By LOUIS FLORES
As the deal collapses to save a controversial, free-standing Emergency Department at the former site of Long Island College Hospital, or LICH, the long string of hospital closings across New York City cast a haunting shadow over city and state politics.
Thirteen New York City hospitals have either closed or been downsized since the Berger Commission empaneled by former Gov. George Pataki (R-NY) issued its hospital closure report. That report, which recommended the closure, downsizing, or merger of hospitals across New York state, was based on obsolete assumptions about the long-term numbers of insured patients. With the advent of Obamacare, signed into law about three years after the issuance of the Berger Commission report, the recommendations for hospitals closures instantly became flawed and unrealistic. However, the conservative mindset of the commission's chief, Stephen Berger, continued to hold sway over Albany politicians, who were looking to make draconian healthcare cuts to Medicaid without ever addressing the for-profit drain on healthcare dollars by large insurance companies. Under Gov. Pataki's worldview, state income and corporate taxes were too high, and the state's hospital infrastructure was too large to support after he had enacted a series of tax cuts. Cutting the supply of hospital beds by the wholesale closure of hospitals ignored, and continues to ignore, the safety net use of, and time sensitivity of receiving complex, life-saving emergency care at, full-service hospitals. Since hospital closures were rightly expected to be unpopular, the Berger Commission report was issued in Gov. Pataki's last month in office, December 2006, and those recommendations were issued by an appointed panel, instead of coming directly from Gov. Pataki himself. The report's findings were left to Gov. Pataki's Democratic successors and the respective, impacted local communities to carry out.
Although politicians anticipated some pushback from the communities affected by the first batch of hospital closings, what politicians did not expect was the relatively minor electoral price that they would initially pay for carrying out the first round of Berger's recommended hospital closings. Locally, important constituency groups found themselves hamstrung by duplicitous Albany and New York City politicians, with a few notable exceptions.
The fight to save LICH has had all the hallmarks of the efforts to stave off hospital closings that came before it in the wake of the Berger Commission report, except that after such a large string of hospital closings or downsizings, voters have been escalating their pushback to the shameless austerity measures of wholesale healthcare cuts in the state's budget.
Of the 13 hospitals to have closed across New York City since 2007, five were in Queens : Parkway Hospital in Forest Hills closed in 2008 ; Mary Immaculate Hospital in Jamaica and St. John's Queens Hospital in Elmhurst each closed in bankruptcy in 2009 ; Peninsula Hospital Center in Far Rockaway was driven to closure in bankruptcy in 2012 ; and Holliswood Hospital, also in Jamaica, was closed in 2013. Holliswood was an important hospital to lose, because it served people, who needed in-patient psychiatric care. The closure of in-patient psychiatric hospitals has meant that other institutions, notably jails and prisons, have had to become inferior places, where psychiatric patients with no access to healthcare receive treatment -- in a criminal setting, but only after their mental illness has driven them to criminality, as opposed to a healthcare setting, where a patient can be supported and their illness be better managed. But when community activists raise the issue about properly treating people with mental illness when they are now jailed, activists receive the same cold response from politicians, as if activists were asking for politicians to fully fund full-service hospitals. Politicians are equally loath to raise taxes to pay for basic healthcare services for people with mental illness, for people in jail, or for the poor. Consequently, healthcare activists have been unable to alter the pervasive austerity narrative in Albany or City Hall.
Some of New York state's tactics to try to drive LICH into closure, such as instituting ambulance diversions to starve LICH of new patients, were also used against Mary Immaculate and St. John's. In spite of some demonstrations, as Mary Immaculate and St. John's were shuttered, and their combined staff of 2,500 employees were laid off, the impression was that state officials in Albany wanted the hospitals to be closed to achieve the healthcare costs reductions called for in the Berger Commission report. The same was true of Peninsula Hospital. When Peninsula appeared to be stuck in bankruptcy court, the state's Department of Health sprung on it a surprise health inspection, and the state basically ordered the hospital closed due to laboratory issues. When LICH was taking too long to close, its current operator, the State University of New York, or SUNY, apparently intentionally botched the billing of LICH's accounts receivable to make LICH look like it was losing more money that it should have. Other times, the healthcare hatchet man, Mr. Berger, would slyly propose that hospitals should merge as a way of shifting the burden of closing a struggling hospital onto the board of directors of the healthier hospital partner. Before and after each hospital closing, advocates claimed that the loss of community hospitals would lead to longer emergency room waits at the remaining hospitals, longer EMS transport times, and to the loss of access to safety net healthcare -- each a threat to public health. Activists trying to save LICH produced a public service announcement about their concern for increases EMS transport times, but the longer EMS transports and the other issues mattered not to Albany politicians and their operatives, whose only intent was to cut healthcare costs.
