Housing, Health, and Harvard Medical School

(This is the first in a series of three articles. Part II will appear tomorrow, and Part III, a photo feature, on Saturday.)

LAST FEBRUARY, 182 tenants of Harvard-owned housing near the Medical School in Roxbury received notice that their homes were to be demolished to make way for construction of the Affiliated Hospitals Center. About three-quarters were told that they would have to vacate by April 1971: the rest, that they had to leave by January 1974.

Then, in April, the SDS occupiers of University Hall demanded that the University cancel the evictions of these tenants, whose apartments they alleged Harvard was "planning to tear down to expand its Medical School facilities in Boston."

Housing conditions in these apartments had deteriorated badly in the months preceding the April demonstrations. As Medical School administrators later acknowledged, maintenance had been extremely deficient, and a large number of safety hazards had been left unrepaired. Some tenants had even been forced to leave their apartments when maintenance surveys revealed violations of municipal housing codes. Tenant eviction in the medical area had already begun.

SDS was incorrupt in asserting that the Affiliated Hospitals Center (AHC) would be a University-owned facility. The AHC is a collective enterprise of tee's decisions. But the committee was given no definitive powers, and Ebert ruled at the outset that it could not place under reconsideration the projected location of the AHC itself.

There were three empty tracts of Harvard-owned land in the vicinity of the Med School on which the AHC could conceivably have been located. But the housing site was selected for the AHC for two reasons: the need to reuse some of the existing Peter Bent Brigham Hospital, and what Richard D. Wittrup, now executive vice president of the AHC, called "internal relations within the medical complex."

AFTER choosing the site, the AHC assumed responsibility for relocating displaced tenants and was engaged in preliminary planning for new housing units. But within days of the University Hall occupation there occurred a transfer of this responsibility and Harvard took charge of the task. As the Fein Committee began its proceedings in late April, the University pledged that there would be no evictions until it had built new housing at comparable rents and in nearby areas.

On May 6, the Corporation announced that Harvard would build 1100 low and moderate income housing units in the medical area to alleviate the housing shortage caused by construction of the AHC. But contracting an architect and developer, producing federal subsidies for the low-income portion of the housing, S. Gruson, assistant to the President for Community Affairs, first appeared before the committee on May 12, the plans had already been made. Neither was the AHC site a subject of the committee's deliberations. Despite numerous objections by committee members, and a petition signed by over two-thirds of all first-year medical students, Fein ruled that the site question was beyond the committee's purview.

Nor were any of these decisions made in consultation with affected tenants. There were no provisions for tenant representation on the AHC governing board, and even the question of community membership on the Fein Committee was a point of sharp contention. Only after extensive debate within the committee (including, at one point, a discussion of whether the affected area fit the definitions of "community" and "neighborhood"), were representatives of five community organizations invited to join. Tenants and others in the area later worked in sub-committees and task forces as directed by the committee, but their effectiveness was limited by the narrow decision-making bounds within which the committee itself was made to work.

The AHC's decision to move the hospital site bore only an incidental relation to the fact that original plans called for the destruction of large numbers of homes. Conceivably, this decision might have been made on the grounds that many families would otherwise have been displaced, and that the subsequent loss of low-income housing would have constricted an already tight housing market. Going a step further, the decision could have been made in consultation with the tenants themselves. Neither of these things was done.

HOSPITAL construction is now planned for a site on which there is no housing, but there is every indication that much of the original site will still be taken. The AHC now maintains a permanent option on an area which contains one-third of the endangered homes. F. Stanton Deland, Jr. '36, president of the AHC and a Harvard Overseer, stated recently that if the AHC finds no use for the land in three years' time, the option will revert back to the University, and possibly from the University to other medical agencies.

And, despite Harvard's assurances to the tenants that the first evictions have been postponed until 1973, the original eviction notices have not yet been cancelled.

The University did not act on a recommendation of the Fein Committee that maintenance be undertaken in deteriorated apartments. A subcommittee survey revealed that over half of the tenants contacted felt that maintenance had been unsatisfactory. The committee ruled in June that the housing "be reasonably improved and maintained at Harvard's expense and in any event that steps be taken to eliminate hazards." Yet six months later, Stephen J. Miller, associate dean for Urban Affairs at the Med School, acknowledged, "Yes, maintainence has been-what do I want to say-lousy."

Conditions resulting from poor maintenance have been treacherous. During a rainstorm last November, leaking water dripped onto electric wires and caused a fire in a building which houses seven adults and eleven children. In another apartment, rented by a 79-year-old man and his wife, one radiator leaks and another has not worked, he said, "for a couple of years." In a third building, many of whose apartments tenants claim Harvard has sought to vacate rather than fix a broken boiler, one woman lived without heat for three months last fall. Tenants have complained about many other maintenance problems.

Nor did Harvard implement a committee recommendation that all vacant apartments in the endangered area be immediately rented. In previous months, it had been Harvard's policy to rent apartments primarily to students, interns, and other transients to case the process of eviction. In July, the committee ruled that apartments should be rented to families only. In October, the ruling was clarified as a rental policy which gave priority to families.

But the University refused to lease apartments in the area on which the AHC held an option. There were conflicting explanations of why this policy existed. At the beginning of January, Shopard Brown, vice president of Hunneman and Co., Harvard's realtor, said "We have been holding for eventual demolition and construction of the Affiliated Hospital." One week later, Med School administrators said that apartments in this zone remained unrented because the tenants' association had not provided the University with relocation plans for prospective rentees of these apartments.

Such a relocation plan had been ratified in early Septmeber by a housing and relocation subcommittee on which the tenants' association was represented. It provided that the tenants would "participate in the decisionmaking of all phases of the planning and execution" of new housing, including selection of a developer, and that the issue of tenant management would be taken up by the subcommittee with the tenants retaining a young majority.

