81

APPENDIX II

CASE STUDY: GOUVERNEUR HOSPITAL

The Gouverneur Hospital (GH) represents one of New York City’s longest and fiercest struggles initiated in the 60s and lasting through the 70s between Lower East Side (LES) community groups and the medical establishment. This fight was only conceived through community- building and unifying efforts among multi-racial, multi- ethnic residents who demanded the maintenance of a community- based hospital threatened to be permanently closed. After twenty- five years it is refreshing to interview several participants and learn about the Gouverneur experience, its actors, the institutions and their positions/claims, issues of shared concern and interest, the basis for collective action/coalition-building, challenges, successes and lessons learned.

METHODOLOGY

To document the fight for Gouverneur, six people were interviewed—four of them had been community residents and two had been professional social workers during those years. Participants were asked five questions (Exhibit 1). Additionally, a 82

series of newspaper articles and documents from the Department of Hospitals was reviewed (Exhibit 2). The GH history and events are detailed in the chronology of events (Exhibit 3).

ACTORS, INSTITUTIONS: POSITIONS AND CLAIMS

1. The Department of Hospitals

In the 1950s and 1960s, the municipal health system was under the umbrella of the Department of Hospitals (DH). Dr. Ray E. Trussell, DH Commissioner appointed by Mayor Wagner, approved staff appointments, hospital inspections, affiliations and licenses and had the authority to remove medical officers. According to Dr. Trussell, the Department also “certified City charge patients in voluntary hospitals to the Comptroller for payment for care from the Charitable Institutions Budget” and later Medicaid reimbursements. “For 1960, such payments probably exceeded 40 million dollars. Such staggering figures are a sobering influence in overall community planning,”1 he stated.

2. Dr. Ray E. Trussell

In 1962, in a speech delivered to the members of the New York Academy of Medicine, Dr. Trussell shared his concern for the “uncontrolled proprietary hospital building boom” that was threatening the existence of voluntary hospitals (used mostly by the middle class while the municipal hospitals were used mainly by low- income people and the poor). To counteract such a threat, Dr. Trussell’s Hospital Council recommended “various ways in which municipal and voluntary hospitals can and should work together for 83

reinforcement and better service to the community.” Dr. Trussell also expressed his main concern about “standards of care, not only in certain of the municipal hospitals, but in many proprietary institutions licensed by the Department, and in certain voluntary hospitals in which City charge patients are certified for care at public expense.”1 Dr. Trussell directed the destiny of Gouverneur Hospital for many years. His leadership position, first in the municipal and later in the voluntary hospital, exerted influence in the decision-making process of both systems. But it seems that Dr. Trussell’s interests leaned toward the voluntary hospitals. There were community protests for years about the poor quality of health services at Gouverneur and Dr. Trussell, as Hospital Commissioner, failed to listen and monitor “standards of care” provided by Beth Israel (BI). Later on, when Dr. Trussell became head of Beth Israel Hospital, his previous concerns were muted. He declared in an interview, “Without Beth Israel there would be no Gouverneur,”1 once again confirming his insensitivity toward community health demands. Most of the interviewees described Dr. Trussell as an arrogant and inflexible individual who demonstrated no interest in improving Gouverneur health services and showed no interest in listening to community health needs. In fact, Dr. Trussell accused the Health Council of being “infiltrated” by “radicals and militants,” and suggested that the Health Council’s “harassment” of the staff and “a riot staged in the hospital lobby” forced Beth Israel to go to court.1 84

3. Hospital Review and Planning Council of Southern New York (HRPC).

The HRPC was a private entity to which the State had given the authority to approve or disapprove capital construction for new hospitals in New York City. According to Professor Terry Mizrahi, it was HRPC in connection with the City Hospital officials who later secretly made a decision not to build the hospital but instead use the site for a nursing home. It seems that this decision responded to the need, expressed previously by Dr. Trussell, for strengthening the voluntary hospital system—but not by working together with public hospitals; on the contrary, it was by sacrificing the public hospital system. It has been a belief in the public health community that “through affiliation contracts, the private teaching hospitals controlled the public sector.”1 HRPC as a private entity hardly represented the interests of the public health system.

4. The Federal Government

Once again the ideal cooperation between the voluntary and the public health systems suggested by Dr. Trussell was diminished by the infusion of new Federal programs such as Medicaid, Medicare which created competition between voluntary and municipal health systems. Since Medicaid gave low-income and poor people choices for treatment, many decided to go to voluntary hospitals. Another Federal initiative, the Neighborhood Health Center Act, had great impact on the community because it mandated community input in health programs. 85

5. Gouverneur Hospital

In 1961 New York City’s health system problems were compounded and the DH Commissioner began to implement some recommendations made by Mayor Wagner’s Commission on Health Services and his later appointed Task Force. The approach was to close or change the functions of certain hospitals. Gouverneur Hospital was the first to close its inpatient services in early 1961. Nine months later, recognizing that Gouverneur “clinics, emergency room, home care and ambulance services are essential in the area because of its cultural and economic characteristics,” Dr. Trussell approved an affiliation contract for a three-year period with Beth Israel.1 Beth Israel assumed administrative responsibilities for the Gouverneur Health Services Program (GHSP) for the next fifteen years.

6. Lower East Side Composition and Community Groups

In the beginning of the 1960s, the LES was composed of a well- organized Jewish and Italian community, and by Black, Puerto Rican and Chinese communities. Community residents, especially the working poor and uninsured, saw Gouverneur Hospital as part of their neighborhood and when Mayor Wagner promised a new hospital, there was community consensus for building a first class health institution. It was a time when community organizations such as the Lower East Side Neighborhood Association (LENA), comprised of mostly Caucasians residents, opened its doors to diversify its membership. According to Professor Mizrahi, Two Bridges and the North East Neighborhood Association (NENA) were two branches created by LENA to attract and organize newcomers. 86

In 1967 under LENA’s leadership, the Lower East Side Health Council-South (Health Council) was created with the participation of forty members representing most of the community organizations in the LES.

ISSUES OF SHARED CONCERN & INTEREST

Participants discussed several issues that affected the LES community at large. There were claims that hospital officials were planning to permanently close Gouverneur Hospital; community residents were dissatisfied with the poor quality of health services provided by the GHSP; there were rumors that Beth Israel was working to convert the new Gouverneur Hospital into one of its satellites, and later that Gouverneur Hospital was going to be converted into a nursing home. Three of the community resident participants concurred that there were other issues of common concern tied to health issues: education, housing and social services. Carmen Cruz remembers marching to the office of the Health Department’s Commissioner to demand the need for testing school children for lead poisoning. “Studies demonstrated that lead was responsible for poor academic performance in primary school children,” she recalls. Tato Laviera remembers the demand for including social services in the new Gouverneur Hospital. He states, “We needed a general health hospital where people from different cultures could be understood, where nutrition services could be institutionalized, and where social workers could make good referrals.” Mr. Laviera remembers that Latinos—mainly Puerto Ricans—who lived in the areas of the Madison Street projects were co-existing with Chinese and other minority groups who shared similar problems (e.g. 87

language barriers, housing shortages, accumulation of garbage and issues of general illness in the neighborhood) that needed the evolution of an institution such as Gouverneur Hospital to serve these disenfranchised communities.

THE BASIS FOR COLLECTIVE ACTION

The LES community leaders under the umbrella of the Health Council defined three specific purposes, which created then the basis for collective action:

1. To ensure that the GHSP was serving the health needs of the Lower East Side community. For this, the Health Council held Beth Israel (BI) accountable and monitored what BI was doing by meeting every month with GHSP staff, developing programs and handling complaints. Undoubtedly, BI’s head was not happy with the Council. Later, BI took the Health Council to court and Council members were barred from the premises.

2. To work on how to improve health conditions in the LES. After getting funds from the Federal Government, the Health Council hired several workers (Latinos and Chinese) to organize additional neighborhood health centers.

3. To keep an eye on the construction of the new hospital. The Health Council started to get its own planners to counter the planning of the HRPC. 88

The primary goal was to get the new Gouverneur Hospital open as a complete community-based hospital, including obstetric and surgery services. Furthermore, community leaders felt the new GH should hire bilingual workers, culturally sensitive and representative of the community residents’ ethnicity.

