Gotham Gazette https://www.gothamgazette.com/component/tags/tag/1348 Mon, 30 Nov 2020 23:02:08 +0000 Joomla! - Open Source Content Management en-gb webmaster@gothamgazette.com (Webmaster) New York Hospitals Brace for a Second Covid Wave. Are They Ready? https://www.gothamgazette.com/state/9943-new-york-hospitals-brace-second-covid-wave-ready https://www.gothamgazette.com/state/9943-new-york-hospitals-brace-second-covid-wave-ready visits covid air

Lincoln Hospital staff (photo: Michael Appleton/Mayoral Photography Office)


As public health officials eye a second major swell of COVID-19 infections and an increase in hospitalizations, New York's hospital systems have begun to brace for another flood of patients. The state has even opened a field hospital on Staten Island in response to rising numbers, a dismal reminder of the devastation of the spring.

In the months since the height of the pandemic in the spring, New York's health care institutions have been making preparations to try to avoid the same chaos and loss of life, which has been partially attributed to a lack of coordination. But in many areas, like before, hospital administrators and staff are just trying to stay one step ahead of the virus, keep staff safe, and maximize patient survival.

The city's hospital systems "faced an unprecedented situation for which no one was fully prepared," wrote City Comptroller Scott Stringer in a review, issued in July, of the city's public hospital system, which saw many of the most severe problems. "The lack of preparedness forced all players to improvise responses, sometimes successfully, sometimes not – but inevitably at a cost in human lives."

Hospital administrators have signaled to their staff, lawmakers, and the public that they don't believe a second covid wave in New York will be as bad as the first -- with lessons learned and months to upgrade facilities, stockpile supplies and ventilators, and develop so-called "surge plans" to be used in the event another round of mass admissions strains hospitals. But experts are questioning whether hospitals will have enough staff and personal protective equipment (PPE) if hospitals see the crisis levels of March, April, and May again, and even ICU nurses onboarding others are expressing doubt about the adequacy of a heavily-truncated training regimen. New York City and State are hoping to better balance patient loads across hospitals to avoid overwhelming any one facility, but no new system has been finalized and much remains unsettled about how a patient diversion program would operate.

In the spring, hospitals were overflowing with covid patients and, along with governments, struggling to procure enough PPE, particularly within Health + Hospitals, the city's network of public hospitals. Government and hospitals worked together to nearly double the state’s bed count from 53,000 to roughly 90,000, and though they were never all filled, there were concerns about the state’s ability to meet the upper projection of 140,000 hospital admissions.

To comply with an executive order from Governor Andrew Cuomo to increase capacity by 50%, hospitals rapidly converted offices and auditoriums into intensive care units; field hospitals were set up in convention centers like Javits, and the USNS Comfort, the Navy hospital ship, docked temporarily in the Hudson. Some facilities, like the now-infamous example of Elmhurst hospital in Queens, one of the city's 11 public hospitals, were overflowing while others had space. At the apex in April, the state had 90,000 additional health care workers, including 25,000 from other states.

More than 26,000 people are confirmed to have died from COVID-19 statewide. According to city data, over 24,000 New Yorkers have died of covid in the five boroughs, which includes unconfirmed but suspected covid deaths, or about 1 in 350 city dwellers.

The spring surge in patients meant hospitals needed more space for beds and more personnel to staff them, more supplies to protect or save both patients and staff, and the systems to manage the new, exhausting demands. Many of those systems remain in place or serve as the basis for current emergency plans, like the "NYC Strategic Reserve” PPE and ventilator 90-day stockpile ordered by Mayor Bill de Blasio that the city says is near completion. These issues were especially acute within the 11 public hospitals run by Health + Hospitals, according to Comptroller Stringer’s report, which had been requested by the governor and also pointed to underfunding by the state.

"All of our hospitals have learned from the devastating first wave of the pandemic and really poured their hearts and energies into preparing for the second surge, which we hope won't happen, but unfortunately we are at risk of given the numbers we are seeing," said New York City Health Commissioner Dave Chokshi, last week.

The next morning Mayor Bill de Blasio said "our hospital system is strong right now," but warned that it remained essential to work to keep covid numbers low and avoid strain on ICUs. At a recent City Council oversight hearing, city public health officials testified about lessons learned from the spring and preparations in place for a second wave, including by noting they now often use less invasive ventilation techniques and new protocols for stabilizing patients before transferring them.

The citywide seven-day average number of hospitalizations per day topped 80 admissions last week, three times what it was in August but still far below the thousands of daily admissions at the peak. As of Monday, 931 people were hospitalized due to COVID-19 citywide, of whom 196 were in intensive care. Test positivity has been ticking steadily upward since the summer and the city and state have begun shutting down key sectors of public life, like in-person schooling, a reprise of the conditions on the eve of the apex. Governor Cuomo, Mayor de Blasio, and others have been sounding the alarm that a second wave is staring New York in the face, and imploring New Yorkers to follow all guidelines.

"Rates go up, you overburden the hospital system, you overburden doctors, nurses...Numbers go up and people die. People die. Period. It is a mathematical equation," Cuomo said at a news conference on Sunday, warning rates could "easily" skyrocket for months "if we are irresponsible."

On Monday, Cuomo announced a field hospital would be opened on the site of South Beach Psychiatric Center in Staten Island in response to a dramatic rise in hospitalizations in New York's most isolated borough. "The hospitals have contacted us, and they say they need emergency beds on Staten Island," the governor said at a press briefing. "Remember when we had to set up field hospitals, emergency hospitals for additional capacity? Well, that's what we have to do on Staten Island.”

Throughout the pandemic, the state has functioned as a regulatory body, coordinating resources among public and private hospitals, suspending some requirements and setting new guidelines. As of August 6, emergency regulations from Cuomo's Department of Health establish the framework to reinstate many of the "surge and flex" provisions imposed at the end of March. Hospitals must have plans to expand capacity by 50%, manage mass casualties, and enlist workers in the event of another state of emergency. Each facility is required to stockpile 90 days worth of PPE.

To manage it all, the plan calls for the state health department to maintain a statewide data system and coordinate patient loads across New York's various hospital systems. In another serious outbreak, the state Department of Health may designate healthcare facilities as covid-priority "trauma centers."

In response, a loose organization of government agencies and private healthcare providers has taken shape across the city and state, mobilizing a massive operation that eight months in is still a bit of a leaky ship.

Space
A big focus in recent months has been upgrading spaces and preparing surge plans for the rapid conversion of hospital units and non-clinical space, the offices and auditoriums, into covid ICU wards.

While much of the space has reverted to its traditional use, officials have retained the knowledge to transform facilities and are building up the infrastructure to do it faster. New York City Health + Hospitals tripled ICU capacity by adding 760 ICU beds, some of which were made permanent, as was much of the digital roadmap for tracking them.

“NYC Health + Hospitals has been on the frontline of the COVID-19 crisis, providing the highest quality care to all New Yorkers in the face of an unprecedented global pandemic – and we stand at the ready to provide that care as we brace for a potential second surge," wrote Stephanie Guzman, a spokesperson for Health + Hospitals, in a statement to Gotham Gazette. "Since the spring surge, the public hospital system has made strategic enhancements in space, equipment and staffing to ensure each of its hospitals is even more prepared now to treat critically ill COVID-19 patients."

The city Department of Health and Mental Hygiene has been working with public and private hospitals using federal grant money to support covid response and improvements at hospitals and long-term-care facilities. Facilities are incorporating design changes to support rapid unit conversion, like negative pressure rooms, which are used to help prevent the spread of the coronavirus through the air.

Health + Hospitals has increased piped oxygen and dialysis capacity to more easily turn beds into covid ICU beds. Hundreds of rooms have been modified to allow for physically distant patient monitoring with more to come soon, according to Guzman.

The city has some sites on stand-by, like the Roosevelt Island Medical Center, which was opened up this spring on the campus of NYC Health + Hospitals/Coler, where Mayor de Blasio announced plans to open 350 additional non-covid beds in March, which by April were also serving covid patients.

"[An]other thing we learned is that temporary field hospitals like the USS Comfort aren't going to be as effective as expanding the current sites or reopening sites like they did on Roosevelt Island," said New York City Council Member Carlina Rivera, chair of the Council hospitals committee, in an interview. The Comfort treated just 182 patients in its one-month stay docked off of midtown Manhattan.

Systems
One of the failures of the first wave was a lack of coordination within and among the public and private hospital systems to balance patient loads.

At Elmhurst Hospital, a Health + Hospitals facility in Queens, health-care professionals were overrun with patients -- one day at the end of March seeing 13 deaths in 24 hours -- despite close to 900 beds open across the public system and 3,500 total beds in New York City, counting private hospitals. The surrounding neighborhoods of Elmhurst, Jackson Heights, and Corona had some of the highest covid mortality rates in the city.

"[T]he problem the Elmhurst situation exposed was not one of hospital capacity, but one of patient load management across all hospitals and hospital systems," reads an excerpt from state Department of Health regulations issued in August and November.

