitions: From the “Old” Lincoln Hospital to the “New” Lincoln Hospital

Initially, media coverage regarding Lincoln Hospital’s transition period was extremely limited and generally positive. Politicians embraced the potential for the new

66 Ronald Sullivan, “Lincoln Hospital’s Chaos Traced to ‘Battle’ Conditions in Bronx,” New York Times, 26 November 1978. 38 facilities to provide better services to the South Bronx community.67 Although English and Spanish-language newspapers do not seem to have covered the opening of the new

Lincoln Hospital, a few articles published months after its opening mentioned the hospital within the context of other issues that had arisen. An investigation conducted less than a year after the “new” hospital opened simply attributed any issues to the transition itself. However, within eight months of its opening, media coverage shifted to highlighting the issues of underfunding and understaffing as an explanation for recurring issues at Lincoln Hospital.

Less than a year after the opening of the “new” Lincoln Hospital, the New York

Times coverage of a Federal Medical Services’ two-day on-site inspection of the hospital suggested that the lack of a well-defined transition period may have affected doctors’ and nurses’ ability to provide the best possible services. Commissioner Robert Whalen was quoted, “There was nothing unusual about the problem at Lincoln…It was exactly what one would expect when a major facility is occupied and pressed into use without the benefit of adequate time to develop work flows and acquaint staff with the operational systems.” According to the cited report, “the operator did not plan the facility or have access to it prior to one week before operations began.” Although the article does not specify the “problems” found at Lincoln Hospital, it states that they were associated with an inadequate transition for hospital staff. Without an opportunity to become acquainted and accustomed to new work settings, medical care suffered. The problems present at the hospital were deemed not “detrimental to patient care, nor causing the leakage of Federal

Medicaid funds.” It remains unclear whether this statement suggested that problems and

67 Sullivan, “Lincoln Hospital’s Chaos Traced to ‘Battle’ Conditions in Bronx,” New York Times, 26 November 1978. 39 inadequacies were acceptable only insofar as they were not “detrimental to patient care” or if they were encouraged by Lincoln’s initiatives to address the problems, as administrators were “addressing [them] in a mature and responsible fashion.”68

The investigation of Lincoln Hospital may have drawn the hospital into a different kind of local politics than those of 1970. Ed Koch, a congressman and then mayoral candidate, demanded the investigation of the “new” Lincoln Hospital less than a year after it opened to the public. Because Congressman Koch called for the inspection as a means to retaliate against the Health and Hospitals Corporation President Holloman’s refusal to dismiss a rival, who at the time was employed at Lincoln Hospital, the potential for bias is important to consider.69 However, from the tone, the findings appear to be unbiased. The New York Amsterdam News declared, “Lincoln Investigation Rebuffs

Koch.”70 It may have been the political maneuvering, rather than concerns with health care that brought media attention to Lincoln Hospital.

When the “new” Lincoln Hospital facilities were completed in 1976, the 1975

New York City fiscal crisis was already leading to reductions in public services and institutions.71 Time may not have allowed for an adequate transition considering that the closing of two other Bronx hospitals (Fordham and Morrisania) forced Lincoln to open its new facilities much earlier than originally planned.72 There is a lack of literature or media coverage on the opening of Lincoln Hospital, possibly due to the unexpected early opening. Had the Young Lords still been an active organization in 1976, perhaps

68 “Lincoln Investigation Rebuffs Koch,” New York Amsterdam News, 8 January 1977. 69 The Health and Hospitals Corporation was the city agency that supported and operated the seventeen municipal hospitals in New York City. 70 “Lincoln Investigation,” New York Amsterdam News, 8 January 1977. 71 William Sites, Remaking New York: Primitive Globalization and the Politics of Urban Community (Minneapolis: University of Minnesota Press, 2003), 35-47. 72 Sullivan, “Lincoln Hospital’s Chaos,” New York Times, 26 November 1978; “Procedure Studied in Lincoln Hospital,” New York Times, 2 August 1978. 40 members would have ensured that the opening of the new facilities received attention as a momentous day marking an accomplishment towards potentially better treatments at

Lincoln Hospital. Unfortunately, new structural facilities could not contend with those medical care issues involving the employees—meaning that the new, modern building could not address the health care inadequacies that resulted from doctors’ errors and attitudes towards patients. Although the commission report noted that “everything should be fine in a few months,” subsequent news articles continued to report concerns over patient care at Lincoln Hospital.73

Less than two years after the new facility opened, the ongoing discourse centered on underfunding, understaffing, the challenges of municipal hospitals, and doctors’ and administrators’ attitudes towards patients. In a November 1978 New York Times article, journalist Ronald Sullivan described how South Bronx residents referred to physicians as

"butchers,” reminiscent of the terminology used by the Young Lords eight years earlier.

Politicians who had previously praised the new facilities began to criticize the physicians at Lincoln Hospital. This suggests that despite acquiring new facilities, little progress had been accomplished in regards to doctors’ treatments towards patients. Much work remained to shift the attitudes of doctors towards patients and for doctors to cope with the unpredictable dimensions of the South Bronx community, circumstances that the construction of new facilities simply could not address. In fact, Sullivan cited a city report concluding that “the hospital simply did not work.”74 Even if this conclusion may have appeared premature in 1978, media coverage and perceptions of Lincoln Hospital show that providing adequate and dignified care would remain an issue for years to come.

