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It takes a community

On Campus
March/April 2013
Feature Story

By Barbara McKenna

New York unions marshal broad coalition to save hospital that serves 2.5 million.

WHEN BROOKLYN, N.Y., resident Simuel Stevenson collapsed while playing basketball, he was taken to a nearby hospital that diagnosed a heart problem. As his family absorbed the news that the 19-year-old needed open-heart surgery, his mother, Deborah Stevenson, started thinking, “second opinion.”

“I took him straight to SUNY Downstate,” she says.

Turned out, Simuel was dehydrated and his heart was fine. Six years later, his grateful mother still says the State University of New York Downstate Medical Center saved her son’s life—or at least the needless pain and anxiety associated with unnecessary surgery.

Downstate was a lifesaver for Dianne Brown, too. Her daughter, Jewel, was born at Downstate 15 years ago with “congenital abnormalities,” as the doctors said. She was missing crucial internal organs. Brown was told her baby would not survive, but nevertheless, the hospital doctors, nurses and medical staff did everything within their power to save her—multiple surgeries, dialysis in the specialized pediatric dialysis center, then a kidney transplant.

Today, Jewel is a lovely young teenager with a radiant smile. Her mother is doing her part to save the hospital that saved her daughter.

SUNY and the New York governor have targeted Downstate for downsizing, privatization or possible closure. On Dec. 6, 2012, Brown stood up at a community forum in Brooklyn organized by a coalition of labor, faith-based and community groups to save jobs and medical services at Downstate. She testified to the role of the hospital in her and her daughter’s lives: “I’m here because I had nowhere else to go with Jewel,” she said. “There’s a saying that it takes a village to raise a child. Well I say, it takes a hospital to save a child.” And, Brooklyn residents might add, it takes a community to save a hospital.

“We are facing the fight of our lives,” says Phillip H. Smith, an AFT vice president and president of the United University Professions of SUNY, an affiliate of the New York State United Teachers (NYSUT) that represents 35,000 SUNY faculty and staff—3,300 of them at SUNY Downstate.

The health hub of the borough

It seems unthinkable that the only public medical center serving a population of 2.5 million people could be viewed as expendable—a candidate for closure. Here are some more facts about the size and reach of Downstate:

  • Downstate cares for 400,000 patients a year; 64,000 come into its emergency room. It runs 75 community health clinics and outreach programs. As a state hospital, it provides treatment to all, whether or not they have health insurance or have the ability to pay.
  • As a medical school, Downstate has trained more New York City doctors than any of the other four SUNY medical centers in the state—many of them people of color. More than 1,700 students are studying to be doctors, nurses or other healthcare professionals at Downstate’s colleges of Medicine, Nursing, Public Health Related Professionals and Graduate Studies.
  • Downstate is also a center for pioneering research. It attracts some $60 million in research grants. In 1998, one of its scientists won the Nobel Prize in Medicine.
  • Finally, Downstate is the fourth-largest employer in Brooklyn. Of its 8,000 employees, 68 percent live in Brooklyn. It is gauged to have a $2 billion economic impact on a community that has been hard-hit by job losses and foreclosures in the aftermath of the recession and the meltdown of Wall Street financial markets. Should the center be closed, not only would the community be deprived of ready access to healthcare, thousands would be put out of work.

A hospital put on life support

Downstate and the other SUNY health science centers reflect the pressures on all healthcare systems in the United States, facing soaring costs. There have been hints of political interest in privatizing public health services for decades. But Downstate was managing to keep its head above water until the SUNY board made “the really bad managerial decisions to take over two hospitals in distress,” says Rowena Blackman-Stroud, an associate director of nuclear medicine and UUP Downstate chapter president.

In 2011, a report of Gov. Andrew Cuomo’s Medicaid Redesign Team Work Group came out with a call for Downstate to eliminate inpatient services and transfer inpatient care to one of those hospitals, Long Island College Hospital. The same year, the governor’s budget proposed cutting the budgets for all four of SUNY’s health centers in half.

Because of the patients they serve, the impact on the Downstate community would be especially dire. Central Brooklyn is a diverse area with high levels of poverty. Two-thirds of the population is African-American or from the Caribbean. According to the U.S. census, one-half of families there live below the poverty line.

“Other area hospitals would simply be unable to handle the influx of patients if the emergency room at University Hospital [part of Downstate] were to close,” Blackman-Stroud told lawmakers at the time. “Patients seeking treatment for critical illnesses and life-threatening injuries would be diverted to distant emergency rooms. Travel times and waiting periods to see medical staff would increase dramatically.”

In labor-management meetings, UUP asked that its professionals be allowed to help design solutions to the financial problems at the center. But mismanagement and a lack of transparency was the management mode of the day. UUP was turned down.