As NYU Langone Medical Center pulls out of its deal to sponsor a controversial, free-standing Emergency Department at LICH, the political fallout of the collapsed LICH deal to maintain some form of healthcare on-site is demonstratively more painful now to each of the state Capitol and to City Hall than some of the earliest hospitals first closed under the Berger Commission report and later expanded under a subcommittee of yet another healthcare cuts panel, the Medicaid Redesign Team, which was created by Gov. Andrew Cuomo (D-NY) in 2011. Tellingly, Mr. Berger, who chaired Gov. Pataki's hospital closure panel, also chaired the hospital closure subcommittee of Gov. Cuomo's MRT. Mr. Berger's reappearance on the MRT subcommittee was no accident : he returned to close more hospitals. In other words, the fix was in.
On Twitter, reporters routinely mocked Mayor Bill de Blasio for speaking in hyperbole when a bidder had been identified, who would maintain a full-service hospital at LICH, an outcome that later unraveled, leading to widespread disappointment and resentment by residents living in LICH's catchment area in Brooklyn. Residents claimed that the mayor exploited LICH as part of a politically-expedient campaign tactic to win last year's mayoral race, and, once having won, he turned his back to Brooklyn residents, who had expected the mayor to save LICH. To stave off any further voter anger, the de Blasio administration tried to spin a political win out of the now-doomed NYU deal, even going to some lengths to use the mayor's nonprofit political lobbying arm, the Campaign for One New York, to send a deceptive, "dark money" mailer to affected residents over the summer in an effort to placate voter anger well in advance of the September 9 primary elections. Yet, nobody questioned how NYU, a very wealthy private hospital, could receive over $1 billion in federal Hurricane Sandy aid, but no provision could be made for other safety net hospitals, which NYU and other medical centers relied upon, to receive overflow and transfer patients when major hospitals suffered hurricane and flooding damage.
The amount of hospital employee, patient, and supporter organizing around the community effort to save LICH built upon some of the organizing that tried, but failed, to save Peninsula Hospital. The effort to save Peninsula built upon the very visible campaign, which tried, but failed, to save St. Vincent's Hospital in Manhattan. Facebook pages were created, activists took to Twitter, e-mail listservs took off, and town halls were held. At every turn, it seemed like some politicians said the right things at public rallies, when they did show up, but when it came time to actually deliver a deal to save a full-service hospital from closing, politicians were unable to make good by their constituents. Some politicians, like then Manhattan Borough President Scott Stringer, said at a 2011 town hall meeting that the Lower West Side of Manhattan needed a full-service hospital to replace St. Vincent's and that politicians should be held accountable to deliver a full-service hospital to the community. But when it came time for him to review Rudin Management Company's $1 billion luxury condo conversion of St. Vincent's as part of the city's ULURP zoning process, Beep Stringer approved the Rudin plan, betraying his earlier promise to St. Vincent's activists. Now that he is the city's comptroller, Mr. Stringer showed up at a rally outside LICH to bemoan how, “We have put luxury condos at the forefront of the debate, not healthcare," according to The Brooklyn Daily Eagle. Desperate for any politician to take up their cause, healthcare activists can't afford to be choosy when it comes to finding an elected official to headline a rally, even one as shifty as Comptroller Stringer.
