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By Mike Hudson

Call it the miracle on 10th Street.

Niagara Falls Memorial Medical Center -- a modern temple to the healing arts and the largest of Niagara County's five hospitals -- has provided the highest standard of care for city residents, tourists and people from throughout the region for the past 116 years, a feat made miraculous by the fact that it is unsupported by any city, county, state or federal government and is not owned by any health care company.

"We are a single, standalone facility here to serve the public. We are not part of a large hospital organization like a Kaleida Health," said hospital spokesman Pat Bradley. "Patient revenues support the facility. We eat what we catch, you might say."

A pair of tragic accidents in 1895 provided the impetus for the hospital. An 18-year-old whose legs were badly mangled when he slipped under a moving trolley and a tourist who was struck by a slow-moving train both died enroute to the nearest hospital, at the time located in Buffalo. Two hundred Niagara Falls families pledged to donate 25 cents a month for the establishment of a hospital here.

From that humble beginning, the hospital gradually evolved into what it is today -- a 171-bed medical center with wide-ranging inpatient and outpatient services that include the Heart Center of Niagara, the Diabetes and Endocrinology Center of Niagara and the county's first accredited stroke center. With an annual budget of around $85 million, the hospital remains true to its original mission -- to provide the best health care possible to anyone who walks through the door, regardless of their ability to pay.

And remarkably, the hospital's ownership is still made up of every man, woman and child living in Niagara Falls.

For hospital CEO Joseph Ruffolo, who came to the facility during a dark financial period back in 2002, the facility's survival as a vital part of the community is a personal responsibility he takes very seriously.

"From 1998 to 2002, this hospital lost over $20 million, averaging a $5 million loss per year. Clearly, it was on the verge of bankruptcy," he said. "I knew going in that people on the outside were looking at me like I had three heads. It was like, 'Why would you want to go there?'"

For Ruffolo, who began his career in health care as a dishwasher at Niagara Falls Memorial in 1972 and has many close ties in the community, the answer was simple.

"Mainly it's the 1,100, 1,200 people that work here, I probably know half of them working here from friends and family," he said. "Many of them in the kitchen when I started working here are still in the kitchen. And so this place, not only in terms of the health care in the community, but the economic reality is it puts food on the table of 1,100 to 1,200 families. It has got to survive.

"So for me, it's a passion, it's emotional. My roots are here; I started here and I know a lot of people who work here and depend on health care and a paycheck."

With 20 percent of Niagara Falls residents living below the poverty line and a full 50 percent receiving some sort of government assistance, Niagara Falls Memorial provides nearly $7 million in uncompensated services each year. And the fact that so many here are poor leads to a general lack of health maintenance, regular checkups and testing.

"This environment would be a challenge for the World Health Organization, it really would," Ruffolo said. "We have some of the highest health indicators in terms of mortality from cardiac arrest, stroke and diabetes, a rise in teenage pregnancy, inadequate prenatal care because teens are getting pregnant and not realizing it until all of a sudden they have abdominal pain going 20 weeks in and then there are issues, then there is miscarriage."

And $7 million of charity work on an $85 million budget represents a large chunk of what would otherwise be available cash.

"I think what the community needs to realize is we need to finance that charity care," he added. "Somehow we've got to pay for the nurses, we've got to pay for the doctors, and we've got to pay for the supplies that go into caring for a population that has no insurance. Somebody's got to pay for it. And that's the challenge of the environment we live in."

But failure isn't an option, Ruffolo said.

"If there were no hospital here, it would be utter chaos. Think about where would the 30,000 yearly emergency room visits go? St. Mary's couldn't or wouldn't absorb the volume, you just can't replace it," he said. "Everyday there is an average of 50 inpatient behavior health patients, where would they go for their care? We have over 900 hours of outpatient behavior health clients, where would they go for their care? We provide over 4,500 admissions, 120,000 outpatient visits per year; where would they go?"

Falls attorney James Roscetti, who serves as chairman of the hospital's board of directors, said the facility's unique ownership status means that problems at the hospital are problems every city resident has a stake in.

"It's owned by the community, it's good for the community, it is an economic stimulant, and it employs a lot of people," he said. "We treat a lot of people, we spend money on construction, we are very lean administratively compared to other hospitals, and when we need something, we are not asking for ourselves, we are asking for something for the people we serve in the city."

Pat Bradley also pointed to the city's poor economy as a major challenge that hospital administrators deal with every day.

"It's a financially challenged city, although we have some regional services here that nobody else in Niagara County can offer," he said. "We have the only psychiatric emergency room in Niagara County here. We have the only inpatient behavioral health or mental health unit in Niagara County here. Most of the population we serve here is from Niagara Falls, and I think we all know Niagara Falls is a financially challenged city with a financially challenged population."

Despite the fact that city residents account for virtually all of the $7 million in uncompensated care, the city gives very little financial assistance to the hospital. Last year, a $250,000 grant from the casino revenue fund and a second $250,000 federal Community Development Block Grant that was funneled through City Hall constituted the city's total commitment to the hospital.

By comparison, $250,000 in casino money was given to the Hard Rock nightclub here to hold a series of rock concerts.

"You know, I am sensitive to that, because it is a balancing act. Should the taxpayers be asked to subsidize Memorial?" Ruffolo said. "We're lucky we have people paying their taxes here, period, much less having to have the burden of a tax levy to support Memorial. We don't want that."

But the most frustrating thing for Ruffolo, Roscetti, Bradley and the 1,000-plus other men and women working for Memorial isn't the constant challenge to make do with less, to provide the best health care possible despite an economy that many have referred to as "Third World," or even the life-and-death struggles that occur within the hospital's walls each and every day.

"We're looked at like hat-in-hand all the time: 'That damn hospital is begging for money again,'" Ruffolo said. "But when that same person comes into the ER with severe abdominal pain or kidney pain, it's help me, please help me, please. If you break your arm, you don't know how much you need it until you can't use it."

Niagara Falls Reporter www.niagarafallsreporter.com Jan. 18, 2011