In 1971, only seven percent of the 400 Gouverneur employees were Chinese while around eighteen percent of patients were Chinese. The Health Council organized a march by Chinatown residents to the offices of HHC President Joseph English, to protest an alleged lack of Chinese bi-lingual staff at GH.1 There were several stories about cultural and language misinterpretations. For example, Tom Tam recalls hearing that “some patients were getting medication, which was supposed to have been dispensed into the nose actually administered to the eyes instead!” Later, the Health Council played a crucial role in helping the new GH in the recruitment process of bilingual workers, especially Chinese and Latinos. The second goal was that the new Gouverneur Hospital should be independent from Beth Israel. Several participants agree that the decision to affiliate GH with Beth Israel was simply political. If health officials were interested in reducing health costs and better distributing resources, why didn’t they strengthen the health system by creating a network among municipal hospitals connecting small hospitals such Gouverneur with larger ones such as Bellevue Hospital? Besides, Bellevue Hospital was closer to the LES community than Beth Israel. From past experience with Beth Israel, the Health Council was aware that BI as a voluntary hospital had no interest in improving and expanding health services in Gouverneur. Leaders charged that due to its affiliation and the incomplete facilities at the new Gouverneur, many Gouverneur patients ended up at Beth Israel 89

for hospitalization. The argument was that BI was earning money on patients who should be in GH. In fact, Beth Israel was expanding its facilities at a time when Gouverneur was contracting its services.1 Many collective action strategies were used to raise awareness in the community. “We went to every church; we made sermons; we had people signing petitions,” states one participant. “We organized community meetings, distributed flyers and organized rallies.” “We marched across City Hall, to the office of the Commissioner of Health and later to the Health and Hospitals Corporation,” adds another participant. The fight for getting back the new GH attracted a range of support from settlement houses to bishops from several churches to Democratic political leadership. “It was quite a coalition of people,” remembers Mr. Tam, who at that time was the Executive Director of the Council and he continues, “All together, young and elderly people working for the same purpose: getting Gouverneur Hospital open.” Some of the interviewees recall that it was obviously not an easy task.

CHALLENGES

Participants consider one of the biggest challenges was to bring different communities together. Professor Mizrahi discusses, “The primary difficulties inherent in organizing around health care: people don’t believe they can effect change. It takes a great deal of community education to convince people that their familiarity with and stake in the health care system as consumers and as community residents gives them as much legitimacy and expertise as the bankers, businessmen, and other lay people who usually sit on the boards of directors of hospitals.”1 90

Another participant, who has been working at GH for thirty years, observes that taking into consideration the dynamic of the rapidly growing neighborhood, it was not only hard to organize at the beginning, but it has been difficult to “hold hands” and keep people together. A third participant adds that it is easy to divide and conquer—minorities need to be cautious and learn to overcome divisions, sometimes created from within, but most of the time manipulated from outside.

SUCCESSES

1. A new Gouverneur Hospital. The LES community finally had a partial win in its long battle. It was not a freestanding hospital; its destiny was still tied to Beth Israel. The new GH offered ambulatory care and other outpatient services, but did not have obstetric and surgery on the grounds that they were too costly. Its inpatient services were added later, but during the city financial crisis of the mid 70s, its inpatient services were once again closed.

2. The new GH had the most sophisticated patient advocacy department in the city. They published a newsletter as well as patient forms and health information in 4 different languages (English, Chinese, Hebrew and Spanish). This would not have been possible without the help from former Health Council workers. The new GH hired the entire leadership of the Health Council, who filled positions of directors of community relations, community programs and patient relations. 91

“It was part of the game plan,” indicates one participant. “What better opportunity can one have to work within the system and make substantial changes?” adds another. Needless to say, a third participant expresses his animosity remembering this event. He believes that GH/BI wanted to silence the community, and the best way to do so was to co-opt these experienced workers.

3. Chinatown Health Fair. The fight for GH activated the issue that health care is a right. The slogan, remembers Mr. Tam, “was to bring the exam room into the community.” The Health Council Health Fair initiative was a great success. The event was well publicized and gained the respect of HHC.1 Furthermore, the Health Fair led to a series of community health initiatives including the Chinatown Health Clinic, a well- established health center that now has branches in Queens.

4. Betances Health Center. It was originally the Judson Mobile Unit, (supported by the Judson Memorial Church) serving the Latino community and other low-income residents. All participants remember with fondness Paul Ramos—who recently passed away—as being instrumental in developing Betances Health Center as a model of comprehensive primary care. (Currently Betances Health Center is under the auspices of Beth Israel). 5. Community Empowerment. One of the participants emphasizes that, “It was a good training ground for community level professionals. Because of what happened in the LES, several Latinos and other minorities have been elected in local elections.” 92

6. Saving Jobs. Gouverneur Hospital is one of the largest employers in the LES, thereby its opening, expansion, and the reduction of its health services, did have a direct economic impact on the community.

LESSONS LEARNED

1. Professor Mizrahi suggests that several components need to be in place for successful health change to occur: • Competent organizers are needed who can mobilize people and sustain their involvement in health-related struggles. Funds must be available to pay organizers to assume this function; otherwise, other community agencies need to make staff available to fulfill that role.

• We need competent and committed government officials who believe in consumer and community involvement in health affairs and who are willing to enforce or develop regulations that mandate an open process.

• We also need a few community leaders and patient advocates who understand the complex health system and are willing to challenge professional authority.

2. Mr. Laviera indicates that “the ultimate goal, the development of our own institution, was suppressed by major institutions in the neighborhood such as Beth Israel, Educational Alliance, Henry Street Settlement and politicians who then supported the hospital affiliation with Beth Israel.” Critically, he continues, “The professional interest of BI had been covered 93

and insured by the power brokers of all establishment of Grant Street institutions.”

3. “We did not look at the entire picture,” says Mr. Tam remembering the demand for obstetric and surgery services. “The whole objective became programmatic, the new place was small and the city was trying to reduce costs.”

4. Ms. Wessler remembers, “The hard work was worthwhile and the community saved many jobs.”

5. Ms. Cruz comments that “The fight for Gouverneur brought many people together under the umbrella of health; it was a great coalition of cross ethnics, religious community residents and ultimately, the goal was overall accomplished: the hospital was established.” Ideally, she thinks, “It would have been beneficial for the neighborhood that after we got the hospital to have continued directing attention to other pressing issues in the community instead of having dissolved such a combative movement.”

The Gouverneur Hospital experience demonstrates that coalition- building is an essential first step for collective action. It reveals that coalition-building must be inclusive, grouping people across languages and ethnic groups in coordination with community organizations and institutions. The Gouverneur’s controversy also shows that coalition leaders and other actors need to be willing to consider various options to avoid inflexibility. Perhaps inflexibility and tunnel vision on the part of hospital officials were some of the factors in keeping the LES community in arms for all those years.

Edith R. Pavez, 11/00 94

Exhibit 1

QUESTIONS FOR THE CASE STUDY ON GOUVERNEUR HOSPITAL

1. What was the timeline/chronology of events?

2. Who were the actors and institutions, and what were their positions/claims?

3. What were the issues of shared concern and interest?

4. What was the basis for collective action/coalition-building?

5. What were the challenges, successes, lessons learned? 95

Exhibit 2

BIBLIOGRAPHY

Gouverneur Hospital, Department of Public Relations. Gouverneur: 115 Years of Community Care. Department of Hospitals Organization. Gouverneur Hospital. 1946. City of New York Department of Hospitals. “Report of the Mayor’s Committee on the Needs of the Department of Hospitals.” February 17, 1950, 8-9. Trussell, Dr. Ray E., Commissioner of Hospitals of New York City. “The Municipal Hospital System in Transition.” Presented as the anniversary discourse of the New York Academy of Medicine, January 4,1962, 1-12. City Restores Cut in Hospital Care: Acutely III Will Get Beds at New Gouverneur Building. February 7, 1967. “Councilmen Begin A ‘Talent Hunt’. Manhattan Members Seek Hospital Appointees.” The New York Times, December 21,1969. Schwartz, Richard. “Chinese Mount Hospital Protest.” New York Post, November 13, 1971. Wetherington, Roger. “While Health Corps. Has Its Woes.” Daily News, January 30, 1972. Bird, David. “City Decision to Shut 4 Hospitals Approved by State Health Chief.” The New York Times, March 13, 1976. Bird, David. “A Report to the Hospitals Corporation Calls for Keeping City Institutions Open.” The New York Times, May 14, 1976. Breasted, Mary. “Shutdown of 30 Hospitals Urged for New York City.” The New York Times, May 28, 1976. Bird, David. “Fact-Finding Panel calls for Fewer Layoffs at Municipal Hospitals.” The New York Times, June 19, 1976, 25. Bird, David. Gouverneur Hospital Periled by Political Controversy. The New York Times, June 13, 1976, B4. Weisman, Steven R. “Panel Fails to Act on Hospitals Report.” The New York Times, July 8, 1977, B2. Mizrahi, Terry. “Coming Full Circle: Lessons from Health care Organizing.” Health/PAC Bulletin, Summer 1993. Bellush, Jewel. “A Municipal Hospital System: Myths and Realities.” June 1980, 313-320. 96

Exhibit 3

CHRONOLOGY OF EVENTS – GOUVERNEUR HOSPITAL

Date Action/Activity

1885 Gouverneur Hospital (GH), a fifty-bed facility, is opened near Gouverneur Slip and Water Street at the East River. GH was designed to serve as an emergency hospital and ambulance station for the congested waterfront district and also to eliminate some of the patient load for Bellevue Hospital located more than two and one-half miles away.