"When it came to patient transfers, I thought, we really wanted the whole system to operate as one," Council Member Rivera said. "And we heard as much in some of the press conferences. But in practice it didn't truly become a reality."

To avoid the Elmhurst syndrome, the city is working with Emergency Medical Services, a division of the state Health Department, and the Greater New York Hospital Association, a consortium of hospital networks, to develop a "unified approach" to balancing patients, according to Victoria Merlino, a spokesperson for DOHMH. The protocol would mean "moving patients from one facility to others that have more capacity available and deferring EMS to overcrowded hospitals when possible," Merlino wrote.

But it is not ready, and there are few details about how it would work in practice. EMT staffing and shortages were ongoing concerns during the siren-heavy months of the first wave, and now will be an even more central component of the city's emergency response if the system is to better balance admissions.

While the state Health Department's emergency regulations say the department "shall coordinate with health care facilities to balance individual facility patient load," the approach appears to be largely decentralized.

"While the determination of when to transfer a patient or divert EMS resources is a local one, the Department monitors facility capacity and is available to assist with the logistics of making a transfer if necessary," wrote Jonah Bruno, a department spokesperson, in an email.

A city DOHMH spokesperson directed Gotham Gazette inquiries to Greater New York Hospital Association who "developed the system for assessing strain and triggers for EMS diversion, which just recently launched."

A spokesperson for GNYHA provided a planning document Monday detailing patient balance strategies, including an outline for redirecting admissions from surging hospitals, but it does not include concrete protocols or thresholds.

Criteria for designations within the three-tiered framework (normal level, elevated surge, and significant surge) are yet to be established, according to the outline, which was circulated to GNYHA member hospitals in late July.

"We're not quite there yet," said Jenna Mandel-Ricci, GNYHA's Vice President of Regulatory and Professional Affairs, and the network's lead on emergency preparedness, in a phone interview Tuesday. "We're making good progress."

GNYHA views itself more as a "thought leader" in surge management, providing insights and a new layer of data, which it hopes the New York City Fire Department will incorporate into its EMT algorithms.

"We're in very close contact with the fire department and we are kind of watching these next couple of weeks," Mandel-Ricci told Gotham Gazette. 

"It's unclear if a real system for patient load has been implemented, or if it has, whether hospitals are actually keen to use it," said Rivera.

Rivera and others have pointed to two decades of hospital closures as contributing the imbalance of the spring apex. Since 2000, the state has lost roughly 20,000 hospital beds due to budget cuts.

"These hospital closures mostly occurred in poor neighborhoods where there were fewer patients who could pay -- not fewer patients, fewer patients who could pay -- so the inequities are clear when there are more beds per person in Manhattan than there are in Queens," Rivera said, adding, "these are also the neighborhoods where more patients are falling ill and dying from COVID-19."

According to Rivera, New York City's public hospitals received $106 million per hospital in federal CARES Act funding, while some private hospitals received four times that amount. The city's safety-net hospitals, where patients are treated regardless of insurance, are struggling to stay afloat as emergency visits have been down significantly since the spring.

FEMA continues to monitor the outbreak and healthcare systems and DOHMH is using federal aid "to improve information sharing and situational awareness of hospital capacity and throughput," according to Merlino.

Staffing
If covid levels reach heights from the spring, officials are worried there may not be enough health-care workers, including temporary personnel, to adequately staff surging facilities.

City health officials say they are working with the state to create a medical reserve corps of volunteers and have devised a procurement plan for emergency surge staffing. But the pool of additional workers eight months into the pandemic is limited, especially as so much of the rest of the country is dealing with spiking covid cases.

"The staffing concern is very real and I think everyone across the board will tell you that it's probably their biggest concern," said Mandel-Ricci of Greater New York Hospital Association.

A Memorandum of Agreement is available to contract personnel from the Department of Defense for private hospitals, according to DOHMH officials, but it is unclear if the federal government will make those resources available.

With covid outbreaks in many of the states where traveling nurses once hailed from, DOHMH and hospital administrators are looking to "cross-train" local non-ICU staff in intensive care, but nurses say the training is woefully lacking.

At Montefiore Medical Center in the Bronx, outpatient clinic nurses are getting online training modules and day of in-person orientation to the intensive care unit.

"These nurses have been out of the hospital for years, you can't expect them to know, to be competent, to adequately care for the patients when they haven't been in that setting," said Shamelee Morrison, who has been a medical/surgical nurse at Montefiore for 11 years. It can take two months to orient a nurse to a new unit, she told Gotham Gazette, "so you can't take these nurses and give them one day and say, 'OK, now go out and take care of these patients in a safe manner.' It's impossible. And that's what they're expecting the nurses to do."

One ICU nurse at NYU Langone Medical Center of Manhattan said it's like the city is already set up for an encore of thousands of nurses scrambling frantically in overwhelmed ICUs.

"I don't feel like I'm an experienced enough ICU nurse to be training anybody to be in the ICU," the Langone nurse told Gotham Gazette, speaking on the condition of anonymity. "And there's nurses who were only trained as ICU nurses during COVID, who are new grads, training new grads now for the second wave, which is absurd."

"The problem with the covid patients is that they're really, really sick and unstable," the nurse said. "They're not like light ICU patients, so to just go in that after a few weeks or like a month or two of being trained by an inexperienced nurse is really dangerous."

Morrison, from Montefiore, believes the hospital had more time to prepare staff for a potential second wave and dropped the ball. "I don't think they're doing much different. They're doing the bare minimum, if anything," she said by phone during a break in her shift. The New York State Nurses Association ​has delivered notice of a two-day strike at Montefiore's New Rochelle campus in an attempt to secure better staffing levels​, wages and benefits.

With numbers rising throughout the city, hospitals are beginning to heighten protocols as staffing levels become an increasing concern. At NYU Langone, nurses are now being told to wear face shields over their masks, an additional precaution, even with patients who don't have covid. More nurses are getting sick, the Langone nurse said, with one floor having ten out.

The nurses Gotham Gazette spoke with said they don't get many details from their hospitals' administration about preparations for a second covid surge, outside of assurances that they have sufficient PPE supplies and indications that a second wave will not be as bad as a first -- both of which there is little proof of.

Supplies
Emergency regulations from the state Department of Health require all hospitals to have had a "90-day supply" of PPE by September 30. In April, Mayor de Blasio said the city would have its own 90-day stockpile, the NYC Strategic Reserve, in addition to the supplies held by individual hospitals. Representatives of the Mayor's Office and DOHMH have both said in separate statements that the Strategic Reserve will be completed "in the next few weeks," though neither office has said whether hospitals are on track to fulfill the state mandate or even whether the city is monitoring hospital supply levels. Guzman, the spokesperson for Health + Hospitals, said that the public hospital system had reached its 90-day goal.

"There are some hospitals that have not been able to achieve 90-days in all of the categories that are required," said Mandel-Ricci, of Greater New York Hospital Assocation. "But even in the categories where they haven't they're at like 70-days or 65-days, so they still have very large inventories," she added, noting, "some of these things are harder to get than others."

Mandel-Ricci pointed out that most hospitals in New York City are part of networks that can mobilize resources among their facilities. 

Ventilators are more widely available than they were in March, when manufacturers couldn't make them fast enough to keep up with New York's most dire modeling.

Merlino, the DOHMH spokesperson, said hospitals were given the option to keep ventilators from national stockpiles and that the city now has "a large cache" for rapid deployment. When he announced the strategic reserve, de Blasio said the city would have a back-up supply of 4,000 ventilators but the administration has refused to say how many it now has.

Council Member Rivera said she has sought documentation on supplies and surge planning from city agencies and hospitals for months using her oversight powers as chair of the Council hospitals committee, without success.

"We have tried to get this information, not just from the Health + Hospital system, but also from the hospitals that are under that larger Greater New York Hospital Association umbrella," Rivera said.

"It's been incredibly frustrating," she added, "they just haven't provided those documents."

It remains unclear what the 90-day supply goal is based on. As Gotham Gazette recently reported, that number appears to be calibrated to PPE burn rates at the peak of the pandemic, when frontline healthcare workers were instructed to reuse equipment like facemasks far longer than what is traditionally advised. DOHMH and the federal Centers for Disease Control (CDC) have both issued conservation guidance to be put in place to reduce severe shortages.

"We were told that Monte had a 90-day stockpile," Morrison said. "But then some of our nurses recently received an email stating that we were going to have to start recycling PPE."

***
by Ethan Geringer-Sameth, reporter, Gotham Gazette
     

Read more by this writer.

