LICH: Is an Amputation Necessary? Are Yuppies to Blame?

Yesterday evening’s meeting on the future of Long Island College Hospital, sponsored by Community Board Six, drew an audience that filled to capacity two adjoining large conference rooms at LICH. Those present included members of C.B. 6, many residents of the communities served by LICH, and several local political figures. Among the latter were City Councilman Bill de Blasio, Democratic State Senate candidate Daniel Squadron, Democratic District 52 Leader Jo Anne Simon, and representatives from the offices of U.S. Congresswoman Nydia Velazquez and State Assemblywoman Joan Millman. Facing the audience were: Stanley Brezenoff (center in photo above), Chairman and CEO of Continuum Health Partners, a not-for-profit consortium of hospitals that owns and manages LICH; Dominick Stanzione (right), newly appointed interim CEO of LICH; and the discussion leaders and moderators, C.B. 6 Chairman Richard Bashner (left) and Housing/Human Services Committee Chairman Brad Lander.

Mr. Bashner opened by noting that C.B. 6 had not yet taken a position on LICH’s proposed elimination of its obstetrics practice, and that the purpose of the meeting was to gather information, both from LICH’s management and from members of the community, not to be a “political rally”. Given that, he asked, “Is this ‘amputation’ necessary?”

Mr. Brezenoff replied that sometimes amputations are necessary, and that, in this case, it is required because LICH faces an immediate fiscal crisis. Unless action is taken quickly, he said, LICH will not have cash on hand to meet payrolls and other current expenses. He ascribed LICH’s problem to three factors. First, the hospital carries a heavy debt burden–approximately $150 million in long-term bonds financed through the New York State Dormitory Authority and $25 million in short-term commercial paper–which results in annual debt service (including interest and amortization) cost of approximately $22 million. Second, LICH has an operating deficit, presently about $40 million on an annual basis, the largest source of which is the obstetrics practice. Third, malpractice insurance premiums, largely imposed on the obstetrics practice, are a severe burden. The solution to these problems, he said, was to close obstetrics and thereby eliminate the expense associated with it, and to consolidate the hospital’s physical plant and use the proceeds of the sale of surplus buildings to pay down debt.

Mr. Stanzione then elaborated on LICH’s problems, saying that any alternative to shutting down obstetrics “would be worse”, and adding that the current overall economic crisis made the situation more difficult. He said LICH had applied in July to the New York State Department of Health for permission to close obstetrics. He added that LICH management had studied whether it was feasible to retain in-patient pediatrics after closing obstetrics, and had concluded that, because the bulk of pediatric intake came on referrals from obstetrics, it would not be possible to keep pediatrics. He said there were discussions between LICH and SUNY Downstate Medical Center concerning possible transition of the pediatrics practice. He also noted that, while LICH had considered closing its dental residency and clinic, there were discussions with other organizations that might continue dental services at LICH under their sponsorship. Later, when asked about rape crisis intervention services, he said that LICH had terminated a program under which such cases were referred from other facilities, but that treatment for rape victims was still available at LICH. He also said there was no plan to terminate gynecology at LICH, despite closing obstetrics.

Mr. Lander asked if closing obstetrics and pediatrics might not simply be the start of a “downward spiral” that would lead to closing more and more departments until there was nothing left. Mr. Brezenoff replied that there could be “no guarantees”, noting that LICH’s problems could be much worse if the New York State Medicaid budget is cut. Later, in response to a statement from Dan Wiley of Congresswoman Velazquez’s office, Mr. Brezenoff said there was a proposal to have the federal government take over more of the medicaid burden from the states, and praised Ms. Velazquez’s support of that legislation.

Mr. Stanzione then said that management’s intent was to have LICH “retrench around core services, and try to grow them.” He noted that the reason LICH, unlike some other hospitals also facing high malpractice premiums, could not continue to subsidize obstetrics was that LICH has also experienced declining revenues from practices like major surgery. When your correspondent asked what was the cause of this erosion, Mr. Stanzione replied that much of it was the result of trends in medical practice and technology that allowed more procedures to be done on a less invasive basis, often in an outpatient setting. Mr. Brezenoff added that, in LICH’s case, demographic trends were also an important factor. As more and more younger people moved into the brownstone neighborhoods in LICH’s area, the average age was declining. The ideal situation for a hospital, Mr. Brezenoff said, was to be surrounded by old people. In the case of LICH, he noted, it is not even surrounded, as “our back is to the River.” Ms. Simon later asked if these demographic trends might not be counteracted by development and by a trend toward more people “aging in place” instead of going to retirement havens like Florida.