1908 Construction for expanding Gouverneur Hospital building is completed. Two additional wings are added with a central connecting building, which enables the hospital to increase its bed capacity to 220. Services provided: medicine, general surgery, pediatrics, orthopedics, eye, ear, nose and throat, skin. Capacity: adults 161, children 59—total: 220.

1946 The Federal Government appropriates the sum of $153,000 for the preparation of surveys, plans, etc. for a new hospital.

Feb 1950 A report of the Mayor’s Committee on the Needs of the Department of Hospitals recommends the construction of a new facility for Gouverneur Hospital. They urge a new hospital of approximately 350 general care beds and 50 beds for tuberculosis. They argue that Lower Manhattan requires the construction of this hospital as replacement of obsolete facilities. 97

Early 1959 Mayor Wagner appoints a Commission on Health Services to review the health services of the City and to recommend action. The Commission makes several recommendations: full-time directors of services, affiliations financed by the City, closing or converting to other uses certain institutions, and various other steps to improve the overall situation.

Early 1961 Mayor Wagner appoints a Task Force to further expedite necessary changes.

Mar 1, 1961 Dr. Ray E. Trussell is appointed by Mayor Wagner’s Commissioner of Hospitals on an interim basis. Dr. Trussell’s appointment is renewed in January 1962. (The Municipal Hospital System in Transition: Presented as the Anniversary Discourse of the NY Academy of Medicine. Dr. Ray E. Trussell, Commissioner of Hospitals of NYC, January 4, 1962, pages 8 and 9).

Mar 1961 GH loses affiliation (this was the case for most municipal hospitals, only seven hospitals were affiliated), loses residential approvals and accreditation—inpatient service is closed. Gouverneur continues as an outpatient clinic. Patients are forced to enter Bellevue or Beth Israel Hospitals for treatment of acute illnesses.

Dec 1, 1961 Beth Israel Hospital assumes responsibility for Gouverneur Health Services Program (GHSP) on a contractual basis.

1967 The Lower East Side Neighborhood Health Council-South is created to provide community input and ensure that the GHSP responds to community health needs. Nearly forty members, reflecting the community’s ethnic composition of 98

Blacks, Puerto Ricans, Chinese and Jews, compose the Council. Later, the Council receives funds from the Federal Government/OEO to hire three employees.

Jan 1967 Combined neighborhood groups from the Lower East Side, which have been protesting the termination of GHSP’s inpatient services, present a petition to Mayor Lindsay bearing 20,000 signatures.

Feb 1967 The Lindsay Administration, reversing a previous plan, announces that the GHSP will reintegrate services for the acutely ill in its new building. It is expected that the new building at Clinton Jefferson, Madison & Henry will be completed by 1970.

May 1967 The construction for the present GHSP thirteen-story building is awarded.

1970 The Lower East Side Health Council-South is barred by a court injunction from GHSP as a result of civil disturbance.

July 1970 The Health and Hospital Corporation (HHC) takes over operation of the City’s twenty municipal hospitals. The HHC is formed to insulate the hospital system from political forces. The Corporation has sixteen members: five of the sixteen are city officials; five are named by the Council and five by the Mayor. It is expected that the sixteenth member, the chairman will be the current Hospital Commissioner.

Summer 1970 Chinatown Health Fair takes place. The ten-day health fair is a great success. The Health Fair provides fifteen tests apiece to 2,500 people! 99

Nov 1971 The Lower East Side Health Council-South organizes a march by Chinatown residents on the offices of Health and Hospital Corporation’s President Joseph English to protest an alleged lack of Chinese bilingual staff at GHSP and to support the reinstitution of a new Gouverneur with full services. According to the community health group, only 27 out of 400 employees are Chinese. The demonstration is also prompted by a general disregard by the hospital for the Chinese community. Dr. English reiterates the original promise and declares, “All facilities in the new Gouverneur, including inpatient care, will be opened for service by July 1972.”

Jan 1972 The Lower East Side Health Council-South files a suit in Federal Court charging Beth Israel with failing to follow federal guidelines that require community participation in the GHSP.

July 1972 The new GH, a 39 million dollar structure opens its doors for emergency and outpatient services. It is the first hospital established by the NYC Heath and Hospital Corporation (HHC) as a model community hospital, becoming the eighteenth municipal hospital to join the municipal system.

Nov 1972 GHSP opens its inpatient services: 206 beds for rehabilitation medicine, medicine and pediatric services.

Mar 1974 GHSP inaugurates its WIC program. It is the first municipal hospital to develop this program.

June 1974 Establishment of Gouverneur Hospital’s Community Board. The election brings more voters to the polls than any other municipal community board election and insures 100

direct participation and involvement from the community in hospital activities.

Nov 1974 GH confronts severe budget reduction. Its mental health funds are eliminated and it suffers a reduction in the HEW grant.

Aug 1975 The Joint Commission for Accreditation of Hospitals awards GH a full two-year accreditation (only forty-five percent of new institutions receive full accreditation on the initial effort).

Nov 1975 GH suffers attrition and lay-offs, and over 3 million dollars in operating expenses are slashed.

Jan 1976 The Board of Directors of the HHC approves the Three Year Plan that calls to shut four hospitals and the elimination of GH’s inpatient and emergency room services. (According to Gouverneur, numerous studies, analyses and reports were submitted proving the irrationality of the decision without success. Gouverneur’s inpatient occupancy was averaged at eighty percent utilization and its ER is an integral component of the well being of the community).

May 1976 A report to the Hospitals Corporation calls for keeping city institutions open. A confidential report commissioned by the Board of Directors of the NYC-HHC calls for a reversal of the Board’s earlier decision to close some municipal hospitals as an economy measure.

June 1976 A fact-finding panel set up by Mayor Beame to avert a strike in New York City’s municipal hospitals calls for a sharp reduction in the number of workers to be laid off. 101

The panel agrees with the closing of inpatient service at Gouverneur Hospital and urges the city be more aggressive in getting a higher rate of reimbursement from the start so that Gouverneur can be turned “at least” into a skilled nursing facility.

Community residents are actively protesting against the hospital being closed. They alternately occupy the hospital’s executive offices and block the street outside the hospital to emphasize their determination to prevent the city from carrying out the plan to close all but Gouverneur’s outpatient clinics. They ask that the hospital not only be kept open, but also that obstetrics and surgery be added to make it a full-fledged hospital.

The contracts with Beth Israel are terminated as of June 30, 1976.

July 1976 GH welcomes professional affiliation with NYU Medical Center. GH can refer its patients to Bellevue Hospital for services not offered by GH.

GH and the community avert the elimination of Laboratory and Radiology services and plans to turn Gouverneur into a satellite of Bellevue Hospital.

GH’s 201 beds in inpatient service are once again closed. Its ER is converted to a general care clinic operating twenty-four hours seven days a week.

1976 Gouverneur opens its Skilled Nursing Facility with forty elderly Chinese men and women as its first residents. 102

1977 Gouverneur expands its Skilled Nursing Facility to 196 beds.

July 1977 A hospital report issued by a mayoral commission calls for the sale or lease of all of New York’s municipal facilities. Mayor Beame’s special panel on city finances commissioned the report. The hospital report recommends the sale or leasing to community organizations, labor unions or other groups of all seventeen municipal hospitals run by the HHC. It also urges the closing down of 5,000 hospital beds out of the total of nearly 38,000 private and public hospital beds in New York City.

