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Know Your Rights
Source: New York Times
Subject: Health Justice & Access
Type: Media Coverage

Hospitals in Brooklyn Defended at Hearing

A stream of hospital administrators, a state assemblyman, doctors and advocates for immigrants took the microphone at a sometimes raucous hearing in Downtown Brooklyn on Thursday to plead with state officials not to close, merge or shrink troubled hospitals in the borough.

The advocates identified at least 5 of the 17 hospitals in the borough — those serving some of Brooklyn’s poorest patients — that they believe are endangered: Interfaith Medical Center, Brookdale University Hospital and Medical Center, Brooklyn Hospital Center, Wyckoff Heights Medical Center and Kingsbrook Jewish Medical Center.

Were they to close, 11,000 people would lose jobs, and other hospitals would have to absorb 325,000 emergency room visits, 83,000 hospital admissions and about 760,000 clinic visits, according to industry data.

“I know you want to be closing more beds,” Dr. Marylyn Martin-Naar, director of primary care for Interfaith Medical Center, told the panel. Interfaith’s operating revenues are 29 percent less than its expenses, according to data presented by a state official at the hearing.

State officials declined to say on Thursday whether they were contemplating closings or mergers, but made it clear they were looking for savings. They suggested that Brooklyn had too many hospital beds and said that patients were using hospitals when they should be using outpatient doctors and clinics.

The hearing, held at New York City College of Technology, was a project of Gov. Andrew M. Cuomo’s Medicaid Redesign Team, created to cut rising Medicaid costs in the state. Stephen Berger, the Brooklyn work group’s chairman, said the panel’s goal was to listen to the community and get ideas that would improve the quality and “financial viability” of health care in Brooklyn.

But most people in the audience appeared to believe that a hidden agenda was to cut hospital beds, especially because about five years ago, Mr. Berger, the chairman of a private equity investment firm, was chairman of a state commission whose recommendations led to the closing and consolidation of hospitals across the state.

Any downsizing would come on the heels of the closing of St. Vincent’s Manhattan Hospital in Greenwich Village in April 2010 and North General Hospital in Harlem in June 2010, and — just announced on Wednesday — Peninsula Hospital Center in Far Rockaway, Queens.

Kenneth E. Raske, president of the Greater New York Hospital Association, an industry group, told the panel that so-called safety-net hospitals, serving the poorest patients, were in trouble not just in Brooklyn but all over the state, because of state decisions under former Govs. Eliot Spitzer and David A. Paterson.

For a while, he said, the state was giving higher Medicaid payments to hospitals with high proportions of poor patients, but that was stopped about three years ago, as state officials decided to put the money toward primary and preventive care instead.

“This is not bad luck,” Mr. Raske told the panel. While the change in policy was well intentioned, he said, “unfortunately, it look a lot of money out of a lot of safety-net hospitals, and it took a lot of money out of the Health and Hospitals Corporation,” the public hospital system.

Dr. Jeff Wuhantu, an emergency room doctor at New York Methodist Hospital, which is one of the stronger hospitals in Brooklyn, said shifting care from hospitals to doctors’ offices and clinics sounded good in theory. But the reality, he said, was that primary care was lacking in poor neighborhoods and that patients would be left floundering until it was developed.

Closing hospitals, he said, would force patients to ride the subway to get care and to wait even longer hours than they already do in emergency rooms.

“When St. Vincent’s closed, we felt the reverberation here in Brooklyn,” he told the panel.

Becca Telzak, health advisory coordinator at Make the Road New York, an immigrant advocacy group, said many Latino immigrants in Bushwick went to Wyckoff and to Woodhull Medical and Mental Health Center for care because they lacked health insurance and did not have primary care doctors.

Assemblyman Vito J. Lopez, who represents Bushwick, told the panel — to cheering and shouting from the audience — that it was unfair of the state to consider “closure or diluting” hospitals in Brooklyn “if there’s three hospitals within three blocks in Manhattan.”

Ivan Nichols, a real estate broker whose office is about 15 blocks from Interfaith, said closing the hospital would devastate the neighborhood, because people would move elsewhere looking for work.

The most troubled hospitals are concentrated in north-central Brooklyn, including Bedford-Stuyvesant, Bushwick, Crown Heights, East New York and Williamsburg, all neighborhoods that have high levels of poverty and chronic health problems like obesity and diabetes.

Several hospitals in Brooklyn are barely breaking even or have negative operating margins, including Brookdale, with a negative 10 percent margin; Lutheran Medical Center, 1 percent; Brooklyn, 0 percent; Long Island College Hospital, negative 7 percent; and Interfaith, negative 29 percent, according to a presentation at the hearing on Thursday by Richard Cook, deputy commissioner of the Office of Health Systems Management.

Mr. Cook said many Brooklyn residents were already deserting local hospitals. About one-quarter of Brooklyn patients seek care outside the borough, especially for surgery and pediatric, newborn and psychiatric care, state officials said at the hearing.

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