73 “Lincoln Investigation,” New York Amsterdam News, 8 January 1977. 74 Sullivan, “Lincoln Hospital’s Chaos,” New York Times, 26 November 1978. 41

The circumstances of the South Bronx, its residents, and the sudden closure of two other Bronx hospitals forced patients to overutilize and place added demands on

Lincoln’s strained resources. As a hospital that already struggled to meet the basic needs of its patients, further pressure would prove to be detrimental and even deadly for patient care. Furthermore, nursing staff performed other clerical tasks, drawing them away from their main responsibility of patient care. According to Sullivan, Lincoln Hospital physicians described the hospital as “a mismanaged and underfinanced hospital operating under battlefield conditions and a siege mentality.”75 Despite having attained new facilities, the ever increasing number of patients exacerbated the issue of bed scarcity. In the emergency room, Sullivan described a “chaotic” atmosphere where an insufficiently staffed room could not attend patients in a timely manner, thus putting patients at high risk of dying. Furthermore, patients encountered a high risk of being sent home early without full treatment in an attempt by doctors and nurses to assist other patients. For those patients needing further assistance, even hiring more staff would not have sufficiently addressed the fact that the hospital could not ensure beds. “Physicians at

Lincoln say they are often afraid to admit a patient to a medical bed because they are overcrowded and dangerously understaffed…[a] physician had little confidence in the capacity of the overwhelmed medical service to provide the care he thought his patient needed.”76 These perceptions of Lincoln Hospital from its own employees, along with a

1978 New York Times article that described nursing shortages as “life-threatening,” should have encouraged immediate action.77

75 Sullivan, “Lincoln Hospital’s Chaos,” New York Times, 26 November 1978. 76 Sullivan, “Lincoln Hospital’s Chaos,” New York Times, 26 November 1978. 77 Peter Kihss, “New York Municipal Hospitals Found ‘Plagued’ by Nurse Shortage,” New York Times, 21 May 1978. 42

Although Lincoln Hospital received significant negative publicity for its continuing issues, financial difficulties, and staff shortages, this circumstance was not limited to Lincoln, but rather relevant to New York’s municipal hospitals. As a result of

New York City’s 1975 fiscal crisis, cuts in salaries and benefits resulted in the hiring of new employees who worked temporarily in municipal hospitals and after gaining experience then left for better paying, less demanding hospitals. At Lincoln Hospital, the lack of funding hindered the hospital’s ability to provide adequate primary care services, to attract doctors invested in the community, or to maintain specialized care equipment.78

Dr. Fitzhugh Mullan, a resident physician at Lincoln Hospital’s emergency room, wrote about his experiences and perspectives on providing better health care for the community in a 1978 New York Times article. He criticized physicians and medical residents especially, for failing to create relationships with Lincoln hospital and its patients, which may have resulted from the fact that they did not spend within the community aside from work time. Moreover, Dr. Mullan claimed that their work was quite passive, as doctors would simply wait for patients to come to them rather than partake in home visits or street clinics. The high turnover also hindered motivations to establish relationships with patients. Instead, Dr. Mullan noted that municipal hospitals in poor communities were often utilized and exploited as stepping stones for higher paying, less demanding, more desirable work opportunities. After gaining experience and completing their residency, doctors moved on to the next step of their lives and considered their own advancement rather than their impacts on health care. Dr. Mullan labeled doctors and the field of medicine as suffering from “social complacency,” in

78 Sullivan, “Lincoln Hospital’s Chaos,” New York Times, 26 November 1978. 43 which the patient was not central but rather “high incomes, professional mobility, [and] social respect” have become motivational factors for progressing within their career.79

Instead, Dr. Mullan provided an alternative notion of professionalism, and what he called “city medicine.” He emphasized the importance of fostering a sense of commitment to the community among medical residents and physicians to provide better care for patients. Dr. Mullan wrote, “The real pay for these physicians will have to come from watching their clinics take root and grow, from seeing their neighborhoods made a little more humane by their labors. Mainline American-trained physicians have largely avoided the tough neighborhoods. If medicine is to be effective, much of it has to be practiced in the neighborhood.”80 Comparable to the Young Lords’ advocacy to bring health care to the people, Dr. Mullan hoped that city doctors would become more engaged in the hospitals’ surrounding community. A similar model of health care treatment would later reemerge and come into fruition as a result of dedicated Lincoln

Hospital staff, as will be discussed later in this chapter.

Continuing Health Care Issues at the “New” Lincoln Hospital

Designed as a tertiary facility, Lincoln Hospital has managed to implement specialized care programs, some of which have even received national recognition for their excellence. An initial example of specialized care at Lincoln Hospital resulted from the Young Lords takeover in 1970. Having deemed it important for community residents, members of the organization worked with hospital administrators to establish a drug rehabilitation program at Lincoln Hospital. However, even after his election as mayor,

Koch once again expressed disdain against Lincoln Hospital and shut down the program,

79 Fitzhugh Mullan, “‘Patient Wheezing—Admit,’” New York Times, 6 February 1978. 80 Mullan, “‘Patient Wheezing,’” New York Times, 6 February 1978. 44 claiming a fear of the “radical” views of the Young Lords Party.81 The next response to community needs for the implementation of a specialized care program is evident in 1984 with the creation of an asthma room within Lincoln Hospital’s emergency room. The asthma room was created in response to the increasing asthma rates in the South Bronx.82

Furthermore, on its website, Lincoln Hospital boasts the awards, accreditations, and recognitions from the following associations: Breast Centers, American Heart, Stroke, and Diabetes Associations.83 More recently, a 2009 New York Times article highlighted

Lincoln’s neurosurgery team for having saved the life of a 15-year-old who received a gunshot in the head. The newspaper even remained relatively optimistic and congratulatory towards doctors’ ability to treat some patients.84 A stark contrast of the negative perceptions towards Lincoln’s emergency room and its medical staff since the