But even Comptroller Stringer is not worse than Mayor de Blasio. When Mr. de Blasio was a candidate for the mayoralty last year, he was arrested in a choreographed piece of civil disobedience to save LICH. The act of civil disobedience and arrest was the creation of Peter Sikora, an operative with close ties to the Working Families Party. Mr. de Blasio, who was previously the city's public advocate, was never visible in the efforts to save any community hospitals until LICH conveniently cross paths with his mayoral campaign. Mr. de Blasio eventually won last year's mayoral race after he each of got arrested to save LICH, benefitted from a controversial Super PAC-funded effort to trash his primary opponent, former Council Speaker Christine Quinn, and a slick campaign commercial featuring his son, in which his campaign promised to end the stop-and-frisk era. The unseemly antics that politicians and their campaign consultants pull to win elections make some jaded political observers think that Mr. de Blasio's LICH protest arrest was just "politics as usual," whereas hospital activists truly felt betrayed by Mr. de Blasio's politically-expedient machinations. Since Mayor de Blasio's nonprofit political lobbying arm sent the dark money mailer, many activists take that as a cue that the mayor is only trying to do damage control at this point, believing that he no longer has any appetite to fight to save LICH. Political insiders privately say that City Hall advisors close to the mayor believe that anything he does for LICH will not end well for him, so he shouldn't even bother to waste the political efforting at this point, reaffirming the viewpoint of those, who felt that the mayor basically exploited LICH as part of his three-pronged effort to move into Gracie Mansion.
In a move that some said was a further attempt to ring fence the political backlash from the end of full-service hospital care at LICH, Mr. Sikora competed for the Democratic Party's nomination to run in the general election race to represent the 52nd Assembly District in Brooklyn, which encompasses LICH. Mr. Sikora lost that race, but his campaign drew criticisms from one opponent, Doug Biviano, who drew attention to the role of the lobbying firm, BerlinRosen, which worked as Mr. Sikora's campaign consultants. BerlinRosen was also involved in sending the dark money mailer on behalf of the Campaign for One New York. The mailer was denounced by the good government group, Common Cause. Advocates for campaign finance reform complained that the role of BerlinRosen in the 52nd Assembly District race was subverting the community from fully fighting to save LICH as a result of the involvement by the special interests behind the Campaign for One New York's big money donors and lobbyists. Mr. Biviano did not respond to a request for comment, but, in numerous press reports, he has been critical of BerlinRosen. Since Mayor de Blasio has both been closely allied with BerlinRosen and actively campaigned for Mr. Sikora, some activists believe that Mr. Sikora's primary election loss reflected, in part, voter anger at Mayor de Blasio, and Mr. Sikora's rejection at the polls may foreshadow political trouble for Mayor de Blasio.
Questions about the role of lobbyists hasn't been limited to only BerlinRosen. Another lobbyist that is common to both the LICH developer, Fortis Property Group, and the St. Vincent's developer, Rudin, is James Capalino. In the past, he has represented both developers. In spite of taking up the cause of saving community hospitals, Mr. de Blasio publicly campaigned with Mr. Capalino, sending a mixed message about his commitment to communities impacted by hospital closings. Mr. Capalino became a critical fundraiser for the de Blasio campaign when Mr. Capalino was on the organizing committee of a controversial $1 million fundraiser hosted by former First Lady Hillary Rodham Clinton at the Waldorf-Astoria. All of a sudden, the campaign milking the theme of "A Tale of Two Cities" set up shop in the luxury Art Deco splendor of the Waldorf with key help, in part, from Mr. Capalino's big money connections. In spite of Mr. Capalino's close association with the de Blasio campaign, it's not exactly clear if that relationship played any role in Mayor de Blasio's about-face on LICH. Many Brooklyn residents believe that Fortis would love to convert the entire site into luxury housing to maximize its profits, but as has been noted by others, Mr. de Blasio publicly opposed the Fortis deal last December, before he even took office. Back then, Mr. de Blasio was already shifting the political goal post to preserving "essential services like emergency care" on the site of LICH without demanding a full-service hospital. Now that the de Blasio administration appears to have washed its hands of LICH, the question that some healthcare activists raise is whether Mr. Capalino's past representation of Fortis holds any sway to affirm City Hall's silence and distance in relation to LICH.