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New York Hospitals Brace for a Second Covid Wave. Are They Ready? Tue, 24 Nov 2020 05:00:00 +0000
The Covid Crisis Made the New York Health Act More Urgent, More Unlikely, or Both https://www.gothamgazette.com/state/9910-covid-crisis-new-york-health-act-single-payer-care-urgent-unlikely https://www.gothamgazette.com/state/9910-covid-crisis-new-york-health-act-single-payer-care-urgent-unlikely 2 commish

New Yorkers at a hospital, pre-pandemic (photo: Michael Appleton/Mayoral Photography Office)


When Mariana Pineda was diagnosed with COVID-19 in April, she spent several days in the hospital being treated for pneumonia and sepsis after not being able to see a primary care doctor due to a recent change in insurance plans.

Pineda, an asthmatic, is one of an untold number of New Yorkers who put off seeking treatment for the coronavirus due to complications with insurance plans or not having health care coverage at all.

“The third day of feeling very sick at home I drove myself to urgent care because it felt like my lungs were filling with wet cement,” she said.

After her stay in the hospital and what seemed like a successful recovery, Pineda began to experience chest pain and difficulty breathing in August. A month later she underwent surgery for a pulmonary embolism and had to have six blood clots removed from her lungs.

Due to long-term complications from COVID-19, Pineda has been unable to work and was set to lose her employment-based insurance on October 19.

She was planning to enroll in COBRA, which will cost her thousands of dollars a month for coverage for herself and her four children, instead of the $400 she would usually pay monthly to get coverage through her job as a special education teacher.

“I'm not working and I don't have an income, there's no way I'm going to be able to afford the COBRA,” she said, “so I have to decide whether I just force myself to go back to work against doctor's orders to keep my health insurance.”

The pandemic has further exposed issues with how health insurance is so often tied to employment in the United States. According to the Kaiser Family Foundation, almost 50% of New Yorkers got their health insurance via their jobs in 2019. Overall, the percentage of New Yorkers with health insurance was about 95% in 2019, a record high thanks to the state’s insurance marketplace and other factors.

But massive job loss has thrown health insurance coverage into question for many thousands of New Yorkers, and during a pandemic no less.

In New York City, the unemployment rate was only 3.4% in February, a record low for the city. However, coronavirus restrictions forced many businesses to close in March, tourism came to a halt, and unemployment numbers began to rise, peaking in June at 20.3%. The most recent numbers released by the Department of Labor show that the city unemployment rate was 13.2% in October. Unemployment has been marginally better statewide. Up from 3.7% in February, it peaked in July at 15.9% before coming back down to 9.6% in October. 

For some, the link between getting health insurance through an employer and sudden job loss during a pandemic has highlighted the need for the passage of the New York Health Act, a bill in the state Legislature that would create a version of a single-payer healthcare system for universal health coverage in the state. The pandemic has dealt a significant blow to people who get their insurance from their jobs, leading proponents of the Health Act to call it more urgent than ever. As of September, the number of New Yorkers enrolled in Medicaid is up by over half a million from the same time last year.

For others, however, the legislation and what it portends is still too expensive and too disruptive, as it would completely change the way health insurance works in New York, and necessitate an overhaul of the tax code and a massive expansion of state government. Governor Andrew Cuomo, a third term Democrat, has long opposed passage of the New York Health Act on the grounds that it would be too expensive and disruptive, and while it passed the Democrat-controlled Assembly multiple times, the bill has not moved in the Assembly or Senate since Democrats took control of both chambers at the start of 2019. The bill’s future appears murky, and there is little indication that either majority plans to make it a top priority in 2021. The offices of Assembly Speaker Carl Heastie and Senate Majority Leader Andrea Stewart-Cousins did not respond to requests for comment about the status of the New York Health Act in their respective chambers.

Under the Health Act, all residents of the state would be enrolled in a state-run insurance system for health care coverage, and one that would remove copays, concerns about finding “in-network” doctors, and other problems often associated with the current health insurance system. Proponents say that major inequalities in the current health insurance and health care systems that have been further exposed by the coronavirus pandemic would have been prevented or to a significant degree mitigated if single-payer health care had been in place in New York.

“If we had the New York Health Act sooner I would have had a primary care doctor all along,” said Pineda, who is working with the Campaign for New York Health to raise funds to cover the cost of her COBRA coverage and is a proponent of the legislation. “I probably would have gone to see him instead of trying to wait it out before I wound up, you know, with pneumonia and sepsis.”

The bill, the lead sponsors of which are State Senator Gustavo Rivera of the Bronx and Assemblymember Dick Gottfried of Manhattan, both Democrats, has passed the Assembly four times since 2015, but has not yet passed the Senate, and neither house has passed it since Democrats regained control of the State Senate in January 2019. Just before those elections, the Assembly passed the bill and all the Democratic members of the Senate signed on to Rivera’s bill as co-sponsors if they hadn’t already.

When both houses of the Legislature had majorities and began passing many progressive priorities, there was greater expectation among advocates and other supporters of the bill, including legislators who’ve sponsored it, that it would move. But given Cuomo’s long-standing opposition as well as questions about its feasibility and criticism from some labor unions, the legislative majorities put the bill on the back-burner while Rivera and Gottfried continued to discuss it with key stakeholders, especially the unions, and held a series of hearings on the bill while tinkering with its language, hoping for further discussion in 2020 and potential movement in 2021, after another state legislative election cycle that is unfolding this year. 

Then the pandemic hit.

Assemblymember Gottfried believes that the New York Health Act would have helped prevent some of the now more than 26,000 deaths caused by the pandemic because New Yorkers would have had better, cheaper access to health care, both before and during the deadly outbreak.

“I believe a lot of people who developed COVID-19 symptoms put off going for care because they were afraid of the cost. And many of those people got a lot sicker, and many died as a result,” he said. Many New Yorkers who died, or got very ill, from COVID-19 also suffered from significant pre-existing conditions, like asthma and diabetes, that can develop or be worsened by insufficient medical care.

According to Gottfried, the bill is likely to have more support than ever in the upcoming session, beginning in January 2021, which he attributes to the pandemic and the new class of progressive Democrats taking office, some joining each of the Senate and Assembly. Several progressive candidates who beat Democratic incumbents in New York City or won open primaries in the city and elsewhere ran on the New York Health Act.

Senator Rivera, whose district has been among the hardest hit by the coronavirus in the five boroughs, says now is the time to get the legislation passed.

“We need to start going in that direction and do so aggressively,” he said. “If not, every time that we delay, it’s people that go broke because they get sick or die because they don't have care.”

The bill faces opposition from Republican legislators, who are not convinced that a single-payer health-care system would be something the state can successfully implement, as well as some moderate Democrats, labor unions, and others.

At a joint legislative hearing on the Health Act last year, Republican Senator Patrick Gallivan said a government-run, taxpayer-funded system was not the way to solve any issues within the current health-care system.

“This seems highly impractical in that no taxpayer-funded program can afford unlimited and unrestricted health care,” he said. “As I learned during a recent meeting with health-care experts in Toronto, approximately 30% of Canadian health care is funded by private insurance and out-of-pocket expenses.”

Bill Hammond, Senior Fellow for Health Policy at the Empire Center, a conservative think tank, said the legislation would be more disruptive than helpful, noting in an interview that 95% of New York’s population is already insured, and implementing the legislation would only disrupt their coverage. Hammond went on to say that the Health Act would consume the state Legislature “for the years that it takes to implement the plan, and probably forever after.”

Currently, the bill is in committee in both houses and the co-sponsors say there haven’t been any changes made to it as a result of the pandemic, though they had been making changes prior to the covid crisis based on the public hearings they held around the state last year.

In an interview on the Max & Murphy podcast earlier this year near the height of the pandemic in the city, Rivera emphasized the need for the New York Health Act and that it was imperative that the legislation gets passed as soon as possible.

“For those folks who would argue that it is complicated and is expensive: I would argue that it is neither as expensive or as complicated as the situation we find ourselves in right now,” he said.

The earliest the bill could pass is 2021, and only after significantly more debate, though that seems especially unlikely given the state’s ongoing public health, fiscal, and other crises wrought by the coronavirus outbreak. The influence of new, more progressive members in both Democratic conferences, including several backed by the New York City Democratic Socialists of America, could prove influential, but a path to passage is currently unclear. For something of this magnitude, a three-way deal with Governor Cuomo would also likely be a prerequisite to passage in the Legislature, and while Cuomo has come out in support of single-payer health care, he has said it should only be done at the federal level.

In August, Democratic State Senator Julia Salazar of Brooklyn, who is backed by the DSA, spoke about how the Legislature should be prioritizing the passage of the New York Health Act, particularly because of the impact the pandemic has had on communities of color.

“We really need to find a way to pass the New York Health Act or to ensure true universal health care,” she said on the Max & Murphy podcast. “A disproportionately high number of Black and brown New Yorkers are or have been dying from COVID-19 due to inequitable access and distribution of healthcare resources.”  

Phara Souffrant Forrest, a nurse and Assemblymember-elect after winning this year’s election, in which she first triumphed in the primary over a Democratic incumbent in Brooklyn, has the passage of the New York Health Act at the top of her campaign platform. She said it was one reason she ran against Assemblymember Walter Mosley, echoing other challengers in recent years who’ve said that Democrats must really fight for the progressive policies they say they support.