1970s, Dr. Sundaresan, the hospital’s chief neurosurgeon, described Lincoln as the

“Mayo Clinic of the Bronx.”85 Despite the hailed specialized care at Lincoln, basic care and emergencies have remained an issue. As one of the busiest emergency rooms in the region, discussions of an under-staffed and over-utilized Lincoln Hospital continue to emerge as an aspect of contention.86

81 In 1978, the Young Lords Party was no longer an active organization. Rather, Mayor Koch disapproved of the drug rehabilitation program due to its radical origins. See Ronald Sullivan, “‘Countercharges by Lincoln Drug Unit,” New York Times, 30 November 1978. 82 Jauhar Sandeep, M.D., “Cases: Comedy, Tragedy, and Coping,” New York Times, 15 January 2002. 83 The City of New York, “Lincoln Achievements: Service Excellence in Action,” Lincoln Medical and Mental Health Center, accessed January 28, 2012, http://www.nyc.gov/html/hhc/lincoln/html/about/achievements.shtml. 84 Erica Pearson and Corky Siemaszko, “‘Shoot Victim Was in Race vs. Time from Moment She Entered ER-Doc,’” New York Daily News, 26 November 2009; Michael Daly, “‘The Men and Women Behind Miracles: Higher Powers & Unseen Forces May Have Been at Work, but the Bravery & Skill of Pilots, Surgeons, and paramedics Must be Remembered,’” New York Daily News, 26 November 2009. 85 Pearson and Siemaszko, “‘Shoot Victim,’” New York Daily News, 24 December 2009. 86 The City of New York, “About Lincoln Hospital,” Lincoln Medical and Mental Health Center, accessed January 28, 2012, http://www.nyc.gov/html/hhc/lincoln/html/about/about.shtml; Tina Moore, Benjamin Lesser, and Greg Smith, “Hospital Specializes in Hiding Fatal Errors: Lincoln is the Worst in Reporting Deadly Medical Mistakes,” New York Daily News, 28 July 2009. 45

A 2007 New York City Department of Health report revealed that South Bronx residents had the highest percentage of residents screened for breast cancer in the Bronx, demonstrating excellent care in this area. However, the Bronx was also the borough with the highest percentage of residents who were uninsured and the least likely to have a primary health care provider.87 In addition, the percentage of Bronx residents who had not received necessary medical care surpassed the New York City average. Although concerns about health care insurance coverage are part of a larger discussion on health care reform, it is evident that health disparities continued to affect South Bronx residents negatively.88 As a borough with a high percentage of uninsured populations not receiving preventative and/or necessary medical care, it seems probable that Bronx residents were more likely to seek primary medical care at hospital emergency rooms for medical concerns that preventative medicine could have addressed. Without early treatment for medical conditions, neighborhood residents were also at risk for developing more serious health issues. Similar to the demonstrated concerns during the late 1970s, the circumstances of the South Bronx residents resulted in added usage and stress on

Lincoln’s emergency room and its staff, which already struggled from financial difficulties.

In 2000, talk of financial difficulties, low salaries, and undesirability of municipal hospitals serving poor communities in New York City echoed Dr. Mullan’s perspective in 1978. Despite having advocated for greater commitment from doctors and nurses to

87 The City of New York, “Neighborhood Statistics,” New York City Department of Health and Mental Hygiene, accessed March 4, 2012, http://www.nyc.gov/html/doh/html/stats/stats-prev.shtml; The City of New York, “Access to Health Care and Health Insurance: New York Community Health Survey, 2007,” New York City Department of Health and Mental Hygiene, accessed March 6, 2012, http://www.nyc.gov/html/doh/downloads/pdf/community/chs2007-access.pdf. 88 Editorial, “Who let the healthcare dogs out?” El Diario-La Prensa, 29 July 2009; The City of New York, “Health Disparities in New York City,” New York City Department of Health and Mental Hygiene, accessed March 4, 2012, http://www.nyc.gov/html/doh/downloads/pdf/episrv/disparitiesonesum.pdf. 46 work in poor, underserved communities, it appears that Dr. Mullan’s wishes remained unfulfilled. Parallel to Dr. Mullan’s concerns, municipal hospitals continued to struggle in attracting committed doctors to work in poor communities due to the low salaries and conditions. While municipal hospitals could attract residents for temporary work, doctors eventually left to work at other hospitals. In addition, the inability to attract primary-care physicians might also explain the lack of primary-care among Bronx residents. The New

York Times emphasized, “Because the pay is low, the best young primary-care doctors are usually not attracted to private practice in poor neighborhoods.”89 Unable to attract doctors who are willing to begin or commit to working extensively in poor neighborhoods, primary health care has remained inaccessible to South Bronx residents.

Furthermore, numerous clinics that since the 1990s had served poor neighborhoods, such as the South Bronx, closed. Decreased Medicaid funding and insurance reimbursements along with the significant population of uninsured patients made it difficult for the clinics to sustain themselves and remain open. Even those doctors who were committed to the

South Bronx residents and interested in establishing a private practice recognized that clinics were not a “financially viable model.”90 For this reason, it may not seem surprising that the Bronx is the New York City borough with the highest percentage of residents without primary-care providers.91

When Medicaid funding cuts in 2008 once again brought financial discussions to the forefront, debates over the best means to attain adequate health care also emerged.