This relocation plan was never honored by the University or even approved by the Fein Committee. In late September, Gruson appeared at a subcommittee meeting with a developer which the University-not the tenants-had selected, and informed the tenants for the first time that Harvard was engaged in filing a funding application with the federal government for the low-income portion of the new housing project. (Gruson later called the tenants' relocation plan "unacceptable.")

AT THIS point, the tenants secured a written agreement from Gruson and Ebert that the University would file no funding application without tenant approval. Since any such application calls for information concerning developing, architecture, etc., this agreement indirectly gave the tenants a veto over all plans for the new housing.

In mid-November, when the relocation plan came before the committee after being tabled the month before, Fein read a letter from Ebert which stated that the Corporation would appoint an individual to engage in final negotiations with the tenants. The committee then passed a resolution which endorsed the "spirit" of the relocation plan, and finally disbanded. The Corporation still has not appointed an individual to represent it in negotiations with tenants.

The University opened the vacant apartments three weeks ago, after the tenants had formally submitted the relocation plan to the University. But many of these apartments still have not been rented. Even outside the zone in question, whole buildings remain vacant and padlocked.

With plans for the new housing still undefined, the result of the University's actions thus far has been to threaten 182 units of low-income housing without offering any realizable alternative. The consequences of this action become more visible with a glimpse of the Boston housing market. Out of 2315 housing units built in Boston during 1969. only 109 were low-income, and all of these were publicly subsidized.

The number of low-income apartments which are in danger thus represent nearly twice the number of low-income units built in the entire metro-palitan area during the past year. And the ?? vacant apartments in the medical area which Harvard has not rented represent nearly one-third of this figure.

Federal and municipal authorities gave 550 families rental assistance last year. But with 4.000 Boston families on public and leased housing waiting lists, the housing problem gains a new dimension.

Many families in the medical area now live in six-or seven-room apartments which they rent for about $100 per month. New housing rates generally offer one to three rooms for $100 to $150. While Harvard can now break even or make a small return on its present housing by skimping on maintenance and repairs, it would be unable to avoid losing money by fulfilling its promise of comparable relocation at comparable rents.

As Gruson put it. "There's no money to be made in housing for low and low-to-middle income people." But this should be an argument for allowing the present homes to stand, rather than for excusing the University if it should destroy existing housing without providing comparable alternatives beforehand.

THE CURRENT system of hospital care presents many of the same problems to lower income people in urban areas that the housing market does. These problems are reflected in the proposed Affiliated Hospitals Center.

As originally planned, the AHC was to increase the number of inpatient beds in its component teaching hospitals from 678 to 910, and the number of ambulatory care visits per year from 90,000 to 250,000. As the cost estimate spiraled, it became necessary to cut back on each of these increases. But, while in-patient beds were reduced by only 15 per cent (to 780), the ambulatory capability was cut back by 46 per cent (to 135,000).

The growing dearth of individual physicians in the core city has caused most low-income people to depend on hospitals for their health care. In addition, the continually rising cost of acute in-patient care (this is particularly true of a teaching hospital) and the impossibility of being admitted to an in-patient bed without recommendation of a physician, have accentuated the importance of ambulatory care facilities.

While in-patient facilities are important for surgical care, and teaching hospitals are essential for researching new medical techniques, the majority of today's urban population depends heavily on ambulatory care. As this dependence grows, the need for ambulatory facilities is likely to increase.

The larger number of beds for the hospitals represents a significant growth in the level of in-patient facilities: but Carl Cobb, health reporter for the Globe and Nieman Fellow at Harvard for 1969-70, maintains that most of the difference, if not all of it, between the present 90,000 ambulatory visits and the projected 135,000 will be devoted to maintaining the present level of ambulatory care.

Although AHC spokesmen contend that new ambulatory methods are now being explored, the 50 per cent increase in ambulatory capacity may well be inadequate for the purpose of extending the current level of care.

Few physicians will disagree that medical care in the Roxbury area, despite the presence of Harvard's medical complex, has been far from satisfactory. As an illustration of regional health conditions, the infant mortality rate in Roxbury is twice to three times as great as that of the rest of the metropolitan area.

The tenants are not satisfied with the medical treatment they now receive. "Who wants another hospital?" said one tenant. "Everywhere you turn in our neighborhood, there is a hospital. But our health care just hasn't been that good at all."

AHC officials acknowledge that there are no tenant representatives on the hospital's governing board. They claim that the AHC will serve communities other than that in Roxbury. "If a man in Virginia wants to come to our hospital for health care. who's to say he can't?" said Executive Vice President Wittrup. "The problem of community representation is not even easy to state."

But Cobb says that, with respect to the "larger community." Boston's hospitals already contain more in-patient beds than the entire New England region needs. "The Affiliated has more research space in relation to delivery of service than can be justified," said Cobb.

THE ISSUES of Harvard-owned housing and the Affiliated Hospitals Center are two sides of the same story for the Roxbury tenants. In neither instance were they represented on important decision-making bo??lies when crucial decisions were made. In neither instance have they exercised any prerogatives in controlling those social forces which affect their own lives.

When tenants demanded that their homes not be demolished, and that the AHC be built only if it served the health needs of their community, they spoke for more people than themselves. It is in the interest of most people in Boston that 182 units of lowincome housing be kept on a severely tightened housing market, and that the AHC budget of $75 million be allocated in a way that can contribute to a genuine improvement of medical care for the urban population.

The tenants, and their supporters among students, faculty, and workers at the Medical School, have begun to demonstrate against the University and corporate authorities who have dealt so unfairly with them. Perhaps these demonstrations will lead to a situation in which the tenants, and others like them, succeed in gaining a measure of control over their own lives.