Interviewees

Judy Wessler, Health Commission, former member of Hospital’s Community Board

Terry Mizrahi, Professor, Hunter College School of Social Work, founder of the Lower East Side Neighborhood Health Council-South

Thomas Tam, Former Executive Director of The Lower East Side Neighborhood Health Council-South

Tato Laviera, poet, former community activist of the Lower East Side

Carmen Cruz, Health Care Planner Analyst, Gouverneur Hospital

Grace Rodriguez, Member of Hospital’s Community Board since 1968 103

GOUVERNEUR: 115 YEARS OF COMMUNITY CARE II. III. THE COMMUNITY The history of Gouverneur Hospital cannot be separated from the history of the community. Over one-fifth of Gouverneur employees live in the community and many can trace their roots below 14th Street. And the needs and aspirations of this community can perhaps be understood most clearly by tracing its development from the early part of the last century. Beginning in 1830, waves of immigrants from all parts of Europe began arriving in America. In quest of opportunities to earn a livelihood, they were attracted to the large urban centers. Thousands of these people settled in New York City in the area east of the Bowery, between Canal and East 14th Streets, which shortly thereafter developed into one of the most densely populated areas in the world. From 1830 to 1840, following the great famine, thousands of Irish citizens had come to New York. They were followed by the Germans and were later joined by the Italians and the Greeks who settled in the area, north of Catherine Street and east of the Bowery up to Grand Street, known at that time as the Fourth and Seventh Wards. Then from 1860 through the eighties in one mighty wave came the Middle Europeans from Russia and Poland, replacing the Irish and Germans and leaving the Greeks and Italians below Canal Street. The immigration continued until what we now know as New York’s Lower East Side became one of the most thickly populated parts of the world.

1885 104

The year 1885 witnessed a rise and fall in the world’s economy. The United States, somewhat more stable, was responding to the steady hand of its new President, Grover Cleveland, in his first term of executive office. David B. Hill was Governor of New York State and William R. Grace was in his second term as Mayor of New York City. The most densely populated area of the City, and perhaps of the nation in 1885, bordered the waterfront of the East River. The old, well-to-do families, the Rutgers and the Delanceys, who had given their names to the streets where they had lived, had moved uptown. Only the tall masts of the clipper ships moored along the South Street and the teeming masses of immigrants were reminders that New York was an overcrowded port city whose citizens were in desperate need of health care. This phenomenal growth soon created overcrowded, squalid and unsanitary living conditions, accompanied by a rise in the prevalence of disease. The city’s authorities recognized the problem of overcrowding and the concomitant health problems it created. They therefore took emergency measures to expand the community’s health facilities. Among the actions implemented, was the selection of an abandoned police station, formerly a consumer’s market, remodeling the building and opening the doors of Gouverneur Hospital October 5, 1885.

IV. THE FIRST GOUVERNEUR HOSPITAL The New York Times of October 3, 1885 noted the imminent opening with the following article:

THE HOSPITAL AT GOUVERNEUR-SLIP The new hospital at Gouverneur-slip is now completely built, and will be ready for patients of all kinds.... it is well built at a cost of 105

$14,000, lighted on all sides, supplied with bathrooms and closets, and an emergency hospital for four precincts… and is a branch of Bellevue Charity. The site occupied was formally a police station, then a market place, and afterward a resort for thieves and low characters. Its regeneration into a hospital grieves the river border gang, but is hailed as a great improvement by respectable neighbors.

Gouverneur was designed to serve as an emergency hospital and ambulance station for the congested waterfront district and also to eliminate some of the patient load for Bellevue Hospital, located more that two and one-half miles away. It should be noted that the name of the market was preserved in the hospital. A description of the physical properties of Gouverneur noted that: “on the ground floor the large room looking west toward Gouverneur Street was used as an ambulance room. The ambulance, a horse, and an old fashioned icebox in which all the milk, cream, meat, and fish used in the hospital were kept, were being constantly exposed to the odors from the stable. The room at the east, or river, side was used as the dispensary. The ambulance patients were received at the south entrance, and in the basement were the kitchen, heating plant and storerooms for food and coal. On the second floor, the large room over the stable was the male ward. On the third floor was the ward for women and children.” 106

The first medical staff was composed of one visiting physical and surgeon. Dr. O.Z. Ward, one consulting surgeon and a house staff of three members. Surgical procedures were performed in the wards on a table surrounded by screens. There were no laboratories at Gouverneur and all specimens were sent to Bellevue for examination. About 150 patients a day were treated in the dispensary (clinic), which was staffed by interns who worked without supervision. So great was the need for the health care that, within months of Gouverneur’s establishment, it became necessary to enlarge and improve the facilities. Nurses from the New York City Training School on Blackwell’s Island, under the direction of a graduate nurse, were assigned to the new hospital and we are told that the top floor was converted into children’s ward with fourteen cribs, each crib bearing the name plate of the donor. This ward was little gem. The ceiling was tinted blue with fleecy white clouds and gilt stars. The walls also were tinted blue and, with eastern and southern exposure, the ward was floored with sunlight. Within two years, news of the splendid service at Gouverneur spread to the medical colleges and the Committee on Examinations received some 40 to 50 applications from colleges to the hospital from as far south as the University of Virginia. In 1895, ten years after Gouverneur’s founding, a serious fire swept the old buildings on the Lower East Side. Such were the demands on Gouverneur’s services that plans were immediately made to build a new and larger hospital. In 1908, after a long delay, the new building was opened. It consisted of two wings and chemical laboratories. Nursing and medical supervisors were appointed and a nurses’ 107

home was opened on Monroe Street. Because of the ever-increasing health needs of the overcrowded community, Gouverneur’s administration led the ways in developing new methods of health care delivery. Gouverneur was the first municipal hospital to establish a tuberculosis clinic, the first to establish a day camp on a ferry boat, the “Westfield: later named ‘Camp Huddleston’” for the physician who organized the programs for undernourished adults and children. It was the first hospital to cooperate with Miss Lillian Wald when she founded the Henry Street Settlement. It was the first hospital to have a woman physician, Dr. Emily Barringer, on ambulance duty. Gouverneur’s first house surgeon, Dr. Charles W. Stokes, was later named Surgeon General of the United States Navy. Gouverneur’s innovative ways spread to the community. The first model housing projects was erected in 1887. In that year Tenement House Commission built six model ‘tenement” houses on Cherry Street, near the hospital. Most importantly, Gouverneur became “first” in the minds and the hearts of the people of the community. Dr. Henry Mann Silver, an early member of the hospital’s medical staff, was the author of an article in the Medical Journal & Record entitled “The Origin and Development of Gouverneur Hospital.” In that article, stressing the strong community spirit, Dr. Silver wrote: “The hospital is as much a part of the community it serves as is the local grocer, butcher or tailor. Within its wards generations have been born; have given birth in turn; have been treated for their ills and comforted in their last hours. To them it is their hospital. In fact, so community-minded are these people and so fixed is the hospital in community life, that many of its doctors, nurses and other professional as well as lay employees have made their homes in the neighborhood.” 108

V. PRE & POST-WAR During both World Wars, Gouverneur’s staff continued to serve not only the families of the community but took on the larger job of serving the nation, as well. In World War II, nearly one third of the Gouverneur’s employees joined our fighting forces as doctors, administrators, nurses, social workers, technicians, aides, and clerks. To replace this loss in personnel, Red Cross Nurses, Nurses Aides, Gray Ladies, American Women’s Voluntary Services helped magnificently in taking care of some of the patient’s needs. In this and every other way, Gouverneur distinguished itself in the annals of health care and endeared itself to the people of the community. After World War II and during the conflict in Korea, Gouverneur continue to serve an increasing numbers of patients and to provide additional services. This so overtaxed the hospital’s physical facilities, now almost 60 years old, that plans were made for a new, modern building at a site to be selected in the community.

VI. THE NEW GOUVERNEUR HOSPITAL After years of planning, labor problems and strikes in the building and construction trades, the New Gouverneur became a reality. The 39 million dollars structure was opened for outpatient services in July 1972 in a square block area facing on Madison Street and bounded by Henry, Clinton and Jefferson Streets. In-patient services were opened in September 1972. However, many of the 216 beds remained unused and only the outpatient departments flourished. There were five floors devoted to ambulatory care, including ophthalmology, dentistry, and podiatry. With a continued low occupancy rate, it was necessary to convert the acute care beds to long term care in August. 109

VII. THE GOUVERNEUR NURSING FACILITY 1976 saw the opening of the Gouverneur Skilled Nursing Facility with 40 elderly Chinese men and women as its first residents. A year later, after the closing of its acute in-patient services, Gouverneur expanded its Skilled Nursing Facility to 196 beds, which were immediately occupied by chronically ill geriatric patients. Adapting to the changing needs of the Lower East Side Community, and prompted by the nursing home scandals, which closed many poorly equipped facilities in the city, Gouverneur was eager to offer this new service to a population long denied adequate health care facilities. The Nursing Facility presently consists of 210 beds with plans to add 66 additional beds in the near future.

