As City Fades, UPMC Mckeesport Hospital Ends Care for the Most Serious Heart Attacks

City parking garages stuffed with cars and stores thriving up and down the block are Mike Kostyzak's memory of McKeesport when he was a child.

"McKeesport was no joke," said Mr. Kostyzak, 62, who grew up in Glassport, a neighboring mill town 3 miles away.

Today, McKeesport is a husk of what it was, with more than one out of four residents living in poverty and an ongoing campaign to demolish boarded-up storefronts in the once bustling downtown.

As the city faded over the past 10 years, UPMC McKeesport Hospital cut its workforce and medical services, shrinking its role as an economic pillar in the struggling Monongahela Valley town.

"Buddy, as much as I hate to say it, it's all about the money," said Mr. Kostyzak, 62, who opened Zak's Bicycle Shop in 2009 on a main drag in McKeesport after getting laid off from a radiator shop. He said he can't afford health insurance. "It's the sad reality."

In recent years, McKeesport Hospital, located 15 miles southeast of Pittsburgh, closed its two-bed intensive care unit, referring critically ill patients to other hospitals.

The hospital has also ended emergency care for the most serious heart attacks, called ST Elevation Myocardial Infarction or STEMI, which mostly tend to be more severe and dangerous. About 40% of heart attacks are STEMIs, according to the Cleveland Clinic.

Civic leaders worry that financial pressures will force the eventual closure of UPMC McKeesport Hospital, but a spokeswoman says that's not in the plans.

Heart disease is the leading cause of death in the U.S., according to the Centers for Disease Control and Prevention. Snaking a catheter into the arteries that feed blood to the heart muscle has long been the most effective way to treat heart attacks caused by a clot, which are often fatal.

Doctors inflate a tiny balloon to open clogged vessels, trying to limit "door to balloon time" to less than 90 minutes to save heart muscle from dying. Every minute counts.

But not every hospital has the staff and equipment to do the procedure, and knowing which ones offer it can be difficult for patients, especially during a medical emergency.

"It should not be a matter of chance or geography that determines what kind of care a heart attack patient receives," Thomas R. Aversano, associate professor of medicine at Johns Hopkins University, wrote in a landmark 2002 study that found that emergency angioplasty was superior to clot-busting drugs in the treatment of the most serious heart attacks.

UPMC acquired McKeesport Hospital in 1998 and soon discontinued maternity care, but other services were added over the years.

The hospital continues to operate a busy emergency room — 26,470 patient visits in 2020 — and recently opened a 27-bed addiction medicine unit.

Despite these changes, the hospital reported an operating loss of 10% in fiscal 2022, according to the Pennsylvania Health Care Cost Containment Council, with flat net patient revenue between 2019 and 2022 as hospital admissions statewide sunk to 1.37 million, the lowest since 2008.

Fewer hospital admissions mean less operating revenue.

UPMC McKeesport Hospital offered emergent angioplasty as recently as 2020. UPMC's Mercy, Presbyterian, and Shadyside hospitals in Pittsburgh continue to offer the care along with East and Passavant hospitals, in the suburbs of Monroeville and McCandless.

Quick access to emergency angioplasty is not just an issue for people living in McKeesport; rural EMS services take "significantly longer" to get patients with a STEMI heart attack to definitive care than in urban areas, according to a 2023 study in the journal Prehospital Emergency Care.

Heart angioplasty, for example, is not available at all in Greene, McKean, and other rural counties.

Today, UPMC McKeesport Hospital sends STEMI patients to other hospitals, and even though emergent angioplasty is no longer done at UPMC McKeesport, a system webpage still listed the service as of Friday. UPMC spokeswoman Lisa Lombardo said the page would be updated.

"Patients can absolutely seek emergent care at UPMC McKeesport," cardiologist Matthew Harinstein, chief medical officer at the hospital, is quoted on a UPMC website. "There is no sense in driving half an hour outside of your community to get care when a minute or two may make all the difference in your survival."

A declining number of cases, a shortage of physician heart specialists, and the need for volume to assure staff proficiency in doing the procedure were among the reasons for ending the service, Ms. Lombardo said.

Also as of Friday, a UPMC web page for the system's family medicine residency program listed an intensive care unit at UPMC McKeesport Hospital among its assets. The beds were recently repurposed to better meet patient needs, Ms. Lombardo said.

UPMC said the scaling back of medical services in McKeesport doesn't affect care because the hospital can quickly divert critically ill heart patients to other hospitals — often while the ambulance is enroute — a practice recommended by the American Heart Association in 2004. Bill Miller, chief of the McKeesport Ambulance Rescue Service, said his service had been apprised of the changes and had altered transport priorities accordingly.

But heart attack victims don't always arrive by ambulance, and studies have shown that a number of issues, including emergency room overcrowding and time of day or night of the emergency, can delay definitive heart care, prompting the warning among physicians that "time is tissue."

"Current treatment strategies aim to provide optimal care while minimizing delays in order to improve clinical outcomes," according to a 2017 analysis that appeared in the journal Cardiology Research. "There still remains a wide range of logistic problems, including patient delays and in-hospital transfer, which can render treatment goals unachievable."

UPMC McKeesport is not alone in cutting medical services. Heritage Valley Health System shifted many services out of its Kennedy Hospital to its other facilities effective July 1, and Bradford Regional Medical Center in McKean County closed most of its inpatient units in 2021, a year after merging into the Upper Allegheny Health System.

Hospitals across the U.S. are facing many of the same fiscal challenges as UPMC in McKeesport, including having to pay premium wages for nurses and other temporary help while reimbursement for services from health insurers has been flat.

"Economic factors, the wind-down of COVID-19-related government spending and subsidies, government and third-party payor reimbursement pressures and hits to investment portfolios have placed many hospitals in a vulnerable position," Chicago-based law firm McDermott Will & Emery wrote in a new hospital industry report.

Downsizing at McKeesport Hospital mirrors the deterioration of the city over the past decade: between 2013 and 2023, the number of licensed beds at UPMC McKeesport was trimmed by 11.2%, to 205, while the workforce was cut by 24.3%, to 854 people, according to UPMC figures.

And even those numbers could continue to shrink. New UPMC revenue bond documents indicate an average of just 150 beds staffed daily at the hospital.

During the same decade, McKeesport's population slid 17%, to 17,082 while the poverty rate more than doubled, to 27.4% from 11.2%, as the community's biggest medical concerns shifted from diabetes to opioid abuse.

Nevertheless, UPMC McKeesport Hospital, which traces its roots to 1894, remains a pillar in the community.

"The hospital is a vital resource in the region," said Robert Johnson, board chair of the Mon Yough Area Chamber of Commerce, who was born at McKeesport Hospital, "a vital, vital piece of this valley. For a lot of people in town, this is their hospital."

Nearby in White Oak, where the borough is getting ready to mark its 75th anniversary, Mayor Ina Jean Marton worries that UPMC McKeesport could close — much like UPMC Braddock Hospital did in 2010 because of operating losses.

"It's important we have a local hospital," she said. "It's essential. We all go to it."

Ms. Lombardo said there were no plans to close UPMC McKeesport. The hospital is hiring for 150 open positions, even as the bed count shrinks.

"We expect fewer beds because care is shifting to outpatient," she said. "We're doing it to meet those needs. The population is changing, their needs are changing."

"It's a vibrant hospital," she said.

Kris B. Mamula: kmamula@post-gazette.com

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