Cuts, Closures Threaten Healthcare
Changes are underway at NYHQ, as an expansion project begins. |
By Theresa Juva and Matt Hampton
The future of Queens healthcare is fraught with challenges as the borough’s population continues to grow, with primary concerns including health insurance coverage, specialized health care, the overall number of hospitals in the borough and essential improvements for hospital care in the future.
There are currently 11 hospitals in Queens: New York Hospital Medical Center of Queens; Parkway Hospital; Long Island Jewish; Mount Sinai Hospital; Elmhurst Hospital, Jamaica Hospital, Mary Immaculate, Flushing Hospital and St. John’s Queens, Peninsula Hospital and St. John’s Episcopal.
The Weak West
In October, the New York City Department of Health released a City health study that identified some of the key problems in Queens, and lack of insurance coverage ranked high on the list. The people with no health care coverage live mostly in Western Queens, the study found. The Tribune reported: “West Queens, including Corona, Jackson Heights, Woodside, Elmhurst and Maspeth, had 33 percent of respondents saying they were uninsured, the most in New York City.”
The study showed that these residents also had the lowest rates of enrollment in the federal Medicaid program, probably the result of the large populations of immigrants, said Bonnie Kerker, the assistant commissioner of the Bureau of Epidemiology Services.
Many immigrants, she noted, aren’t familiar with how the healthcare system works, where they can fill out applications, or what they’re entitled to by employers. The situation is exacerbated by the fact that the residents with no health coverage are also the ones listed in fair to poor health, the study found.
Need For Growth
Another obstacle in providing solid health care in Queens is specialized care, an issue important to Queens Borough President Helen Marshall. In November, she announced the proposal of a plan to bring two hospitals to Western Queens and the Rockaways, two areas she said were in need of facilities. The plan was suggested by the firm of Pricewaterhouse Coopers, which was commissioned to study the borough’s health needs.
“The borough of Queens has 2.3 million residents with a ratio of one-point-four beds per thousand people,” Marshall said in November. “By comparison, Manhattan has 1.5 million residents and seven-point-one beds per thousand people.”
She pointed out that the combination of population growth and aging borough residents complicates the future of health care.
She said in November: “Currently, there are more than 374,000 residents in Queens who are 60 years of age or older. That is one-third of the city’s elderly population. Make no mistake, this increase in the elderly population will result in a heightened demand for inpatient, outpatient and emergency room services.”
A need for more hospitals is coupled with a need for specialized care, like cardiac facilities, Marshall explained. In Eastern Queens, near the Nassau County border, many residents traveled across the county lines to receive cardiac care, the Borough President’s study said. The study also found that 40 percent of Western Queens residents received a cardiac treatment outside the borough, a statistic reflected in the 16,000 cardiac patients from Queens who sought treatment in other parts of the City.
Dr. Furqan Tejani, director of Advanced Cardiovascular Imaging at Long Island College Hospital of Brooklyn, told the Tribune in November that patients flock to Manhattan cardiac facilities so they can receive all stages of treatment in one place; this is not the case in Queens where patients are shuttled among a few facilities in the borough, he said.
But providing quality specialized care like cardiac treatment is not as easy when many Queens hospitals are just struggling to keep their doors open.
Parkway Hospital faces a potential closure. |
Doors Closing?
This was highlighted in the report “Health Care Facilities in the 21 st Century,” known as the Berger Commission report, released in November, which assessed the viability of hospitals throughout the state and recommended that specifically in Queens, Parkway Hospital in Forest Hills should close and St. John’s Episcopal and Peninsula Hospital Center hospitals in the Rockaways should merge into one facility—the opposite suggestion of the Borough President, which was to add an additional facility.
It also recommended a 40-bed increase at Queens Hospital Center in Jamaica. The report acknowledged the population growth the borough has seen, but said because neither St. John’s nor Peninsula operated at full capacity, the two should consolidate their services to best meet the needs of the community.
The commission’s charter, which forced the state Legislature to either accept all the report’s findings or ignore them completely, was a significant obstacle for Queens legislators who spoke out against the findings.
Marshall said in statement following the report: “While I applaud the stated goals of the Berger Commission, it missed the mark by not strengthening patient access to high level services in Queens. With more than 2.2 million residents, and more than 1,400 of them utilizing hospital beds outside the borough on any given day, we can do better.”
U.S. Rep. Anthony Weiner said at the time that rather than making cuts as a way of coping with health care costs, there are less extreme ways of improving the financial state of hospitals.
