‘A smart operator could make a lot of money’
By Mary Frost
Brooklyn Daily Eagle
The revised bidding process for Brooklyn’s Long Island College Hospital (LICH) got off to a strong start on Monday as a number of potential bidders heard from LICH supporters about why the hospital is a compelling investment – and why it should remain a full-service hospital.
Moderated by New York City Public Advocate Letitia James, LICH’s doctors, nurses and health care workers described LICH’s dedicated staff, high standards of excellence and proud history, while community groups painted a picture of the money-making opportunities offered by a well-run hospital in the center of Brooklyn's affluent and rapidly-growing Brownstone belt.
The forum took place at the SUNY College of Optometry in Manhattan. Lora Lefebvre, SUNY’s Associate Vice Chancellor for Health Affairs, welcomed the participants.
Observers in the auditorium buzzed as they recognized not only participants from an earlier round of SUNY’s RFP (Request for Proposals), but new faces, including Toll Brother and Memorial Sloan Kettering.
Those presenting at the forum had fought a year-long battle against SUNY’s attempts to close LICH. These included Public Advocate James, six community groups; Concerned Physicians of LICH; New York State Nurses Association (NYSNA) and 1199 SEIU healthcare workers union.
"We are glad -- but not surprised-- to see a robust turnout of prospective bidders,” said attorney Jim Walden of Gibson, Dunn & Crutcher, who represents the six community groups. “This community is galvanized to see a new hospital operator succeed, and succeed wildly."
Public Advocate James said the goal of the reissued RFP is a “full service inpatient hospital that reflects the values and needs of the community.” The new RFP weights health care at 70 percent; an earlier RFP weighted health care services at only 40 percent, with financial and other considerations given more weight.
“Today’s meeting is to share our vision with perspective bidders,” James said. She pledged, “I will use the office of the Public Advocate to expedite and prioritize the transition to a full-service hospital.”
Dr. Balendu Vasavada, representing the Concerned Physicians of LICH, described LICH, a teaching hospital founded in 1858, as a gem with excellence in many areas including cardiology, pulmonary critical care, nephrology, infectious disease care, and OB-GYN care, and outstanding programs in dialysis and neurosurgery.
Until SUNY pulled LICH’s residents in June of 2013, Dr. Vasavada said, LICH was fully accredited in numerous areas and constantly performed above benchmarks. “U.S. News & World Report in 2011 and 2012 ranked LICH as the second-best hospital in Brooklyn after Maimonides,” he said.
Just that day LICH’s cardiac team saved a patient’s life by putting in an emergency stent. “He came in with chest pain,” Dr. Vasavada said. If LICH closes, “God forbid there is a traffic jam, he would not have made it” to the next closest emergency angioplasty hospitals, Lutheran or New York Methodist.
Lukmon Kalejaiye, a registered nurse at LICH with a Master’s degree from SUNY Downstate, spoke about the highly trained and dedicated nursing staff that has stayed at LICH over the years, even as SUNY tried to close the hospital. “The average nurse has spent 20 years at LICH,” he said. “That is dedication. A business depends on the dedication of its staff.”
He also described the emergency capacity LICH has provided throughout history -- from treating those sickened by a disease outbreak on Governor’s Island, to the panicked crowds who streamed over the Brooklyn Bridge during the September 11 terror attacks, to the care provided to victims of Hurricane Sandy.
“You’re not walking into an empty shed,” Kalejaiye said. “The staff, patients and community have stood with the legacy of the founders. When you bring your money, you get a lot for it.”
Mercedes Folks & Shawn Richardson spoke for 1199 SEIU. Richardson debunked the notion that patients were not utilizing LICH. “Last year, despite all the tribulations, patients showed up in droves. Workers were asked to do more with less and we always showed up and filled those shoes.” He added that LICH needed an investment in modern technology.
Folks said that she has worked at LICH for 53 years, drawing applause from the crowd. “My five children were raised there, I gave birth there.” Despite SUNY’s cutbacks, the staff keeps producing, she said. “The Joint Commission did a review a week ago. They were so impressed with the excellent job we do, given the little we have to work with.”
