Talking Back to Berger: Victory Fights Closure

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A lot can happen in the time it takes to get from Victory Memorial Hospital in Bay Ridge to Lutheran Medical Center in Sunset Park, one of the closest hospitals nearby. A patient suffering from a stroke can be disabled for life. An asthma sufferer can experience long-term respiratory damage. A person with chest pain can have a heart attack and die. Critics say those are some of the risks that may be taken to drive to the closest emergency room if Victory Memorial – one of nine city hospitals that the state has suggested closing or consolidating – shuts its doors.

Dr. Pritpal Kang, a cardiologist and emeritus director of medicine at Victory, said it recently took him 42 minutes to drive to Lutheran. “On a map it looks very close, but forget it when it comes to traveling,” Kang said.

“Most of our patients live in this area and are old…asking them to travel far is asking for a lot,” said James Sessa, the director of admissions at Victory Memorial. “It’s a matter of life and death.”

Victory is fighting its own death knell, delivered a year ago when the state Commission on Healthcare Facilities in the 21st Century – also called the Berger Commission – named it one of the hospitals recommended for closure to make healthcare delivery more cost-effective. Since then, SUNY Downstate Medical Center in central Brooklyn has proposed taking over running at least some of Victory’s services – and a coalition of community groups, hospital staff and a church, with the help of a lawyer, is working to convince the state Department of Health to accept the proposal.

The group’s message to decision makers is: “If you have a proposal to keep health services in the neighborhood, you should approve it – or tell us what your plan is,” says Nisha Agarwal, an attorney with New York Lawyers for the Public Interest (NYLPI) who is working with the coalition. She and coalition members had a conference call last week with state health department Deputy Commissioner Jim Clyne to discuss the SUNY proposal. A department spokeswoman would say only that the proposal is under review.

“They’re not saying that the community does not need health care services,” Agarwal said of health officials. “They really feel like their hands are tied because of the Berger Commission. So do we.”

That’s not stopping healthcare facilities from trying to break free, however. Agarwal’s group, NYLPI, also represents Soundview resident Mary McKinney, who suffers from cancer and asthma and is a patient at New York Westchester Square Medical Center in the Bronx. Along with co-plaintiff Mechler Hall Community Services, McKinney filed suit – which is now on appeal – against the state’s recommendation to close that hospital. Parkway Hospital in Forest Hills, Queens also is suing the state to stay open.

The Westchester suit “was filed because the state legislature violated the New York state constitution when it allowed unelected members of the Berger Commission to make law and institute sweeping changes in health care policy,” Agarwal said. “Although the suit is on McKinney’s behalf, every hospital involved in the Berger Commission will be affected by the court’s decision.” A number of other hospitals around the state also have filed suit to reverse the commission’s decree.

Victory Memorial Hospital sits alongside the Gowanus Expressway close to the base of the Verrazano-Narrows Bridge. Across the road, golfers stroll on the fresh-cut grass of Dyker Heights Golf Course and high school students roam the campus of Poly Prep. The hospital has served southwest Brooklyn for more than a century and accommodates acute care patients as well as long-term care residents. The hospital aids poor patients, those without insurance, and immigrants, many with questionable legal status. “Some of the immigrants do not really have documents. We are fighting to stay open because we understand patients, and they feel comfortable when they come here,” said Dr. Kang.

The next closest hospital is Maimonides Medical Center, which is three miles away in Borough Park. “We are increasing our ER by 40 percent, which will open in a few weeks, so we will have more capacity to accommodate the community if Victory closes,” said Maimonides spokeswoman Eileen Tynion.

On a warm night in August, St. Vincent’s Midtown Hospital closed at midnight. It was the first of five New York City hospitals slated for closing to actually shut its doors. “Our patients were from the underserved population in the community…it’s too soon to tell how they are affected,” said St. Vincent’s chief operating officer Regina Zuvich.

The state panel charged with addressing New York’s strained health care system released its findings and recommendations last November. Led by former state Social Services Commissioner Stephen Berger, the commission recommended extensive changes to New York City’s health care system. The report demands consolidation, closure, conversion, restructuring of institutions, and reallocation of local and statewide resources. In addition to closing Victory Memorial, Westchester Square and seven other city hospitals, it also calls for merging and downsizing at two Brooklyn hospitals, New York Methodist Hospital in Park Slope and New York Community Hospital in Midwood.

The mandate of the commission was to be sensitive to local needs. Berger and his colleagues used six criteria to evaluate each hospital and nursing home: volume of visits; quality of care; the amount of service it provides to the poor; services to minority and elderly patients; the availability of alternatives in its area; and the consequences of closure and consolidation impact on the neighboring communities.

The evaluation process baffled Sessa, the Victory administrator. “By those criteria, how are they going to close all of our doors? It’s very contradictory from what they claim, to what they are actually doing. They are focusing on the business perspective and neglecting the community,” he said.

But the commission’s report was not completely rejected by Victory Memorial’s staff. “We actually welcomed the Berger Commission’s purpose of attempting to restructure the hospital so that it functions efficiently,” said Kang. “Although I don’t think we should completely shut down, we do need to make some changes.”

Changes are vital to keeping Victory Memorial’s doors open. Last year, before the commission’s report was released, the hospital had filed for bankruptcy due to financial mismanagement, making Victory a target for the Berger Commission. In addition to its financial woes, the hospital has been fighting an array of rumors – the most detrimental one being that the hospital already has closed. This rumor has confused the community and heightened the high level of uncertainty.

With support from SUNY Downstate, which has proposed to take over the hospital and continue to manage its emergency room, and a dedicated community, Victory Memorial is trying to prevent a complete shutdown. “The ER, at least, needs to stay open. Having no ER would be a disaster to the community,” says Sakibeh Mustafa, the hospital’s community outreach coordinator, who has become a leader in the struggle to keep the facility open. “[The SUNY] proposal is in line with the Berger Commission,” she insists.

Under SUNY’s plan, Victory Memorial would retain a small inpatient facility, 30 acute care beds – instead of the current 243 – and operate a diagnostic and treatment center that would tend to the community’s outpatient needs, like geriatric and family health care. “We think that the ER is critical to that community,” said SUNY Downstate spokesman Ron Najman. “We are awaiting a decision from the Department of Health.”

The coalition working to keep Victory open took its message to the path of the New York City Marathon on Sunday, holding signs advertising its position. Beyond the fate of this facility, however, Agarwal said the effects of the Berger commission are stimulating the formation of a general advocacy campaign to think about community health planning in the city. “How can we plan, instead of reacting? What would a different kind of health decision-making structure look like?” are some of the bigger questions, she said.

– Abraham Paulos

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