As she sat in her office on a summer day, Mary Sheridan, assistant deputy fire commissioner, pulled out a cellphone to check which hospitals were on diversion at that moment. Three hospitals had closed over the course of an hour.

That is nearly 10% of hospitals, but in a system where diversion is common, it didn’t raise an alarm.

“We are in pretty good shape,” she said. “But when they start closing, they start falling like dominoes.”

Depending on the hospital, ambulances carrying trauma, stroke and heart attack cases will still be allowed to come.

In addition, under the state guidelines, if it will take more than five minutes to get to the same kind of care, paramedics — if they get the approval of medical authorities at dispatch — can break the hospital’s diversion.

“Our policy is if the medical benefits outweigh the risk, that is what is critical,” said Stein-Spencer. “If a patient has a life-threatening injury or illness or has a compromised airway, they go to the closest (hospital) whether or not on bypass.”

The department, however, declined to release data that would show if this is happening.

Meanwhile, the Chicago Fire Department said it sometimes has to take immediate action on its own.

“We’ll start screaming and things come back up,” said Larry Langford, spokesman for the department. “We make a few calls and magically it happens and they are able to open back up.”

A City of Chicago paramedic said if enough hospitals go on bypass, ambulance drivers can ignore the order but they have to be careful. Chicago’s EMS procedures say such overrides should happen only “under unusual circumstances.”

“I could potentially be disciplined by the EMS system and if the EMS system disciplines me, that may make me take leave from the city because I need that license to work,” the paramedic told the Journal Sentinel. The paramedic spoke on the condition that his name not be used as he was not authorized by the department to speak.

Sheridan, the Chicago Fire Department official, said she believes hospitals close themselves to ambulances due to economics, as administrators try to match their limited staffing resources with the flow of patients.

“I don’t believe that they are doing it deliberately as a way of doing business,” she said. “They are just trying to stay in business.”

But the data reveals a predictability to hospitals closing to ambulances. The Journal Sentinel analysis found the biggest day of bypass in the week is Tuesday, a time when many elective surgeries are scheduled and those patients are taking up in-patient beds.

Elective surgeries are coveted by hospitals because they mean more money. A 2008 study of 1 million Medicare cases found hospitals made $700 more on elective admissions than ER patients.

With so much at stake, patients who are in the back of an ambulance might not know they were turned away from a hospital, said Maglione, who represented the family in the death of Lenise.

“You or a loved one could have gotten better care at another hospital. How do you know that? In the case I represented, it got out,” he said. “But there are people out there who might not even know it and are not getting the level of care they needed or maybe even died because they didn’t go to the right hospital.”

Patient advocates agree. Most sick patients have no idea their ride to the ER may involve bouncing from place to place and losing precious minutes, said Raquel Gabriel-Bennewitz, owner of Chicago Health Advocates, a business that helps patients navigate the system.

“Those are not moments to hesitate. That is atrocious,” said Gabriel-Bennewitz, a nurse since 1974. “You really are gambling with someone’s life, right? The punchline is that could be you, that could be me.

“That could happen to any of us.”

Advocate Christ on high bypass for years Advocate Christ Medical Center in Oak Lawn, Illinois, is part of the Advocate Aurora Health chain, a major player in the Milwaukee health care market.

Advocate Aurora’s hospitals in Milwaukee County stopped diversion after a voluntary countywide ban was brokered in 2016.

The hospitals went from nearly 4,800 hours on diversion for a six-month period in 2015 to 13 hours in the same period the following year.

Advocate Aurora, though, continues to allow its hospitals outside of Milwaukee County to go on diversion. And one of it's Illinois hospitals, Advocate Christ, has a long history of turning away ambulances, according to Illinois state data.

Since March 2018, state regulators have been warning the hospital to cut its hours on bypass, but the practice continues.

In early September, the state sent a warning letter to Advocate Christ saying the hospital's hours on ambulance diversion remain high. The state visited the hospital in July and noted efforts to improve operations.

Despite that, Advocate Christ’s hours went up, not down.

“The department expects to see a progressive improvement in the coming months, which may entail another IDPH visit or further action,” the Sept. 3 letter said.

Hospital officials told the Journal Sentinel they are often overwhelmed with patients drawn to specialty centers in their facility, such as for cardiovascular care. They said their ER sees more than 100,000 patients a year. They call diversion their “last resort.”

In an April letter, Advocate Christ told state regulators the hospital had rescheduled 232 surgeries to ease overcrowding.

Advocate Christ on high bypass for years Advocate Christ Medical Center in Oak Lawn, Illinois, is part of the Advocate Aurora Health chain, a major player in the Milwaukee health care market.

Advocate Aurora’s hospitals in Milwaukee County stopped diversion after a voluntary countywide ban was brokered in 2016.

The hospitals went from nearly 4,800 hours on diversion for a six-month period in 2015 to 13 hours in the same period the following year.