VIII. NEW IMMIGRANTS, NEW NEEDS The sixties and seventies witnessed a change in the ethnic character of Gouverneur’s catchment area. Some of the older Italian and Jewish families in the community moved north to the Bronx and east to Queens and a new wave of immigrants from the East, China, Korea, and Vietnam took their places. To meet the health care of the new community residents, it became necessary to discontinue some under-utilized services and add new ones. In 1978 Alan H. Rosenblut, the new executive director, maligned Gouverneur’s management team to conform with the new health care needs of the community’s families. In 1984 the Asian Mental Health Clinic was opened, staffed entirely by physicians, nurses, and social workers, aides and clerks who are fluent in Cantonese, Mandarin and Vietnamese as well as English. In 1985, Gouverneur opened the Roberto Clemente Family Guidance Center for the benefit of the thousands of Hispanic 110

patients. This clinic, located at the northern end of our catchment area, is served by a completely bilingual Spanish and English staff. The Judson Health Center, a satellite clinic of Gouverneur since October 1966, located at 34 Spring Street, provides continuous care with a broad range of diagnostic and therapeutic services including mental health, adolescent medicine, dentistry, podiatry, nutrition, cardiology and “well baby” clinics. A Mobile Crisis Unit staffed by physicians, nurses and social workers who operate as a team, was established to restore order in critical emotional and social situations. “Project H.E.L.P.” was founded by Gouverneur’s Department of Mental Hygiene to provide food, shelter and psychiatric care as needed, to the growing number of homeless men and women making their “homes” on the streets of the Lower East Side.

IX. PREPARING FOR THE NEXT CENTURY Advances in medical technology and the rise of managed care changed the direction of health care in the 1990s. Patients that were previously taken for granted by private facilities were now more desirable as patients. In spite of these changes, Gouverneur resolved to strengthen its commitment to community care. As part of the South Manhattan Network of the New York Health and Hospitals Corporation, Gouverneur expanded its commitment to care under the new leadership of Executive Director Samuel Lehrfeld. Samuel Lehrfeld has for many years been the executive director of Goldwater Memorial Hospital. After successfully overseeing the consolidation of his facility with Coler Hospital, he was asked by HHC President Dr. Louis Marcos to strengthen Gouverneur. Mr. Lehrfeld oversaw the expansion of services at Gouverneur while many other facilities were cutting back. He greatly increased Rehabilitative Services, strengthened Dental Services and 111

renovated clinics and lobby areas. New satellite facilities were added, including The Baruch Houses Child Health Clinic and the Smith Communicare Center. The Judson Health Center was renovated and will be expanded due to greatly increased patient usage and the Roberto Clemente Center added primary care services in addition to behavioral health.

NEW MILLENIUM, CONTINUED COMMITMENT The event that you are attending tonight marks the continuation of Gouverneur’s commitment to our community. Plans are underway to locate services for easier and quicker access, expand the number of beds in our Nursing Facility, increase access to the TEMIS medical interpretation program, and provide service by medical van throughout our area. Whatever we undertake in the years ahead will be determined by the same criteria that was used exactly 115 years ago — how to best provide care to our community.

X. YOUR NEIGHBORHOOD HEALTHCARE PROVIDER Gouverneur has been the main provider of healthcare to the Lower East Side community for more than 110 years. We have always been committed to providing dependable, high quality health care at an affordable price. Our staff is composed of highly skilled and experienced professionals who are dedicated to the care and well- being of those we serve, from newborns to senior citizens. Both New York State and independent agencies have praised Gouverneur for the consistently high standard of care that is provided. Quality is maintained and monitored on a continuous basis by Quality Assurance Programs in Ambulatory Care and the Nursing Facility. Ambulatory Care offers a full range of health care services. 112

XI. BEHAVIORAL HEALTH The Department of Behavioral Health employs a multi-disciplinary approach in attending to the emotional well being of our adult and child patients. Through the use of social workers, psychologists, psychiatrists, and behavioral health workers, the department has developed multi-faceted programs that deal with both the psychological and social aspects of urban living. The traditional approaches of individual and group therapy are offered, and in addition, special programs have been designed to deal with unique aspects of life on the Lower East Side. Services include:

Central Assessment Service: Serves as the entry-point for behavioral health referrals and provides easy access to a wide- array of services and programs. A multidisciplinary and multilingual team of clinical staff provides comprehensive psychiatric, psychosocial, and substance abuse assessments, urgent care, treatment planning and linkages to appropriate services.

Comprehensive Healing Center for Women: An innovative service that was established to address the unique needs of women who are experiencing chronic mental illness and concomitant medical, substance abuse, social and housing issues. A multidisciplinary team of clinicians provides holistic woman-centered and family-oriented care, employing traditional and alternative therapies. The program also employs a coordination of care approach and encourages client empowerment opportunities. 113

Citywide Assistance Team (C.A.T.): Is responsible for collaborating with Assisted Outpatient Treatment Programs (A.O.T.) operating throughout the City of New York. It is comprised of licensed mental health professionals who work with A.O.T. programs and other government agencies to facilitate psychiatric evaluation and treatment for patients in acute distress, and who have a demonstrated need for close supervision of treatment to ensure compliance. This team has statutory authority to facilitate treatment under “Kendra’s Law, and is available to support program requirements 24/7 (24 hours a day, 7 days a week).

The Acupuncture Program: Gouverneur patients may be referred for whole body and auricular acupuncture treatments. The program offers adjunctive mental health and recovery readiness services for substance abusers, assessment, counseling and referral to other agencies.

Child and Adolescent Services: This service provides comprehensive outpatient care to families with children up to eighteen years of age who have emotional, social and/or behavioral problems. Services include evaluation for treatment, individual, family and group therapy, parent counseling, pharmacological treatment and psychological testing. The service also offers two other programs: a free Family Support Program for parents and caregivers of children with special needs, and Turning Points, a mental health school-based program at JHS 56. 114

The Adult Mental Health Clinic: The Adult Mental Health Clinic is comprised of a multi-disciplinary team designed to help clients reduce symptoms and change problematic behaviors through the use of individual group, couple, family, and medication therapy. We also provide crisis intervention, assessment and referral services. Our goal is to improve the quality of life for individuals with behavioral health problems.

The Young Adult Program: Provides treatment for individuals aged 18 to 35 who have a chronic mental illness or who are dual diagnosed MICA clients. The program provides the same full range of services as our Adult Clinic, with the emphasis on maintaining the patient within a community setting. Collaboration with community housing providers and social service agencies is an essential component of the treatment paradigm. Case management services to address client housing, entitlements, education, and employment issues are also provided.

Center for Older Adults & Their Families: The Center for Older Adults and their Families assists older adults and their families in coping with the problems and challenges of later life by empowering them to problem solve more effectively. An experienced multi-ethnic team of geriatric specialists provides individual, group, family and medication therapy in English, Spanish, Chinese, Slovak and Czech. Through our Clinic and Day Treatment Programs, we provided transportation, nutrition counseling, medical care coordination, dementia screening, crisis intervention, as well as recreation and activity therapies. Our Elder Outreach Team offers community outreach and education. 115

The Asian Bicultural Clinic: This clinic is staffed with an inter- disciplinary team of bilingual and bicultural professionals who provide comprehensive and culturally sensitive services to Asian-Americans who have been unable to use mental health services due to language and cultural barriers. The staff works closely with Gouverneur’s ambulatory care medical team to provide a truly comprehensive and holistic health care approach.

Ryan White Counseling & Support Team: This is a Ryan White funded program serving the mental health needs of HIV+ individuals who have a history of or current homeless and substance abuse. The team provides mental health services, training and consultations at Housing Works.

Mobile Crisis Services: This mental health crisis intervention team reaches out to children, adults, and families within the Gouverneur district who are in psychiatric crisis. The multi- disciplinary team visits patients and families in their homes to provide psychosocial and psychotherapy, medication and linkage to other service providers. The team’s goal is to maintain patients in the community and prevent hospitalization. The team is also authorized to order transportation to a hospital if necessary.

The Parent-Infant Program: Offers a unique therapeutic program for expecting parents and parents who are experiencing the 116

stress of mental illness and emotional instability. Our goal is to foster healthy parent/infant/child interactions, to stabilize the parent’s emotional or mental illness, and to stimulate the emotional and cognitive development of the child at risk through the preschool years.

Project H.E.L.P.: The Homeless Emergency Liaison Project (H.E.L.P.) provides emergency evaluation, referral and hospitalization services to people who are mentally ill and living on the streets of New York. The multidisciplinary team of psychiatrists, social workers, and nurses conduct on-site assessments in streets, parks, transportation terminals and other areas where homeless people congregate. The team operates seven days per week in all five boroughs.

