COALDALE, Pa. - For a hospital that has been declared terminally ill, Coaldale State General is a lively place.
The residents of the fifth-floor geriatric center, drawn by the fragrance of ham and cabbage, are maneuvering their wheelchairs toward the dining room, lining up for lunch with their friends.
White-haired, frail and often tremulous, they move slowly from the day room, where some have been watching news of war. Or they come from their beds, where many of them spend their days, suffering the ailments of age.
Down in the pediatric ward, a father plays quietly with his sick son in a sun-streaked playroom, and a mother sits on her daughter's bed, helping the girl color a picture.
On the first floor, an elderly man waits patiently for a friend to complete his cardiac examination. The emergency room is bustling, and the six-bed intensive-care unit is nearly full.
Born in 1910 to care for coal miners, Coaldale State General is to die next year. It is among the last four state-operated general hospitals in Pennsylvania, and Gov. Casey said earlier this month that all will be shut down to save money.
A total of about 950 workers will lose their jobs. About 250 patients a day will have to go elsewhere. A $17 million annual deficit will be shaved from the state budget. And Pennsylvania's century-long era of caring directly for its sick and injured citizens in the coal country will come to an end.
That will leave apparently only one state in the nation - Louisiana - still operating its own general hospitals.
"It just got to the point where we couldn't justify it anymore," said Vicki Smink, spokeswoman for the state Department of Public Welfare. "While the patient census was getting lower and lower, the payroll continued to go up, and so did operating costs."
But in the anthracite region, where unemployment is high and the residents are among the nation's oldest, the prospect of losing medical care and major employers at the same time is a terrifying one.
"This will be a major catastrophe," says Geno Poli, a retired schoolteacher who is president of the town council in Coaldale, on the eastern edge of Schuylkill County. "We're all stunned. We are so dependent on that hospital. We have taken it for granted because it has always been there, but what will we do now?"
Sitting in the Russian Citizens Club, just down the street from the onion- domed St. Mary's Russian Orthodox Church, Steve Kacik remembers how proud his coal-miner father was of the hospital.
"I remember how he used to tell me it was built for the miners, how the miners paid for it. Ever since I'm a kid, they've been talking about shutting them down, but I never really thought they'd do it."
In 1910, using contributions from miners - each gave a day's pay - and the Lehigh Coal & Navigation Co., the first Coaldale hospital opened (it was replaced with a new building in 1973). It was designed to care for injured miners, who until then had to be taken as far away as Reading and Philadelphia for treatment. In 1917, it became part of a system of 10 hospitals scattered through the coal region and operated by the state, for anybody who needed treatment, regardless of ability to pay.
Outside of the coal regions, the hospitals were virtually unknown, or were confused with the state's mental hospitals (which will continue to be operated). But from Ashland to Nanticoke, Locust Mountain to Shamokin, Connellsville to Blossburg, the state general hospitals accepted all comers. In the coal towns such as Hazleton and Scranton and Philipsburg and Coaldale, the hospitals were as much a part of the community as the Ukrainian social
clubs and the Irish bars and the mountains of coal waste.
Eventually, in many of the towns, the hospitals became bigger employers than the mines that spawned them. They nursed residents' economic as well as physical health.
But, since 1973, beginning with Blossburg, the state has been closing the hospitals or turning them over to other operators. The advent of Medicare and Medicaid and state medical assistance and supplemental health insurance increasingly made the original mission of the hospitals unnecessary, and other community hospitals began to draw many of their paitients.
Today, only Philipsburg, in Centre County, Shamokin, in Northumberland County, and Ashland and Coaldale in Schuylkill County, remain.
Philipsburg will be the next to go. The Casey administration, citing the hospital's aging facilities, its high staff-to-patient ratio, its dwindling patient population and its $3 million annual deficit, said it would close the hospital on March 31.
The closure will cost the community its last major employer, 270 jobs and a payroll of $9.3 million.
The workers "will have to go out. That's it," Philipsburg Borough Manager Don Enck said. "There's no other place to go - not in the Moshannon Valley."
The nearest hospitals are in Clearfield, 18 miles away, and State College, 24 miles away.
"If you get sick, or have a heart attack, what are you going to do?" asked Enck, whose town in recent years has lost an airplane-parts plant and a cigar factory.
The other three hospitals are to be closed by the end of June 1992.
In Schuylkill County, where the unemployment rate already is above 8 percent, the loss of Ashland and Coaldale would eliminate 600 jobs and boost the unemployment rate by more than 1.2 percentage points.
And in Coaldale, it would mean the nearest hospital would be about 20 miles away, in Hazleton or Pottsville.
"That distance is too great if you have a cardiac arrest," said Inez Larichiuta, Coaldale General nursing director. "It means you might as well not even get in the ambulance."
The union that represents most of the state hospital workers, the American Federation of State, County and Municipal Employees, has vowed to fight the hospital closures. And three state lawmakers last week introduced legislation that would prevent the hospitals from being closed without the legislature's approval.
"These people here should be able to live and die in dignity," said Marion Wargo, a night-shift nursing assistant at Coaldale General and the president of AFSCME Local 2445, which represents 130 workers at the hospital. ''Don't save money on the poor, the indigent and the elderly in a very depressed part of the state.
"Casey is doing this at the same time he's taking that $20,000 raise," she said. "He says he's taking it for his family. What about our families?"
The state and some local groups are continuing to look for medical agencies willing to take over the hospitals - and their expensive union contracts.
David Donlin of the Pottsville Chamber of Commerce and a member of the community board of the Ashland hospital said he still expected that some group could be found to rescue the hospital. And he said he was optimistic that with new management, the hospital could be made more efficient and more widely used.
"Although Gov. Casey handled this about as bad as any politician could have, I think it's very possible that the prospects for creating a solid future may be better than ever," Donlin said. He said he knew of a group that had expressed interest in at least the Ashland hospital, but did not identify it.
At Coaldale General, where about two-thirds of the 156 beds are filled every day, administrator Frank J. Parano said he believed that another owner - unencumbered by the overhead costs of state government - could make a profit at the hospital.
"You're talking about a serious vacuum if this hospital isn't here," said Parano, who was born at Coaldale General 50 years ago. "We're an up-to-date, modern hospital. Hopefully, if there is a need for any of the state general hospitals, some group will come forward for Coaldale.
"It's almost to the point where it's now or never."