During a late October interview on Max & Murphy, Souffrant, also a DSA member and endorsee, suggested that in order to repair the state’s budget and find the revenue to pay for the New York Health Act, the state needs to “instill justice into this budget where we have people paying their fair share.”

“We have 126 billionaires living in New York City that made billions during a pandemic. So money is being made. It's just people aren't getting any of it, and some people are getting all of it,” she said.

But both legislative majorities have a diversity of Democrats, and there are few beyond the furthest left candidates and incumbents who cite the Health Act as a top priority for the near future.

Gottfried said both he and Rivera are prepared to make the appropriate amendments in order to get the legislation passed and signed. What those amendments may be is not totally clear, however.

“It’s not really the state’s responsibility”
Whenever it is brought up, the New York Health Act faces scrutiny over the estimated cost of the program, though those concerns are heightened for some now that the state is facing large deficits given the massive drop in tax revenue due to the covid shutdown and resultant job losses and limited economic activity.

A 2018 assessment done by the RAND corporation has been the main source of information about the potential impacts of the New York Health Act. Overall, it showed that the state would need to collect massive additional amounts of tax revenue, but that that revenue would negate similar overall expenditures on health insurance and health care that New Yorkers currently pay. Depending on the tax structure involved, many New Yorkers would save money on health costs.

The study suggested that if the Health Act was soon passed, state government would be spending about the same amount of money in 2022 as it currently spends on health care and would only see significant savings in health care costs by 2031 -- a roughly 3% decrease in overall spending. The report went on to say that in 2022, the state would need to collect $139.1 billion in tax revenue to pay for the program, a 156% increase from what the state collected in tax revenue at the time. However, what the state collects in taxes for the program would replace what New York was spending on health care services, about $141 billion.

All New Yorkers enrolled in the state’s single-payer health care program would only pay the taxes taken out of their income -- every other cost associated with health insurance and care would be covered under the program. The Health Act is similar to how health insurance and care works in Canada and several other countries around the world, automatically providing residents access to both.

The proposed tax would be based on a person’s ability to pay -- anyone making less than $25,000 a year would be exempt. Rand’s 2018 assessment estimated that the new tax would range between 6.1% and 18.3%, depending on income, for everyone else.

However, under this model, Rand estimated that 98% of New Yorkers would end up paying less for their health care than they do now.

The state would require that all residents enroll in the program, which would essentially make private insurance in New York obsolete. This includes those enrolled in Medicare and Medicaid as well -- with permission from the federal government, the state would use the funds it receives from the federal government for those existing programs to pay for executing the new single-payer system. That would be in addition to a payroll tax, some of which would come out of workers’ paychecks and vary depending on how much money they make annually, with higher taxes on those making more income. Employers would pay at least 80% of the tax on payroll, and employees would pay up to 20%.

In order to use the funding the state gets for Medicaid and Medicare for implementing the New York Health Act, the state would need to receive a waiver from the federal government. Assemblymember Gottfried said New York may be able to get that waiver under a Democratic presidential administration, but that the state can proceed with creating a single-payer system if the legislation is passed.

“It is very clear that even without federal cooperation, a state can create a single-payer system without losing any of our current federal funding. Federal cooperation would make it simpler but is not really necessary, legally or financially,” Gottfried said, noting that a Biden administration may be more open to the idea of single-payer in New York, but did not elaborate on how the state would be able to implement the plan without a waiver.

One of the most prominent voices regularly arguing against the New York Health Act is Hammond, who says that the real issue is containing health care costs, which requires different answers. Hammond and other opponents of the legislation argue that the necessary taxes could discourage the wealthy from living in New York, and that the shifts involved would be incredibly disruptive to the way insurance and care work in the state.

“The majority of people have private coverage, it's not really the state's responsibility to take care of that,” Hammond said in an interview. “They're taking care of it on their own, either with their own money or their employer's money.”

Medicaid enrollment is up by about half a million people after the pandemic led to thousands of New Yorkers losing their jobs and their employment-provided insurance. To some, this means there are already systems in place to ensure people have access to insurance and care.

Hammond said there are more important things that state legislators should be focused on instead of creating a single-payer health-care system.

“We have a deficit of unprecedented proportions. We are right now thinking about major cuts to existing spending on schools, and transportation and health care,” he said.

The state budget deficit is estimated to be around $14.5 billion in the current fiscal year, which runs through March. Legislators and advocates have been pushing tax increases on top earners and the wealthy to plug that gap as well as to help fund the New York Health Act and other progressive priorities.

According to Lev Ginsburg, Senior Director of Government Affairs at the Business Council of New York State, introducing another income tax now could drive businesses and the wealthy out of New York.

“We already see a lot of problems in New York State with companies relocating out of the state or not coming to the state because of various expensive burdens,” he said. “We think that it would be a true economic disaster to put it in place now.”

Government Regulation, Health Care, and Labor Unions
Advocates for universal health insurance and care coverage in New York say that the system already in place for both private and state insurance plans is confusing and hard to navigate. They also point to the battles people must wage with their health insurance companies to get coverage for care.

Elisabeth Benjamin, Vice President of Health Initiatives at the Community Service Society, a nonprofit advocacy group focused on advancing opportunity for underserved communities, said that the current pricing system for hospitals is the biggest indicator of why the state needs a single-payer health system.

Hospitals charge a person depending on what insurance they have, rather than establishing a fixed set of prices for every service they offer. This can result in patients paying different amounts based on the type of insurance they have, and can discourage them from seeking care.

“If the hospitals charge the health plans more, the health plans can charge the consumer more, right? No one has an incentive, actually, to control costs,” she said.

Benjamin believes that there should be more government regulation on how much hospitals can charge patients, and said a single-payer health-care system can help achieve that. There are proposals to mandate uniform hospital and health care charges without moving to a single-payer insurance and care system.

A report done by the Campaign for New York Health, an organization advocating for universal health coverage for all New Yorkers, found that 50% of those surveyed said they were on private health insurance but couldn’t afford to use it because of copay costs. Katie Robbins, Director of the Campaign for New York Health, said that rising health-care costs likely contributed to the spread of coronavirus in New York.

“It would be really critical for a better response to this kind of pandemic to make sure that people have coverage as a guaranteed right and they don't delay because they're afraid of how much the treatment is going to cost,” she said.

The New York Health Act has garnered the support of several labor unions in New York, including the New York State Nurses Association (NYSNA) and 1199 SEIU, a union for many health care and hospital workers. Both unions potentially see job security for their members in such a system.

Having health care off the bargaining table would allow the unions to negotiate better contracts for their members and potentially lead to a stronger union presence in New York, according to Judy Sheridan-González, the President of NYSNA.

“If unions seek out support for people, whether they're in their union or not, union density grows and union credibility is much more valued,” she said.

Sheridan-González said the passage of the New York Health Act could also lead to more job creation in the healthcare industry as a result of heightened demand for doctors.

“I certainly see it in primary care. I think that the initial phase-in, if people know that they don't have to pay anything, I think more people would access preventive care and primary care,” she said.

Not all unions are on board, however: the New York State United Teachers (NYSUT) has testified against the bill, most recently in 2019.

In a statement, NYSUT spokesperson Matthew Hamilton noted that the union supports efforts for universal health care, “especially during a public health crisis,” but that the union believes “a national health care system would be the most effective way to address this issue.”

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by Caroline Leddy, Gotham Gazette
  @GothamGazette

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The Covid Crisis Made the New York Health Act More Urgent, More Unlikely, or Both Mon, 23 Nov 2020 05:00:00 +0000
Citing Lessons Learned, City Officials Outline Preparations, Cautious Optimism for Handling Potential Second Covid Wave https://www.gothamgazette.com/city/9899-new-york-city-preparations-for-potential-second-covid-wave-cautious-optimism https://www.gothamgazette.com/city/9899-new-york-city-preparations-for-potential-second-covid-wave-cautious-optimism lh hc w

Covid testing (photo: Michael Appleton/Mayoral Photography Office)


City Council members and public health professionals gathered over Zoom late last week to discuss how the city can better support public hospitals so that they’re prepared for a potential second wave of COVID-19, which experts say could overlap with the annual flu season and recent case upticks indicate may be looming.

The public hearing — held by the Council’s Committee on Hospitals and billed as an oversight hearing “Examining the City's Support of NYC Hospitals During the COVID-19 Pandemic” — covered issues including the widely agreed upon underfunding of public hospitals, access to personal protective equipment, and improving equity. 

Looking ahead, Council members said one key goal is to mitigate the disease’s disproportionate effects on working-class people and people of color, the very people who are disproportionately “essential workers” and who the city’s public hospital system, NYC Health + Hospitals, struggled to serve during the worst of the initial outbreak, especially in Brooklyn, the Bronx, and Queens.