The 44th Street Independence Support Center: This low demand drop-in center provides case management services to homeless adults who have a history of serious and persistent mental illness or MICA clients. The multidisciplinary team works with clients utilizing a socialization model. The Center provides assistance in educating and helping clients negotiate medical, mental health, substance abuse and social service agencies, with the ultimate goal of helping clients to obtain housing. In addition, clients may be provided with food, clothing, shower facilities, basic support and emergency shelter.

MTA Connections Program: MTA Connections is an outreach and case management program providing services to people who are homeless in Penn Station, Grand Central Terminal, and the NYC Subway System. The Program’s multifaceted team provides clients with assistance in obtaining concrete services, 117

entitlements, medical psychiatric and substance abuse treatment and supportive housing. The Program’s goal is to achieve placement of clients in permanent housing.

DENTAL The Dental Clinic offers comprehensive dental care for the residents of the Lower East Side, ranging form age 2 and up as well as prenatal patients. In addition to general dentistry, the clinic offers prosthetics and oral surgery. Children are followed from a young age to foster sound dental health throughout their growth period to assure good health in adult life. The dental clinic also shows their participation in health fairs and community centers.

MEDICINE The largest provider of health care services at Gouverneur, the scope of medical services extends far beyond the perimeters of the practice of general medicine. In cases where a patient’s problems are of a specific nature that cannot be treated by his primary physician, the patient is referred to one of our medical specialties. These include:

Asthma Project: The Gouverneur Asthma Project is dedicated to improving the care of people with asthma, thereby reducing emergency room visits and hospital admissions. This is accomplished through patient education and by treating acute exacerbation so that the patient goes home rather than admitted for treatment.

Daniel C. Leicht Assessment Clinic: This clinic is dedicated to comprehensive care of people living with HIVIAIDS. Some of their services are HIV testing, support groups, social work, home care, 118

addiction counseling and recovery groups, acupuncture health education programs and nutritional services.

Pain Treatment Center: The goal of the Pain Treatment Center is to minimize or eliminate pain through the use of interventional techniques, analgesic management, physical therapy, behavioral therapy in additional to other approaches. They aim to decrease an individual’s dependence on medications, improve functionality and quality of life as well as facilitate a return to the workforce.

Pulmonary: The Pulmonary Department performs complete pulmonary function testing. The department also provides respiratory care for our Nursing Facility residents, instructs Gouverneur staff in CPR techniques and a part of the hospital Medical Emergency Alert Team.

Surgery/Minor O.R.: The Department of Surgery provides treatment of minor surgical wounds, ulcers, and infectious tumors. They also perform general and plastic surgery. Testing is done for breast, rectal (flexible sigmoidoscopy), vascular and ENT problems.

OBSTETRICS/GYNECOLOGY Comprehensive and preventive medical procedures, such as pap smears, venereal disease screening, and family planning, along with the treatment of regular gynecological problems are offered. Among the specialty areas available are:

Prenatal Clinic: Designed to treat any medical problems an expectant mother may encounter throughout pregnancy. The clinic addresses itself to a proper diet, exercise, and education so 119

that the pregnancy is problem-free.

Post Partum Clinic: After delivery, mothers are requested to return for a postpartum examination to insure that no complications, during or after the delivery, had occurred that might affect the health of the mother.

High Risk Clinic: Designed to attend expectant mothers whose health or medical problems may complicate pregnancy or delivery, special attention is given to the patient to minimize potential problem areas.

Natural Childbirth: Mothers interested in natural childbirth are instructed, under the direction of a nurse midwife, in the LaMaze method of natural childbirth. The program consists of special breathing and physical exercises to aid in the delivery without the use of drugs. Expectant fathers are welcome to participate in these classes.

XII. OPHTHALMOLOGY Comprehensive ophthalmic services are offered for both children and adults in the eye clinic. Available, are a variety of specialty areas that include glaucoma testing and examination for cataracts and retinal disease, as well as the prescribing of any needed eyeglasses or contact lenses. Glaucoma meets weekly for the treatment of patients suffering from glaucoma. Corneal Clinic meets monthly for the treatment of external and infectious disease of the eye. Optometry provides a full-time optometrist to detect the presence of vision problems, eye diseases and other abnormalities. Patients suffering from poor vision, uncorrectable by normal glasses, are fitted for special optical devices which enable the patient to function more 120

effectively.

PEDIATRICS The Pediatric Clinic offers a comprehensive health care program form the newborn period through adolescence. This includes physical exams, immunizations, anticipatory guidance, safety assessments, nutritional counseling, behavior & school function assessments, growth & development evaluations, screening tests, referrals to child & adolescent psychiatry, referrals to social service and to rehabilitation medicine. Additional services for adolescents include nutritional counseling (including weight related issues), guidance counseling (including substance use & abuse and family violence), sexuality counseling & family planning, and prenatal & postnatal care.

XIII. PODIATRY The Gouverneur Podiatry Department employees twenty fully trained podiatrists using six modern, fully equipped examining treatment rooms and a minor operating room to provide services for both children and adults. These services include Podiatric Medicine (treatment of conditions such as arthritis), Surgical problems (removal of warts, ingrown toenails, etc.) and Orthopedics (fabrication of orthotic devices). Equipment employed for specialized vascular examinations include doppler, plethysmography and oscillometry (measuring blood circulation).

XIV. RADIOLOGY The Gouverneur Radiology Department performs all routine x-rays, routine ultrasounds, Screening Mammograms & Diagnostic Mammograms. The department services the outpatient clinics of the 121

Diagnostic & Treatment Center, the residents of Gouverneur’s Nursing Facility and all patients that come for care. They have been honored each year with grants supported by the Revlon Run/Walk for Women and have provided free or low-cost mammograms to women over 50 as part of the Manhattan Breast Health Partnership.

XV. REHABILITATIVE SERVICES Gouverneur Rehabilitative Services is the overall name for these areas of care:

Occupational Therapy: A rehabilitation profession providing skilled treatment to residents in order to improve function or gain independence in daily living skills. Treatment includes practice, relearning activities of daily living (feeding, bathing, dressing, toileting, etc.) therapeutic exercise, wheelchair mobility training, assistive devices and adaptive equipment.

Physical Therapy: Gouverneur Physical Therapists help patients by evaluating physical problems: increasing and maintaining muscle strength and endurance; restoring and increasing range of motion in joints; increasing coordination; decreasing pain; decreasing swelling/inflammation in joints; alleviate walking problems; decrease stress; educate patients and families about their care.

Speech Pathology and Audiology Services: These services provide intensive one-to-one speech and hearing services to children (ages two and older), adults, and geriatrics. Their multilingual speech pathologists treat a variety of communication disorders including stuttering, voice disorders aphasia and swallow disorders. Their comprehensive audiology services 122

include screenings and evaluations, tympanometry, and testings (auditory brainstem response and otoacoustic emission testing).

XVI. BARUCH HOUSES CHILD HEALTH CLINIC The Baruch Houses Child Health Clinic, located within Baruch Houses, provides primary pediatric care for children through the age of 18 years. An assigned health care team of pediatricians, public health nurses and public health assistants create a caring and supportive environment for both parent and child. Services include ongoing and sick care, periodic physical examinations and scheduled immunizations. Additional services include including asthma care, screenings (dental, vision and hearing), diagnostic testing (lead poisoning, sickle cell anemia, pregnancy testing for adolescents, etc.), developmental/behavioral assessments, injury prevention education, and coordination of referrals to other providers such as WIC.

XVII. JUDSON HEALTH CENTER The Judson Health Center, located in the neighborhoods of Chinatown, Little Italy, Soho, and the Bowery, is a unique health care center that focuses on the patient’s total environment, not merely their immediate acute or chronic problems. This approach begins with an emphasis on preventative medicine as well as curative medicine for the individual. The next aspect involves the care of the entire family, not just individual members. This aspect recognizes that the health of one family member has an influence on other family members as well as a potential indicator of family health problems. The last aspect considers the relationship between the family and the community. The improved health care of families has 123

a positive socioeconomic effect leading to better health and a better community. The services include complete Adult Medicine and Pediatric Care. Additional services include Obstetrics, Gynecology, General Dentistry, Podiatry, Ophthalmology, and Health Education.

