What can de Blasio do with Long Island College Hospital now?
As a mayoral candidate, Bill de Blasio took ownership of the cause of keeping the financially beleaguered Long Island College Hospital open.
Now that he's almost mayor, it's not at all clear what he's going to do with it.
The hospital, according to the SUNY board of trustees that oversees its operation, currently loses $13 million a month, employing more than a thousand members of staff to serve a relative handful of patients.
Governor Andrew Cuomo, de Blasio's putative ally and the public official with the most power to affect the hospital's circumstances, wants nothing whatsoever to do with it. (The governor's press office didn't respond to repeated requests for comment for this article; his health commissioner talks publicly of a glut of hospital capacity in Brooklyn.)
SUNY board chairman Carl McCall (a Cuomo appointee) all but dared de Blasio, who drew headlines during the campaign when he got arrested at a pro-LICH protest, to take the whole thing off the state's hands once he becomes mayor.
“Since he is committed to keeping it open, he would have that opportunity were we able to transfer the facility from the state to the city,” McCall told Capital. “Maybe they can do a better job.”
The de Blasio camp had no immediate reaction to McCall's proposal. Asked earlier what de Blasio planned to do about the Cobble Hill hospital's perilous situation, the mayor-elect spokeswoman Lis Smith said, "He's made clear that he is committed to preventing the outright closure of LICH. He is committed to working with the community to ensure LICH continues to deliver quality health care to the tens of thousands of residents on the hospital."
He'll have his work cut out for him.
SUNY Downstate Medical Center C.F.O. David Ho said SUNY is losing $12.7 million each month, in large part because a court order has forced them to keep the hospital fully staffed though the patient census hovers between 12 and 20.
By February, Ho said, there will be no more cash, and SUNY might be forced to find money elsewhere, possibly through tuition hikes at New York's public colleges.
If those numbers—and the attention-getting tuition threat, as the governor heads into a re-election year—are accurate, the incoming mayor will have a very short window to work the magic he suggested he could during the campaign.
“Community hospitals in Brooklyn are standing on the brink,” de Blasio said during the campaign, when he was down in the polls and trying to draw a contrast with Council Speaker Christine Quinn, who he criticized for allowing the closure of St. Vincent's hospital in her Council district. “If we don’t act, real estate developers will turn these critical health care facilities into luxury condos for the wealthy, while some of the poorest neighborhoods in the city will lose their emergency rooms, clinics and doctors. These battles—LICH, Interfaith and all those coming in the months ahead—are all parts of a bigger whole. We need a plan that keeps the doors of Brooklyn’s hospitals open for the long haul.”
De Blasio has put forward a four-point plan, which includes creating a Brooklyn Health Authority—a joint city-state authority with power to implement reforms in Brooklyn—and a Healthcare Transformation and Construction fund, which would require developers who purchase city-owned property to support health care facilities or pay into a fund to support the Brooklyn Health Authority.
Nothing in the plan, however, solves LICH's largest and most basic problem: no one—not the unions, not the neighborhood groups, not de Blasio—can agree on who should operate the hospital going forward.
No one wants the current hospital administration to stick around. Supporters of LICH have decried SUNY's perennial mismanagement and accused the trustees of being more interested in real-estate deals than health care. A better operator could save LICH, they argue.
“(SUNY) uses the Humpty Dumpty approach,” said City Councilman Stephen Levin, who represents Brooklyn Heights. “They break it and say you can't put it together again, and then they go to court and say it is broken.”
SUNY trustees deny the allegations but don't deny that they're desperate to extricate themselves from the financial quicksand that is threatening to swallow the system.
Not only is there no universally acceptable player willing to take over a hospital that has been losing money for nearly two decades, but there's not anything close to a consensus on what a new operator should do with the facility. Ideas range from keeping LICH as a full-service hospital to converting it to a children's hospital to keeping only portions of it open.
“So now we have this mess,” said Assemblywoman Joan Millman, whose district includes LICH. She hopes the new mayor will play negotiator-in-chief.
“That's a role the incoming mayor could assist in,” she said. “Have a meeting and get everyone on the same page. Bill is very good about that.”
Which is how de Blasio's camp describes his potential role, too.
“City Hall can be a powerful convener to bring stakeholders together to preserve and expand vital services,” Smith said.
And therein lies the hope of the unions and the neighborhood groups. They believe that de Blasio's ascendency will compel Cuomo and the SUNY trustees to listen to their pleas. Without the governor's support, they're nowhere: A Brooklyn Health Authority requires state approval and the legislature would have to approve a new construction fund.
The Cuomo administration, for now, doesn't seem inclined to go along with that. “There is too much hospital care,” said state health commission Nirav Shah during an recent interview on WNYC, during which he estimated that there are 1,000 excess hospital beds in Brooklyn. “What we're trying to do as an administration is right- size it.”
David Sandman, a former executive director of the Commission on Health Care Facilities in the 21st Century, a nonpartisan panel charged with evaluating and reforming the State’s health care delivery and financing systems, said the needs of the community have already been studied.
“There is more than enough data available,” said Sandman, who is currently senior vice president at the New York Health Foundation. “What is needed is the will to act.”
Sandman said the protests and rallies have obscured the reality that the surrounding community is far less reliant on LICH than it once was.
“Data suggest low community dependence,” he said. “Many residents of Cobble Hill seek care in Manhattan.”
He believes that what the community needs is more ambulatory care and primary care, some kind of outpatient facility with X-Rays.
“You may even want some holding beds in the event a patient was very sick,” he said. “They can be held stabilized and transferred to a full-service hospital but we should be looking at new kinds of configurations. That does not automatically mean a full-service hospital.”
There are dissenters among the experts, though.
Fred Hyde, a clinical professor in the department of health policy and management at Columbia's Mailman School of Public Health, takes the position, contrary to the state commissioner of health, that Brooklyn actually has too few beds.
“I don't think people have looked at the facts recently,” he said. “You need every bed you can get in Brooklyn.”
Hyde's plan, like most others, involves ramping up ambulatory care, clinics and urgent care centers, while also having the state's Department of Health lean on a private operator to buy and operate LICH.
As for the governor's apparent lack of support for saving the hospital, Hyde said, it may just be because he's yet to see a compelling plan to do so.
“I think it really has a chance,” Hyde said. “You've got a mayor who comes from Brooklyn, who says LICH is important, whose campaign was catapulted to the front pages because of this. If he can't get this done I don't know who could.”