A major economic opportunity
While all of the presenters said the community's greatest need was for the resumption of first-rate medical services in a full-service hospital, Jeff Strabone, spokesperson for the Cobble Hill Association and five other community groups, emphasized the financial opportunities presented by LICH.
Strabone said that LICH’s catchment area, with roughly 300,000 residents, “includes some of the most affluent communities in Brooklyn: Cobble Hill, Brooklyn Heights, Carroll Gardens, as well as some of the fastest-growing neighborhoods in the city,” including Gowanus, Downtown Brooklyn, the new towers in Brooklyn Bridge Park, and the large populations in the Red Hook, Gowanus, and Wyckoff houses.
"Our neighborhoods are consistently rated as the best residential quality in all of New York,” he said, adding that individual brownstone properties in the immediate vicinity of LICH are now selling in the $5 to $8 million range.
“Our area represents a major economic opportunity for an operator who is prepared to engage our community's needs and partner with our community.”
Strabone described increasing rents, major new retailers like Ikea, Whole Foods, and Fairway, and the “conservative” estimate of 40,000 to 60,000 new residents in Downtown Brooklyn by 2020. He also provided figures countering SUNY’s claims of millions of dollars of losses at LICH. (See letter from the community groups below.)
The area’s growth was driven predominantly by younger families “attracted to our excellent schools, cultural attractions, well-maintained parks, and proximity to Manhattan,” he said, advising that the hospital focus on the area’s oldest and youngest patients. “Centers for excellence in Pediatrics, OB/GYN and all services relating to children and teens are essential and will be heavily used.” The health care issues of the Red Hook and Gowanus Houses—including diabetes, high blood pressure, asthma and other services – must be also be addressed.
Strabone spoke about the need for more, not fewer hospital beds in Brooklyn. With only 2.51 hospital beds per 1,000 population, “There simply are not enough hospital beds for Brooklyn's exploding population.”
“To put it in dollars-and-cents terms, a smart hospital operator could make a lot of money providing top-notch health care in Cobble Hill,” he said.
'We will go back and evaluate'
During the previous RFP process, respondents said that figures provided by the state and SUNY's “guidance on the RFP” showed a hospital at LICH was “not feasible.” After Monday’s presentation, the audience seemed more receptive to the idea of a full service hospital.
Developer Joel Kestenbaum of Fortis Property Group, told the Brooklyn Eagle, “We will go back and evaluate what we heard, and see what to do to satisfy the community’s needs.
“I know the neighborhood, my office is in DUMBO. I’ve used the hospital many times,” he added. “I know what it is [to] feel the loss if they close the hospital.”
In the earlier RFP, Fortis had proposed to partner with L&M and KF Brock to build large-scale housing, and partner with NYU-Langone and Lutheran Family Health Centers to provide a free-standing ER and other health care services, but no hospital.
Other previous respondents in the audience included Peebles Corporation, partnering with the Institute for Family Health; the Related Companies, partnering with Blue Wolf Capital, the Brooklyn Hospital Center and the Mt. Sinai group; and Brisa Builders, partnering with the Chetrit Group.
Representatives of the Chinese Community Accountable Care Organization (partnering with the Eastern Chinese American Physician IPA, John Catsimatidis, and Rudy Washington) were also in attendance. CCACO was the only respondent in the first RFP round to propose a full service hospital.
Other groups represented at the forum included Memorial Sloan Kettering, Toll Brothers, MedDev LLC; Brooklyn Health Partners LLC; and more.
Sue Raboy, spokesperson for Patients for LICH, told the Eagle, “I’m confident that the potential bidders will see what they have here to work with. It’s like a jewel. How can they not apply?”
Mandatory site visits take place Tuesday and Wednesday, March 4 and 5. Bidders have until March 19 at 3 p.m. to submit their best proposals. Evaluators will have until March 26 to consider and rank the proposals.
