Cobble Hill

TOO SOON FOR LICH OBIT? Give its doctors and nurses a chance to decide

February 11, 2013 By Raanan Geberer Brooklyn Daily Eagle
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Back in late 2009, when everyone, including myself, was hailing SUNY Downstate’s imminent acquisition of Long Island College Hospital (LICH) as the long-awaited development that would save LICH from destruction, Denis Hamill, in the Daily News, wrote a column that called the agreement “a smelly political back room merger of LICH with SUNY Downstate Medical Center is imminent.”

Hamill quoted Dr. John Romanelli, then head of the LICH medical staff, to the effect that the deal was brokered by Stanley Brezenoff of Continuum which, after years of building up debts, dumped LICH “in an orphan’s basket on the state’s doorstep.”

“Continuum took a vital LICH and ran it into the ground. And they are trying to bury the body with this deal with Downstate,” Hamill quoted Romanelli as saying.

Romaneli’s group, Concerned Physicians of LICH, distrusted the state’s motivations (and SUNY, of course, is an arm of the state), and wanted LICH to become an independent community hospital.

At the time, I dismissed Hamill’s ideas as the grumblings of a chronic malcontent. As for the doctors’ group, I felt that it could not possibly represent the opinions of all the hospital’s physicians.

After all, I reasoned, I personally had seen Dr. John LaRosa of SUNY Downstate and Dominick Stanzione of Long Island College Hospital promise that SUNY would assume LICH’s debts, would transfer many of SUNY Downstate Medical School’s classes to the LICH campus, and would make SUNY’s expertise and resources available to LICH patients.

By most accounts, that didn’t happen, and the two gentlemen I just mentioned are long gone. Now I’m wondering if Hamill wasn’t right after all.

The problem may not be only that the board of trustees of SUNY Downstate, led by Dr. John Williams, voted to close the facility. The problem is the process.

It is inconceivable that, in a democracy, a decision involving thousands of employees and thousands of patients could be made by such a small number of people. Back in 2009-2010, the Medical Staff’s main objection to the deal was that they were not consulted, and they were right.

Instead of a backroom deal, let’s have a referendum among the employees. And if that’s too unwieldy, let’s have the hospital governed by an elected board, with representatives of doctors, nurses, “techs,” patients and others.
And let that body govern the hospital, hiring their own lawyers, accountants and so on. Back in the 1960s, people used to talk about “participatory democracy,” and this could be one shining example.

Finally, a word on an item in a letter by Dr. Stephen Berger, formerly head of the state’s Brooklyn Task Force on healthcare, that was reprinted by this paper. Dr. Berger, a supporter of the decision to close LICH, resorted to some almost-indecipherable jargon about “case mix index” and “tertiary volume” to explain why SUNY Downstate didn’t move many of its functions and “business” to LICH, as it had promised to do. The very fact that refers to kidney operations as “business” raises questions about the values our society is promoting.

Then, more to the mark, he points out that many (although certainly not all) of the residents of Cobble Hill and Brooklyn Heights “do not consider LICH their hospital of choice,” and that being “upscale,” many of them “probably get their care across the river.”

Not being a resident of those areas, I cannot say with certainty whether this is true or not. But if it is, this is akin to the situation, on “Downton Abbey,” where when Lady Sybil is present, her father, who is very status-conscious, decides that she should no longer be in care of Dr. Clarkson, the country doctor who has known her since birth and who knows her case. Instead, he hires an upper-class doctor, Sir Philip Tapsell, to make the decisions regarding Lady Sybil’s pregnancy. Sir Philip ignores the medical evidence, and as a result, the baby lives but Sybil dies.

The situation described above, with status-conscious residents ignoring LICH and instead flocking to New York Presbyterian, Cornell-Weill Medical Center, Beth Israel and what have you, is akin to the “Downton Abbey” episode. The only difference is that in this case, rather than one woman dying, it is an entire hospital that will bite the dust.

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