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De Blasio Tackles Brooklyn Hospital Crisis — And Cuomo


de-blasio-lich

ALBANY, N.Y. — On July 7, Public Advocate and Democratic mayoral candidate Bill de Blasio joined a group of protesters demanding Long Island College Hospital in Brooklyn be saved from closure. “Our message to Governor Cuomo today is: ‘Don’t let this happen on your watch, don’t let us lose more hospitals. You can be the difference maker,” De Blasio said.

Three days later, police escorted De Blasio into the back of a police van, hands zip-tied behind him. He had intentionally disobeyed police orders at another protest to save LICH.

The scene was unique for two reasons — not many Democratic lawmakers have the guts to tell Cuomo to do anything, and De Blasio has been one of the only elected city officials to truly focus on the fact that Brooklyn is facing a hospital crisis.

For over a year, advocates and legislators have been struggling to get Cuomo publicly involved in the issue as LICH and Interfaith — both roiled by financial problems — have begun winding down service in preparation for closure. In the meantime, hospital emergency rooms across Brooklyn have become crowded and wait times have gone up.

Healthcare experts and public officials say the situation in Brooklyn is a microcosm for hospitals around the city and state that have been impacted by lowered reimbursement rates from Medicare and Medicaid while continuing to serve an indigent population.

As the mayoral race heated up with scandal, De Blasio has taken on the Brooklyn hospital crisis as his headline issue, highlighting the fact that the city has mostly ignored a series of hospital failures and increasing the pressure on Cuomo to act.

Cuomo oversees the State University of New York system and has a great deal of influence over what it does. LICH is run by SUNY Downstate; Cuomo appointed 15 of the 18 members of the board that voted to shutter it.

De Blasio recently proposed a plan that would create a super-authority to oversee Brooklyn hospitals that would be led by the governor and mayor. This week, he issued a report on the ability of residents to access convenient and safe healthcare were LICH and Interfaith were to close. The report estimates that 250,000 people will be affected by the closures of both hospitals and that the nearest hospitals are already nearing or at full capacity.

He’s also written to the state Department of Health urging them to accept a restructuring plan from Interfaith Hospital and to help them fund the plan to avoid a major disruption in service to the community. On top of that, the mayoral candidate secured a restraining order against the closure of LICH, even if it isn’t clear whether it is doing any good.

While fellow Democratic mayoral candidates Comptroller John Liu and former Congressman Anthony Weiner were at the protest when de Blasio was taken into custody, both obeyed police and avoided arrest — leading some political observers and reporters to see De Blasio’s intentional arrest as a move of desperation by a mayoral candidate who had up to then been eclipsed in the polls.

It’s fair to say that none of the mayoral candidates has been more vocal on the issue of ailing Brooklyn hospitals than De Blasio. City Council Speaker Christine Quinn, also a Democratic hopeful, has been criticized by Brooklyn residents for not getting more involved in the hospital crisis. However, the Council passed a resolution to save LICH in April and released a statement urging the federal government to release funds to buoy Brooklyn hospitals. Liu has not used his position as comptroller to focus on the hospital closures. De Blasio has strong ties to labor and has been endorsed by SEIU 1199. The national union has donated $4,950 to his 2013 campaign for mayor.

De Blasio’s staff has sought to emphasize after his arrest that he has been engaged on the issue for years, even when he was a City Councilman. The hospital is in his old district.

As if to prove naysayers wrong, De Blasio has continued to roll out statements, reports and make appearances to call attention to the Brooklyn health crisis.

In his role as public advocate — commonly considered a platform for being a watchdog over city government that rarely engages the state — De Blasio has announced a plan to save failing hospitals that calls for the establishment of an authority to oversee spending of health funds and stopping hospital bankruptcies.

As mayoral candidate, he has launched a “Save Our Hospitals” tour that kicked off on Wednesday at Interfaith Medical Center in Bedford-Stuyvesant, which could close under financial duress by Aug. 15. On Wednesday, De Blasio visited Wyckoff Heights Medical Center while touting a plan to create a state and city super authority to oversee hospital service in Brooklyn. The plan would allow the authority to fire hospital CEO’s who aren’t successful.

Wyckoff CEO Ramon Rodriquez told The New York Daily News he welcomed the authority. “I don’t feel uncomfortable saying Wyckoff should be helped by the city and the state,” Rodriguez said.

But other elected officials wonder why, even after all the noise that he has been made, De Blasio has been all but publicly ignored by Cuomo.

State Sen. Kevin Parker, who represents parts of Brooklyn, has sent Cuomo letters since last summer requesting an audience about LICH and took to the Senate floor this year to protest what he saw as a lack of interest from the Cuomo administration in the LICH situation.

