Cooking Up Controversy : Burger Wars Invade Hospital Lobby With Plans for a New McDonald’s

Plans to open a McDonald’s franchise at Childrens Hospital of Los Angeles next month has hospital officials, doctors and nutritionists embroiled in a sizzling debate over nutrition and ethics.

The restaurant, which will serve a traditional McDonald’s menu plus soups and fresh fruit, is the first of its kind in a California hospital. Scheduled to open July 10 just off the hospital’s main lobby, the restaurant will be the 12th hospital-based McDonald’s in the country.

Hospital administrators said the McDonald’s will be good for business. But parents, staff physicians, nutritionists and health groups nationwide question whether a fast-food restaurant--which offers foods high in calories and cholesterol along with salads and bran muffins--is appropriate in a hospital for children.

Dr. T. Y. Lawrence, a cardiologist at Childrens Hospital, said she worries about the cooking oils and the high cholesterol content of many fast foods, although she acknowledges that the issues the hospital faces are complicated.

“I would not recommend anyone to set foot in there,” Lawrence said. “But I have to consider the hospital budget. (McDonald’s) is helping the budget in other ways. You can’t have everything.”

The American Cancer Society also opposes the move.

“It is not the kind of thing we are real excited about,” said American Cancer Society spokeswoman Sally Brother. “It is not a very good message to be sending to kids concerning what good eating is about.”

The McDonald’s is for the convenience of staff and visitors, not patients, stressed Dr. Carl M. Grushkin, Childrens Hospital medical director. Patients will be allowed to eat there only with doctor approval, he said.

The hospital cafeteria will remain open, although its hours will be scaled back slightly, and the grill, which features hamburgers and hot dogs, will be eliminated. McDonald’s will not close its doors until 11 p.m, four hours after the cafeteria is dark, Grushkin said.

The food the patients receive in their rooms is tailored to their specific dietary needs and is not the same as that sold in the hospital cafeteria, according to hospital nutrition officials. With a doctor’s approval, patients may also order food from the cafeteria.

Hospital administrators two years ago began negotiations with McDonald’s to open a franchise at the 331-bed private facility, in part to offset the $650,000 lost by the cafeteria annually. Several other chains, including Wendy’s and Burger King, also have restaurants in hospitals.

“I am hoping we can stop losing money or stop losing as much,” Grushkin said. “Whether we are going to recoup it is another issue.”

But contract negotiations between the fast-food chain and the hospital moved slowly because staff physicians were unsure whether they wanted the McDonald’s, said Steve Roth, McDonald’s manager of hospital development.

Doctors Visit Other Sites

The deal was closed only after a group of doctors visited other McDonald’s restaurants in hospitals around the country, Roth noted. Grushkin said he was unaware of any turmoil among his staff over the contract.

In-hospital McDonald’s restaurants elsewhere in the country have drawn mixed reviews.

In St. Louis, where a McDonald’s opened three years ago in Christian Hospital North East, the restaurant remains a sore spot.

“The McDonald’s is still considered controversial because of the high-cholesterol, high-fat content of all fast foods,” said Rick VanBokkelen, Christian Hospital’s executive vice president. “I think it is a success in our hospital, but I am sure there are people in St. Louis who would violently disagree.”

And at the Children’s Hospital of Philadelphia, where the first hospital-based McDonald’s opened in 1977 to replace an overburdened coffee shop, hospital officials do not recommend the restaurant as a steady diet.

“We reasoned that people wouldn’t eat there every day,” said hospital spokeswoman Shirley Bonnem. “The fact of life is people are going to eat fast food unless they are nutrition buffs.”

Many of McDonald’s most popular items are chock-full of calories. A Big Mac has 562 calories. A regular bag of french fries adds 220 calories and a chocolate milkshake racks up 388 calories--bringing the total meal to 1,170 calories.

For those with willpower, a McDonald’s chef salad with a vinaigrette dressing is 246 calories.

Caloric Intake

The National Academy of Sciences recommends that men between the ages of 23 and 50 restrict their daily calorie intake to 2,700 and women in the same age group to about 2,000. For children between the ages of 4 and 6, the recommended daily calorie allotment is 1,700.

Childrens Hospital visitors who routinely ordered cheeseburgers and french fries at the hospital cafeteria probably will not be much worse off if they order those same items at McDonald’s.

A hospital cheeseburger is 479 calories, according to a staff nutritionist, while a McDonald’s quarter-pounder with cheese is 517. For dessert, a serving of McDonald’s apple pie at 262 calories is actually about 40 calories less than a serving of apple pie from the hospital cafeteria.

