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Cost-saving measures at city hospitals have made basic health care harder to access for millions of poor and uninsured New Yorkers, according to a new report by a major health care watchdog group.

Staff shortages have reportedly forced patients at one Bronx hospital to wait up to a year and a half for dental appointments, the nonprofit Commission on the Public’s Health System reveals in its study of cuts and consolidation at 21 city heath care facilities.

Since 1995, the Giuliani administration has cut payroll at the Health and Hospitals Corporation (HHC) by 10,000 employees and slashed the budget from $350 million a year to about $55 million. In addition, HHC has closed or consolidated many specialized clinics and units at hospitals in Queens and the Bronx. An additional 900 job eliminations are slated for Harlem Hospital this year.

The consolidation plan has stripped many facilities of preventative care clinics, forcing patients to run from hospital to hospital to obtain the care they need, the report charges. “If you need an X-ray, rehab and primary care for one problem, you may go to three different places,” said Linda Ostreicher, the report’s author. Ostreicher has spent much of the last year collecting documents from HHC and local hospital advisory boards to portray what she calls “a snapshot of a system in trouble.”

Because of chronically long waiting lists at walk-in clinics, many of the city’s estimated 1.9 million uninsured patients continue to flock to city emergency rooms–even if overall ER visits declined by 13 percent since 1995. “They can wait until they are very sick and go to the emergency room at hospitals or go to a [non-HHC] community center,” Ostreicher said. “But it’s not enough in any way to make up for HHC’s role [in providing non-emergency primary care].”

Other findings include:

–Visits to the Belvis and Morrisania walk-in clinics dropped by a quarter in 1997–possibly as a result of 20 percent staff cutbacks.

–Patients wait up to ten weeks for appointments at Bellevue’s gynecology, arthritis and spine clinics.

–The emergency room at Jacobi Hospital in the Bronx is chronically understaffed during its busiest evening and weekend hours.

–Kings County hospital doesn’t offer night hours at its psychiatric clinics, due to staff cutbacks.

Waiting lists have always been long, but advocates charge that the Giuliani administration’s HHC cuts aren’t helping matters–despite the administration’s promises to streamline care. Although, statistics on waiting lists have not been released by HHC, the report provides a glimpse into some particularly disturbing examples. Morrisania Hospital in the South Bronx often sends patients over to nearby Lincoln Hospital for services no longer offered on site. But many Morrisania patients have simply been told to cool their heels. More than 2,500 people currently sit out an 18-month dental care waiting list.

“Cutting down on both hospital and ambulatory care is a vicious cycle,” said Carmen Becerril, chairwoman of Morrisania’s community advisory board. “There is nowhere else to go.”

Still, there have been some improvements. Of Bellevue’s 57 clinics, 30 reported shortened waiting lists. However, four of the hospital’s clinics still make patients wait a month or longer.

HHC officials say the consolidation program is the result of a recent decline in patients and HHC’s continued shift to managed care. “The workforce reduction is simply the result of a 24 percent decline in inpatient utilization,” said HHC spokesperson Jane Zimmerman. About 85 percent of the staff cuts were in jobs that do not directly impact patient care, she added.

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