Mr. Lander asked whether LICH’s problems were being addressed in the context of its being a community hospital, or if considerations affecting Continuum’s hospitals in Manhattan might be affecting plans for LICH. Mr. Brezenoff said that decisions affecting LICH were ultimately made by its Board of Trustees, which had made the initial decision to have LICH affiliate with Continuum eleven years ago. That Board is now comprised of the same members, described by Mr. Brezenoff as highly dedicated and qualified people, as the Board of Continuum and those of its other member hospitals. Mr. Brezenoff vehemently denied that LICH was in any way subsidizing its affiliate hospitals, all of which are located in Manhattan. Indeed, he said, there is a benefit to LICH from its affiliation with Continuum which he quantified as about $10 million per year.

Several members of the audience, including Councilman de Blasio and Mr. Squadron, asked how the community could become more involved and could help solve LICH’s crisis. Mr. Stanzione said LICH was collaborating with a number of community organizations, such as nursing homes and federally qualified health centers, concerning provision of emergency services. Mr. Brezenoff said he was very comfortable working with community boards and welcomed their input, but that the crisis was severe and quick action was imperative. Mr. Bashner asked if LICH was contemplating a bankruptcy filing; Mr. Brezenoff said it was not.

Paul Nelson, from Assemblywoman Millman’s office, asked how the State Legislature could help. Mr. Brezenoff said that if the Department of Health were to deny LICH’s application to close obstetrics, he would “be banging on your door” to seek a legislative solution. Dorothy Siegel, a community activist living in Cobble Hill, said that the solution for LICH should be the same as it was for the Cobble Hill Nursing Home some years ago: turn it over to the community to own and manage. “Give us your debt,” she said, noting that community management had succeed in turning around the Nursing Home when it was in financial straits, and in maintaining it as a first-class facility.

Notably absent from those making statements or asking questions at the meeting was any representative of the LICH physician staff.. However, there is strong and organized staff opposition to Continuum’s plan and, during the meeting, cards were circulated in the audience giving the web address of the medical staff’s site. The staff has retained the prestigious law firm Arnold & Porter to assist it in drafting an alternative plan that, it claims, can allow LICH to survive without terminating obstetrics or any other practice area. The plan is available in pdf format through a link on the medical staff site. It stresses rebuilding sources of patient intake, such as community clinics, while reducing losses by more aggressively pursuing overdue receivables, minimizing overhead costs, and renegotiating arrangements with insurance carriers.

Asked if he would meet with representatives of the staff concerning this plan, Mr. Brezenoff said “No.”

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  • nabeguy

    Some partnership. Management won’t talk to the medical staff. Yeah, that’s a hospital that I’m going to want to go to when I’m sick. Seriously though, the insurance issues that are mentioned in the article are a very real and serious problem in the pediatric and obstertics fields (as well as orthopedics). The premiums that insurance companies require (due to equally enormous payments for losing suits) make it almost impossible to maintain a practice and probably acts as a deterrent to anyone entering the medical arena. The standard of excellence that OB-GYN’s are held to is overwhelming, considering that one mistake on their part can have devastating results.

  • Rosie, rn

    Still can’t believe the signs all over inviting people to the gala ball. They are going to lay off people but want the staff to come roast and toast the top nurse. They are not telling the whole truth. About 100 nurses will be laid at end of year. They can not place the employees if they cut all the departments.

  • T.K. Small

    This is a very well presented summary of the meeting last night. Although I would add that Brezenoff was more condescending and confrontational. As for the interim CEO of LICH, it was readily apparent that he does exactly as he is told.

    This morning I read the summary of the alternative plan submitted by the Medical Staff. At the very least the plan looks to be a plausible solution. It was my recollection that Brezenoff completely discounted this proposal as being viable. Given the reasonableness of the medical staff proposal for me, Brezenoff’s credibility was compromised.

  • bornhere

    Perhaps my understanding of the situation, as presented above, is pitifully superficial and ill informed; but some of the arguments submitted by the LICH/Continuum crew seem, shall we say, specious. I can name several Manhattan hospitals that don’t necessarily serve “aging communities,” and I can name an equal number of Manhattan facilities with their backs to the water, a “deficit” that is almost laughable. I also believe that the costs of liability coverage, whether in Ob-Gyn, radiology, orthopedics, or plastic surgery, exert their heavy burden on ANY facility offering those services and that less invasive or more ambulatory interventions are the lay of the medical landscape — no matter where that landscape is.
    But not to address the quality of care is bizarre. I know I’d be happy to seek excellent, state-of-the-art care 5 blocks from my house if it were available; the truth is that it is not available. I doubt that there are many physicians/services at LICH that might attract anyone not already “engaged” with a particular doc or compelled to seek LICH assistance in anything other than an emergency. And for that I blame a misuse of dollars; if the best docs and staff can’t be attracted — and that means with money — Continuum can keep “saving” by closing whatever units they want. All they’ll end up with will be a cafeteria, a decrepit playground, and a pretty snappy parking garage.