“This is the equivalent of treating a head cold with euthanasia,” he said. “If changes need to be made, we have some ideas for change.”
Not Giving Up
Parkway Hospital, despite being cited in the report for low quality care and lack of incoming patients, was not ready to lock its doors without a fight.
Even though on Jan. 1, the state Legislature’s inaction resulted in the Berger Commission findings being passed into law, Parkway Hospital responded with a lawsuit and continues to fight.
It argued that because it is a private hospital and does not receive state funds, the state could not order it to close. Though it may not see financial penalty, it could lose its state accreditation.
Before the Berger recommendations were passed into law, Fred Stewart, the vice-president of marketing at Parkway, explained the hospital’s position.
“We’re the lowest-cost acute care hospital in the borough of Queens,” Stewart told the Tribune in November. “Why not single out a hospital in this borough that’s costing the state money?”
Also, Parkway argued that closing would prevent the hospital, which has a plan in place to emerge from bankruptcy, from paying back creditors, news reports said in January.
Hospital officials said that filing a lawsuit was the only way to resist closure in the short-term. In addition, in early February, Parkway confirmed discussions were in place about a possible affiliation with Mt. Sinai in Long Island City.
Stewart told the Tribune that with Parkway’s recent emergence from bankruptcy, a relationship with Mount Sinai could bolster Parkway’s chances at flourishing.
“We would not be owned by Mount Sinai,” Stewart said earlier this month. “It really is not a financial thing. It enhances the services that we’re able to offer here.”
In a recent phone interview, Stewart said health care in Queens will only be more squeezed in the future with the rise in population, and that offering only 1.3 beds per 1,000 people is grossly inadequate compared to 7 beds per 1,000 people in Manhattan.
Not Crisis Ready
Stewart added that besides a growing population, Queens needs to be prepared to handle a crisis.
“The borough is not prepared for anything catastrophic,” he said. “The borough is not prepared if any of the most recent reasonable threats to health, like avian flu, came to pass, there would not have been enough hospital beds.”
He said Parkway in particular is centrally located if an incident occurred at nearby LaGuardia Airport.
“You can time it any way you want, [Parkway] would be the quickest hospital,” he said. “We have an area to do triage. We’re adjacent to Flushing Meadows Park, we would have access to fresh water… these are all things people have to take into consideration.”
He said Parkway is holding onto the hope that the Berger Commission recommendations turned into law can be amended and exclude the facilities that serve a purpose; Parkway was not the only hospital that was unfairly put on the chopping block, he said.
“This was not based upon criteria; this was based a lot on local political maneuvers, which impacts the people we serve,” he said.
Growth Undermined
Stephen Mills, president of New York Hospital of Queens, said that while the borough is under-bedded, rehabilitating beds at struggling hospitals is more costly than adding new ones. NYHQ is currently undergoing a $200 million expansion and renovation that includes improved cardiac services and 80 more beds to the 520-bed facility.
But his biggest concern is the proposed federal and state Medicaid and Medicare cuts recently announced by Gov. Eliot Spitzer and President George W. Bush. Spitzer’s proposed $1.2 billion cuts would have a detrimental effect on hospitals across the state, he said, and even a smaller reduction than what was proposed would be a huge blow to the industry.
Mills said the proposed federal and state cuts to healthcare combined with the Berger Commission hospital closures could be “devastating” to the Queens health system. And, he added, no one has addressed how the two will impact each other.
The complicated process of Medicaid and Medicare reimbursement often baffles the general public, he said, adding that it is important for people to know that all aspects of a hospital operation are negatively affected when there are funding pullbacks.
He also explained that lack of capital dollars for major renovations to hospitals presents a big problem to Queens hospitals in the future.
Calling the NYHQ Board of Directors “very brave and bold” for pursuing the current project, Mills said they made the necessary advancements to the facility - always a tough task.
It begins, he said, with the public understanding “of what their hospital down the street is facing,” and how those challenges are ultimately the challenges of everyone who seeks care when they set foot into a Queens hospital.
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Ambulances sit in their bay at New York Hospital Queens in Flushing, ready to respond to emergencies. Tribune Photo By Ira Cohen |
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Not every cut leads to the emergency room. Not every chest pain means a heart attack. Not every bump on the head is a concussion. Not every upset stomach is food poisoning.
We hope that you use this guide to better understand maladies; to get to know about Queens’ health centers and the people behind them; to learn where to find a good gym; or to at least learn the difference between good cholesterol and bad.
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After all, sometimes you do need to go to the ER, it could be a heart attack, that may be a concussion and perhaps those clams you ate are poisoning you.
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