Federal changes to the allocation of Medicaid funds meant that New York City’s eleven public hospitals, including Lincoln Hospital, could lose at least $390 million a year. The

89 Jennifer Steinhauer, “Financial Struggles,” New York Times, 17 April 2000. 90 Steinhauer, “Financial Struggles at Medical Clinics for the City’s Poor,” New York Times, 17 April 2000. 91 The City of New York, “Health Disparities.” 47 effects within hospitals if they lost significant Medicaid funds was a crucial concern, but more specifically, the central focus of controversy involved the elimination of medical students’ reimbursements.92 A considerable portion of the Medicaid funds hospitals received were typically allocated for training of medical students, rather than utilized for direct care of poor, low-income patients.93 These differing perspectives on how Medicaid funds might best be used became a divisive topic among medical staff. Some focused on what the cuts in Medicaid funding could mean for patients, while others considered the repercussions of decreasing medical training as a result of losing Medicaid reimbursement funds. The conversations over Medicaid funding not only provide insight into the allocation and usage of hospitals’ economic resources, but also provide important perceptions of how doctors and health care providers might understand health care.

While some doctors argued that usage of funds would be most efficient and effective through direct services, treatments, and preventative care, others argued that utilizing funds for medical training could provide more and better trained doctors.94

Tensions over funding are a difficult, but an important conversation to consider because it could determine the future of medical care and the nature of doctor-patient interactions.

Training seems especially important in poor neighborhoods where working conditions are noted as undesirable, stressful, and inadequate—such as those at Lincoln Hospital.

However, diverting Medicaid funds towards medical training may not necessarily translate into better care, especially if doctors are not invested in their patients and the community they serve. Still, a major concern that would remain from this discussion was

92 Kirsten Danis, “City Hospitals Face $390M Cut in Aid,” New York Times, 14 May 2008; Anemona Hartocollis, “Cuts in Medicaid May Mean Billion-Dollar Loss to New York for Training Doctors,” New York Times, 14 May 2008. 93 Hartocollis, “Cuts in Medicaid,” New York Times, 14 May 2008. 94 Hartocollis, “Cuts in Medicaid,” New York Times, 14 May 2008. 48 whether the lack of medical training funds might lead to a decrease in future doctors that might be willing to work in understaffed hospitals, especially public hospitals.

Possibly motivated by the city’s underfunded and understaffed public hospitals, the Health and Hospital Corporation signed a controversial agreement with a Caribbean medical school to allow their students to attain clinical training at the city’s eleven public hospitals. City doctors disapproved of the HHC’s decision for several reasons. They feared that allowing “foreign” students training positions in municipal hospitals would

(1) take away positions away from qualified medical students (2) take positions away from qualified medical students in nearby institutions, and (3) that the students would lack adequate skills.95 While the possible decrease in the availability of clinical opportunities was a concern among city doctors, they mainly framed the issue in terms of the threat that it could pose to patient care. New York City doctors criticized the

Caribbean school for being a for-profit institution known to attract wealthy students who were denied acceptance at U.S. medical schools. Local doctors at the foreign school may have also received a primarily vocational rather than research-based training.96 It appears that public hospitals, such as Lincoln, were chosen for this agreement due to their most significant shortage of doctors. In fact, this agreement seems rather similar to programs

Dr. Mullan had discussed in 1978, in which the city’s Department of Health successfully recruited medical residents to receive training at hospitals situated in poor neighborhoods.97 Still, concerns about the doctors’ technical skills and their ability to interact with patients were an important consideration within the discussion.

95 Anemona Hartocollis, “City Hospitals Create Outcry in Foreign Deal,” New York Times, 5 August 2008. 96 Anemona Hartocollis, “City Hospitals Create Outcry in Foreign Deal,” New York Times, 5 August 2008. 97 Mullan, “‘Patient Wheezing ,’” New York Times, 6 February 1978. 49

Public hospitals situated in poor neighborhoods often require that doctors uphold greater cultural and language sensitivity towards patients. The South Bronx’s significant

Hispanic population makes it extremely important for translators and/or medical staff who might communicate in different Spanish dialects, or at least have a basic understanding of Spanish. Still, the sentiments of hospital administrator Dr. Lacot and El

Diario-La Prensa journalist Pagani regarding the struggles of Spanish-speaking population at Lincoln Hospital would still remain relevant decades later.98 In response to the language barriers that continued to hinder patient care at municipal hospitals, anthropologist and health care advocate Elena Padilla wrote Lower the Barriers: An

English-Spanish Transcultural Glossary for Medicaid Managed Care Providers.

Published in 2000, it was specifically aimed for medical staff at municipal hospitals, to ensure that doctors employed in city hospital have access to meical and condition terminology in Spanish.99 However, in some cases, the patients themselves would serve as interpreters for one another and assist in creating a more welcoming atmosphere.

In 2002, Dr. Jauhar Sandeep wrote observations about his experiences working night shifts at Lincoln Hospital’s emergency room in his article titled, “Cases: Comedy,

Tragedy, and Coping.” While he aimed to present the numerous, distinctive coping mechanisms of Lincoln’s emergency room patients, he demonstrated the communal and friendly atmosphere that could potentially exist at Lincoln Hospital despite understaffed facilities and continued struggles for timely care. At first glance, Dr. Sandeep’s observations might appear to sensationalize the hospital, as it vividly describes the sound

98 Judith Pagani,“Señalan Insensibilidad Médica Hacia Pacientes Habla Española,” El Diario-La Prensa, 21 July 1970. 99 Elena Padilla and Nelky Ramirez, Lower the Barriers: An English-Spanish Transcultural Glossary for Medicaid Managed Care Providers (Bronx, NY: St. Barnabas Hospital, 2000). 50 of gunshots and unusual behaviors from drunks, drug addicts, and prisoners. However,

Dr. Sandeep instead presents a vivid image of a hospital where the patients looked out for each other. In the midst of the “party” atmosphere, as a Lincoln Hospital nurse described it, patients translated and entertained one another, “A 52-year-old [patient] started doing a stand-up routine…his audience wheezed its approval. Between laughs, the patients translated for me.” One patient “wiped away a tear” while another asthma patient “gasped for breath” after both laughed so intensely at the man’s jokes.100 The positive attitudes in the midst of adversity and health difficulties astounded Dr. Sandeep and motivated him to write this article. In this situation, it was as if Dr. Sandeep had much to learn from patients’ coping with illness.

