June 14, 2016
State Officials Discuss Brooklyn Health Care Plans with Residents
Gov. Andrew Cuomo's top health officials went to Brownsville Monday night to solicit community input for the future of health care in central and eastern Brooklyn, as they try to address one of the toughest health policy challenges facing the administration.
The beginnings of a plan are already in motion, with the state in April awarding Northwell Health $500,000 for a feasibility study to determine what it would take to replace four struggling independent hospitals - Brookdale Medical Center, Interfaith Medical Center, Wyckoff Heights Medical Center and Kingsbrook Jewish Medical Center, the only unaffiliated hospitals remaining in the borough - with a financially viable, integrated health system that will care for one of the least healthy, most densely populated communities in the state. The study will also consider what to do with University Hospital, part of SUNY.
How this new health care delivery model is organized, what services it provides and who is in charge won't be decided for some time, but whatever transition is to come, the Cuomo administration is anxious to avoid the kind of prolonged, ugly battles that characterized the fights over St. Vincent's in Manhattan and Long Island College Hospital in Brooklyn.
State Health Commissioner Howard Zucker, Deputy Secretary of Health Paul Francis and Deputy Commissioner Dan Sheppard spent more than two hours listening to local residents at I.S. 392, and assuring them no decisions would be made without first weighing their concerns.
"We're here to hear what you feel you need from the health system as we move forward to transform," Zucker said. "The whole thing here is to fix central and north east Brooklyn's health care, and as I've said before, no one should have to leave Brooklyn to get care."
The forum, part of the state's Voice Your Vision campaign, was hosted by Brookdale, which, along with Interfaith, Kingsbrook and Wyckoff will require nearly $300 million in direct operating assistance this year to remain open, according to state officials. And the state would have to spend nearly $2 billion through 2022.
Letting these hospitals go bankrupt could devastate their communities, which have high rates of diabetes, obesity and gun violence.
Brookdale, which lost approximately $35 million last year, provides the only trauma center in the area, said Mark Toney, the hospital's CEO.
"We're underserved in primary care and we're underserved in urgent care," Toney said.
Dozens of residents mentioned other needs including more mental health care, fresh food, a burn unit, an arthritis center, primary care, mobile health vans and aquatic therapy.
Zucker nodded along and promised to look into these deficiencies while Francis and Sheppard took notes.
In some ways, the conversations taking place in Brooklyn over the next several months will mirror those taking place on the Lower East Side of Manhattan, where Mount Sinai Health System also wants to transform health care delivery, proposing to replace Beth Israel Medical Center with a much smaller inpatient hospital as well as additional ambulatory care sites.
In an early sign that Sinai's plan may not encounter the kind of resistance that plagued St. Vincent's, fewer than two dozen people showed up last Thursday to an informational meeting hosted by Community Boards 3 and 6. Like Zucker, Mount Sinai representatives said they wanted to hear what the community needed before cementing their plans.
The future of central and east Brooklyn health care is far more complicated than that of lower Manhattan, but in Brooklyn there are also few signs so far of the protests and anti-Cuomo chants that echoed around threatened health care sites throughout 2013 and 2014.
Mount Sinai promised to keep all 4,000 union jobs and won the support of 1199 SEIU, the state's largest health care union. State officials believe they have the union's support for Brooklyn's transformation as well. 1199 SEIU and the New York State Nurses Association, the state's largest nurses' union, were instrumental in the protests surrounding the closure of LICH and Interfaith bankruptcy.
If they hold their fire, local residents who oppose whatever transformation plan is settled upon are robbed of their most potent weapon.
The state is also in a position to help build new facilities before taking anything away. Though no new construction has been proposed, Cuomo did set aside $700 million in capital money for Brooklyn, and former budget director Bob Megna said the money could build a brand new Brookdale.
That doesn't guarantee the community ends up with the same number of inpatient beds but it does prevent the kind of sudden closing that threatened Interfaith when it declared bankruptcy in 2012.
The challenge for the Cuomo administration - similar to what Mount Sinai is facing - is convincing a community that ambulatory care can replace inpatient care.
Sitting toward the back of the auditorium, making notes of their own, were executives from Northwell Health, which has made no secret of its interest in the Brooklyn health care market, a rapidly growing space that is changing both demographically and economically.
Northwell, which has so far committed to no more than a feasibility study, is the most likely health system to lead the transformation envisioned by the Cuomo administration.
Northwell tried unsuccessfully to take over LICH in 2014 and last year partnered with Maimonides Medical Center, which covers Southwest Brooklyn. Having a presence in central and eastern Brooklyn would make sense for the Long Island-based system, which has been shut out of the north by the city's other large health systems.
Taking over the struggling hospitals seems far-fetched given how much debt Northwell would have to assume and what that might to do the system's credit rating.
It could, however, sign a management contract that lets it play an active role without becoming an active parent.
What Northwell officials do not want is to become the focal point of community anger. The outreach from Zucker and Francis is effectively a demonstration that the Cuomo administration is willing to explain to the community why change is needed and to bear at least partial responsibility for whatever criticisms inevitably arise.
"It tells the community the governor is invested," said Senator Roxanne Persaud, who represents the area. "His investment now is not just lip service."