SUNY/LICH Community Health Forum Presentation – March 3, 2014
Statement from the Boerum Hill Association; Brooklyn Heights Association; Carroll Gardens Neighborhood Association; Cobble Hill Association; Riverside Tenants’ Association; Wyckoff Gardens Association, Inc.
We would like to thank SUNY and Board of Trustees for hosting this Community Health Care Forum. We welcome the opportunity to discuss the needs of the roughly 300,000 residents in the catchment area of Long Island College Hospital. This area includes some of the most affluent communities in Brooklyn: Cobble Hill, Brooklyn Heights, Carroll Gardens and some of the fastest-growing neighborhoods in the city like the exciting community springing up around the Gowanus Canal, the new residential towers in Downtown Brooklyn and Brooklyn Bridge Park, as well as the very large residential populations in Red Hook, Gowanus, and Wyckoff public housing. All of our neighborhoods share a strong desire to attract the best possible health care provider in this historic location and all share a single objective: excellent medical services in a full-service hospital. So, rather than speak in terms of needs, we would like to speak to the opportunities that we see for potential operators.
Let's look at the population and communities served by LICH.
First, the physical facility is located in the center of Brooklyn's affluent Brownstone belt. Some of Brooklyn's wealthiest residents call Brooklyn Heights, Cobble Hill, and Boerum Hill home. These communities are consistently rated as having the best residential quality in all of New York. Property values are among the highest in the city and retained their value when almost all other communities across America lost value after the financial crisis of 2008. Individual brownstone properties in the immediate vicinity of LICH are now selling in the $5 to $8 million range. It would be fair to say that this area's per capita health care expenditures are some of the highest in the world and that this group represents a major marketing opportunity for an operator that is prepared to address and serve the needs of this group.
Second, we are a growing community. From Red Hook to Gowanus and Downtown Brooklyn to Brooklyn Bridge Park, new residents are moving in at a pace that has not been seen for many years. Residents are moving to brownstone Brooklyn from all over America and all over the world. This growth consists predominantly of younger families attracted to our vibrant communities, excellent schools, cultural attractions, well-maintained parks, and proximity to business and shopping opportunities in Manhattan, located just one subway stop away for many. This population growth is particularly evident in the number of young children now populating our commercial streets. Neighbors now speak of "stroller jams". All of our businesses – book stores, clothing stores, and restaurants – that cater to this youthful population explosion are experiencing major growth. The economic desirability of our neighborhoods is evident in the rapidly increasing rents on all of our major shopping streets. This rising trend is true throughout the entire LICH catchment area. Red Hook and Gowanus are now two of the fastest-growing communities, with major new retailers like Ikea, Whole Foods, and Fairway providing a major boost to the local economy, employment, and residential quality of life. The prediction of 40,000 new residents in Downtown Brooklyn by 2020 may, in fact, be a conservative estimate.
Over the past decade, Downtown Brooklyn and its surrounding residential communities have become the fastest-growing, most dynamic residential hub in the entire New York metropolitan region. Every indication shows that this upward trend is going to continue for the forseeable future. We believe that access to top-quality health care is critical to sustaining this growth.
What do we think it will take for you to succeed in our community?
First, for excellence in medical services, the medical and nursing staff and the physical facility are prerequisites to success. Our residents have access to the finest medical facilities in the world but have a strong desire to seek providers located near their homes, so it is imperative that the highest standard of excellence and quality of care be offered. It is critical to recognize the competitive environment and to calibrate the level of services based upon what the market demands. Previous operators have violated this first and most important law of supply and demand to their peril.
Next, focus on the youngest and oldest members of our community. This has proven to be an effective strategy for success in Cobble Hill. The LICH catchment area contains some of the largest concentrations of children of any census tract in America. It is critical to recognize the importance of this market and how critical serving them will be to your success in this market. Centers for excellence in Pediatrics, OB/GYN and all services relating to children and teens are essential, strongly desired and will be heavily used. The Pediatric Emergency room is an example of how catering to this segment of our population will help attract and retain a loyal patient base. A children's hospital, a full-service Pediatric Clinic, and even private doctors' offices for pediatric specialties would all be embraced by our residents.
