The busy emergency room at Aria Health's Frankford campus, formerly known as Frankford Hospital, was on "divert" status for 121 hours last month.
In other words, for 121 hours - an average of four hours a day - things were so tight that ambulances were advised to take patients elsewhere. That's nearly as much as the hospital's total number of diversion hours for all of last year - 134 - according to the Philadelphia Fire Department, which oversees city ambulances.
It is unclear whether high volume at the hospital played any role in the death of Joaquin Rivera, whose watch was later stolen, while he waited for care Nov. 28.
But health care experts and one state official say there is clearly a crunch at the Frankford Avenue facility - due in part to the midyear closing of nearby Northeastern Hospital, which used to see at least 45,000 emergency patients a year.
And given the economics of urban health care, more emergency-room customers is not a good thing.
Facing a higher proportion of unprofitable patients - those on Medicaid or with no insurance - the Frankford facility is losing money, and Aria officials have even discussed the possibility of closing it, State Rep. Tony Payton Jr. said.
"Right now they're overwhelmed," said Payton, a Democrat whose district includes the hospital.
He said he had met with Aria officials a few weeks ago, before Rivera's death, to look at possible solutions. Among them was applying for a federal designation that would make the hospital eligible for funding to attract new physicians.
A hospital spokeswoman did not return several requests for comment on its apparent financial difficulties or its ER volume. Jay W. Blumenthal, an Aria Health board member, declined to comment, other than to say: "I don't think we're going to close it. I haven't heard anything about that."
Late yesterday, the hospital released a statement saying that "the entire Aria Health family again wishes to express our sincere condolences to the Rivera family on the loss of Joaquin."
The hospital is investigating its policies and procedures, and so is the Pennsylvania Department of Health.
"We are taking a number of proactive steps to ensure that nothing like this ever happens again," the hospital's statement said. "Aria Health's Frankford campus has been a part of the fabric of this community for more than 100 years, and we are absolutely committed to continuing our recognized exemplary service to this historically underserved population."
Aria Health consists of two Philadelphia hospitals - the one in Frankford and a Torresdale campus - and a third in Langhorne. It is also seeking approval to build a hospital in Lower Makefield, Bucks County. Until the end of 2008, it was part of the Jefferson Health System.
Northeastern ceased operating as a full-fledged hospital at the end of June and is now an ambulatory care center. Patients who once would have gone there are believed to be spread among Aria's Frankford and several other facilities.
Temple University Hospital and Temple's Episcopal campus have seen more emergency-room volume, spokeswoman Rebecca Harmon said.
For example, Episcopal used to get 36,000 patients a year at its emergency department but is on a pace to see 45,000 this year, Harmon said. In anticipation of that increase, the hospital opened a separate minor-care unit and hired extra staff to handle minor injuries and ailments that would otherwise have been seen in the ER, she said.
Aria Health, on the other hand, said in January that it was laying off 100 people and eliminating 50 open positions.
Alan Zuckerman, a health-care consultant in Philadelphia, said the closing of an urban hospital makes things harder for those that remain.
"You basically have underinsured and uninsured patients that for the most part no institution can bear the burden of," said Zuckerman, president of Health Strategies & Solutions. "The places that remain bear a disproportionate burden. As long as they can cope, they cope."
Aria's push to build a hospital in Lower Makefield makes sense from a business standpoint, said Jerry Katz, a health-care consultant with Kurt Salmon Associates.
"You have less poor patients out in Bucks County," Katz said. Seeking a more "regional brand," the health system replaced the Frankford name with Aria Health in May.
Rivera, 63, a popular musician and mentor, died in the waiting room at the Frankford hospital of hypertensive heart disease. Police who reviewed a security camera tape say he struggled to breathe, brought a hand to his chest, and apparently died 11 minutes after telling intake personnel that he had pain on his left side.
Thirty-nine minutes later, one of three people in the waiting room stole Rivera's watch, the security tape showed. Hospital workers walked by him several times, and at 11:45 p.m., nearly 50 minutes after Rivera stopped moving, hospital personnel noticed he appeared to be dead, a witness told police.
The case seemed eerily familiar to Dennis Hyland, 54, of Mayfair. He said he had gone to the emergency room at the Frankford facility Aug. 29, complaining of pain in his chest and left arm and shortness of breath.
Hyland said he had told intake personnel of his symptoms and then sat with his wife for more than 15 minutes in the waiting room, never seeing a nurse or doctor. Increasingly angry, he finally asked his wife to take him to Penn Presbyterian, where, he said, he got immediate treatment and was soon fitted with a pacemaker-defibrillator.
Hospital officials did not respond to a request for comment on Hyland's case. But he said he was not the only one to see a parallel with Rivera:
"I must've gotten about 20 calls after this incident, saying 'That would've been you.' "