Interestingly enough, the kind of atmosphere that Dr. Sandeep described in the article presented Lincoln as a safe haven for patients in the midst of the chaotic societal environment surrounding the hospital. A nurse interviewed described the polar environments as follows, “In the asthma room, the patients don’t fight. The tough guys outside are the drunks. They always want to bite us, to cut us. Here it’s different. Here everybody gets along.” The surrounding South Bronx community where Lincoln Hospital was located may have been volatile, but according to the nurse and Dr. Sandeep, the hospital was an area where patients got along, their coping mechanisms proved effective, and they were “treated without unnecessary delay.”101 Despite Dr. Sandeep’s attempt to provide a distinct perspective of the interactions at Lincoln Hospital, the rise in law suits and fines against the hospital would highlight the ongoing struggle to address malpractice and medical fatalities. Dr. Sandeep’s claim of prompt care was debatable among patients

100 Sandeep, “Cases,” New York Times, 15 January 2002. 101 Sandeep, “Cases,” New York Times, 15 January 2002. 51 and staff considering that the understaffed facilities were often discussed as being unable to keep up with incoming patients, leading to long waiting periods in the emergency room. Although the article highlighted positive aspects about the coping mechanisms that patients employed, it also presented potentially misleading praise regarding Lincoln

Hospital’s care.

As one of the busiest facilities in the nation, Lincoln Hospital should uphold even greater responsibility to ensure excellent patient care.102 However, a 2009 Daily News report revealed that Lincoln Hospital actually had “the worst record of any city-run medical center when it comes to reporting in-hospital deaths caused by medical mess- ups.” Despite 213 incident reports, it appeared that the Health and Hospital Corporation was inadequately enforcing regulations. Even after such accumulation of citations for failing to report fatal medical errors, Lincoln Hospital only incurred about $14,000 in penalties.103 This may not have been sufficient pressure for hospital administrators to take action and address the issue regarding fatal medical errors. These statistics demonstrates that even after attaining new facilities, Lincoln Hospital was unable to conceal persisting underlying issues of dignified and adequate medical treatment. In fact, shortly after the new facilities opened, a Lincoln Hospital patient died from accidental malpractice.

Although specific individuals were not blamed for his death, an investigation revealed that the death was preventable if physicians had been present in assisting residents.104 As a recurring issue, malpractice might become more salient for Lincoln Hospital administrators as lawsuits pressure the hospital to address the issue. It is unfortunate that

102 The City of New York, “About Lincoln Hospital.” 103 Tina Moore, Benjamin Lesser, and Greg Smith, “Hospital Specializes in Hiding Fatal Errors,” New York Daily News, 28 July 2009. 104 “Procedure Studied in Lincoln Hospital,” New York Times, 2 August 1978. 52 this has remained an issue despite numerous efforts to improve patient care, and the extensive criticism the hospital received following Carmen Rodriguez’s death in July

1970. Indeed, alternative approaches and discourses for addressing the continuing concerns of negligence, overcrowding, and long waiting periods at Lincoln’s emergency room have emerged from community residents and hospital employees.

Constructing Alternative Discourses

Patients as well as their relatives and friends have continued to advocate for the importance of dignified care from doctors and medical staff. As a concerned friend of a patient, Gloria Altieri noted the following to a New York Times journalist, “I cannot question their medical expertise. But I know about dignity.”105 Not only is it important to have adequately trained doctors, but also for patients to receive dignified and respectful treatment at the hospital. According to this statement, adequate medical services and dignified treatment may be considered as different, but equally important aspects of health care. Despite witnessing inhumane care at Lincoln Hospital, Altieri remained committed to the South Bronx community, where she ran a child development center in a public school. Her dedication to the South Bronx was especially important due to the need for adequate treatment and services. It insinuated that poor access to dignified treatment should not mean that one has to seek care else, but rather one should vocalize and demand it.

Recognizing the societal circumstances affecting its patients, Lincoln Hospital and its staff members have participated in both institutional and grassroots efforts to draw attention to community needs in addition to addressing health care access. Since 2000,

Lincoln’s literacy program “Pediatrics Heads Up Reading Program” has sought to

105 David Gonzalez, “In Bronx, a Fight for Health and Dignity,” New York Times, 26 July 2005. 53 address illiteracy and deficiencies in language development among its child patients coming from low-income households. With each visit, children under the age of 5 receive age appropriate books to take home.106 However, this effort may pale in comparison to those of Maria Ramos, a Lincoln Hospital employee who started the notable Taxi and

Limousine Health Screening Program. As director of Lincoln Hospital’s Community

Health Education, Maria Ramos, established and facilitated collaboration between the hospital and local cab drivers, using her connections with Lincoln Hospital to create a program that would serve the needs of community residents through a “service model.”

The program functioned as follows: Lincoln Hospital nurses went to the headquarters of the numerous cab companies (about 120 total throughout the Bronx and East Harlem neighborhoods), announced on the radio “Lincoln Hospital is in the house,” and drivers then made their way to the headquarters for health care services. The drivers would sometimes bring their families as well, demonstrating the extensive potential of this service program to reach several generations of low-income populations.107 Ramos’ service models embodied the Young Lords’ tuberculosis truck and Dr. Mullan’s vision of engaging medical staff within the communities they served.