Bringing in the community

Blackman-Stroud began organizing her union and reached out to others representing hospital workers, including the New York State Public Employees Federation, an AFT affiliate that represents nearly 800 nurses at the hospital, and the Civil Service Employees Association. Their coalition convinced the entire Brooklyn delegation of legislators to support keeping the hospital open, and the state Legislature reinstated some of the funds.

Last year, talk of “restructuring”—downsizing—began anew. This time, pink slips and nonrenewal notices went out, and UUP started losing members. Potentially, the impact of hundreds, even thousands, of lost jobs on Brooklyn’s fragile economy would be severe. It would have a ripple effect of unemployment, more foreclosures, families unable to make tuition payments, and so on.

But the word was not out in the community.

“Very few people could take a 50 percent cut in their income and survive,” says NYSUT executive vice president Andrew Pallotta, who is an AFT vice president. “Our SUNY hospitals have suffered just that, but I doubt anyone who has been a patient in these hospitals in the last two years would know how much funding they have lost, because staff members are meeting this challenge through heroic efforts.”

UUP started broadening its organizing efforts, escalating actions in the community. The chapter organized marches monthly, demonstrated, and attended huge community gatherings, such as the West Indian Day Carnival parade that attracts a million people. It blanketed neighborhoods with fliers.

“We spoke at health fairs, tenant association meetings, at community board meetings,” says Blackman-Stroud. “To apprise a huge population is a lot of work, but people were stunned” when they learned what was afoot.

Bishop Orlando Findlayter is pastor of New Hope Christian Fellowship in Brooklyn and also chair of Churches United to Save and Heal, a coalition of 179 churches based mostly in New York. “We want to keep quality healthcare here in the neighborhood,” he says.

That’s why Findlayter decided to jump into the fight to save the hospital when a UUP member reached out. Since then, his group has held informational forums for clergy and community members. “Our challenge is getting the word out to people because many of them don’t know what’s happening,” he says. And every Sunday is an opportunity for him to talk to his 200-member congregation. Many members of his group have been involved in a variety of activities, from delivering petitions to the governor and visiting legislators to rallying in Albany.

The powers that be respond to numbers,” says Findlayter. He is encouraged by the work of the coalition.

Another year, another budget battle

In January, Gov. Cuomo submitted his budget to the state Legislature. Again, he proposed cuts to the SUNY hospitals—this time, cuts of 32 percent. Again, the community coalitions, led by UUP members and leaders, are rallying to defend the healthcare services and save jobs.

UUP president Smith provided testimony to the New York State Assembly Committee on Health on Feb. 8, reporting that the restructuring plan at Downstate has already put hundreds of UUP members there on notice that they will be losing their jobs by the end of the summer. He warned the community could not withstand another blow to its economy.

“Over one-quarter of the residents in Downstate’s primary service area earn less than $15,000 per year,” Smith testified. “A significant loss of jobs at Downstate would have a horrific impact on Central Brooklyn—jobs will disappear, homes will be lost, and small businesses will shut down. Central Brooklyn is already suffering from one of the highest unemployment rates in New York City. It would take years for the Central Brooklyn economy to recover from the loss of more jobs at Downstate.”

Also delivering testimony to the legislators was Karen Benker, a UUP member, physician, and associate professor of health policy and management in the Downstate School of Public Health, who explained the severe need of Central Brooklyn residents for access to primary care. There are too few primary care physicians practicing in the area, too few people with insurance, and fewer with the ability to pay. The structures of the insurance programs that exist—Medicare, Medicaid and Family Health Plus—don’t reimburse enough to cover the cost of supporting primary care practices.

Lacking access to care, people don’t manage their health and end up seeking help in emergency rooms. The toll is great—more chronic diseases, shorter life spans, higher infant mortality, greater need for highly specialized services and more suffering. Downstate is there for them.

To close the hospital, said Benker, or “turn this public hospital over to a business corporation, … evades governmental responsibility for providing the care that residents of Central Brooklyn need and deserve. This move represents the political abandonment of black Brooklyn.”

Blackman-Stroud notes that the health professionals at Downstate are a medical brain trust that can address the problems at the medical center and set the stage for implementation of the Patient Protection and Affordable Care Act. Closing the hospital now would be a terrible missed opportunity, she says, when the union has repeatedly offered a solution based on collaboration.

Benker echoes that thought: Wrapping up her remarks to the Assembly Committee on Health, Benker said, “As the only academic medical center in Brooklyn, Downstate is in an excellent position to become part of a trial site for an Accountable Care Organization under the Affordable Care Act.”

“It makes no sense for the state to take an action that will so negatively affect a community that needs more—not less—state assistance,” says Smith.

Adrienne Coles contributed to this story.

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