For many of our residents in the Red Hook and Gowanus Houses critical health care access issues that must be addressed include: Diabetes, High Blood Pressure, Respiratory (Asthma from the mold in NYCHA), Dental Care and Reproductive services in addition to community education and training to insure better health care education, access and treatment. Maintaining outpatient services for community members who depend upon them is essential.
LICH also has 12 state-of-the-art operating suites, a linear accelerator, CAT scan and MRI machines that are in demand for Cardiac, Orthopedic and Stroke-related surgeries.
Then, become a part of the community! LICH is located in one of the most exciting, dynamic multi-cultural communities in the world, one that is prepared to work for and support institutions that they see as part of their community. We are creative, we are loyal and we are prepared to fight for what is important to our children, our families, our seniors and our hospital! We have fought for LICH again and again and we will fight for you – but only if you embrace our communities, treat us with care and respect, and accept us as your partners. Many years ago, we developed a simple but successful formula: what's best for LICH is best for the community, and what's best for the community is what's best for LICH. Neglecting this simple rule has proven to be catastrophic, but following it is easy (and we will help you every step of the way). It is a business plan that is guaranteed to succeed.
How viable is LICH?
There's ample evidence that LICH can be viable with the right operator working with the community. LICH was in the black as recently as the first quarter of 2011 according to its last pre-SUNY CEO. According to New York State Controller Thomas DiNapoli's January 2013 audit of SUNY Downstate, LICH's total operating losses for 2010 were only $4.7 million. More recently, Justice Carolyn Demarest of Brooklyn state court concluded in her Decision and Order of August 20, 2013, "SUNY-Downstate's actual losses attributable to LICH approximate $30 million dollars at this time."
The Daily News reported on January 24, 2013 that LICH's staffed beds were nearly full: "The number of staffed beds is about 260 – and on average 237 per day or more than 90% of them were in use last year".
The laws of supply and demand favor LICH. As SUNY's April 20, 2011 verified petition to the court stated, "Kings County, where LICH is located, has a relatively low hospital bed per 1,000 population ratio. There are 6,408 certified hospital beds in Kings County, which yields a ratio of 2.51 hospital beds per 1,000 population. [...] In comparison, New York State has a ratio of 3.30 hospital beds per 1,000 population." There simply are not enough hospital beds for Brooklyn's exploding population.
Why do we strongly favor a full-service hospital?
We know that you are all aware of our year-long battle to save our hospital, but you may not be aware of why this is so important to us. First and foremost, we believe that a full-service hospital – large or small – is essential for providing life-saving emergency and acute care. We have thoroughly investigated existing "stand-alone emergency rooms" and “urgent care centers” and we do not believe that this concept will provide the scope of critical care services that are sufficient to serve a population that includes Downtown Brooklyn and a major swath of Brooklyn's brownstone belt. Second, we are convinced that stand-alone ER's don't work for pediatric cases, and the same applies for the elderly. Apart from a stand-alone ER being only a stepping stone for seriously ill patients, the choices of which hospital where a patient would be sent are inadequate or unacceptable. At a very minimum the choice should be that of the patient. However, every additional step in care transitions, creates more opportunities for error and miscommunication. We are absolutely convinced that neither a stand-alone ER nor an urgent care center will provide sufficient protection for our residents nor will be insufficient to sustain the economic growth of our region. Governmental and business leaders have been rightfully proud of the tremendous prices ”Luxury Condos” bring in our community, but will this growth be sustainable if there is a perception that there is insufficient medical service? We strongly believe that the answer is NO. No matter how wonderful the harbor views are, they cannot make up for a lack of basic lifesaving services.
A few words about the Cobble Hill Health Center.