He said it was odd to see the cool reaction from Cuomo’s office about De Blasio’s arrest. When asked about De Blasio’s arrest, a Cuomo spokesman responded stingingly to a query by The Daily News that “the people of New York deserve an honest dialogue from those hoping to represent them — not political gimmicks.”

“Look, Bill de Blasio and Cuomo are supposed to be good friends,” Parker said, “and if Bill hasn’t been able to talk to the governor about this what does that tell you?”

When asked Tuesday at a campaign event whether he had discussed his plan with Cuomo or the state, De Blasio indicated state officials haven’t responded as quickly as he would like them to. He lobbed criticism at Mayor Michael Bloomberg.

“We have had some initial discussions with state officials on the kinds of changes we need...But I think at the state level there's some cognizance of the fact that hospitals closing without any kind of plan, without any kind of provision for healthcare for the future of this borough and this city is unacceptable. I don't think they're acting aggressively enough, but I think they get the point.”

Cuomo and De Blasio do have longstanding ties: In 1997, Cuomo was appointed to head the Department of Housing and Urban Development under President Bill Clinton. Cuomo then named De Blasio — who had worked for the Clinton/Gore campaign in New York — to represent HUD in New York and New Jersey. In 2002, Cuomo helped negotiate Cuomo’s exit from the governor’s race and the pair were reportedly close after Cuomo’s divorce from Kerry Kennedy. In 2010, De Blasio helped negotiate Cuomo’s relationship with the Working Families Party.

Cuomo administration officials indicated that the governor has not spoken directly to mayoral candidates about the Brooklyn hospital crisis, but that there may have been discussions between intermediaries. They acknowledged that a larger plan for sustaining the hospital system in Brooklyn is needed and that something is being discussed.

A source in the Cuomo administration who requested anonymity because negotiations were ongoing said that some sort of plan would likely be rolled out in early September. “No one is going to step foot in Brooklyn for the West Indian Day Parade without addressing the hospital situation,” the person said.

In May, Cuomo wrote U.S. Health and Human Services Secretary Kathleen Sebelius asking for $10 billion in funds to save four Brooklyn hospitals — LICH, Interfaith, Brookdale Medical Center and SUNY Downstate. Cuomo proposed that the $10 billion would come from the $17.5 billion the state says it will save from restructuring the state’s Medicaid program.

“Due to a rapid deterioration in the financial status of essential components of the health care services system in Brooklyn, if nothing is done within the next 12 months, the outcome will be disastrous,” Cuomo wrote, adding: “Access to care will be compromised and the remaining health care providers in the borough will be destabilized.”

The Cuomo administration is still waiting to get approval from HHS for the funding. Federal officials recently visited the four hospitals named by Cuomo in his letter with DOH officials.

In 2011, SUNY Downstate took over LICH’s assets with permission from a judge on the condition that it keep running the hospital but SUNY has not honored the ruling. SUNY has closed its residency program at LICH as well as a number of specialty departments including the maternity ward. It banned ambulances from delivering patients to the emergency room. SUNY has also begun sending patients elsewhere. A SUNY spokesperson said they were taking the steps for patient safety because the hospital is short-staffed.

LICH staff are concerned that the company hired to process LICH’s bills, Continuum Health Partners, has failed to collect payments. Some staff estimate the company has failed to collect nearly $15 million.

A spokesman for Continuum Health Partners declined to respond to the charge. “While Long Island College Hospital was a member of Continuum Health Partners, we did everything possible to keep it financially solvent so that the hospital could continue its mission to meet the healthcare needs of all who turned to us for help,” the hospital said in a statement.

Meanwhile, according to a report by Comptroller Thomas DiNapoli, SUNY has transferred cash from LICH to other accounts.

Parker said it may be too late to save LICH. A combination of factors have led to the failure of Brooklyn hospitals, he said, including lower reimbursement rates, the large indigent population they serve and what he described as a failure of the state to acknowledge the change of how healthcare is provided in the country.

“Instead of coming in with a hatchet and closing hospitals willy-nilly the state needs to help manage communities through it,” Parker said, adding that he has worked closely with people at SUNY and feels that they simply don’t have the background in managing hospitals to make LICH a success.

He also said the people he has dealt with at SUNY regarding LICH are “feeling frustration over a lack of direction from the governor.”

All this is taking place as Interfaith Medical Center has filed for bankruptcy and the health department has rejected proposed restructuring plans. It plans to wind down on Aug. 15. Kurron Shares of America has been accused by many of mismanaging the hospital into bankruptcy. Kurron is a for-profit company that comes in when medical facilities are on shaky ground and replaces management. Just before Interfaith filed for bankruptcy in 2012, the hospital renewed a $3 million contract with Kurron to outsource its management. Hospital executives have defended Kurron, saying the hospital was doing well until cuts in Medicaid rates in 2011.