The hearing, chaired by Council Member Carlina Rivera, a Manhattan Democrat, featured representatives from Mayor Bill de Blasio’s administration and from the public hospital system who defended the city’s record and said the city is ready for another surge of coronavirus cases. After city officials testified, advocates spoke on issues like funding for Health + Hospitals (H+H) and equity for marginalized people.

“This pandemic proves that our healthcare system is too disparate, not just in times of crisis but year-round,” Rivera said in her opening statement. “We are committed to ensuring that the path we build forward out of this pandemic is more equitable for all.”

Joined only by Council Members Mark Levine and Diana Ayala, Rivera asked about PPE access, transfers between hospitals, equity, and the city’s preparedness for a second wave, while officials signaled cautious optimism thanks to lessons learned from March and April. “We are better at caring for sick patients” now, said H+H President and CEO Mitchell Katz.

At the height of the pandemic, the public hospitals struggled to provide their employees with adequate PPE such as N95 masks, gloves, and gowns. Katz said the hospital system ordered PPE in January but “those shipments never arrived” because of a surge in demand worldwide. But NYC Emergency Management Commissioner Deanne Criswell said the city will be prepared this time around for whatever comes its way.

“Each hospital, even outside of the NYC Health + Hospital system and the independents, all have their own 90-day supply of PPE,” she said, “and then through our PPE Service Center we have an additional 90-day supply of PPE.” Criswell said the city also monitors state and federal PPE stockpiles.

According to NYC Test and Trace Corps Deputy Executive Editor Jackie Bray, some of this PPE can be manufactured in New York, but other equipment, like N95 masks, must be purchased from outside the state.

Katz also said that the city is unlikely to experience the same ventilator issue it faced in spring. “Intubation is not always the right answer,” he said; in fact, many patients do better with non-invasive ventilation, like devices that push air into the patient at high pressure.

Katz also shared takeaways about transferring patients between public hospitals, an important issue since during the height of the outbreak in the spring some intensive care units, especially in parts of Queens, were much more crowded than Manhattan ICUs. But there were some cases where hospital administrators wanted to transfer people between H + H hospitals but didn’t because they were unstable.

“You can’t put a patient into an ambulance to go to a less crowded hospital if you think they’re about to go into cardiac arrest,” Katz explained. If there’s a second wave, “we will stabilize patients and transfer them before we run out of space in our ICUs so that every hospital will still have available ICU beds.” This could help ensure that New Yorkers, especially people of color and working-class people who live in areas without many hospitals, can still access adequate care.

H+H has also changed the physical layout of its rooms, adding windows so that people can see each other without breathing each other’s air, putting video and sound monitors in every room so that nurses understand patients’ needs before they visit them, and expanding use of tablets for patients to communicate with loved ones, Katz said. 

Something else the city hopes to do is send out health-related text message alerts in more languages. Notify NYC, the city’s emergency alert system, recently began sending text alerts to more than 31,000 New Yorkers in Spanish, but it hopes to expand. “One of our goals as we move forward is to work with our messaging platform and cell service providers to be able to issue these real-time alerts in additional languages,” Criswell said.

After officials spoke, advocates discussed issues of underfunding and inequality. H+H, which is run by the city but technically its own public benefit corporation, gets funding to treat uninsured patients from the state and city governments, and has faced what some call chronic underfunding. The pandemic has only added to the hospital system’s expenses, though significant federal aid has helped.

Elisabeth Benjamin, Vice President of Health Initiatives at the Community Service Society of New York, a nonprofit focused on the city’s most vulnerable residents, said historic underfunding is part of the reason the pandemic had a worse effect on people of color and people living in boroughs other than Manhattan. “New York State has made a series of policy decisions that have resulted in really unfair allocation of health-care resources, that have in fact exacerbated the disparities in the covid pandemic,” she said.

They include giving aid to bad actors among private hospitals that could’ve gone to public hospitals, Benjamin said. She pointed out that while hospitals in Manhattan have grown, hospital closures have negatively affected communities in the less wealthy boroughs and neighborhoods, including areas served by Elmhurst Hospital, which was overwhelmed during the worst of the first wave in New York and is situated near the sites of four closed hospitals. The Queens neighborhoods around Elmhurst Hospital, an H+H facility where mobile morgues stored increasing numbers of dead bodies this past spring, was one of the areas hardest hit by the pandemic.

Benjamin also criticized the city’s use of indigent care pool funding, which is funding from the government that’s meant to go to hospitals that serve poor people. “Every hospital gets a little bit of this funding, whether they serve poor people or not, whether they offer financial assistance or not, whether they sue their patients or not. That’s wrong,” Benjamin said. The state recently closed a loophole allowing hospitals to collect funding from the indigent care pool for bad debt even if that debt was from wealthy people, but Benjamin said that’s not good enough. “Maybe we should only then be spending the indigent care pool money on the hospitals that are about to go under first of all, but also that serve high-need communities and communities of color.” Coronavirus-spurred CARES Act funding from the federal government also went more to private than public hospitals, Benjamin said.

“I agree with you wholeheartedly,” Council Member Rivera told Benjamin.

The devastating coronavirus outbreak in the city led to and exposed a shortage of skilled medical staff and a lack of PPE. Judith Cutchin, a director of the New York State Nurses Association and director-at-large at Woodhull Hospital in Brooklyn, said that at the height of the pandemic, it was possible for one nurse to have to tend to “as many as eight patients at a time.” According to the New York Times, the situation was even worse than that in some places. “In the emergency room, where best practices call for a maximum of four patients per nurse, the ratio hit 23 to 1 at Queens Hospital Center and 15 to 1 at Jacobi Medical Center in the Bronx,” the Times reported.

“This is unacceptable,” Cutchin said, later adding that when the hospitals did hire more workers or recruit them from other departments within the hospital, she was concerned by the last-minute nature of their training. “We are going into a next surge and we have to assure that people are properly trained,” Cutchin said. “Lives are at stake.”

Anthony Feliciano, Director of the Commission on the Public's Health System, a nonprofit that advocates for equal access to healthcare, said he thinks funding for public hospitals should come from the budget of the NYPD, echoing calls to “defund the police” in light of the Black Lives Matter movement that surged earlier this year after high-profile police killings of Black people in other parts of the country. “We need to ensure that the Board of Health declares racism as a public health crisis,” Feliciano said.

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by Lauren Hakimi, Gotham Gazette
   

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Citing Lessons Learned, City Officials Outline Preparations, Cautious Optimism for Handling Potential Second Covid Wave Wed, 11 Nov 2020 05:00:00 +0000
Supreme Court Hearings Could Be the Beginning of the End of Your Healthcare https://www.gothamgazette.com/130-opinion/9888-supreme-court-hearings-beginning-of-end-of-healthcare-affordable-care-act-scotus https://www.gothamgazette.com/130-opinion/9888-supreme-court-hearings-beginning-of-end-of-healthcare-affordable-care-act-scotus hospital health care emergency room sign

Hospital emergency room (photo: Michael Appleton/Mayor's Office)


It has been a tumultuous week for all of us. The uncertainty about who will lead the country for the next four years has left America anxious, scared, and exhausted.

But with that question appearing settled, other threats remain. Starting Tuesday, the Supreme Court will hear oral arguments in a case that will decide the fate of the Affordable Care Act.

The consequences could not be more dire. As a health-care professional, I see firsthand how important access to quality, affordable health-care is to Americans—especially our country’s most vulnerable.

The timing could also not be worse. Medicaid budgets are shrinking across the country as a pandemic ravages our communities and finances.

Should the ACA be repealed, millions of Americans will lose their healthcare overnight. Premiums will skyrocket. Protections for pre-existing conditions will disappear. The tens of millions who have benefited from the Affordable Care Act will suddenly find themselves scrambling for healthcare—and likely a more expensive version than what they currently have.

It did not have to be this way. The ACA allowed states to expand Medicaid, allowing more Americans access to the core health-care program that’s benefited our country for decades. It allowed young adults to stay on their parents’ health-care plans until the age of 26. It ensured that the one-third of Americans with pre-existing conditions – like diabetes and cancer – are not discriminated against when it comes to health insurance.

I know from both work and personal experience the importance of these aspects of the ACA. As someone who has lost a loved one who battled cystic fibrosis and passed away from pancreatic cancer, I know first-hand how important these protections are, and have dedicated myself to working in healthcare to ensure that I can save as many lives as possible.

Yet for four years, President Trump, his administration, and the Republican Party have done everything in their power to dismantle the ACA and see that millions of Americans either lose their healthcare altogether or pay a higher premium for the care they deserve. The failed attempt to repeal the ACA altogether was a blow to the GOP, but thanks to their changes to the individual mandate, they now have another chance at destroying a landmark health-care law that has proven for more than a decade how valuable it is to the American people.

There have been over 100,000 new COVID-19 cases every day over the past several days. More than 1,000 Americans are dying every single day. The fact that Americans have to even worry about their access to healthcare is not only disconcerting; it’s un-American. As a health-care worker I know first-hand that we take care of one another, and I have been risking my life to save the lives of others for months now.

