By Mary Frost
Brooklyn Daily Eagle
An overflow crowd packed Brooklyn Borough Hall's courtroom Friday morning for a hearing on the borough's health care crisis, sponsored by the New York State Assembly's committee on health.
The hearing began just moments after Assemblywoman Joan Millman (D - District 52) confirmed to the doctors and nurses rallying outside that SUNY's board of trustees had voted that morning to close down Long Island College Hospital (LICH).
In spite of the sleet and freezing rain, so many people poured into the courtroom that extra chairs were added, then an another room was opened and a live video feed was set up. A dozen Brooklyn Assembly representatives, chaired by Richard Gottfried (D- Manhattan District 75), chair of the Assembly's Health Committee, questioned the witnesses, who were sworn in before testifying.
There was one glaring absence, however. "I regret the state Health Department chose not to send anybody to testify," Gottfried said, eliciting boos from the crowd. "I told the commissioner that in view of the pilot program in the state budget for a for-profit health center it would be appropriate for them to come to the hearing and tell us what's on their minds. But they declined."
Stephen Berger, who in 2011 led the Brooklyn Work Group, a panel appointed by Gov. Andrew M. Cuomo to report on how to restructure Brooklyn’s failing health system, was the lead witness, and every representative on the dais asked him what went wrong and how to fix it.
The panel's original report included an analysis of the quality of health care in Brooklyn, Berger said, and recommended sacrificing SUNY Downstate Medical Center's hospital in favor of LICH. "We were wrong about LICH," he said. "We assumed the SUNY situation would deal with it."
SUNY Downstate took over an ailing LICH from Continuum Health Partners in 2011. In light of SUNY's lack of follow through and its actions to now close the hospital, many LICH supporters speculate the takeover was a transaction driven by real estate rather than medical considerations. SUNY Chairman Carl McCall has refused to rule out selling the valuable Brownstone Brooklyn properties, estimated to be worth anywhere from $100 to $500 million.
On Wednesday, Berger sent a letter to SUNY board chairman H. Carl McCall, in which he explains why he now endorces closing LICH.
"Our recommendations were based to a large extent on the proposals and plans outlined by your then existing Management Team in Brooklyn," he wrote. "Unfortunately as we have seen the assumptions underlying their plan proved to be unattainable and frankly was based on assumptions and conditions which we now know did not exist or were rapidly changing."
Berger said on Friday that he subsequently learned that SUNY Downstate has very few "tertiary" -- or higher level -- operations to transfer to LICH, as the original plan called for. Moving that business was a bust because, he said, "There wasn't much business to move to LICH."
"None of our other recommendations were carried out," he added.
Brooklyn has to work towards a health care future where residents are less dependent on hospital ERs for their day-to-day health issues, Berger said. "Big box hospitals are not the hospitals of the future. Acute care institutions [hospitals] are just part of the health care system, not the whole system. They deal with sick people -- they don't have a system that tries to keep people from getting sick. "We're putting money into bricks and mortar, not primary care."
Berger said the challenge was "how to get from here to there," and sketched out the idea of a ten-year plan. "The quality of health care in Kings County is unacceptable, and the present infrastructure is not set up to deliver health care. We have to build around a primary care model."
Assemblyman Vito Lopez (D - District 53), however, countered with proposals of his own. "The hospitals you're talking about are in the poorest areas," he said. "We went from 25 to 15 hospitals. If it goes down to 10 in Brooklyn we'll be worse than some southern states in terms of hospital capacity, and all impacting one particular area in Brooklyn."
He brought up the issue of insurers reimbursing less for treatment in Brooklyn hospitals than they do in Manhattan hospitals. "What would happen if Wyckoff got the same reimbursement rates as Manhattan hospitals?" he demanded, as some in the audience cheered. "We're the only area having to redesign hospitals -- 2.7 million people with 10 hospitals -- while in Manhattan they're building two hospitals. Sloan [Memorial Sloan-Kettering] should be in Brooklyn, and Wyckoff should merge with Sloan and get reimbursed at Sloan's rates.
"If you're poor or minority, the implication is the reimbursement is less," Lopez added. "Give us the Manhattan rate."
Lopez also got a rise from the crowd when he mentioned that developer Bruce Ratner was on the board of Memorial Sloan-Kettering. "Maybe he could be on the board of a Brooklyn hospital, too. The revenue would be tremendous."
"You're right about philanthropy," Berger agreed. "But the rate issue is more complicated. We're looking at new rates for the 'safety net communities.' It's not just the rate, it's the pair mix -- Medicare, medicaid and commercial insurance."
Gottfried asked Berger about the controversial pilot program Gov. Cuomo included in his budget that would allow one for-profit hospital in Brooklyn. "The budget speaks of overriding provisions limiting the corporate ownership of hospitals. It has to be affiliated with an academic medical center, but that doesn't mean it couldn't be a fully for-profit hospital," he said.
"That's not my understanding of the goal," Berger said. "There are a variety of structures where not-for-profits get a 25, 30 year lease with long term infrastructure funding providing capital." He compared this to real estate funds where control returns back to the not-for-profit. "Public-private partnerships are done all over the world."
Assemblyman Karin Camara (D- District 43) said he had grave concerns about turning a hospital over to a corporation. "There's a danger we start measuring success by quarterly earnings."
"We would be bringing in outside capital, not ownership," Berger emphasized.
Assemblywoman Annette Robinson (D- District 56) said, "We could find hundreds of millions to build Barclay Center but we can't find the money to stabilize hospitals." She and other representatives emphasized the economic impact closing or merging more hospitals would have on their neighborhoods.
"St. Mary's closed in my district, and all around it is devastated -- wages, vendors, the whole economy is impacted. The mental health of the community starts to deteriorate as well. The conversation has to change."
Borough President Marty Markowitz pounded the table as he said, "New York Presbyterian comes to the rescue of New York Hospital -- what are we, chopped liver? You can't tell me not an institution in the state would look at LICH as a possible expansion opportunity. LICH has not been shopped around.
"Brooklyn is growing, and positively," he said. "With the new buildings, we're growing affluent folks as well. You can't tell me the borough now faces two hospitals closing. [Interfaith Medical Center in Crown Heights filed for bankruptcy in December.]
"You're the legislature. The budget must be approved by the legislature. You have to draw the line in the sand."
After the hearing representatives and LICH staff vowed to continue to keep up the pressure.
"Our fight isn't over," state Senator Daniel Squadron said in a statement on Friday. "As I said yesterday, SUNY's plan essentially turns a $63 million state grant into a subsidy for a massive real estate deal that will cut essential services without any community benefit. It should be no surprise that our community and Brooklyn will feel looted with this result."
“This vote by the SUNY board was a slap in the face to patients, caregivers and all working families in Brooklyn,” George Gresham, President of 1199SEIU United Healthcare Workers East said in a statement. “We will do everything in our power to make sure this disastrous closure is avoided and we keep LICH’s care and jobs in our community.”
Also participating in the hearing were Assemblypersons Joseph Lentol (D - District 50), Jim Brennan (D - District 44), Walter Mosley, Joan Millman (D - District 52), Inez Barron (D- District 40), the office of Rhoda Jacobs (D - District 42), Nick Perry (D - District 58), and Steven Cymbrowitz (D - District 45). State Senators Velmanette Montgomery was also recognized, and state Senator Daniel Squadron's representative was in attendance.