XVIII. ROBERTO CLEMENTE CENTER The Roberto Clemente Center in Loisaida provides medical and behavioral health care as well as health education. Beginning as the first bilingual-bicultural (Spanish) mental health program in New York, Clemente offers comprehensive, family-oriented treatment that promotes problem solving and personal healing. Its sister facility, The Sylvia Del Villard Continuing Day Treatment Program, offers clinical and rehabilitation services in a structured program. Services include therapy (individual, family, and group), marital counseling, psychiatric consultation and pharmacotherapy. In addition to behavioral health services, Clemente offers comprehensive medical care for adults. This includes general physical examinations and treatment of asthma, diabetes, high blood pressure, heart disease as well as comprehensive HIV services. Women’s Health Services include Pap smears, mammograms, treatment of sexually transmitted diseases, contraceptive services and hormone replacement complete pediatric care with specialty services for children with allergies is also provided. SMITH COMMUNICARE HEALTH CENTER 124

The Smith Communicare Health Center, located within Smith Houses, provides comprehensive primary health care to the surrounding communities that it serves. Adult preventative care includes age-appropriate blood tests and health screenings (gastrointestinal, breast, prostate and cervical cancer). Health care management deals with hypertension, diabetes mellitus, arthritis, bronchial asthma, respiratory infections and vision & hearing testing. Women’s health care provides family planning services, childbirth classes, cancer screenings (pap smear, breast exams, colposcopy and rectal examinations) and sexually transmitted disease education. Pediatric care includes examinations and evaluations (vision, hearing, speech, etc.) Smith also provides child care information regarding nutrition, taking temperatures, fire safety, car safety, drug and poison prevention, lead poisoning prevention, dealing with stomach disorders, diarrhea and juvenile diabetes mellitus.

OUTREACHING TO OUR COMMUNITY Gouverneur is committed to serve as the gateway for the many programs that are offered through the New York City, New York State and Federal governments. These services include:

WIC: Our onsite WIC Program enables Women, Infants and Children to save money on their food budget, to obtain nutritional information on healthy foods, to learn about community services and to assist them in finding medical help.

PCAP: A comprehensive prenatal care program for pregnant women and their newborns that do not have health insurance.

CHP: A program providing coverage for many children whose parents are not eligible for other assisted health care programs. 125

Medicaid Onsite: Assistance in applying for Medicaid conveniently located within Gouverneur Hospital.

MEETING OUR COMMUNITIES NEEDS Gouverneur strives to meet our communities needs with these additional departments:

Walk-In-Clinic: The entry point for the services provided by Gouverneur. Patients are examined to see if their medical needs can be treated in this clinic. They may be referred to one of our clinics or, if they need more extensive care, transferred to Bellevue Hospital.

Pharmacy: Filling the prescriptions issued by our physicians for our patients.

Jitney Service: Provides free transportation between the community and Gouverneur Hospital. Also provides free transportation services for patients with appointments at Bellevue Hospital.

Volunteer Department: Community members giving their time to assist the hospital in meeting the needs of our patients.

TEMIS Program: Provides translation between medical providers and patients by using medical interpretation technology. Gouverneur Outreach Department: Contacts community-based organizations and patients to determine the needs of our community members. Organizes healthcare events; arranges staff speakers and healthcare providers for community groups; and provides information about the latest healthcare programs to 126

our community.

THE GOUVERNEUR NURSING FACILITY Since 1976, Gouverneur has been providing outstanding nursing facility care to our community. In fact, the Joint Commission on Accreditation for Healthcare Organizations (JCAHO) has awarded the Gouverneur Nursing Facility Accreditation with Commendation honors, their highest category of achievement. Our outstanding multicultural programs, reflecting our Lower East Side location, were singled out during this recent survey. We specialize in quality skilled nursing and rehabilitation services. We are unique in providing on- site medical treatment, including all of our ambulatory care services. The Gouverneur Dietary Department provides the Nursing Facility residents with a restaurant dining experience and food that meets their health, religious and cultural needs. This is in addition to their meeting the entire hospitals dietary needs. 127

DEPARTMENT OF HOSPITALS ORGANIZATION – 1946

GOUVERNEUR HOSPITAL

DATE OPENED: 1885

LOCATION OF HOSPITAL AND AREA OCCUPIED: 621 Water Street, borough of Manhattan Posta1 Zone 2—occupying 0.6 Acres.

NUMBER, DESIGNATION, CAPACITY, AND PURPOSE OF VARIOUS BUILDINGS:

1. Hospital Building — Capacity 200 patient beds and 20 bassinets. Interne quarters for 17.

2. Garage bui1ding.

3. Nurses Home – First, second and third floor used as Out-patient Department -- Rest of bui1ding for quarters. Contains 64 single rooms, 1 suite of 3 rooms and bath and 1 suite of 1 room and bath.

TYPE OF HOSPITAL: General (Maternity service temporarily discontinued). Service provided: Medicine, General Surgery, Pediatrics, Orthopedics, Eye, Ear, Nose & Throat, Skin.

CAPACITY OF HOSPITAL: Adults – 161 Children — 59 Total: 220

Camp Huddleston Health Classes: From about 1915 to 1929 the Ladies Auxiliary of the hospital maintained a boat on which anemic and malnourished children and those who had t.b. contact, would spend several days a week, receiving class instruction at the same time.

Since 1929, t.b. contact children of the district bounded by South Ferry to 25th Street and Franklin D. Roosevelt Drive to the Bowery, may be referred to a class in P.S. 31 which is adjacent to the hospital. These children are patients of the Chest Clinic of the hospital and they receive instruction through the Board of 128

Education, but the health activities are under the hospital supervision. The Ladies’ Auxiliary says the salary of a social service aide in the school.

These chi1dren occupy several rooms in the school. They are given a full meal (meat) at lunch time and two periods of nourishment in the morning and the afternoon. They have regular physical examinations and X—rays of the chest in addition to initial examination in our Chest Clinic.

Recommendation to the class are through the Chest Clinic, the Department of Health, the school nurse, or the Pediatric Clinic. The average census for 1946 was 61.

SCHOOLS AND AFFILIATIONS: Do not operate a school of nursing. Do, however, receive affi1iating students from the department’s school for practical nurses and from time to time cadet students, to finish their course of studies. At present, there are ten Pupil Practical Nurses affiliating for three months, and three Senior Cadets affiliating for six months. The cadets are from Bellevue Hospital School of Nursing.

VISITING STAFF:

Service In-Patient O.P.D. Staff Staff

Medicine 42 41 Surgery 43 21

Fracture & Orthopedics 14 3 Pediatrics 9 0 Urology 9 1 Otolarygology 19 7 Ophthalmology 5 3 Neuro-Psychiatry 4 2 Dermatology 6 1 Hematology 2 0 Obstetrics 4 1 Dentistry 10 12 Anesthesis 2 0 Roentgenology 5 0 129

VISITING STAFF:

Consultants 18 Visitings 18 Assoc. Visitings 49 Asst. Visitings 94 Clinical Visitings 126

305

HOUSE STAFF: Rotating Interns 6 Asst. Residents 6 Residents 4 Interns (Dental) 2 Fe11ow 1 C1inic Clerk 1

PAID PERSONNEL – 391

PERSONAL SERVICE COST (1945) – Sa1aries $469,245.04

GROSS COST (1945) for operating and maintaining institution – $635,569.68

AVERAGE DAILY PATIENT COST (1945) $11.12

AVERAGE COST PER VISIT IN OPD (1945) $.73

COMPARATIVE ACTIVITY ANALYSIS: 1941 1942 1943 1944 1945 1946 Admissions 4,493 4,090 3,951 2,887 2,967 3,451 Discharges 4,094 4,499 3,923 2,915 2,937 3,452 Mortality Rate 5.5% 6.9% 8.5% 13% 12.9% 12.6% Avg. Daily Census 163 159 165 158 140 165 Avg. Days’ Stay 13 13.6 14.7 19 16 16 Total Patients’ Days 64,136 57,993 60,391 57,868 51,009 60,163 Deaths 250 282 334 383 379 435 Autopsies 57 61 31 36 54 43 Autopsy % 18% 18.8% 12% 12.5% 20.5% 14% Total OPD Visits 179,045 140,505 103,863 92,002 81,879 86,247 130

Total Visits by Visiting Staff 5,418 4,038 Not recorded.

PLANS FOR FUTURE: In 1946 the Federal Government appropriated the sum of $153,000 for the preparation of surveys, plans, etc. for a new hospital.

FORDHAM HOSPITAL

Founded in 1892 as a branch of Bellevue Hospital. Total bed capacity: 414 Type: Acute General Hospital

FRANCIS DELAFIELD HOSPITAL

Opened February 1, 1951 Total bed capacity: 307 Type: Cancer and allied diseases Note: Built at a cost of $8,618,000, this hospital is equipped with the most modern machinery to treat and carry on research in the field of cancer and allied diseases. Affiliated with Columbia University, College of Physicians and Surgeons and the Presbyterian Medical Center. The clinical and research activities function under the Faculty of Medicine, and all work is integrated with that of the Medical Center. The facilities of the hospital are used for teaching purposes.