  • E G

    If the community really wanted a great hospital offering the best of care, they would demand it, they would get it.

    Community involvement w/t LICH has been close to nil. LICH serves the minority communities of central Brooklyn and other areas, not the heights, Carroll G. etc. LICH has been left for dead for a long time and most people in the community are shrugging and probably thinking it’s about time. There exists a profound apathy towards this institution that could be as good as the community wants it to be. Or it won’t be at all. By default this will be the eventual outcome.

    btw, I did not find the CEO of continuum to be condescending, he was the smartest guy in the room and he knew it. I agree the new man is a yes man.

  • Rosie, rn

    I liked they way he dodged his question about his salary. Maybe the people at the top need to take some pay cuts to save the hospital. Not only has there been a lack of involvement fromt he community but a lack of involvement from Continuum. They are closing and amputating at LICH but expanding the exact department at Beth Israel and St. Lukes. It is is an uprofitable business with high insurance rates wouldn’t it have the same effect on the other hospitals.

  • lakisa

    the hospital is a disgrace! filthly and inadequate staff!!

  • http://deleted buddy

    The Continuum management is in denial. This is a death spiral. Take out babies and you take out the future. They should do the complete opposite: make this a children’s hospital. There isn’t one in the city and this could be the jewel in the Continuum crown. Also, for those of us who have used their pediatrics group (and been to the dismal emergency room for other ailments), the best doctors are in OBGYN and pediatrics and the worst are in the internal care/specialists. So if they kill the best (pediatrics) the rest will just wither and die. Dorothy Siegel was right – give it back to the community. Maybe they can make sense of it. Certainly Breznoff is so arrogant he can’t do it.

  • Peeter Jakobson, MD

    Back in 1978 I was an intern at LICH. At that time there was a very fundamental dispute between the residents, interns and the administration. I remember a senior resident in medicine giving a speech to a rather large assembly of hospital doctors and administrators. He brought the house down saying that his grandmother told him “A fish starts to stink from its head” obviously referring to the CEO. Here we are again with a stinky fish.

  • E G

    Not really relevant to this situation/discussion, but I find it interesting that the CEO of Continuum holds but a BA (in Philosophy) from Brooklyn College. I was surprised to learn this. I expected a different educational foundation- business/finance oriented and more of it.

  • Greg

    The fact that Mr Brezenoff does not want to look at the plan proposed by the LICH Physician Staff shows that he does not want a real solution to save the hospital and that he is not committed to women having babies in Brooklyn. PLease note that while they are closing the maternity at LICH, they just opened a 40 million dollar maternity at Beth Israel ! (It would be good to know why these “nonprofit” organizations need so many CEO and also to know their salaries. What if their books were audited for possible embezzlement ? Will anyone be held accountable for the mess ?)

    It will be best for LICH to be managed by a community board and by the LICH Medical Staff. Millions will be saved since there will be no expenses for MULTIPLE CEO’s and other executives. We all know that they want to close the entire hospital so they can take the money to improve Beth Israel and St Lukes Roosevelt. If Continuum has failed in properly managing LICH, they should step out of LICH and let those who want to try to make it work, take over. By the way, why, if there is a major financial crisis, are they spending thousands of dollar to celebrate “150 years” of existence of the hospital ? It does not make any sense. The Management of LICH by Continuum Health Partners has been a DISASTER and the local community, who cares about the hospital, should take over.

  • community member

    Can Mr. Brezenoff explain what happened to monies that were left to LICH by the donors and why if there is no monies for obs/maternity/peds or GYN which must generate revenue when the Maternity unit was always full to capacity.Why was LICH’s Financial dept. taken to Manhattan and then all of a sudden LICH is the institution that is a financial burden on Continuum and must be dimantled. Why not dismantle the CEO’s who have been mismanaging LICH funds for 10 years. How is it that every time a new Acting Director came to work at LICH the first thing that was changed was the interior decor of the offices of upper management and since 10 years the only one I can say did anything for LICH was Mr. Bill Madden. If the CEO’s would cut the BS and allow the community’s plan to try and save OUR hospital which is a Great hospital and should be treated with the utmost respect and consideration. Why not close Beth Isreal’s maternity unit.

  • E G

    Community Member- If more community members felt as you do- supportive and prideful of LICH, that would go a long way towards saving it. Problem is you are among but a handful.