Despite the efforts of my colleagues and me, we are nowhere near off the hook when it comes to protecting American lives amid this devastating pandemic. We need funding for our hospitals, funding for Medicaid, funding for PPE, and broader assistance from those leading the country. It’s not just my life that depends on it, or the patients I care for in hospital beds; it’s the lives of every New Yorker and every American that are at risk.

The stakes could not be higher. The Supreme Court will rule one way or another in the coming weeks; regardless, we must find solace in unity, and that means we cannot lose hope but must be spurred to action. Under the leadership of President Biden and Vice President Harris, we can not only preserve -- or reinstate if needed -- quality, affordable health-care our fellow citizens deserve, but strengthen the laws and insure even more Americans.

Every voice matters in this fight while we wait for a ruling from the highest court in the land. Call your local representatives, call your Congressional representative, call your U.S. senators. And most of all, call your family to tell them to make calls to remind our lawmakers that healthcare should be a human right, not a privilege.

Together, we can fight this virus, and keep America healthy into the future.

***
Mary Maggio Fischer has worked at Flushing Hospital for 39 years and is a local political activist. She is a member of 1199 SEIU.

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Have an op-ed idea or submission for Gotham Gazette? Email opinion@gothamgazette.com

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Supreme Court Hearings Could Be the Beginning of the End of Your Healthcare Sun, 08 Nov 2020 05:00:00 +0000
A Healthcare Worker’s Plea: No Matter Where You Live, Go Vote https://www.gothamgazette.com/130-opinion/9869-healthcare-workers-plea-no-matter-where-you-live-go-vote-2020-election https://www.gothamgazette.com/130-opinion/9869-healthcare-workers-plea-no-matter-where-you-live-go-vote-2020-election healthcare workers hospital nurses

Frontline healthcare workers (photo: Michael Appleton/Mayor's Office)


Skipping family gatherings. Skipping necessary doctor’s appointments. Missing school. Missing time with friends. Losing jobs. And the deaths of loved ones. At this point, COVID-19 has affected every single American in one way or another.

As a frontline healthcare worker, I have seen firsthand the damage this pandemic has caused. While the death toll has surpassed 225,000 in the United States alone and hospitalizations begin to rise again, I have gone to work and risked my life to save the lives of others.

It did not have to be this way. And that’s why I’m urging everyone to join with me in voting for a change of leadership so we can begin to contain this devastating pandemic. No matter where you live or whether you’ve ever voted before, if you’re eligible to vote, please go out and make your voice heard for change.

President Trump and his administration – and most of us in the healthcare profession – knew in January that there was a serious virus already in the U.S. that had the potential to wreak havoc on our everyday lives. By March, we knew this was not the typical flu, but something that would spread at a much higher rate if we did not take the precautions necessary to mitigate its impact.

States began to close themselves because there was no official mandate from the federal government. President Trump repeatedly said the virus would go away quickly and easily. Meanwhile, hospital beds filled up and our access to personal protective equipment (PPE) such as masks, gloves, and gowns began to disappear, thanks to a lack of planning by the federal government that put healthcare workers at even greater risk.

In past circumstances, we have relied on science to guide us through these difficult illnesses. Contact tracing, testing, and wearing a facemask are essential. Yet, despite plenty of warning and ample time to put these measures into place, our national leadership chose to limit these proactive measures, because as President Trump phrased it in a June 15 tweet, testing “makes us look bad.” That was several months into the pandemic. After having tested positive and being hospitalized himself, the president still mocks the use of masks and downplays the virus’ risk and toll.

We need to once again allow science to guide us. President Trump has failed to protect the American people through his actions, and there are hundreds of thousands of grieving families today, and more every day, because of his administration’s inaction.

There are also millions of Americans out of work, and many families are facing childcare crises and evictions. Healthcare workers like myself are working hard every day to simply keep victims of this pandemic alive, and there is no real end in sight as we enter the winter season where things are projected to get much worse.

Healthcare workers are not the only ones who have a say in the current state of affairs—everyone should be casting their vote. Even if you live in New York or another state where you may not think the electoral votes are in play, everyone’s votes matter and are shown in tallies of the final results.

Seeing firsthand the effects of this pandemic while our president not only does nothing, but in fact makes matters worse, is as much a call to action as possible. This year, more than ever, healthcare workers must let their voices be heard and cast a vote. And so must anyone who sees the wreckage that the virus has caused, made much worse by the president’s failed leadership.

COVID-19 has ruined the lives of far too many families, and led to too much heartbreak, frustration, anger, and fear. Just like wearing a facemask, do the responsible thing, and do your civic duty. A vote on Tuesday is a vote to end this pandemic.

***
Chandra Tameshwar is a Registered Nurse who has worked in Brooklyn for five years and is a member of 1199 SEIU.

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Have an op-ed idea or submission for Gotham Gazette? Email opinion@gothamgazette.com

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A Healthcare Worker’s Plea: No Matter Where You Live, Go Vote Sun, 01 Nov 2020 04:00:00 +0000
City Council Holds Hearing on Sexual and Reproductive Right https://www.gothamgazette.com/city/9860-city-council-hearing-sexual-reproductive-rights-abortion-scotus https://www.gothamgazette.com/city/9860-city-council-hearing-sexual-reproductive-rights-abortion-scotus cm hr chairs

City Council Member Helen Rosenthal, right (photo: John McCarten/City Council)


New York City Council Members will hold an oversight hearing Wednesday on “sexual and reproductive rights in New York City” and consider a package of legislation on those subjects, at a joint hearing of the Council’s Committee on Health and Committee on Women and Gender Equity. 

The bills cover a wide range of issues, including access to contraception, establishing a board on gender equity in hospitals, and providing health care professionals with training on how to identify the signs of female genital mutilation. Most of the bills fall under the World Health Organization's 17 indicators of reproductive health, according to a City Council spokesperson.

The hearing comes at a time where reproductive rights in the United States are again at the center of the national political conversation, amid a presidential election, the recent death of Supreme Court Justice Ruth Bader Ginsburg, a strong supporter of abortion rights, and the confirmation of Justice Amy Coney Barrett, who has expressed opposition to abortion, to replace Ginsburg on the high court, tilting it further toward conservatives and raising concerns among pro-choice Americans that the Court’s Roe v. Wade ruling could be overturned. 

The National Organization for Women’s New York City chapter issued a statement soon after Justice Barrett was confirmed, signaling that women’s reproductive rights may now be at stake with her on the bench.

“We're on the brink of losing our hard fought right to choose. We're going to have to fight like never before to protect our rights and those of the next generation," said Sonia Ossorio, President of NOW-NY.

In New York, abortion protections provided by Roe v. Wade were codified into state law last year, while insurance companies were also mandated to cover contraception. But various aspects of reproductive health continue to be debated and discussed.

Among those testifying at Wednesday’s hearing, which is expected to largely focus on the bill package but to also look at sexual and reproductive rights more broadly, will be representatives of the New York City Department of Health and of the city’s Commission on Gender Equity, according to City Council Member Helen Rosenthal, a Manhattan Democrat who chairs the Council Committee on Women and Gender Equity.

In an interview, Rosenthal said that the package of bills is a result of meetings with experts to figure out how to best support women’s reproductive health.

"The Women's Caucus, and the BLAC -- the Black, Latino, and Asian Caucus -- has been meeting jointly on a number of these issues, to hear from advocates, activists, and medical professionals themselves, who are experts in these areas. And that's why you have this broad range for very thoughtful legislation," she said.

Rosenthal is the lead sponsor on a bill that would create an advisory board on gender equity in city hospitals. The bill was written after a group of female medical students sued Mt. Sinai hospital for gender discrimination last year. 

Rosenthal said that gender-based discrimination in hospitals not only harms the employees, but also affects the patients as well. 

“If a doctor berates a female medical student who is responsible for a particular patient and then leaves the room, how is that patient supposed to respect that medical student?” she said. 

The board would consist of 13 members, including city officials as well as members of the medical community and students.

Both emergency and long term-reversible contraception would be made available at Department of Health and Mental Hygiene facilities if a bill sponsored by Council Member Carlina Rivera, a Manhattan Democrat who chairs the Council’s Committee on Hospitals, is passed. 

The bill would provide free or low-cost access to the insertion or removal of long acting-reversible contraception such as an intrauterine device or subdermal contraceptive implants.

As chair of one of the committees at hand, Rosenthal will lead the oversight portion of the hearing along with Council Member Mark Levine, a Manhattan Democrat who chairs the Council’s health committee, while other members of the two committees and of the larger Council who decide to participate will also be able to ask questions of those testifying.

Also in the package of legislation are two bills on female gential mutilation and cutting, which aim to create an advisory board and educate health-care professionals on how to identify the practices. Female genital mutilation is outlawed in New York State but has gone underground and continues to affect an estimated 60,000-plus women in the New York and New Jersey metro area, according to Council Member Rosenthal, who is the lead sponsor on the education bill. 