Even decades after the organization of the Young Lords Party was no longer active, their strategy of addressing inequalities through a combination of community engagement for societal concerns and direct services resonated in Maria Ramos’ approach. For Ramos, it was important to not only support informational campaigns, but also to provide direct patient care to community residents, “Instead of just going out and giving flyers, we do initiatives that are related to the health care needs and disparities in

106 The City of New York, “Lincoln Achievements.” 107 Clem Richardson, “Bringing Better Health to Workers on the Go,” New York Daily News, 8 December 2008. 54 the community.”108 Ramos’ service model of actually going into the communities and providing medical services makes health care accessible to a population that otherwise might struggle to find time and resources to receive preventative and/or treatment care.

Still, even with direct health services at the forefront of the Taxi and Limousine

Health Screening Program, Ramos also recognized the numerous societal factors that account for why health care may not be prioritized in poor communities. Cognizant of the housing, welfare, food, and safety concerns of South Bronx residents, Ramos worked with several city agencies to also provide their services, as well as assisting the cab drivers on housing applications and welfare benefits to name a few. She explained,

“Many issues can get in the way of health care…if you don’t have housing, you can’t think about health…if you don’t have food, you can’t think about health…we start with the quality-of-life issues first, then we talk about health.”109 Ramos emphasized that the working poor might be unable to prioritize their health due to other societal concerns, not necessarily because the community is unmotivated. The varied components of Maria

Ramos’ program demonstrated that while medical service is a crucial aspect of conceptualizing health care, it is also important to consider quality of life issues that may impede health.

After a press conference held at Lincoln Hospital, South Bronx residents similarly highlighted the quality of life issues negatively affecting their community. On December

27, 2011, Mayor Michael Bloomberg chose Lincoln Hospital to deliver a speech announcing that the life-expectancy for 2009 babies had increased in New York City, and

108 Richardson, “Bringing Better Health,” New York Daily News, 8 December 2008. 109 Richardson, “Bringing Better Health,” New York Daily News, 8 December 2008. 55 even surpassed the national average.110 While pointing to health campaigns launched under his administration, Mayor Bloomberg especially emphasized the efforts of city residents for contributing to these promising statistics. Mayor Bloomberg stated, “It’s the people in this city that have really done the work, with some help from city- government.”111 Yet it was not clear that higher life expectancies or Mayor Bloomberg’s comments were applicable to the South Bronx community where he held the press conference and that Lincoln Hospital served. Instead, his explanation misrepresented poor communities and implicitly blamed them for the inability to achieve the same results.

South Bronx residents asserted a different image of health conditions and health care in their community while also offering alternative explanations. Although their motives for choosing this location remain unclear, the fact that the Bloomberg administration chose Lincoln Hospital is noteworthy for several reasons. Besides boasting a high birth rate, Lincoln Hospital is an unusual location to highlight improved life-expectancy rates considering the prospects were not as optimistic for poorer neighborhoods. Situated in the South Bronx, one of the poorest Congressional districts in the United States, it seems unlikely that the life-expectancy Mayor Bloomberg announced would be applicable to the majority of Lincoln Hospital patients. According to the New

York Daily News, “The Bloomberg administration didn’t release a borough-by-borough breakdown, but he acknowledged the news wasn’t as good in poorer neighborhoods.”112

Still, the press conference presented several implications for the hospital and its

110 Kate Taylor, “Life Expectancy for Babies Climbs to Record Level in City,” New York Times, 28 December 2011; Corinne Lestch and Tina Moore, “The Livin’ is Longer: Life Expectancy in City Rises Sharply & Now Exceeds the National Average,” New York Daily News, 28 December 2011. 111 Lestch and Moore, “The Livin’ is Longer,” New York Daily News, 28 December 2011. 112 Lestch and Moore, “The Livin’ is Longer,” New York Daily News, 28 December 2011. 56 surrounding community. First, choosing Lincoln Hospital as the location to present information regarding the average life-expectancy for New York City residents positioned the hospital as representative of the city’s overall health system. It appears that the Bloomberg administration’s decision to host the press conference on improved life- expectancies at Lincoln directly linked the hospital with positive advancements in health.

Second, it reinforced the positive images that Lincoln Hospital administrators have attempted to promote. Still, the reality at Lincoln Hospital suggested otherwise.

When Mayor Bloomberg took the podium at Lincoln Hospital to proclaim improvements in New Yorkers’ health, South Bronx residents instead used the opportunity to point to health care disparities and the unmet health needs of their community. The news coverage of the press conference allowed for South Bronx residents to respond to Mayor Bloomberg’s findings and attributions of the improved life- expectancy prospects, providing a broader view of health care issues and emphasizing on-going challenges. While it seems unusual to highlight New York City residents’ overall health improvements in a neighborhood where better life-expectancies may not be the reality, the media coverage at Lincoln permitted South Bronx residents to discuss their perspectives of the issues. The resident discourses following Mayor Bloomberg’s press conference provided further insight into the societal inequalities affecting the community, which expanded from solely focusing on the inadequacies of Lincoln

Hospital and its failure to serve the South Bronx community. Their assertion of socioeconomic imperatives and the broader health needs of their community provided a contrast to Mayor Bloomberg’s emphasis on individuals. 57

From the residents’ perspectives presented in the New York Daily News, the South

Bronx community did not believe that the statistics showing improved life-expectancy rates were applicable for their community. Instead, community residents pointed to broader social issues, such as a lack of access to the healthy choices that Mayor

