Testimony before the State Assembly Health Committee on the Report of the Commission on Health Care Facilities in the 21st Century, December 11, 2006, New York, N.Y.
Good afternoon. My name is Anne Bové. I am a registered nurse and president of the New York State Nurses Association Delegate Assembly. Beside me are Lolita Compas, a former president of NYSNA and chair of the NYSNA bargaining unit at Cabrini Medical Center, and Judy Sheridan-Gonzalez, an emergency room nurse and president of the NYSNA bargaining unit at Montefiore Medical Center and a member of both the NYSNA Delegate Assembly and 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 true 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.
NYSNA has identified these major problems with the Commission’s report:
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:
My colleagues will address the issue of hospital closings in New York City:
My name is Lolita Compas and I am a registered nurse and clinical instructor at Cabrini Medical Center in Manhattan. I have worked at Cabrini since I came here from the Philippines in 1969. For 37 years, I have provided and continue to provide, together with hundreds of healthcare workers before me and those currently employed, compassionate, professional and excellent health care to tens of thousands of patients admitted to many of our services.
In 1892 St. Frances Xavier Cabrini, the first American immigrant saint, founded this hospital to provide health care to the poorest residents of New York for free, at that time when the government was unable or unwilling to care for its poorest immigrants. There is a great heritage and an important mission to our community that Cabrini has continuously represented to the citizens of New York throughout all of these years.
Over its long history, Cabrini has changed with the times, responding to the growing need for specialized care. It began three years ago to convert medical-surgical beds to provide care that is not available elsewhere. The State Department of Health approved a certificate of need for a geriatric mental health unit and plans were underway to develop and open an end of life services with Calvary Hospital and create a greatly needed and world class, palliative end of life and post acute care for Manhattan residents.
If the Commission’s purpose was truly to reduce Medicaid spending, the obvious choice for closings would have been the large hospitals on the East Side, many of which duplicate specialty services and drive up the cost of care. Instead, the Commission has targeted Cabrini, which has only 338 beds currently staffed and in service. The biggest beneficiary of closing our hospital will be Beth Israel Medical Center, where our patients are expected to go – if they can afford it.
The Commission’s own regional advisory committee stated that Cabrini is a critical provider of ambulatory care in an area where there is a serious shortage of primary care for low-income and Medicaid residents. There also is a high incidence of mental illness, substance abuse, and HIV/AIDS infection in the surrounding area.
Many of these patients will not be able to afford care at nearby corporately owned hospitals. Along with the other data in the Commission report, the public should be informed of the number of patients who will no longer have access to care.
I also wish to speak on behalf of my fellow nurses who work at Westchester Square Medical Center in the Bronx. This is an example of a small community hospital that keeps the cost of care down and stays in the black. It has formed a partnership with New York Presbyterian Hospital that promises to keep it financially strong and responsive to community healthcare needs.
Westchester Square, or “The Square,” is a model for providing quality care at low cost. Yet, it too has been targeted for closure, despite the opinion of the Commission’s own advisory committee that it is a high-quality facility serving an area where there is a shortage of primary care providers. According to the committee, “closure could significantly disrupt access.”
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.
There is no question that our healthcare system is in crisis. I would like to speak about the human side of that crisis.
I have worked for 23 years as a registered nurse in the busiest emergency room in New York City. I want to share with you what it’s like to be a patient in our ER today. I will preface my remarks with the comment that our staff are the most competent, caring, and loving that any patient could encounter. Montefiore is an exemplary teaching facility, among the most respected in the nation.
At our facility, there is simply no physical space to contain the hundreds of patients that are ill, injured, or in pain on any given day. When our cubicles are filled (which happens daily), patients are crammed together in gurneys with no space to move between them and no curtains or walls separating them. People are coughing, vomiting, and bleeding in full view of others.
It is routine to have 20, 30, 40 or more admitted patients waiting for beds upstairs that don’t exist. This is in addition to 100 more who are in the process of being evaluated and treated.
It is routine to admit patients to what are called “hallway beds.” To decompress the ER, these patients are admitted to hallways on the inpatient units. Each unit has a maximum of three hallway patients per day.
We sometimes run out of cardiac monitors in the ER and have to triage patients accordingly, checking on them periodically rather than continually.
We have been threatened, beaten, and stabbed by angry patients and family members who wait inordinate periods of time to be treated, due to overcrowding.
There have been physical injuries to patients and staff due to the proximity of people and equipment.
Patients with non-acute complaints can wait up to seven hours to be seen by a provider.
While the recommended patient load for an ER nurse is 1 or 2 in critical areas, we can carry 7 or 8. In urgent care areas, 4 is the recommended load. We can carry 11-15 patients at one time on a busy day — more than 20 during a shift.
Suicidal, homicidal, and schizophrenic patients are almost always on “overflow,” meaning our psychiatric unit is filled to capacity. We have depressed children as young as three years old needing to be hospitalized. We have depressed and disoriented patients in their nineties who need to be housed and cared for.
These are someone’s children; these are someone’s parents.
It is horrifying.
The Berger Commission has called for the closing of Westchester Square Medical Center. This hospital projects 24,000 ER visits in 2006. Where will those patients go if that facility is closed? They will come to us, placing an additional burden on the system I have just described to you.
We need more space, more beds, more hospitals and more treatment facilities — not more patients in a medical center that is chronically filled past its capacity.
Will you come to my ER when those thousands arrive and cannot get past the front door?
Will you explain to them that it is called “rationalization of care”:
Sensible consolidation, regionalization and rationalization of health care may be reasonable – but the process must be transparent, accountable, and humane. I urge you to reject the Berger Commission recommendations and address our disastrous healthcare situation in more responsible manner.
Thank you for allowing me to testify.
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