SUNY Downstate has been taking bids on the LICH property and Legislators, including Parker, have called on SUNY to reveal the ever one of them so that public can see how the decision process is working.

State Sen. Daniel Squadron, who is running to succeed De Blasio as public advocate, has pushed the Legislature to come up with a comprehensive plan to save LICH since last year. He said he wants another operator to come in and continue to provide medical service to the community but he says he thinks SUNY’s failure to manage LICH stems from the fact that “they have been allowed to think of it as $500,000 in real estate — not a hospital that provides an important service to the community.”

Community members are worried that LICH will be sold to developers who want to build condos rather than continue to provide health care.

Parker, Squadron and De Blasio all note that the hospital closures are going to mean painful job losses to one of the poorest areas in the state. “The governor wants to talk about job creation upstate well then how is he going to let us lose 2,000 jobs in an area with some of the most intense poverty in the state? Meanwhile he wants me to vote for SUNY Free or whatever it is called while he putting my constituents out of work,” Parker said.

Squadron said a solution could be hammered together, but it requires one thing: working together.

“Right now progress is not being made when it comes to LICH,” Squadron said. “If folks sat down together at a table to talk about it, I think it would be very clear what the answer is.”

City Government reporter Chester Soria contributed to this report from New York.

City Will Appeal Judge's Ruling Against Limits On Large Sugary Drinks


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NEW YORK — Mayor Michael Bloomberg is far from accepting the bitter taste of defeat after a judge barred his administration from putting into practice its signature ban on large sugary drinks.

"We believe that the judge's decision is clearly an error and we will prevail on appeal," Bloomberg said in a press conference hours after state Supreme Court Judge Milton Tingling ruled against the policy on Monday.  

The limit on sugary beverages larger than 16 ounces, which was supposed to start on Tuesday, would have applied to any vendor that was inspected by the city’s Department of Health. But the rule had gaping loopholes: While it might apply to most restaurants, chains like 7-11 would still be able to sell wondrously large drinks because they are not regulated by the DOH but instead by state authorities. The rule also would not have applied to alcoholic drinks, or any drinks with more than 50 percent milk. And refills also would not be limited.

Recognizing the loopholes, Tingling called the limits “arbitrary and capricious.” In his 36-page decision, the judge said that the mayoral-appointed Board of Health, which promulgated the rule, had overstepped its authority as an administrative agency of the executive branch.

The City Charter, the judge wrote, does not grant the BOH the sweeping and unbridled authority to define, create, authorize, mandate and enforce the so-called “soda ban.”

"The rule would not only violate the separation of powers doctrine," Tingling wrote, "it would eviscerate it. Such an evisceration has the potential to be more troubling than sugar sweetened beverages."

Instead, he implied that such a sweeping mandate should be taken up by the legislative branch.

Bloomberg, who said his administration would not pursue any action through the City Council, argued that Tingling's decision is only the latest in a string of lower court rulings that would not stand upon appeal.

"There are many, many instances where a lower court decision has gone against us and then been reversed," the mayor said. "If lower court rulings had always stood, Grand Central Terminal would have been knocked down forty years ago."

One reporter asked Bloomberg at tonight's news conference if the recent string of court upsets against the Bloomberg administration shows a trend of overreach. Specifically speaking on court rulings on the city's restrictions for single adult homeless shelter eligibility and the mayor's taxi medallion plan, Bloomberg responded that the city would win on appeals.

The city’s Law Department said it was “confident” the rule would stand on appeal. “This measure is part of the City’s multi-pronged effort to combat the growing obesity epidemic, which takes the lives of more than 5,000 New Yorkers every year, and we believe the Board of Health has the legal authority – and responsibility – to tackle its leading causes.”

The lawsuit was brought against the city by a coalition of business groups, unions, merchant associations and beverage makers, who acknowledged the problem of obesity, the judge wrote in the decision. But he said the groups argued  “the link between sugary drinks and obesity are not as clear” as the city has asserted.

One of the groups that sued the city over the limits, the American Beverage Association, said in a post on its website applauding the judge’s decision that “the court’s decision upholds a principle that most of us believe in — freedom of choice.”

Democratic Councilwoman Letitia James of Brooklyn has been a vocal opponent of the mayor's ban on large sugary beverages from the get-go, and said she was pleased with the judge’s ruling.

"The mayor overstepped his executive power by not securing a vote in front [of] the City Council or the state Legislature," James said.

She said that the city's decision to appeal is par for the course, and creates more opportunity to debate the subject.