The hospital closing crisis affecting New York City is being driven, in part, by the changing way that healthcare insurance companies prefer that patients receive the lowest-costing care in order to maximize profits. By shifting care from full-service hospitals to out-patient clinics, healthcare insurance companies can cut the reimbursement rates, arguing that there is less overhead to support at specialized clinics than at full-service hospitals. There are healthcare risks to this kind of approach to healthcare, as witnessed by the whole world when comedienne Joan Rivers went into cardiac and pulmonary arrest at an out-patient clinic, leading to about a week on life support, before she passed away at Mount Sinai Medical Center in Manhattan. Complications can arise at out-patient clinics, which lack complex, life-saving healthcare treatments and certified, trained staff, which are only available at full-service hospitals. But some healthcare activists believe that the economic pressures that are driving hospitals to closure actually come from New York State government, which authorized the Berger Commission and the Medicaid Redesign Team. No other source of influence is greater than the political pressure to close hospitals as a backdoor to cut the state budget in an effort to prevent tax increases on the wealthy.
The unraveling of multiple deals to save LICH has exposed a series of failures in state and city politics around healthcare. LICH was basically destroyed in 2013, some political insiders say. Ambulance diversions began last year, the residency program was ended, and its fate was essentially sealed by negotiating away the responsibility to pay back the depleted Othmer endowment. Add in SUNY's scandalous handling of LICH's accounts receivable, and the motive seems clear : SUNY was driving LICH into the groud. Consequently, doctors and patients fled to other hospitals. Last year also coincided with the final year in office by each of former Mayor Michael Bloomberg and former Council Speaker Quinn. Neither Mayor Bloomberg nor Speaker Quinn ever saved any hospital from being closed or downsized, and neither of them fully challenged Albany officials to save any community hospitals. Their belief that full-service hospitals had to close, in accordance with the Pataki-Berger-Cuomo doctrine of healthcare cuts, was in opposition to community demands to preserve strategic, complex, and full-service hospital healthcare infrastructure across New York City's communities. Moreover, the Bloomberg-Quinn support for luxury housing development of former hospital sites made clear that they supported real estate over healthcare. That LICH had been basically driven into the ground by the time of last year's general election, which Mayor de Blasio won with an anemic voter turn-out, was inconsequential to his need to exploit LICH for his own electoral campaign purposes. He won, and that was all that seemed to matter to him. And it was no coincidence that before Bloomberg-Quinn left office, there was already speculation of some form of luxury condo development on LICH's large complex. Activists, who were critical of the Bloomberg-Quinn pro-development era, pointed to Speaker Quinn's cold treatment of hospital activists in her own Council District after the closing of St. Vincent's, as one reason she lost last year's mayoral race. That same angry voter reaction is what Mayor de Blasio fears will be directed to him, if he doesn't find a way to do permanent damage control around LICH. Even though NYU has promised to operate a controversial, free-standing Emergency Department on a small portion of the former site of LICH, NYU has balked at hiring union nurses, even with its large Sandy aid package. If Mayor de Blasio wanted to prod NYU to consider a full-service hospital at the site of LICH, even one that was smaller than the size of LICH prior to the MRT hospital closing effort, some activists say that the de Blasio administration could lead the charge, given the high number of NYU officials that were tapped to join the de Blasio administration early this year. But thus far, City Hall refuses to engage this possibility.
If Mayor de Blasio really cared about saving LICH, then hospital activists believe that three viable options remain available to him : (i) the mayor could request an amended Sandy aid package that would fund emergency preparedness at community hospitals to ensure a safe capacity to accept overflow or transfer patients, should other hospitals go off-line, as happened during Hurricane Sandy ; (ii) the mayor could press the city's Health and Hospitals Corporation, or HHC, to operate the scaled-down Emergency Department at LICH until a viable operator can present a plan to restore full-service hospital services at LICH ; or (iii) if he objected to using taxpayer money to bailout LICH, then the mayor could lead the charge to raise philanthropic monies through his Fund to Advance New York City to replenish LICH's endowment and operating capital. Resources exist, in the form of billion of dollars in Wall Street settlements at the state level and an anticipated $1 billion in new tax revenues from the up-zoning and sale of air rights around Grand Central Terminal at the city level ; these resources could severally or jointly fund the HHC option. Phil Walzak, Mayor de Blasio's spokesman, was asked about the viability of these three options, but he did not answer a request for comment.
