And There the Heart Remained: A Critical History of Alachua General Hospital in Gainesville, Florida, 1945-2009 Joy Liu Thesis submitted in partial fulfillment for Honors in Science and Society, A.B. April 2011 Adviser: Lundy Braun, Ph.D. Second Reader: Deborah Weinstein, Ph.D. © 2011 Joy Liu. All rights reserved. Table of Contents Acknowledgements i Foreword iii Introduction 1 Chapter 1: Expansion of the 16 Hospital and Professional Boundaries, 1945-1959 Chapter 2: Reform and 50 Governmentality, 1960-1969 Chapter 3: “We believe healthcare 79 is more than just a business:” incorporation and competition, 1970-1995 Chapter 4: AGH in Critical Condition, 1996-2009 110 Conclusion 141 Bibliography 157 Appendix 1: Timeline of Alachua 181 General Hospital Appendix 2: Memories of Alachua 184 General Hospital Appendix 3: Historical 198 Photographs Acknowledgements This section, to borrow from the ecological framework, shows that no one person can produce a work of this size without the support of those around her. First, I must thank my adviser, Professor Lundy Braun. Her class, “Health Inequality in Historical Perspective” got me started on the history of medicine in the first place. I could not have written this thesis without her constant guidance and encouragement. Professor Debbie Weinstein, my second reader, offered keen insights and deserves huge credit for the completion of this thesis. Her class, “Health and Healing in American History,” provided a solid foundation for my understanding of the history of American medicine. My family gave me reports on AGH from the ground in Gainesville and unfailingly supported me the whole way through. Thank you for always being there. My friends, from Brown and Gainesville, were sympathetic to my spontaneous and sometimes nonsensical expositions on hospital history, and I thank them for humoring me, and for reminding me that there is life after a thesis. There are many people at Brown who in some way contributed to this project. Dr. Timothy Empkie and Dr. Albert Wessen gave both their enthusiasm and their experience on this project in its planning stages. My Science and Society senior seminar, taught by the excellent Catherine Bliss, familiarized me with the theoretical background for this thesis, and I thank my co-students for offering feedback. I also thank the Dean of the College, the Office of Biology Undergraduate Affairs, and the Department of Science and Society, for providing financial support (so many articles, so little PawPrints left). I am lucky to have such a strong research base in Gainesville with such enthusiastic and dedicated local historians. The Matheson Museum archives were a i bonanza of historical resources with a team of extraordinarily accommodating staff and volunteers (who occasionally provided delicious food). Special thanks goes to Sam Putnam and Chloe Richardson, who were always ready to help. At Shands Hospital, Kim Rose was a crucial connector and veritable fountain of knowledge. Nina Stoyan- Rosenzweig, a Brown graduate who is now the director of the University of Florida Medical Humanities program, Garrett Hall and Tina Mullen, helped me locate resources and entrusted me with valuable material. I especially thank Florence van Arnam, who introduced me to several of the folks I interviewed, and whose passion for AGH and medical history was inspiring throughout. It is people like Florence who “keep the spirit of AGH alive.” I’d also like to thank my interviewees, who will remain anonymous. They agreed to speak with me on a politically sensitive local issue, and in some cases, sought me out to speak passionately and eloquently about the hospital that they loved. ii “A fitting tribute would be to keep the hospital open.” Alachua General Hospital memory wall, 2009 Foreword I have never been a patient, nor set foot on AGH’s premises, before writing this thesis. Somewhat ironically, I became interested in the story of AGH as it was nearing its end in 2009. I followed the story of the closing of AGH in the Gainesville Sun with fascination during winter break. The closing of the hospital seemed to provoke a visceral outcry from some and apathy from others. I became excited by the idea of uncovering a trajectory that pointed to reasons for the hospital’s closing, and comparing AGH to other hospitals, specifically, Shands Teaching Hospital, the academic research hospital affiliated with the University of Florida, which is belongs to the same corporate parent. What I ended up working on is a critical history that may indeed point to reasons for the hospital’s closing, but more importantly, develops a theory of how the community hospital functions as a mediator of medicine and society. Once I delved into the history of AGH, I realized that the story of AGH was much more than just the story of a cluster of buildings that made up the hospital campus. The lifelong friendships and pride in displays of compassion revealed a deeper