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"Beds Not Bodybags": Activists Warn Hospital Closures Make NYC Vulnerable To Another COVID Wave
By
Caroline Lewis
Published Aug 16, 2020
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By
Caroline Lewis
Published Aug 16, 2020
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After two decades of New York hospitals merging, closing, and shedding beds with the blessing of state officials, the coronavirus pandemic has triggered a sudden panic about the health system’s capacity, with some questioning whether New York has gone too far in cutting roughly 20,000 beds in 20 years.
Queens, which was recently the “epicenter of the epicenter” of COVID-19 in the U.S., is at a particular disadvantage: The borough has just 1.5 beds per 1,000 people, compared with 6.4 per 1,000 in Manhattan.
It’s a statistic that showed up on signs held by protesters calling for bed capacity to be restored in the borough during a small "Beds Not Bodybags" demonstration Friday evening outside Elmhurst hospital, the beleaguered public hospital that bore the brunt of the coronavirus crisis in New York City.
“This is an old issue,” admitted Anne Bove, a recently retired nurse who lives in Queens. She ticked off the closures of other hospitals that once served the area. St. John’s in Flushing, Parkway in Forest Hills, St. Joseph’s in Fresh Meadows, and Mary Immaculate in Jamaica all closed between 2004 and 2009.
As the dust settles from the first wave of coronavirus and state lawmakers take stock of whether New York has the infrastructure in place to weather another wave, if it comes, some advocates are striving to keep the spotlight on longstanding structural issues with hospital planning and financing that have been brought to the fore by the pandemic. At a joint hearing on hospitals and COVID-19 held by the state Senate and Assembly this week, health equity activists pointed out that state lawmakers and public health officials play a big role in shaping the health care landscape and controlling the distribution of resources.
“The hospital beds are maldistributed. There are too many in some places, like the Upper East Side,” while other areas don’t have enough, said Lois Uttley, program director of the Women’s Health Program at the health care affordability nonprofit Community Catalyst.
The state’s Public Health and Health Planning Council has the power to approve or reject most major hospital projects. Uttley urged the state Health Department to conduct a thorough geographic analysis of bed capacity and use that to guide officials' decisions in the future.
The overall loss of hospital beds in New York can be attributed to multiple trends in health care, but it has largely been by design. During the Pataki administration, a taskforce that became known as the Berger Commission recommended that hospitals that were losing money either shut down or merge with larger hospital networks.
During the hearing on hospitals this week, Assemblyman Richard Gottfried raised the question of whether the pandemic proved the state had ultimately gone too far.
State Health Commissioner Dr. Howard Zucker didn’t directly answer the question. But Jim Malatras, president of SUNY Empire State College, who has been advising Governor Andrew Cuomo during the pandemic, stepped in to say he didn’t think so.
“You need different amounts of beds and different capacity at different times,” Malatras said. “What we’ve learned with the current pandemic is you don’t always need the same amount of beds but you may need to ramp up exponentially in a crisis.”
Zucker emphasized that it was not just bed capacity that mattered but also coordination between hospitals. He said there was a learning curve when it came to figuring out how to efficiently transfer patients from overrun hospitals like Elmhurst to those that still had room to spare--something that he says would be better coordinated in the event of a similar crisis.
Even with the current bed capacity, some said the state has to do more to direct resources where they’re most needed.
“There has to be some commitment from the state to make sure we stabilize safety-net institutions,” state Senator Gustavo Rivera, who represents the Bronx, told the health commissioner. “They were in crisis before the crisis.”
Hospitals that serve low-income communities, many of which were hard-hit by coronavirus, are at a particular disadvantage under the current system because they lack the right ‘payer mix.’ That means they are serving too many people who are uninsured or pay through Medicaid, which pays lower rates for care than private insurance. This can contribute to unstable finances and under-resourced facilities.
At this point, even hospitals that have been blessed with a good payer mix are losing significant revenue because people are bypassing elective procedures during the pandemic. But advocates say those institutions providing essential services to the neediest communities should still be prioritized for aid--something that hasn’t happened thus far.
Health care reform advocates have long documented the state’s unfair distribution of funds in the Indigent Care Pool, which is meant to support New York hospitals that provide a lot of unreimbursed care. Those funds have also flowed to wealthy hospitals that provide minimal charity care.
Now, advocates are highlighting similar problems with the federal government’s distribution of billions of dollars allocated for hospitals in the CARES Act COVID-19 relief bill.
The formula used to distribute the federal funds “has created results that are shockingly unfair within New York City,” the Community Service Society of New York said in a report released earlier this month. “For example, New York’s richest hospital, New York-Presbyterian, received $119 million for just one facility, while the city’s public hospital system, [NYC] Health + Hospitals, received just $46 million for all 11 of its hospitals combined.”
While the CARES Act funding is a federal issue, health care activists say there are plenty of ways in which state policies help perpetuate the iniquities baked into the hospital system.
“Until we recognize that there is racism and resistance to changing the way institutions and the state do business and until we show what those issues are, it’s just going to continue,” Judy Wessler, former director of the Commision on the Public’s Health System, testified at the hearing on hospitals and COVID-19. “It will be a damn shame if what we didn’t learn coming out of this horror was to change the way we do business.”
Tagged
COVID-19
queens
coronavirus
hospitals
Caroline Lewis
Caroline Lewis is on the health care beat for WNYC and Gothamist. She has covered COVID, a nurses' strike, the overdose crisis and New York’s marijuana legalization effort, and spent a year investigating patients' medical bills. She always wants to hear about how everyday New Yorkers experience the health system. Got a tip? Email [email protected].
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Gothamist is funded by sponsors and member donations
Gothamist is funded by sponsors and member donations
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