Advocate Aurora, though, continues to allow its hospitals outside of Milwaukee County to go on diversion. And one of it's Illinois hospitals, Advocate Christ, has a long history of turning away ambulances, according to Illinois state data.

Since March 2018, state regulators have been warning the hospital to cut its hours on bypass, but the practice continues.

In early September, the state sent a warning letter to Advocate Christ saying the hospital's hours on ambulance diversion remain high. The state visited the hospital in July and noted efforts to improve operations.

Despite that, Advocate Christ’s hours went up, not down.

“The department expects to see a progressive improvement in the coming months, which may entail another IDPH visit or further action,” the Sept. 3 letter said.

Hospital officials told the Journal Sentinel they are often overwhelmed with patients drawn to specialty centers in their facility, such as for cardiovascular care. They said their ER sees more than 100,000 patients a year. They call diversion their “last resort.”

In an April letter, Advocate Christ told state regulators the hospital had rescheduled 232 surgeries to ease overcrowding.

Little legal recourse for families

Just months after Lenise Nelson died, the family filed a $20 million state lawsuit, claiming negligence under state law and a violation of a then-new federal law, which says that any patient brought to a hospital must be treated.

The case was moved to federal court where a longtime emergency medicine doctor in Illinois, enlisted by the family in its case, issued a report that determined Lenise’s chance of survival was reduced because of the diversion.

At the federal appeals court, a three-judge panel found the University of Chicago’s decision to turn away Lenise violated the 1986 federal law requiring the hospital to treat all patients. The hospital “had a duty” to care for the infant, the court held.

The ruling sent shockwaves through hospitals in Chicago and beyond.

“The hospitals were scared because it was going to make a bunch of law that was unfavorable to them,” Maglione said. “They were in a panic and you can’t blame them. This was federal court so it meant the whole country.”

Pressure mounted.

Hospitals and lobbying groups asked the entire 7th Circuit — all 14 judges — to take up the case. In a typical year, based on two decades of 7th Circuit records, fewer than five of the court's typical docket of more than 600 cases go to a full-court hearing.

According to the court docket, eight groups backed the University of Chicago’s request to have the court review the ruling, including Northwestern Hospital and the Illinois Hospital Association — even the state Department of Public Health. Documents filed by the groups in favor of reconsideration are no longer available.

Six weeks later, records show, the three-judge panel went back, vacated its ruling and then reversed itself.

The judges offered no explanation for their change.

Indeed, the official ruling acknowledged ambulance diversion could be used to discriminate against poor people: “A hospital could conceivably use a (911) system in a scheme to dump patients (but) a persuasive argument to this effect is not before us in this case.”

With the case sent back to the local court, the family ended up settling for $125,000.

After paying the lawyers and other fees, Denise and Michael each received $23,000; her two sons got $10,000 apiece.

Case fades from memory

While the headlines about Lenise’s death quickly faded, for Maglione the case became a passion during the years the litigation ground on.

Denise landed in the hospital several times during that period, as the stress made her lupus worse. The relationship between Denise and Michael dissolved.

“It was a lot on them,” Maglione said. “It was tearing them apart as you can imagine. Being that young and having all this happen to you and losing a child in that manner.”

Besides the legal duties, Maglione was helping Denise find a place to live, buying the family food and cutting through red tape to get them public assistance. He also was trying to protect the family from those who thought there was money to be had. “Parasites,” he called them.

Maglione remembers that last time he saw Denise. His secretary told him Denise was there to see him.

That was unusual because traveling across town took a toll. When he saw her, she handed him a $10 bill. Maglione didn’t understand.

“She said, ‘This is for you. Buy yourself lunch. You have helped me so much.’ ”

“I thought, ‘I can’t take this $10 from this poor girl who went through so much,’ but she insisted. So that was her way of thanking me because she felt like she was so needy and she wanted to say, ‘Let me do something for you.’ I think that shows the kind of person she was.”

Denise Johnson’s health declined in the years after her baby’s death. She died in August 2001 at age 34, little more than a decade after she lost her child.

Lenise is buried at Washington Memorial Cemetery in Homewood, an hour south of Chicago’s Loop. It’s next to a cemetery where many of the city’s indigent were buried.

The babies are in front of the cemetery.

Lenise’s plot is hard to find. There is no headstone.

Rick Wood / Milwaukee Journal Sentinel Infant Lenise Johnson was buried in a stacked unmarked grave with other babies in section 661 of Washington Memory Garden in Homewood, Illinois.

We want to hear your story about ambulance diversion The Milwaukee Journal Sentinel is investigating the issue of ambulance diversion including the consequences when people don't get timely care from hospitals. We are looking for information from patients, paramedics and other health providers across the country.



John Diedrich is an investigative reporter whose work has revealed injustices and wrongdoing including hospital policies that turn away ambulances, federal agents whose flawed undercover gun-buying stings took advantage of those with mental disabilities, and fight officials who failed to protect an amateur kickboxer who died in his first bout. Diedrich, who joined the Milwaukee Journal Sentinel staff in 2004, has been recognized with numerous national journalism honors, including a George Polk Award and a National Headliner Award for public service journalism. He is a Milwaukee native and graduate of the University of Wisconsin-Milwaukee.