“When a medical professional, a doctor, is presented with someone who is trying to get pregnant or who may already be pregnant and has undergone female genital cutting,” Rosenthal said, “that doctor needs to know what they're looking at. And many doctors don't.”

According to the U.S. Department of Health & Human Services’ Office of Women’s Health, female genital mutilation and cutting may complicate a childbirth if not properly identified by a doctor. 

The bill seeking to establish an advisory board for female genital mutilation and cutting, sponsored by Council Member Alicka Ampry-Samuel, a Brooklyn Democrat, would help educate providers and establish guidelines on the identification and protection of those at risk of the practices. 

The board would also change the way the city collects data on the practice and would develop outreach campaigns aimed at preventing such practices from occurring.

In a follow-up to his original bill, which required that employers provide breastfeeding employees with on-site lactation rooms, which went into effect last year, Council Member Robert Cornegy, a Brooklyn Democrat, is sponsoring a bill that would require lactation rooms to be regularly inspected by the city Health Department and also provide training on how to prepare and clean the rooms.

Also on the agenda for the hearing is consideration of a bill introduced by Council Member Danny Dromm, a Queens Democrat, that is aimed at preventing medically unnecessary procedures on intersex infants will also be considered on Thursday. If passed, it would create a public outreach campaign to educate New Yorkers about “medically unnecessary treatments and interventions performed on infants born with intersex traits.” The bill would also postpone any procedure until the intersex person can make an informed decision about the procedure, rather than having that decision made at birth by their parents.

Along with the bills under consideration, the Council will be considering two non-binding resolutions on abortion, one specifically calling on the federal government to rescind the changes on Title X funding issued last year, which prohibits health care providers who recieve federal funding from performing abortions or providing abortion referrals to patients as a part of family planning. 

According to the resolution, introduced by Council Member Diana Ayala, a Democrat representing parts of Manhattan and the Bronx, the federal changes disproportionately impact communities of color and low-income communities whose members rely on Title X clinics for reproductive and preventative health care services. 

The second resolution, proposed by Council Member Margaret Chin, a Manhattan Democrat, calls on federal and state legislators to oppose a ban on sex-selective abortions, arguing that they perpetuate a racial stereotype against Asian-American and Pacific-Islander women. A ban on sex-selective abortions, according to the resolution, could potentially lead to further restrictions on access to abortion and “scrutinizes a woman’s reasons for making the decision to terminate a pregnancy.”

 

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by Caroline Leddy, Gotham Gazette
  @GothamGazette

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City Council Holds Hearing on Sexual and Reproductive Right Tue, 27 Oct 2020 04:00:00 +0000
A Change New York Must Make to Protect Safety Net Providers and Their Clients https://www.gothamgazette.com/130-opinion/9819-change-new-york-protect-safety-net-providers-and-clients https://www.gothamgazette.com/130-opinion/9819-change-new-york-protect-safety-net-providers-and-clients spk co jo br bell

Health care professionals (photo: John McCarten/NY City Council)


Finalizing a budget can be chaotic in the best of times. This year, we hammered out the last details of the state’s $177 billion spending plan as the COVID-19 crisis was approaching its peak in New York State. 

It was in this context that the Legislature agreed to a little-noticed recommendation from the Governor’s Medicaid Redesign Team II (MRT II) that strips a critical federal benefit from health-care providers and patients in New York. Luckily, we have until April 1, 2021 to undo this mistake. I will be working non-stop over the next seven months to do just that, along with a coalition of advocates and Medicaid patients as part of the Protect the Safety Net campaign. 

The MRT II pushed through a provision in the budget that would “carve out” a pharmacy benefit from the state’s Medicaid managed-care program and shift payment to a fee-for-service reimbursement. The commission claimed its goal was to lower costs and increase transparency, but in reality this provision would devastate Ryan White Clinics, federally-qualified health centers, safety net hospitals, and other safety net providers in the 340B drug discount program. In Monroe County, for example, Trillium Health, Jordan Health, and the University of Rochester Medical Center all rely on 340B to provide essential services to families in our community. 

The federal 340B Drug Discount Program protects safety net providers from drug price increases and gives them access to pharmaceuticals at discount prices. This includes HIV/AIDS clinics that receive support under the Ryan White CARE Act as well as community health centers that have been on the frontlines of fighting COVID-19. 340B providers rely on this funding to operate food pantries, provide transportation assistance, STI screenings, mental health and wellness programs, and run harm reduction programs – services that are often grossly underfunded by the state.

If the carveout is not reversed, many patients across New York State will simply have nowhere to turn. These are not savings that should be made on the backs of those who can ill afford these cuts. 

The 340B Program is under constant threat from Big Pharma, which has tried to distort and undermine the program since it was established with broad, bipartisan support back in 1992. For the pharmaceutical industry, a discount program for Medicaid patients just means less profit. For short-sighted bureaucrats in Albany, it’s a chance for accounting gimmicks that allow them to claim “savings” that would actually harm the vulnerable New Yorkers they are supposed to be serving. 

The Medicaid commission chose the worst possible time to experiment with changes to New York State’s safety net. 340B providers care for patients in communities that have been hardest hit by the COVID-19 pandemic. If these providers are forced to eliminate services, more patients will be forced to go to hospital emergency rooms for care – swamping our hospital system and driving up costs while leading to poor health outcomes. 

This would also threaten the progress we’ve made in fighting the HIV/AIDS epidemic. Ryan White Clinics have built comprehensive models of health care and social services to address the diverse needs of their patients. This comprehensive model of care is only possible because of the clinics’ participation in the 340B program. 

In the weeks and months ahead, New Yorkers will be hearing a lot more about this issue. The New York chapter of Ryan White Clinics for 340B Access recently launched a campaign to Protect the Safety Net, led by advocates and Medicaid patients. We’re going to keep fighting until the state reverses course and restores this critical benefit for the most vulnerable New Yorkers.

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Assemblymember Harry Bronson represents Rochester and surrounding areas. On Twitter @HarryBBronson.

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Have an op-ed idea or submission for Gotham Gazette? Email opinion@gothamgazette.com

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A Change New York Must Make to Protect Safety Net Providers and Their Clients Tue, 13 Oct 2020 04:00:00 +0000
Health Care Heroes Had Our Backs. Now We Must Have Theirs https://www.gothamgazette.com/130-opinion/9803-health-care-heroes-coronavirus-mental-health-doctors-nurses https://www.gothamgazette.com/130-opinion/9803-health-care-heroes-coronavirus-mental-health-doctors-nurses applaud thank staff

Honoring health care heroes (photo: Michael Appleton/Mayor's Office)


Roars of applause, cheers, and clanging of pots and pans – the familiar 7 p.m. signal in New York for many bleak early spring days of 2020 quickly became a daily ritual in fervent support of health-care workers on the front lines of the COVID-19 pandemic. While most watched the wave of infections unfold through the media from the safe havens of their homes, health-care workers went to work hoping, praying, and questioning the chance of infection and survival for themselves, their families, and their patients.

Jarring stories from intensive care units and reports of suicide among clinicians demonstrated that our claps and recognition were not enough to sustain their well-being. In a new normal where the present and future of this pandemic remain uncertain, we must prioritize mental health services for our front-line health-care workers.

The unknown aspects of the COVID-19 virus presented unprecedented challenges for health-care staff, especially in the outbreak’s epicenter, New York. Lingering uncertainty and a heightened sense of anxiety were fostered by extensive media coverage and a declared state of emergency. The rapid call to response for clinicians set forth a range of obstacles including unmanageable patient loads, providing care outside their skill sets, and witnessing firsthand the growing illness and morbidity rates among coworkers and patients. Health-care workers were living in a constant state of fear and psychological stress, rooted in the risk of transmission of the virus to others and inability to save patients despite their efforts.

While the added sources of stress may have subsided after the city’s immense wave of infections, for many health-care workers, mental health issues stemming from these experiences can and, for many, will persist long after the peak of the pandemic.

The negative mental toll on health-care workers from COVID-19 and previous pandemics is well documented. An analysis published by British Medical Journal of SARS, H1N1, MERS, Ebola, COVID-19, and other pandemics found that staff working directly with infected patients reported higher levels of distress, burnout, and post-traumatic stress. In a systematic review of COVID-19-related studies, insomnia, depression, and anxiety were also reported among health-care workers. Factors such as inadequate personal protective equipment (PPE), risk of infection among medical staff, long hours, and lack of organizational support were noted to contribute to adverse psychological outcomes. These results enforce the growing evidence of mental health challenges among health-care workers treating patients with COVID-19. 

Health organizations must promote a culture of caring and psychological wellness to protect the long-term wellbeing of their staff. Experts recommend that leadership can help normalize a focus on mental health needs by providing models for self-care and help-seeking behaviors, and establishing opportunities for staff to share concerns for themselves, colleagues, and patients in a safe and anonymous way.