connection to the community than I guessed. The story of AGH was the story of Gainesville itself—a small Floridian town that is living out the changes that liberalizing forces (from the University of Florida), a more pronounced market economy, and social trends have wrought on the “old-time” way of living. iii Thus, my goals in writing this thesis are two-fold. First, to bring hidden stories to light: to show how AGH’s staff, administration, and productions were shaped by sociopolitical factors that influenced perception of medical care in the community. Second, to suggest that the past shapes the future: that a historical approach to healthcare, with an emphasis on local texture, can and should be considered in healthcare policy. Gainesville is a town in flux. Many relatively new residents, like me, were never patients at AGH and never experienced “family-like” care at the hospital, and in all likelihood, will not remember AGH. But those who did certainly will. While it is not possible to bring AGH back, this thesis is my contribution to the hospital’s story, and to the people who love it still. iv Introduction Beyond the chain link fence and cracked asphalt, tangled metal rods rust next to piles of dusty brick. Buildings that look bright and functional on one side have gaping holes and shattered windows on the other. Bits of plaster are heaped next to live oak trees that sag with Spanish moss; a resting backhoe completes the scene. What is most jarring is the absolute stillness in this moment of destruction—just a few months ago, this same view would have been filled with patients, doctors, nurses, volunteers, and employees coming and going from the hospital. Alachua General Hospital (AGH) served Gainesville, Florida and the surrounding area of North Central Florida from 1928 to 2009.1 The hospital grew alongside Gainesville, and saw it through times plentiful and lean. AGH fashioned itself as a hospital that provided family-like loving care based on expert medical knowledge and old-time values. In 2008, AGH’s parent corporation Shands HealthCare announced that AGH would be closed the following year because of financial difficulties. When AGH closed, Gainesville lost a historical institution and source of medical care for many of the county’s poorer residents. At a tribute ceremony for the hospital a month before its closing, Mayor Pegeen Hanrahan, who was born at AGH herself, proclaimed October 9th Alachua General Hospital Remembrance Day.2 Dr. Richard Anderson, who practiced at AGH for over 40 years, said of the hospital’s closing, "I'll try not to cry. I feel like I'm losing my hospital 1 Gainesville shares many of the same anthropological characteristics of other small southern college towns, with one observer noting its “evidences of the past, a stagnant downtown with a surrounding area of [black] quarters and modest homes, but a plethora of university-spawned suburban housing developments, quick-food establishments, and shopping centers.” T M Johnson and G H Stein, “Politics and personality in medicine: genesis of an indigent clinic.” American Journal of Public Health 65, no. 3 (March 1975): 253- 259. 1 home…I was born there, my grandmother died there, my father died there, and I figured eventually I would die there. But I don't want to speed up the process just because they are closing the hospital."3 The emotion, mostly of gratitude and fondness, which characterizes memories of “our AGH,” has much to show us about the mythos of community hospitals in small communities. This thesis intends to explore, through an ecological framework of healthcare, how the history of AGH reflected trends in community hospitals in the United States. My retelling of the history of AGH, filtered through my understanding of works in Science and Technology Studies, history, sociology, and policy, is intended to shed light on how community hospitals and the actors therein define and manage or provide community- based medicine, and thus how the hospital mediates medicine and society.4 Background and Aims: Hospital as Mediator of Medicine and Society Over the last three centuries, popular perceptions of American hospitals have been transformed from that of holding pens for the destitute and deranged to prestigious, technologically rich institutions that specialize in advanced medical treatment.5 As standard bearers for the medical field, hospitals have become the gatekeepers of illness, 2 See Picture 15 in Appendix 3. 3 Albert Isaac, “The End of an Era--Alachua General Hospital Closes,” Senior Times Magazine, October 2009, http://www.seniortimesmagazine.com/features/805/the-end-of-an-era. 4 Robert Starke defines “instrumental case study” as a “study undertaken to provide insight into a particular issue or refinement of theory, case of secondary interest and looked at in depth, its contexts scrutinized in order to help us understand the external interest.” The SAGE Handbook of Qualitative Research, 3rd ed.