State Unions Alarmed
Health-Care Cuts Won't Affect HHC

By RICHARD STEIER

Even as unions representing hospital workers upstate decried the potential impact of a state hospital commission's recommendations that include the closing of nine hospitals and the loss of 7,000 jobs statewide, the President of the Health and Hospitals Corporation noted the likely cutbacks will have no direct impact on municipal hospitals.

DR. BARRY LIEBOWITZ: 'City's foresight pays off.'

In a statement issuing following the Nov. 28 release of the report by the New York State Commission on Healthcare Facilities in the 21st Century, HHC President Alan D. Aviles acknowledged that city hospitals were spared in large part because of belt-tightening they had done during the past decade, which included eliminating more than 2,400 patient beds and cutting the work force by 9,000 employees.

'Saw Gains We Made'

"The Commission clearly recognized the significant gains that HHC has made in improving the efficiency of its hospital operations," he said.

The panel described the health-care system as being in a state of crisis, noting that several institutions had filed for bankruptcy and others were steadily losing money, while "our Medicaid program, already the largest and most expensive in the nation, is growing at an unsustainable rate," according to its report.

ALAN D. AVILES: HHC unscathed.

The commission's chairman, Stephen C. Berger - who played a key role in rescuing New York City from the brink of bankruptcy 30 years ago - told the New York Times that the financial condition of the health-care system was comparably bad and that a failure to act now would only compound the problems.

Five of the nine state hospitals slated for closing - unless the State Legislature chooses to disregard the entire report by the commission, which was appointed by Governor Pataki - are private-sector institutions based in the city. public-employee unions were most alarmed about upstate closings or reductions, as well as the panel's advocacy of privatizing the State University of New York teaching hospitals in Brooklyn, Stony Brook and Syracuse.

Doctors Council President Barry Liebowitz broke with his state union colleagues in praising the report, saying, "In a changing atmosphere in medicine, it is an attempt to make it cost-effective.

Lauds HHC, Mayor

KEN BRYNIEN: Privatizing won't help.

"I'm happy to see that there was a primary-care thrust to the report," Dr. Liebowitz said in a Nov. 30 phone interview, referring to its emphasis on treatment by doctors before patients have become seriously ill and require extensive care and/or long-term hospitalization. "It certainly highlights a lot of forethought by the Health and Hospitals Corporation and the money that was put in by Bloomberg."

The mix of building and equipment improvements, service upgrades, and pay increases for his members that resulted, Dr. Liebowitz continued, has placed HHC "in a spectacular position" at a time when other hospitals throughout the state are facing either imminent closing or severe cutbacks in their operations. "We have the diagnostic and treatment centers, we've upgraded the facilities and we've downsized the hospitals over the years. [HHC has] also developed a whole cadre of primary-care doctors."

Although the State Legislature is required to either adopt the commission's recommendations in total or scrap them all, Dr. Liebowitz said he believed there might be some fine-tuning depending on the reaction of the affected local communities.

DANNY DONOHUE: 'An attack on public care.'

"The road to Damascus is paved with changes along the way," he said.

PEF: Won't Save Money

The president of the Public Employees' Federation, which represents 900 Nurses and other health-care professionals at SUNY Upstate Medical Center in Syracuse and a combined 2,000 at SUNY Downstate in Brooklyn and SUNY Stony Brook, questioned the commission's authority to recommend privatization as well as the wisdom of doing so.

"These hospitals treat a large indigent population whose care could be threatened by privatization," said PEF President Ken Brynien. "Additionally, there is no evidence that privatization of these facilities would save any money."

The state panel's proposal would lead to SUNY Upstate being taken over by Crouse Hospital, which Mr. Brynien noted recently emerged from bankruptcy after falling $91 million into debt and has an average occupancy rate of under 50 percent. "SUNY Upstate Medical Center, on the other hand, has an average occupancy rate of 80 percent and is financially sound," Mr. Brynien said.

The push for privatization upstate also troubled the New York State Nurses' Association, which cited the call to combine the Erie County Health Department with Kaleida Health. "Privatization would worsen the disparities in health care experienced by the uninsured, the underinsured, the elderly, and minorities," the union said in a statement.

'Half-Empty Hospitals'

The commission said a primary reason it had recommended the closings and consolidations was the dwindling occupancy rate throughout the state, which plummeted from 82.8 percent in 1983 to 65.3 percent in 2004, with the biggest drops occurring outside the city. "Some individual hospitals are more than half-empty," it stated in the report.

The head of the state's largest public-employee union, Danny Donohue of the Civil Service Employees' Association, said the panel's recommendations amounted to "an all-out attack on public health-care, at least as far as upstate communities are concerned, and that is unacceptable."

He continued, "Wholesale changes that will affect Level One Trauma Centers, leave communities without facilities of last resort and make profitability issues the most important priorities demand much further review and debate. In the twilight of his administration, Governor Pataki seems to be trying to achieve an ideological victory that he was unable to secure on its merits during 12 years in office."

Some legislators vowed to fight the cutbacks, with U.S. Rep. Anthony D. Weiner, standing outside Parkway Hospital in Queens, describing its slated closing as the equivalent of "treating a head cold with an amputation."

But Governor-elect Eliot Spitzer sent a clear signal to state legislators that if they rejected the commission's report - which they would have to do before the end of the year - he might be asking for equally severe actions once he takes office. He told the Times, "Our state's broken health-care system requires drastic reform, and it is critical that we consider these recommendations seriously."