Grushkin discussed the new venture with guarded enthusiasm. “The food is generally quite nutritious,” Grushkin said. “There are a lot of things you could get there on a balanced diet, but you have to select very carefully.”

But Grushkin conceded that McDonald’s is not a place he would like to eat at regularly.

“I hope I don’t go there a lot,” Grushkin said. “I will eat there from time to time.”

The hospital is planning an education campaign for patients, staff, and visitors specifically tailored to the McDonald’s menu, but the details have not been worked out, said Linda Brown, director of food and nutrition services.

Dr. Michael Goldblatt, McDonald’s director of nutrition, said the fast-food chain uses only the best ingredients.

‘Highest Quality Food’

“The taste of McDonald’s food speaks for itself,” Goldblatt said. “Without a doubt, McDonald’s is of the highest quality food you can get anywhere.”

But several physicians and health care professionals strongly disagree.

“It is shameful,” said Michael Jacobson, director of Washington-based Center for Science in the Public Interest. “Hospitals are seen as images of health. It’s sneaky to associate images of health with unhealthy food.”

Dr. Liz Applegate, a lecturer in nutrition at UC Davis, said fast food is the last thing parents need when they are under stress.

“Here put in front of them (at McDonald’s) is high-fat food which is also low in nutritional content,” Applegate said. “Parents are in need of a balanced diet especially because in dealing with a child’s illness they’ve probably not been eating well.”

Michael Jackson, an Inglewood piano tuner who brought his son to the hospital recently, said he could do without the added convenience.

“I think McDonald’s is bad for kids,” Jackson said. “I try to avoid feeding them that kind of thing, but if it it’s right here in front their faces, it is hard to weasel out of it.”

Jackson’s 7-year-old son, who is also named Michael, disagrees with his dad.

“It’s so much fun,” the second grader said. “I don’t like salad, but I could really take a ‘Happy Meal.’ ”

The young Jackson is not alone. Chances are, noontime crowds will not be clamoring for fruit and salad, nutritionist Applegate said. Studies show the more nutritious items often draw people inside a fast-food restaurant, but when it comes to ordering, the high-calorie, high-cholesterol items are irresistible, she said.

Fran Jones, who will operate the hospital franchise, said she is dedicated to showing kids a good time.

They can ride Mr. Hamburger in the restaurant’s enclosed play area, listen to a story told by the talking apple tree, or chance a visit by Ronald McDonald, who is already booked for six monthly appearances, Jones said.

Conveniences for Employees

With a seating capacity of about 160, the restaurant also offers special conveniences for hospital employees. Doctors and nurses can be paged there and express lines will be set up to speed the process for staff members at peak hours, Jones said.

Jones operates two other restaurants in Southern California. She also serves on the board of directors of the Los Angeles Ronald McDonald House, a home for families of hospitalized children subsidized in large part by McDonald’s.

Despite all the criticism, in some situations a visit to McDonald’s could be just what the doctor orders, according to Grushkin. Patients who have undergone chemotherapy often lose their taste for hospital food and may go without eating, he explained.

“It is important to get cancer patients to eat something high in calories--french fries, milkshakes, cheeseburgers,” Grushkin said. “Not as a steady diet, but it is better than nothing.”

The golden arches are firmly planted at Childrens Hospital. McDonald’s has a 20-year contract there although the hospital can call off the deal earlier if the quality of the food slips below standard, said McDonald’s Roth. Roth and Grushkin declined to disclose the amount of rent the restaurant is paying the hospital.

There is no guarantee McDonald’s will bolster finances at Childrens Hospital.

At Denver General Hospital, where McDonald’s has been open for about a year, the fast-food restaurant has not helped the hospital’s bottom line one bit, said hospital administrator William D. Wild.

“Whatever we get from McDonald’s is offset in revenues we’ve lost from the cafeteria,” Wild said. “If we went into this for financial reasons, it hasn’t panned out.”

To cut the loss, Wild said he is considering eliminating cafeteria service entirely at breakfast and dinner, leaving McDonald’s as the only on-site option for those meals.

It is highly unlikely Childrens Hospital will resort to such an idea, Grushkin said.

Only One Considered

McDonald’s was the only fast-food chain the hospital considered for the spot, Grushkin said.

When McDonald’s wants a hospital franchise, it has no true competition, said Wendy’s spokesman Denny Lynch. “They can pay too much for property and too much in rent. They can sit on (a restaurant) until they make money.”

McDonald’s Roth is the first to admit the company has invested in hospitals with an eye toward the future.

“It is definitely intended to be for profit,” Roth said. “We want to be in these sites for the next hundred years.”