Ruth Rothstein has always believed quality healthcare is a right, not a privilege-and she's spent more than three decades putting that belief into action by helping keep alive two Chicago-area hospitals that serve the poor.
At Mount Sinai Hospital on the city's West Side, where she served as president and chief executive officer from 1972 to 1990, Rothstein reached out to the mostly black and Hispanic neighborhoods surrounding the hospital. She managed to retainmost of the hospital's medical staff despite the departure of its medical school partner.
As chief of the Cook County Bureau of Health Services--a job she began when most people would have been contemplating retirement--Rothstein, now 80, pulled together a coalition to rebuild the physically obsolete Cook County Hospital. That facility, which opened in 1914, was the inspiration for the overburdened public hospital on TV's "ER." She also opened two dozen community clinics and an infectious-disease center that bears her name, and quieted what had been raucous relations with the hospitals' unions.
"She has an unbelievable commitment to the cause of good healthcare for all people, regardless of whether or not they have money," says John Stroger, president of the Cook County Board, for whom the new 464-bed hospital is named. "She has been instrumental in developing the healthcare system in Chicago. Working at Mount Sinai, she brought it from the bottom to the top, and she has done the same for the Bureau of Health."
Richard Davidson, president of the American Hospital Association, praises Rothstein for keeping her eye on the twin bottom lines of fiscal and social responsibility. "She's built and enhanced the reputations of institutions that serve the underserved," he says. "When people think about Ruth, they think about an advocate for the underdog-and she has been very successful at it. Places that might normally have had serious financial difficulties, she's managed to make them healthy."
"She has a deserved reputation for being tough, but people sometimes miss the compassionate person that's underneath that," says her son, Jonathan Rothstein, deputy chief of human resources for Cook County. "She's a person of huge compassion and a real capacity to empathize with people less fortunate than her, but more importantly with a strong desire to take those insights and convert them into action that will help people."
Rothstein's toughness, compassion and desire to help those less fortunate all have roots in her childhood during the Depression in the hardscrabble, immigrant Jewish neighborhood of Brownsville in New York. The daughter of a shoe worker and union organizer, Rothstein had a bent toward social change early in life and worked in the union movement for a number of years before entering healthcare.
"I grew up at a time when people spoke on the street corner for justice and equality. I did it when I was 11," Rothstein says. "People in my community were poor, we needed to band together, we needed to organize, to bring about social change, and indeed we did. I believed working with the union was one way of making that change. As I got older, I found out there were other ways to make change."Union roots
Upon graduating high school, Rothstein-who never had formal education beyond that point-went to work for the Communication Workers of America in New York, then the United Electrical, Radio and Machine Workers of America, in Cleveland. She moved to Chi-cago to be an organizer for the electrical workers, but she found they were planning to fire another woman and hire Rothstein in her place. "I wouldn't do it," she says. "I said, `You're not going to use me to do this. You need to do this on your own without me. You should have done it before I got here.' "
Instead, Rothstein went to work for the United Packinghouse Workers, where she helped expose hiring discrimination in a Swift & Co. packing plant in Chicago. At the plant's hiring hall, she heard a man announce: "We have no jobs today," at which point the black women all left. When Rothstein stayed after hearing the announcement, she and a group of Polish women, all there with interpreters, were brought into the back and given jobs. "I didn't know anything about working in factories, and here I am," she says. "I only stayed about a week because we clearly had enough evidence."
Upon moving to Chicago, Rothstein met her husband, David, a labor lawyer, and they had two children, Martha and Jonathan. After taking "a couple years" off to be a stay-at-home mother, Rothstein ventured into the healthcare field as a lab technician working at Union Health Service and then Jackson Park Hospital and Medical Center. After moving with her family to Evanston, Ill., and taking another year off from the workforce, Rothstein applied for an administrative position at Mount Sinai.
The CEO refused to hire her for that job because she did not have a college degree. "But he did say, `I'll hire you. I need a secretary,' " Rothstein says, gesturing to a poster on her office wall at the Cook County Bureau of Health that features a picture of former Israeli Prime Minister Golda Meir with the inscription, "But can she type?" She adds, "And I said, `But I can't type. So you're just going to have to hire someone else.' "
Rothstein eventually took another administrative job at Mount Sinai, joining the admitting department in 1966, and then moved upward to become a self-described "aide-de-camp" to the president and CEO within a few years. When her boss left, Rothstein was asked to serve on the search committee to hire his replacement.
"I decided after listening to all the people they were interviewing that I could probably do the job very much better," she says.
"They did hire somebody. And I told them that if they did that, I was not going to be there when he came. And he opted not to stay if I wasn't going to be there, so they gave me the job. They offered the job to me for very much less money, I assure you, but the money wasn't the issue. The issue was getting the job."
In doing so in 1972, Rothstein became one of few women who were not members of a religious order to become a top healthcare executive. "It never would have occurred to them to hire a woman," she says. "It didn't bother them that I was a woman. It truly didn't bother them. They just hadn't thought about it."
In the years since, Rothstein has become a role model and mentor to countless women in healthcare, says Emily Friedman, a writer and lecturer on health policy and ethics who has known Rothstein for about 25 years. "She has inspired women across the United States who are interested in healthcare careers, that it is possible for a woman to get to the top," Friedman says.
Jackie Reed, executive director of Westside Health Authority, located near Mount Sinai, counts Rothstein both as a prime mentor and the key force in keeping the hospital open during her tenure as CEO. "I liked the way she thought: She was practical, she wasn't so pie-in-the-sky, and she really did understand the issues facing the African-American community in terms of health and poverty," Reed says.
In the early 1990s, Rothstein, in her late 60s, decided to take the reins at another institution that some say might not still exist without her leadership: Cook County Hospital. After decades of people saying the physical infrastructure was crumbling and the hospital needed to be replaced, Rothstein helped create a political coalition to make it happen.
She began by persuading then-County Board President Richard Phelan to consolidate the downtown hospital with the outlying Oak Forest and Provident hospitals, jail health services and the county's Department of Public Health under one umbrella-the health services bureau-from which Rothstein will retire this spring.
She also convinced hospitals' often-fractious unionized workforce that while she might not always agree with them, she would be fair. "She could be a hard bargainer but always a fair bargainer, always looking to solve problems instead of keeping problems going," says Tom Balanoff, president of Local 1 of the Service Employees International Union.Expanding access
During the next several years, Rothstein expanded the county's constellation of community clinics from six to 30 and led the opening of a facility to handle infectious diseases and AIDS, called the Ruth Rothstein Core Center. The expansion of ambulatory clinics was probably Rothstein's biggest contribution, says Jack Raba, chief operating officer at Cermak Health Services, which provides healthcare at the Cook County Department of Corrections.
Others would say the main hospital, which had lost accreditation and was both fiscally and functionally challenged, proved her most significant triumph. A county study showed a new hospital would be not only more cost-effective but more humane, Rothstein says.
Her determination helped lead to the opening of John H. Stroger Jr. Hospital of Cook County in December 2002, with a final price tag of more than $630 million.
Friedman hopes that Rothstein's legacies continue. "If she is treated as some kind of an anomaly-if nothing moves forward in terms of the coverage of health of communities or women achieving high positions, she would be horribly disappointed," Friedman says. "There's a terrible tendency in healthcare to focus on personalities. The problem with personalities is that they become one-shot deals, and that is not what she wants."
"For me, it wasn't a job," Rothstein says. "It was a way to make change."
Ed Finkel is a freelance writer based in Evanston, Ill. He can be reached at firstname.lastname@example.org.