Bloomberg described. According to some South Bronx residents, the less optimistic life- expectancies in poor communities resulted from inaccessibility to healthy options and economic disparities, which should be considered as interrelated. In terms of food accessibility, residents complained of the prevalence of unhealthy options in lieu of healthier fruits and vegetables. One resident observed, “Most places tend to have junk food, and there are less places you can buy vegetables. Most people don’t eat vegetables and the reason is poverty….whatever vegetables they have, people won’t buy because they’ve been there for so long.” 113 These statements highlighted the inaccessibility of healthy dietary options for South Bronx residents—where even if stores supplied fruits and vegetables, they were unlikely to be fresh. Despite city initiatives to increase the availability of fresh produce in poor neighborhoods, South Bronx residents still perceived these as relatively unavailable in their community.114

In addition, residents’ perspectives speak of poverty as a major hindrance and contributor to the existing disparities, such that affording fresh fruits and vegetables may be a more significant economic struggle in comparison to junk food options. The lack of accessibility to fresh fruits, vegetables, and exercise venues makes it challenging for poor

New York City neighborhoods to attain as positive health and life expectancy outcomes

113 Lestch and Moore, “The Livin’ is Longer,” New York Daily News, 28 December 2011. 114 The City of New York, “Farmers’ Markets—Bringing Fresh, Nutritious Food to the South Bronx: A Neighborhood Report from the Bronx District Public Health Office, 2008,” New York City Department of Health and Mental Hygiene, accessed March 16, 2012, http://www.nyc.gov/html/doh/downloads/pdf/dpho/dpho-farmersmarket.pdf. 58 as wealthier city residents. When questioned about the less than optimal health statistic in poorer neighborhoods, Mayor Bloomberg responded, “There’s no question we still have a challenge with that.”115 Although it is unclear whether he spoke on behalf of ameliorating health services or access to healthier lifestyles, it is important to note that the two are complimentary and important for understanding the persistent struggles that poor, underprivileged communities have encountered in achieving adequate health standards and care.

Despite the importance of new facilities, the “new” Lincoln Hospital only temporarily concealed the continuing discourses and issues of patient care. As an underfunded and understaffed municipal hospital, great limitations remained on the

“new” facilities potential to improve the health care services provided and the perceptions of the hospital. Mayor Bloomberg’s press conference provided insight into the competing perceptions of Lincoln Hospital while also revealing underlying realities for patients, not only at Lincoln but within their societal context. While the Bloomberg administration has focused extensively on health campaigns that promoted healthy, individualized choices and living, it has also promoted a health care discourse in which the individual is the central means to achieve improvements. Yet, the South Bronx residents’ perspectives and the interactions among Lincoln Hospital patients demonstrated a communal approach to health care similar to that espoused by the Young Lords Party, through which changes are achieved at the systemic level. South Bronx residents engaged in a discourse about the societal circumstances of their communities and the effects on health disparities. Despite the absence of social movements, such as those witnessed from the Young Lords Party,

115 Lestch and Moore, “The Livin’ is Longer,” New York Daily News, 28 December 2011. 59 there have been continued efforts to improve health care and to formulate alternative discourses.

60

Conclusion

For the Young Lords, health care was part of a larger political agenda, which at its core, sought to protect the rights of “Third World People.” With an explicitly socialist agenda, the Puerto Rican activist group incorporated ideas of community control and self-determination in their efforts to address social, health, education, and sanitation issues. At Lincoln Hospital, the Young Lords sought to address these inter-related social justice issues with the South Bronx community and to promote community control and self-determination. Community control meant that the insight of community residents’ and patients’ needs should be at the forefront of the decisions regarding accessibility to patient services and treatments. Self-determination implied liberation from Lincoln

Hospital as an institution that subjected the underprivileged patients and South Bronx to oppressive circumstances—inaccessibility to essential services, as well as indecent and inhumane patient care.

The Young Lords insisted that capitalism was responsible for the oppression of underprivileged populations. By focusing their efforts at the institutional and systemic level, the Young Lords hoped to break down the barriers that continued to oppress populations, such as South Bronx residents. When promoting self-determination, the

Young Lords not only addressed issues of equality, but they also perceived “liberation from oppression at the level of society and state” as essential.116 Hence, embedded within their efforts to promote community control at Lincoln Hospital, the Young Lords sought to improve health care for South Bronx residents through implementing institutional changes. Rather than discussing ways in which patients could attempt to prevent illnesses

116 Lorrin Thomas, Puerto Rican Citizen: History and Political Identity in Twentieth-Century New York City (Chicago: The University of Chicago, 2010), 237, 240.

61 and medical conditions, the Young Lords focused on the ways that the institution failed patients and community residents.

In 1970, while the Young Lords emphasized a commitment to the South Bronx community through their advocacy for dignified and humane services, the New York

Times revealed that some Lincoln Hospital doctors instead promoted the more traditional notion of professionalism. For the doctors, professionalism meant that medically-trained professionals should be in charge of making decisions within the hospital. As described in the New York Times, doctors, understood community control and professionalism as opposing concepts, yet the Young Lords believed that ideas of professionalism and community control could be incorporated simultaneously. For the Young Lords, it was imperative that doctors recognized and integrated the needs of the community into their medical practice—an understanding and practice that medical allies such as the Health

Revolutionary Unity Movement (HRUM) and the Think Lincoln Committee (TLC) often conveyed. While maintaining this relationship was important, the Young Lords hoped that community residents and patients would become empowered within the hospital to make-decisions regarding the accessibility of treatments and of services they perceived as necessary.

