Testimonies/Reports

Regional Hearing: Report of the Commission on Healthcare Facilities in the 21st Century

Testimony before the State Assembly Health Committee on the Report of the Commission on Health Care Facilities in the 21st Century, December 11, 2006, Medford, N.Y.

Good afternoon. My name is Barbara Crane. I am a registered nurse and chair of the New York State Nurses Association bargaining unit at St. Catherine of Siena Medical Center in Smithtown. I also serve on the NYSNA Board of Directors and the American Nurses Association Board of Directors.

The process used to create the Berger Commission report was flawed from the beginning. The Commission was given the foregone conclusion that hospitals and nursing homes needed to be “right-sized.” It then manipulated data to support that assumption. This information was analyzed behind closed doors, with little or no input from the communities that would be affected. The public also had no access to the Commission’s closed-door discussions about “voluntary downsizings” with hospital administrators.

As might be expected, we now have a flawed report which, if implemented, will hurt more than it heals. NYSNA is urging the State Legislature to reject these recommendations and use this opportunity to undertake a comprehensive review of the state’s healthcare delivery system. At the very least, the time period for implementing the recommendations should be extended to allow more time for public input and a thorough analysis of the impact of these proposals on the system as a whole.

Our concern is that state leaders will implement these recommendations as a “quick fix” and fail to take other steps that are needed for genuine healthcare reform in New York.

The report’s executive summary states that “a fundamental driver of the crisis in our healthcare delivery system is excess capacity.” Without any documentation, the report claims that “hospitalizations expand in relation to the number of available beds” and accuses healthcare facilities of admitting patients solely to generate revenue.

Nurses, who provide most of the care to patients in hospitals, firmly disagree with this statement. The acuity of the patient population actually has increased over the past ten years. Due to pressure from insurers, patients are less likely to be admitted and are discharged from the hospital more quickly.

In general, NYSNA sees the following major problems with the Commission’s report:

1. The recommendations concern only hospitals and nursing homes.
   The continuum of care extends beyond these facilities to home care, ambulatory care, psychiatric facilities, and more. These settings must be included in any plan to revamp our state’s healthcare system. It is potentially devastating, for example, to close nursing home beds and not provide funding to expand and improve non-institutional care for the elderly, disabled, and mentally ill.
   
   
2. The report implies that excess beds mean excess staff.
   The facilities where our members work are far from overstaffed. A report released last January by Governor-Elect Spitzer found that a majority of nursing homes in the state were staffed below federal guidelines. Thousands NYSNA members working in acute-care and long-term care facilities have filed protests claiming that their patient load is too high and they are concerned about being able to provide safe nursing care.
   
   
3. The report does not address the inevitable displacement of nurses and its effect on the nursing shortage.
   Nurses will lose their jobs due to these recommendations. Contrary to popular opinion, it will not be easy for RNs just go work at another facility, nursing shortage or not. Nurses who are close to retirement have already told us they will not seek new positions in direct care. Others will require education – not just “retraining” – to perform effectively in new specialties and practice settings. Unless there is a funded program in place to meet their needs, these nurses will be lost to the profession and the nursing shortage will worsen.
   
   
4. The report is biased against public healthcare facilities.
   By recommending that public facilities merge with private ones, the report ignores the vital role played by publicly operated hospitals and nursing homes. These facilities allow government to fulfill its responsibility to ensure that the poor, the uninsured, and the underinsured are not left without care. For example, in the 1970s, when AIDS patients were being turned away from private hospitals, public hospitals admitted and cared for them. Public healthcare facilities are a safety net we can’t afford to lose.

Although the Commission has not called for the outright closure of hospitals on Long Island, its recommendations may have that effect. St. Charles Hospital in Port Jefferson is part of the Catholic Health System of Long Island, as is St. Catherine’s. The nurses at St. Charles are fellow members of NYSNA.

The Commission has recommended that half of the medical/surgical beds at St. Charles be transferred to J.T. Mather Hospital and that the emergency department at St. Charles be closed. While this would appear to merely eliminate duplication of services, it actually could be a death sentence for St. Charles.

If these recommendations are placed into law, St. Charles would provide physical rehabilitation, psychiatry, and alcohol rehabilitation – and obstetrics. One of our members stated flatly that expectant parents are unlikely to prefer such a facility and OB/GYN physicians and nurse midwives will be unlikely refer their patients there. The loss of these patients would be a financial blow to St. Charles, which in just two years has successfully recovered from significant fiscal problems. St. Charles does more joint replacement than any other LI hospital. Where will the over 800 joint replacements done at St. Charles go when that OR ceases to exist.

There is a question about whether patients who now would go to J.T. Mather for medical, surgical, and emergency care would be treated according to the ethical and religious directives now in effect at St. Charles. In addition, the emergency departments at both hospitals now operate at near capacity. Closing the ED at St. Charles would mean longer waiting times and less access to care for Port Jefferson residents.

NYSNA and its members urge the Legislature to reject this report and take action that will truly reform health care and reduce costs, such as:

• Establish universal healthcare coverage in New York to make affordable care available to everyone – one of the policy recommendations made by the Commission itself. A system based on coverage by private, for-profit insurance companies is a major driver of healthcare costs and does not improve the quality of health care.
• Ensure that comprehensive, quality health care can be accessed by all New Yorkers through the removal of barriers based on culture, ethnic background, geography, and language.
• Invest in ensuring an adequate nursing workforce now and in the future. Nurses are the most numerous healthcare providers and staffing shortages lead to more patient complications, longer hospital stays, and higher costs.
• Reform healthcare financing and address fundamental problems with the current reimbursement structure.
• Develop an effective system for monitoring and disclosing the quality of care provided in hospitals and nursing homes. Of particular value are patient outcomes that are specifically related to nursing care.

Thank you for the opportunity to submit testimony. NYSNA looks forward to working with the legislature to craft a healthcare system in New York that will be a model for the entire nation.

For more information, contact Governmental Affairs at 518.782.9400, ext. 283 or by e-mail.