NYC Health + Hospitals, the city’s public hospitals system, has led the way by establishing partnerships to provide mental health support to health-care workers and first responders on the frontlines of the pandemic. This is an opportunity for other health-care organizations to follow suit by ramping up mental health and wellness programs for employees and sustaining comprehensive support services post-crisis.

In the United States, providing mental health services for clinicians is not a standardized practice. With the COVID-19 pandemic disrupting so many facets of the health-care landscape, health organizations have largely prioritized immediate needs, such as patient care coordination and acquisition of necessary equipment, over mental health. In the aftermath of the most devastating period, the provision of mental health support services will be especially crucial for health-care workers to combat both the short- and long-term effects of stress endured during the worst of the pandemic and into the months of its persistent presence. As the potential for a second wave looms, it is imperative for health organizations to implement effective measures to preserve the mental well-being of their staff.

Now more than ever, proactive and longstanding changes to health-care infrastructures are necessary in order to normalize and integrate mental health services for staff on a routine basis. Recognition alone will not suffice as the future recurrences of the COVID-19 pandemic remain ominous. We owe it to the heroes in this fight to support their recovery and ensure they can continue providing quality care for whatever may come our way. Our lives depend on it.

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Sandra Carlino Oliveri is a Quality Improvement Specialist at Memorial Sloan Kettering Cancer Center and an MPA Candidate at the NYU Robert F. Wagner Graduate School of Public Service.

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Have an op-ed idea or submission for Gotham Gazette? Email opinion@gothamgazette.com

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Health Care Heroes Had Our Backs. Now We Must Have Theirs Mon, 05 Oct 2020 04:00:00 +0000
Black Mothers Matter: Bringing Justice to Maternity — Now https://www.gothamgazette.com/130-opinion/9689-black-mothers-matter-bringing-justice-to-maternity-now https://www.gothamgazette.com/130-opinion/9689-black-mothers-matter-bringing-justice-to-maternity-now fl bk baby

Deep and deadly health care disparities persist (photo: Edwin J. Torres/Mayor's Office)


In December of 2019, Sha-Asia Washington joyfully announced her pregnancy to her mother. In December of 2018 I had done the same. Throughout the Spring of 2020, she and her boyfriend counted down the days until her June due date. I had done the same in 2019. As she neared her due date, she went into the hospital with high blood pressure. Diagnosed with preeclampsia, I had done the same. 

A year later, I’m sitting with my son on the floor. I playfully comb my fingers through his hair as he leans into my chest. But Sha-Asia can’t do the same -- she tragically died in the hospital during an emergency c-section. 

Why? 

Maternal mortality, the death of a mother from pregnancy-related complications, is a crisis in the United States. While the global maternal mortality rate dropped by 44 percent between 1990 and 2015, the U.S. was one of only 13 countries, including North Korea and Zimbabwe, that saw its rate increase.

In New York it’s even worse. In 2016, New York was ranked 30th in the nation for its maternal mortality rate. Maternal deaths increased from 15.4 deaths per 100,000 live births in 2001-2003 to 19.6 deaths per 100,000 live births in 2014-2016.

Maternal mortality is highly racialized; in New York City, from 2006 to 2010, Black women were 12 times more likely than white women to die from pregnancy-related causes.

Yet over 60 percent of these deaths are preventable, according to the CDC Foundation. In recent years, both New York City and State have announced plans to address these disturbing trends; officials have held press conferences and established committees. And yet mothers like Sha-Asia Washington, Amber Rose Isaacs, and Cordielle Street have all died in New York City this year alone. 

The COVID-19 pandemic has only magnified the inequities in our health-care system, made worse by inequities in housing and education, revealing just how dangerous it is to be a pregnant Black woman in our city. We can’t expect to eliminate or even reduce maternal mortality when we don’t guarantee Black and brown mothers the right to clean and safe housing. 

Creating a more just and equitable city demands the active dismantling of systemic racism that is ingrained within other social structures that govern our lives, including law enforcement, health care, housing, and education. It also requires the commitment of decision-makers at every level to value the lives of women of color, particularly when they are most vulnerable: pregnancy and childbirth. 

Addressing maternal mortality begins with valuing women’s health and increasing access to health care and family planning. It involves ensuring that expectant mothers have access to comprehensive reproductive health care, counseling, and housing. We need more community health centers, assistance for working women to keep their prenatal visits, and to ensure expectant mothers have access to health advocates, such as doulas or social workers, throughout every phase of pregnancy.

Finally, this essential work involves holding our hospitals, government agencies, and elected officials accountable, ensuring implicit bias trainings for all hospital staff and demanding transparency in reporting on frequency, cause, location, and racial breakdown of maternal deaths and major complications that arise in our maternity wards or in the following postpartum months. 

Ending this crisis involves all of this and more. It’s also going to take all of us to come together and say no more mothers lost. Black lives matter. Black mothers matter. It’s time we prove it by demanding justice in maternity. 

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Tricia Shimamura is a candidate for New York City Council District 5. On Twitter at @ShimamuraTricia.

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Have an op-ed idea or submission for Gotham Gazette? Email opinion@gothamgazette.com

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Black Mothers Matter: Bringing Justice to Maternity — Now Tue, 18 Aug 2020 04:00:00 +0000
Telehealth is Helping New York Tackle Our Mental Health Crisis, But It Must Be Funded https://www.gothamgazette.com/130-opinion/9678-telehealth-help-new-york-tackle-mental-health-crisis-funded https://www.gothamgazette.com/130-opinion/9678-telehealth-help-new-york-tackle-mental-health-crisis-funded tour linc cm

Health care by video has increased in importance (photo: Jeff Reed/City Council)


When we first met Alice two years ago, she suffered from schizophrenia, depression, uncontrolled diabetes, hypertension, and high cholesterol. Even though we set up pill boxes for her and arranged home health aides, she chose to seek treatment only in emergency rooms. Her health continued to deteriorate. 

Last year, Alice finally began to engage in treatment for her diabetes by phone, but her nurse practitioner provided this treatment on her own time, without government funding. Alice’s serious health problems put her squarely in the high-need, high-cost category of patients who demand innovative treatment approaches. But our 20th century regulatory system held her back. 

Ironically, the COVID-19 epidemic changed things. By necessity, Alice was offered more care by telephone and videoconference. She was able to accept these offers, and began following up with her appointments. This only became possible because emergency orders issued by Governor Cuomo allowed the state to reimburse health-care providers for telehealth services as if they were in-office visits, while suspending bureaucratic rules that made it hard for providers to offer telehealth services in the first place.  

The pandemic will end someday. But treating our clients with serious mental illness — many of whom, like Alice, also have debilitating physical issues — by telephone and video conference has proven to be an unexpected success. We need to take advantage of this crisis and bring our laws into the 21st century.   

At the Institute for Community Living, which provides care to people living with a range of mental health issues, a survey of almost 1,500 clients showed high satisfaction with telehealth. Many of them prefer it to visiting a clinic, and 80% said they wanted to continue remote appointments after the pandemic ends. 

Telehealth is convenient for people with multiple health problems, and it’s helping clients get better. From March to May, the percentage of clients who failed to keep medical appointments dropped from 33% to just 15%. Using telehealth has allowed us to triage health issues in our residences immediately, rather than requiring clients – accompanied by two staff – to travel to their appointments. This has helped to reduce costly emergency room visits. 

None of this would have been possible in February. Prior to the pandemic, we could only bill for telehealth at a fraction of the rate for in-person services. And outdated rules, such as a requirement that both the patient and the physician be physically located in a licensed facility, meant that only a fraction of patients could actually benefit from telehealth services.  

COVID-19 has put tremendous stress on our health and mental health systems. The pandemic itself and the subsequent economic fallout are causing widespread and profound distress that could lead to a lasting mental health crisis. It has also put New Yorkers who were already struggling with severe mental health conditions at even higher risk.

The emergency orders have been extended short-term by the governor and the Legislature should act to make them permanent. State Senator Peter Harckham and Assembly Members Linda Rosenthal and Aileen Gunther have introduced legislation that would allow telehealth sessions to be reimbursed at the same rate as in-person visits, and Harckham and Rosenthal introduced separate bills that would expand eligibility for telehealth. When the Legislature next reconvenes, we hope these bills can be passed quickly and signed into law, enabling organizations to better serve New Yorkers living with mental health issues and meet the mental health challenges caused COVID-19. 

This pandemic has shown us that technology can be used to connect people remotely in ways we didn’t think were possible. Millions of Americans are now working from home just as productively as they were at a desk in an office prior to COVID-19, with companies like Twitter changing their policies to allow employees to work remotely full-time. There is no reason our regulations can’t allow us to use this technology to better provide life-saving health-care services to New Yorkers like Alice. 

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David Woodlock is the president and CEO of the Institute for Community Living. He is a former deputy commissioner at the New York State Office of Mental Health.

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Have an op-ed idea or submission for Gotham Gazette? Email opinion@gothamgazette.com

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Telehealth is Helping New York Tackle Our Mental Health Crisis, But It Must Be Funded Sun, 16 Aug 2020 04:00:00 +0000