You know of our battle to save our hospital, but you may not be aware that it is just as much a battle to preserve and protect the Cobble Hill Health Center. LICH has been a mainstay for the sole remaining major health care provider in Cobble Hill – the Cobble Hill Health Center which provides services for rehabilitation, homecare and long term nursing to our aging residents. This institution is one of the area's major successes and up until a year ago, half of the residents at Cobble Hill came from LICH. LICH provided safe, nearby support for the elderly in need of emergency care, too. The Cobble Hill Health Center's success should be the model for the new LICH operator's success.
The elderly need access to primary care physicians and specialty services that would include: Cardiology; Gastroenterology; Pulmonary; Urology; Orthopedics; Cancer services; Dialysis; Psychiatry and Behavioral Health services; and Diagnostic imaging. Services to patients with Alzheimer’s disease and related disorders and their family caregivers are seriously inadequate. A diagnostic and treatment center would be an invaluable additional resource. Where admission to acute care is unavoidable the following services are essential: Coronary care, intensive care, medical/surgical, physical medicine/rehabilitation, and palliative care. Having geriatricians on staff can significantly enhance hospital in-patient services. The above mentioned specialty care services also need to be available for in-patient care.
Some of the previous proposals indicated that they would operate a free standing emergency room and that patients requiring hospital services would be transferred to a neighboring hospital. It is important to understand that for a geriatric patient to be admitted to an emergency room is a traumatic experience. If the patient is taken to the ER to be stabilized and is then required to be transferred again to a hospital located elsewhere for in-patient care, this doubles the trauma and increases the possibilities for poor transitions of care.
We deeply appreciate that you are here today to listen to us. The opportunity to share our concerns, our needs and our goals is a rare opportunity that few communities have ever had. We thank SUNY, the SUNY Trustees and all of the elected and governmental officials who have made this meeting possible.
• LICH, a teaching hospital founded in 1858, serves one of the fastest growing residential and commercial neighborhoods in New York City:
• With approximately 110,000 residents (statistics are from government sources, unless noted), the area (zip codes 11201 and parts of 11231 and 11217) is swelling with young families: Children under 9 years old have increased by 31% in Brooklyn Heights and Cobble Hill since 2000.
• Four public housing projects with over 13,400 residents are here.
• The Cobble Hill Nursing Home, serving 1150 home and adult day care patients and 365 resident nursing and rehabilitation patients, is LICH's next-door neighbor.
• Seven colleges and universities educate 40,000 students in the neighborhood -- more even than Cambridge, Massachusetts.
• The Downtown office population is soaring, with 70,000 workers in Metro Tech.
• DUMBO, home to the City's burgeoning high-tech industries, has 9,600 employees in 500 companies and projected to rise to 17,900 by 2015.
• The area draws thousands of employees, lawyers, litigants, and jurors to the NYS and federal courthouses; shoppers and tourists crowd the Atlantic Center, Fulton Mall, Smith Street restaurants and Brooklyn Bridge Park; and at night, 17,000 fans pour into the new Barclay's Center.
• There is no precinct in the Brooklyn with more terrorist sites than the 84th, which includes two bridges, the headquarters for the NYC Fire Department and the NYC Transit Authority, the 911 center, the NYC Office of Emergency Management, courts, two mosques, and several synagogues.
• LICH had the second best payer mix in Brooklyn with 32% of patients covered by private insurers, 65% by Medicare and Medicaid, and only 2.5% uninsured in 2010. Residents in LICH's 11201 zip code are among the city's most affluent with an average household income of $114,165 in 2012, compared to $58,030 in Kings County overall.
• Contrary to Downstate's public statements that local residents don’t use the hospital, fully 50% of LICH patients reside within 2 miles of the hospital.
• Downstate, listed LICH’s total operating losses for 2010 at $4.7 million, and Judge Demarest’s August 2013 Decision and Order stated that “SUNY-Downstate’s actual losses attributable to LICH approximate $30 million dollars at this time.” This is far cry from the hundreds of millions SUNY Board members have claimed in the press. Think of what a good hospital operator could achieve given the wealth of patients, workers and visitors to the area each day!