Although the perspectives of several Lincoln Hospital doctors during the early

1970s focused heavily on the notion of professionalism, the story of Carmen Rodriguez began to reveal a health discourse with an emphasis on individual people and circumstances. As revealed in the New York Times, Dr. Smith, Department Chief for

Obstetrics and Gynecology, and his supporters discussed the abortion-related death of

Rodriguez as an unfortunate tragedy that resulted from her heart condition, which doctors 62 failed to identify.117 By attempting to remove Dr. Smith from office, the Young Lords attempted to hold Dr. Smith responsible for the medical errors of his department. In targeting the department chief, the Young Lords sought to hold Lincoln Hospital, as an institution, accountable for the indecent and inhumane treatment its doctors provided.

For the Young Lords, systemic mechanisms were important for improving the doctors’ protocols when providing services and preventing further exploitation of poor, underprivileged populations. However, rather than notice institutional problems, Dr.

Smith and his supporters continued to frame Rodriguez’s death in terms of her medical condition. Still, the phrase “fired by the people,” describing the pressure that allowed community activists, the Young Lords, HRUM, and TLC to temporarily remove Dr.

Smith from his position encompassed the goals of the community control and self- determination. “Fired by the people” represented how institutional changes could be achieved through a shift in the traditional power relations. Although Dr. Smith returned to his position as department chief, his removal from office demonstrated an instance in which the media could perceive the power and influence of the South Bronx community.

By 1976, community control and professionalism were no longer terms that continued to emerge within the health care discussions regarding patient care at Lincoln

Hospital. Although the Young Lords Party had disbanded and was no longer an active organization, their formulation of power relations and “greedy businessmen” as sources of oppression remained evident.118 In 1978, when Dr. Mullan criticized doctors who were in the profession primarily for its economic advantages, he echoed sentiments expressed

117 Martin Gansberg, “Abortion Death Reported by City: Victim is First Here Since State Law was Relaxed,” New York Times, 21 July 1970. 118 Carlito Rovira, “The Fight Against Prospect Hospital,” Palante, 19 June 1970, quoted in Ch. 9 “Health and Hospitals,” in The Young Lords: A Reader, ed. Darrel Enck-Wanzer (New York: New York University Press, 2010), 194. 63 by the Young Lords.119 Doctors who prioritized monetary compensation over adequate and humane treatment of patients could be equated as subjugating low-income, minority populations to capitalist oppression. Similar to the Young Lords efforts, these doctors hoped to engage disconnected doctors and the hospital to promote more extensive outreach to the South Bronx community. And even in the 2000s, the activism of Maria

Ramos continued to model the ideals of the Young Lords. Her Taxi and Limousine

Health Screening Program, which provided Bronx taxi drivers and their families health services within the comforts of the taxi headquarters, bared resemblance to the Young

Lords TB truck.120 But while these efforts resulted in outreach mechanisms to address the health care needs of the community, they do not attempt to create systemic changes within the health care system—a central component of the Young Lords’ broader agenda and activism.

Demands for community control were no longer part of the health care discourse, nonetheless, the needs of the South Bronx community remained important. Together, the struggles of Lincoln Hospital to provide adequate treatments and preventative care to its patients in conjunction with societal factors have exacerbated the poor health among the

South Bronx residents. Without healthy dietary options, medical insurance, and routine health care, it might be expected for South Bronx residents to demonstrate a high incidence of medical conditions and to place a greater stress on the resources at Lincoln

Hospital. For this reason, it is important to address health needs at the community level.

Accessibility to adequate and humane routine health exams, preventative care, and treatments is the most literal understanding of improved health care. However, it is

119 Fitzhugh Mullan, “‘Patient Wheezing—Admit,’” New York Times, 6 February 1978. 120 Clem Richardson, “Bringing Better Health to Workers on the Go,” New York Daily News, 8 December 2008. 64 imperative to understand that the contributing factors responsible for the poor health statistics among South Bronx residents are not solely related to treatments and services received at Lincoln Hospital, but also to societal factors that affect the community. When the Young Lords participated in the East Harlem’s 1969 garbage offensive, in which protestors filled the streets and complained of the city’s failure to collect garbage in the community, the Young Lords pointed to the risks that unsanitary conditions posed to East

Harlem residents.121 Still, they used garbage in a metaphorical sense to criticize capitalism and government for subjugating populations to oppression and to emphasize the need to get rid of such “garbage.”

With time, it became evident that although community control and self- determination were not the terms used within health care discussions, the notion of doctors as the central decision makers in patient care—termed as professionalism during the early 1970s—did not prevail either. Instead, a third party, which usually involves insurance companies, makes the decisions regarding funding for health care, treatments, and prevention. The mere allocation of funds is potentially powerful considering that it determines what is deemed important and worthy of priority. Just as the way health care operates has evolved, changes in the health care discourses and the influencing societal conditions from 1970 to the present has also led to different means to address health care issues. As evident in Mayor Bloomberg’s health care campaign, health care has become increasingly individualized. However, South Bronx residents have continued to echo the importance of addressing issues systematically and within the community instead.

121 Yoruba, “Young Lords Block Street with Garbage,” Young Lords Organization, 1969, quoted in Ch. 8 “The Garbage Offensive,” in The Young Lords: A Reader, ed. Darrel Enck-Wanzer (New York: New York University Press, 2010), 185; Miguel “Mickey” Melendez, “Nobody Likes Garbage,” in We Took the Streets (New York: St. Martin’s Press, 2003), 88-111. 65

Through the efforts of individuals like Maria Ramos, as well as the expressed perspectives of South Bronx residents, it is evident that the Young Lords’ vision for the community has remained relevant. Locally within the Bronx, initiatives that make fresh produce more accessible to residents and inform them of this option have emerged. Yet nationally, the present health care reform debates reveal tensions between reconciling the extent to which services provided should target individuals or larger community groups.

66

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