As voter discontent has grown with each successive hospital closing, two Albany politicians made a joint effort to push back against the Berger Commission hospital closings : then Assemblyman Rory Lancman (D-Fresh Meadows) and former Senator Shirley Huntley (D-Jamaica). Their leadership stood in stark contrast to all the other politicians, who just gave lip service to the importance of community hospitals. In September 2010, New York City leaders urged former Gov. David Paterson to sign the Hospital Closure Planning Act, a bill which would have required the state’s Department of Health to hold a public forum and report on the impact of a hospital's closure on the surrounding community's access to medical care. The legislation, which was sponsored by Assemblyman Lancman and Senator Huntley, came in response to the notorious closings of Mary Immaculate, St. John's, and Parkway hospitals in Queens. After these hospitals closed, each community was outraged and complained that the state lacked a plan for providing adequate and safe replacements of emergency healthcare for their former hospitals' respective catchment areas. “A hospital's closing should not mean the closing off of healthcare services for the surrounding community, but that's what happens unless the state listens to the community and makes plans for meeting its healthcare needs," then Assemblyman Lancman said, at the time.
“Losing a hospital can adversely affect a community and its residents. We’ve seen it happen here in Southeast Queens and most recently in Manhattan, with the closing of St. Vincent’s hospital. Due to current economic climate New York State is facing, we must ensure that neighborhoods across the state can access alternative health care when a hospital closes. It is equally important to involve communities in the planned closure of a hospital and in replacing the most important services residents rely on. The residents of the community where a hospital is located have the best understanding of the services they need and what needs to be done,” said Senator Huntley. In October 2010, Gov. Patterson signed the Hospital Closure Planning Act into law after he had vetoed a similar bill in 2009.
In spite of the intentions of the Hospital Closure Planning Act, state and city politicians can still turn a deaf ear to communities impacted by hospital closures, to which the community formerly served by LICH can surely attest. SUNY's apparently intentional bungling of $100 million in LICH's accounts receivable made LICH look like it was losing more money faster. Gov. Cuomo's yes-men at SUNY, from the Chair of the Board of Trustees, H. Carl McCall, to SUNY Trustee, Richard Socarides, failed in their duties to save LICH, perhaps in accordance with the Cuomo administration's wishes, some healthcare activists say.
Political insiders say that the key to any restoration of a full-service hospital at LICH is to craft a sustainability plan. One person with inside knowledge about LICH said that, in a best case scenario, it may take three years to return LICH back to its former fully-functional self. However, even then, LICH would need to improve its payer mix, a term used to describe the ratio of privately insured patients versus Medicaid or Medicare patients. Conditioning LICH's long-term sustainability on the free-market forces that push for ever decreasing reimbursement rates sounds like an easy way to say that it is impossible to save LICH. Healthcare activists, who take the long-view about financing healthcare in the United States, point to a single payer healthcare system as the surest way to adequately fund healthcare access to all, whilst, at the same time, eliminating any need to fix a hospital's payer mix. A single-payer system would also address the for-profit drain on healthcare dollars by large insurance companies. However, taking such a long-term view on LICH and the broader healthcare industry would be a challenge when politicians make politically-expedient decisions during campaign seasons about strategic community resources, like full-service hospitals.
Complicating matters for Mayor de Blasio is that, besides LICH, Interfaith Medical Center, also in Brooklyn, is on the verge of either closing or downsizing. Funding a long-term sustainability plan for both LICH and Interfaith -- at the same time -- may be too much to expect from Mayor de Blasio, who heavily relies on the advice of lobbyists, such as BerlinRosen, before he promulgates important city policies. Therefore, it's not just short-term electoral politics that plays a role in how the de Blasio administration can be counted on to respond to LICH, but it will also depend on the special interests of lobbyists, which form the core of Mayor's de Blasio's inner circle. Since Mayor de Blasio, and the new Council speaker, Councilmember Melissa Mark-Viverito, are working to reelect Gov. Cuomo this year, they cannot be relied upon to confront Albany politicians, who are driving the austerity cuts that are closing so many of New York City's community hospitals. So long as the fate of the city's community hospitals rests on such situational, political partnerships, the future of LICH, Interfaith, and other financially-troubled community hospitals may take on the look of that of Mary Immaculate and St. John's.
Updated to include information about the high number of de Blasio administration staff that hail from New York University, as well as Stephen Berger's strategy of merging hospitals into closure.