Email him at is an investigative reporter whose work has revealed injustices and wrongdoing including hospital policies that turn away ambulances, federal agents whose flawed undercover gun-buying stings took advantage of those with mental disabilities, and fight officials who failed to protect an amateur kickboxer who died in his first bout. Diedrich, who joined the Milwaukee Journal Sentinel staff in 2004, has been recognized with numerous national journalism honors, including a George Polk Award and a National Headliner Award for public service journalism. He is a Milwaukee native and graduate of the University of Wisconsin-Milwaukee.Email him at jdiedrich@journalsentinel.com ; follow him on Twitter: @kcrowebasspro



Kevin Crowe is an investigative reporter/data specialist with USA TODAY and a former member of the Milwaukee Journal Sentinel’s watchdog team. He was part of a Journal Sentinel team that won a 2019 Online News Association award for Lessons Lost, an examination of the impact of evictions and student churn on academic performance in schools. Among other recognitions, he worked on a series about hospitals that moved from low-income areas to wealthy suburbs that was recognized by the Society for American Business Editors and Writers. Prior to joining the Journal Sentinel, he worked for Investigative Newsource in San Diego and the St. Louis Post-Dispatch. Crowe, a native of St. Louis, holds degrees from Marquette University in Milwaukee and the University of Missouri in Columbia.



Email him at is an investigative reporter/data specialist with USA TODAY and a former member of the Milwaukee Journal Sentinel’s watchdog team. He was part of a Journal Sentinel team that won a 2019 Online News Association award for Lessons Lost, an examination of the impact of evictions and student churn on academic performance in schools. Among other recognitions, he worked on a series about hospitals that moved from low-income areas to wealthy suburbs that was recognized by the Society for American Business Editors and Writers. Prior to joining the Journal Sentinel, he worked for Investigative Newsource in San Diego and the St. Louis Post-Dispatch. Crowe, a native of St. Louis, holds degrees from Marquette University in Milwaukee and the University of Missouri in Columbia.Email him at kcrowe@usatoday.com ; follow him on Twitter: @kcrowebasspro

Additional credits Data analysis: Kevin Crowe

Photos and videos: Michael Sears, Bill Schulz and Rick Wood

Digital design and graphics: Erin Caughey, Andrew Mollica, Kevin Crowe

Copy editing: Mike Johnson

Editor: Greg Borowski

How we reported this story

As part of its ongoing investigation into ambulance diversion, the Milwaukee Journal Sentinel has examined the practice across the country and in this story focused on the situation in Illinois.

The practice in Illinois was shaped by the death, nearly 30 years ago, of 4-week-old Lenise Nelson. The infant was in cardiac arrest five blocks from the University of Chicago's Wyler's Children's Hospital, but she was turned away and eventually died.

The Journal Sentinel unearthed details of the case through interviews with attorneys and examining media reports, medical examiner and state records and hundreds of pages of federal court files. Injustice Watch, a nonprofit, nonpartisan news operation in Chicago, helped locate records and news articles on the case.

In order to understand how often hospitals in Illinois are diverting incoming ambulance traffic, the Journal Sentinel requested data from the state’s Department of Public Health.

Hospitals in Illinois used a web-based system to alert in real time the department and other hospitals when hospitals go on bypass, another term used for the practice of effectively closing the emergency room doors to incoming ambulance traffic. The department only makes that data available to the public through an open records request.

Reporters requested data on each instance of bypass for every hospital in the state from June 2006 through September 2019. An analysis of that data showed some of the state’s most prestigious hospitals are diverting ambulances for significant stretches of time.

The Illinois state law that directs the Department of Public Health to investigate hospitals when they go on bypass does not state what level of ambulance bypass is too much. Reporters asked the department what threshold it uses to determine which hospitals were diverting ambulances too often and a spokeswoman responded that it investigated when a hospital spent a “significant amount” of time on bypass or when the bypass levels were “out of the norm.”

Reporters used the department’s March 2018 warning letters, and the history of diversion at four hospitals, to determine the threshold regulators were using.

The letter to the University of Chicago Medical Center noted the hospital had been on bypass for 16% of the time, and it sought an explanation from the hospital’s CEO as to why it was necessary to turn away incoming ambulance traffic so often. A similar letter to Advocate Christ Medical Center cited a 20% ambulance bypass rate. One to Franciscan Health-Olympia Fields said a 21% bypass rate was the reason for the letter, and the warning letter to Northwestern Memorial Hospital noted a 58% bypass rate.

Using the bypass data provided by the state, reporters were able to identify dozens of previous instances in which hospitals had passed thresholds cited in the 2018 letters without receiving any warning or fine from the Department of Public Health.