To the Editor.
—In Dr Goldberg's1 letter concerning the effects of the demise of Philadelphia General Hospital,2 he states that "it appears that all patients in Philadelphia, regardless of economic status, are adequately cared for without hesitation at the city's numerous private hospitals." While we wish that were the case, a survey performed by medical students at the University of Pennsylvania provides evidence to the contrary. Last spring, to identify the health care needs of homeless and indigent people in west Philadelphia, students carried out standardized personal interviews with attendees of local soup kitchen suppers on five consecutive weeknights. Of approximately 120 attendees, 99 consented to be interviewed and 97 interviews were completed. Sadly, 16 of the 97 reported that they had recently been turned away from area hospitals because they could not pay for medical services. Furthermore, some claimed that they did not seek care when they