"It's not over yet," James said. "So continue to drink your Big Gulp."

Image of Bloomberg at Monday's news conference, courtesy of the mayor's office. Photo Credit: Kristen Artz.

Weaning Nursing Homes From Their Dependence On Antipsychotics


betty carol hitz

NEW YORK — After every meal, Betty Hitz would try to clean up the dining room of the nursing home where she lived.

When the staff tried to stop her, Hitz, a 78-year-old Alzheimer’s patient, became furious, screaming, and punching people.

This is the point where many New York City nursing homes would turn to powerful antipsychotic medications to control Hitz’s behavior. The drugs sedate patients so they’re unable to act out. But they also come with serious side effects. For decades, these medications have been known to increase the risk of falls, strokes, and death among people with dementia, which includes Alzheimer’s.

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The drugs are so dangerous they’re banned as “chemical restraints” under state and federal regulations. Still, they’re loosely regulated and commonly administered to New York City patients. An analysis of recent Medicare data reveals an estimated 9,400 elderly New York City nursing home residents — about one-in-four — are administered the dangerous drugs.

Some nursing homes have more than 50 percent of patients on antipsychotic drugs.

Officials with the state Department of Health say their inspectors are trained to look for the use of unnecessary drugs — not whether powerful antipsychotics are being prescribed legally and in accordance with best practices. The Long Term Care Ombudsman Program, a joint federal and state program, says antipsychotics are "outside their sphere of responsibility."

Not all nursing homes drug their seniors into submission. Some are on the other end of the spectrum, working to reduce the reliance on chemical restraints. And it is at those nursing homes where some of the best solutions to weaning dependence on the use of antipsychotics can be found.

Providence Rest Nursing Home, with less than two percent of residents on antipsychotics off label, is one of them. Susan Steinberg, administrator of Providence, said their staff avoids the use of antipsychotics and provides personal attention to address behavior problems. She also started a program where high school students help feed seniors dinner in the dementia ward every weekday.

Cobble Hill Health Center, a nursing home in Brooklyn, is also trying to reduce its dependence on antipsychotic drugs to control patients. Most nursing homes are institutions designed to provide acute care, which requires strict schedules, food guidelines, structured activities, and mandated physical therapy. That aggravates people with dementia, says Tony Lewis, administrator at Cobble Hill.

"A dementia unit has to teeter on the brink of anarchy but not slip into it,” Lewis said. “There has to be enough space for people to do their own thing.”

On the night Hurricane Sandy struck, many residents at Cobble Hill were upset. But instead of sticking to the institutionalized schedule, nurses allowed four patients to get up at 3 a.m. and eat peanut butter sandwiches.

"That was one of my proudest moments," Lewis said. "That's a situation that would never happen in most nursing homes, where strict rules govern sleeping and eating patterns for the convenience of the staff.” 

Lewis said simple things make a big difference. For example, during shift transitions, staff are silent, they don't say hi, goodbye, visibly put on their coats, or chat with each other. The commotion of people coming and going can upset and confuse residents with dementia, Lewis said.

It's not all simple. Sometimes figuring out individuals' triggers can take months while staff members compare notes. Every person brings different experiences, cultures, and habits that require interpretation.

"Each one [of us] has to become a little Sherlock Holmes to unlock the little mysteries,” Lewis said.

Lewis described a resident that yelled and screamed about dying babies. After some investigation, staff realized screeching wheels on the medication cart sounded like crying babies to her. They could have controlled the outbursts with antipsychotics. Instead, they spritzed WD-40 on the wheels.

There are times when limited use of antipsychotics are warranted, doctors said. Dr. Dilip Jeste, a professor of psychiatry and neuroscience at the University of California San Diego, who recently published a study of long term antipsychotic use said, “Antipsychotics should be used in shorter term, side effects monitored, low doses, and stopped when possible.”

That’s what happened for Betty Hitz, after Cobble Hill staff tried for several weeks to calm her down, according to her daughter, Carol Hitz.

The younger Hitz, a psychiatric social worker, reluctantly allowed them to administer a low dose of an antipsychotic medication that “helped take the edge off.” At the same time, the nurses, realizing that Hitz was a retired substitute teacher, decided to allow her to help clean up after meals. They also gave her simple administrative tasks like organizing index cards. Now they’re weaning her off the drugs.

“It was the social interventions that made the difference,” Hitz’s daughter said.

____

Elbert Chu is a science and education journalist. He’s worked for The New York Times, Popular Science, Fast Company, and ESPN. His documentary photography has spanned Lubavitch Jews and Orphans in Nepal, to the devastation of Haiti’s earthquake and a school shooting. He and his wife live amazed by grace in New York City. www.elbertchu.com | @elbertchu

 



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