XIX. GOLDWATER MEMORIAL HOSPITAL

Opened July 1, 1939 Total bed capacity: 1,500 Type: Long term illnesses Note: This special hospital, exclusively for the care and research of chronically ill patients, (except for tuberculosis, cancer and mental illness), has become famous the world over for the work done in the field of chronic disease and the aging process (geriatrics). It is affiliated with Columbia University, College of Physicians and Surgeons, and the New York University College of Medicine. 131

XX. GOUVERNEUR HOSPITAL

Founded in 1885 as an emergency hospital and ambulance station to serve the congested waterfront area near its location. Total bed capacity: 177 Type: Acute General Hospital (maternity) Note: Plans are now in progress to alter the hospital to include a maternity and newborn service. The hospital’s affiliation with the New York University, Bellevue Medical Center for the training of residents in surgery, gynecology, pediatrics, anesthesia, and X-ray.

XXI. GREENPOINT HOSPITAL

Opened October 1915 Total bed capacity: 281 Type: Acute General Hospital Note: This hospital is affiliated with the State University of New York Medical School, to provide training of physicians in Obstetrics and Gynecology. Also affiliated with the New York State Institute of Applied Arts and Sciences, for the training of dental hygienists.

XXII. HARLEM HOSPITAL

Founded in 1887 Total bed capacity: 705 Type: Acute General Hospital Note: Originally organized as a reception hospital for patients awaiting transfer to hospitals on Wards and Randall Islands. Harlem Hospital has a very large out- patient department, and an extremely active emergency and ambulance service.

1900 The City began reimbursing voluntary hospitals for patients accepted by the City as public charges.

1902 Under the new charter, four city hospitals (Bellevue, Gouverneur, Harlem and Fordham) were removed from the jurisdiction of the Department of Public Charities end became the Board of Trustees of Bellevue and Allied Hospitals. The Board consisted of seven city residents, serving from one to seven years, and a Commissioner of Public Charities.

1909 The Board of Ambulance Service was established. 132

1929 The Department of Hospitals was founded, bringing together the functions of Bellevue and Allied Hospitals, the Board at Ambulance Service, and the Department of Health and Public welfare, formerly a loose-knit confederation of separate institutions and activities.

1938 The new charter established an Advisory Council of the Department of Hospitals consisting of one representative from the medical board of each hospital under the Department’s jurisdiction, and seven members to be appointed by the Mayor without salary.

1948 The Department was reorganized for more effective service, functioning through several bureaus, i.e., Administration, Engineering and Mainten- ance, Medical and Surgical Services, Supplies, and Business Administration.

l950 The Board of Hospitals was created. The Board was composed of the Commissioner of Hospitals as chairman, and ten members appointed by the Mayor. The board was given powers formerly the Commissioner’s.

1965 The investigative functions of the Division of Collections were transferred to the Department of Welfare along with the Hospitals Section of the Managing Attorney’s Division of the Law Department.

By 1966, there were 21 different hospital institutions within the Department of Hospitals: seven general care hospitals; three separate special institutions (cancer, chronic care, nursing); and Gouverneur Ambulatory unit. (see NYC’s Municipal Hospitals: A Policy Review, p.25) The two principal functions of the Department area are: to provide hospital care primarily for the medically poor of New York City, and to regulate the private proprieties hospitals and other private institutions for medical or nursing care, unless these are otherwise supervised. In addition, the Department is responsible for the temporary care, of persons alleged to be insane and for persons awaiting arraignment, trial 133

or sentence, who are seriously ill or injured. The Department’s five city mortuaries (once in each borough) are responsible for the care and reception of the unclaimed dead. Other activities include extensive programs of medical and nursing education and research, namely in collaboration with the New York City medical schools associated with the Department. The Department has jurisdiction over four main bureaus: Administration, Medical and Hospital Services, Engineering and Maintenance Supply. (See Smith, pp. 151- 52 for description of each bureau.) It supervises and directs all emergency ambulance service in the city, both in its own and in private hospitals; it licenses all proprietary hospitals, convalescent and recovery hoses.

Affiliated Boards and Councils (Smith, 152—53.) Also: The Council is a device for protecting the autonomy of the 28 separate hospitals and their medical boards against any inclination on the part of the Commissioner to integrate or centralize the management of the Department.

Medical Boards Each of the 23 hospitals under the jurisdiction of the Department of Hospitals has its own medical board composed of attending physicians and surgeons. The members of each board are appointed by the medical staff, subject to general rules prescribed by the Commissioner. All terminations of office and dismissals are made by the Commissioner; however, he may not dismiss a board member without first consulting that member’s board. The Commissioner also appoints the medical house officers, who are nominated by the board. The board has powers to establish regulations governing the medical procedures in the hospital—subject 134

to the Commissioner’s approval—and these procedures must be enforced by the superintendent of the hospital.

Board of Administrative Consultants An independent body, composed of eminent specialists, its purpose is to investigate the qualifications of candidates for important clinical positions.

The Commissioner of Hospitals As chief executive officer of the Department of Hospitals, the Commissioner shares his powers with the Board of Hospitals, and Advisory Council and the medical board of each hospital. Hence, he is rather an agent, or representative, of the board, than its autonomous head. He is appointed by the mayor for a term of five years and is removable only by him. He receives an annual salary of $32,500.

The Board of Hospitals The Board of Hospitals is composed of the Hospitals Commissioner, who is its head, and ten members—five physicians and five laymen. The five physicians are required to have broad medical, public health and hospital backgrounds and experience; the five laymen must be distinguished in community and business affairs. Like the Commissioner, all ten members of the Board are appointed by the mayor for a term of five years and are subject to removal by him only. Terms of members are for five years, overlapping so that the terms of one physician and one laymen expire each year. The members are unsalaried. As top policy-making body of the Departments of Hospitals, the Board is responsible for the development of long-range programs of hospital service, including care of the sick, injured, the aged and infirm. In addition, the Board sees to the development and enforcement of standards and methods of efficiency in the Department; approves the capital and expense budget 135

estimates of Department before the Commissioner submits them to the city planning commissioner, mayor, or budget director; and reviews any action by the commissioner concerning revocation of a license. The board is empowered to establish and promulgate a hospital code. 136

Excerpt from (Pages 8-9)

February 17, 1950

REPORT OF THE MAYOR’S COMMITTEE ON THE NEEDS OF THE DEPARTMENT OF HOSPITALS

Your Committee recommends that the following projects are deemed necessary and should be initiated immediately. These projects constitute five—year program. The $150,000,000 is available toward this program; the balance of the money to be secured by annual appropriations in the capital budget. The listing does not indicate any priority.

Modernization and Rehabilitation of all Hospitals Suitable for long-range planning. This includes the expansion and modernization of all out—patient departments, X—ray and laboratory services, and ancillary services. Work of this type is particularly urgent in such hospitals as Cumberland Hospital, Greenpoint, Harlem, Lincoln, Fordham and

Sydenham. Kings County Hospital requires alterations which will serve the dual purpose of improving patient care and integrating the services of the hospital with the State University Medical School Program. The estimated cost of this phase of modernization and rehabilitation is $15,000,000.

Welfare Island. New Hospital providing 1,000 Beds for the Care of Chronic Patients, and 500 for Tuberculosis Patients. Because of the urgent needs for beds for tuberculosis, all 1500 beds, when available, should be used for the care of tuberculosis until additional facilities are avai1ab1e for this purpose. There must be ample provision of laboratory and research facilities. Affiliation with a medical school is essential. 137

East Harlem General Hospital New general hospital containing 750 beds for general care and 300 for tuberculosis. This is an essential replacement of the obsolete Metropolitan Hospital on Welfare Island. Every effort should be made to relocate the families now occupying buildings on the proposed site of this hospital as soon as possible, since plans for this construction are completed.

East Bronx Hospital New hospital, of 750 beds for general care and a hospital of 500 beds for tuberculosis. Affiliation with a medical school is most desirable. The commitment service (70 beds) for psychiatric patients is essential.

Queens General Hospital Addition of 236 general care beds and expansion of other services. Effectiveness of this hospital can be markedly increased. Funds for one—third of the cost of construction have been approved under the Hill—Burton Bill.

Elmhurst General Hospital New hospital of 750 beds with a commitment service of 82 beds for psychiatric patients. This hospital replaces the obsolete facilities of the City Hospital on Welfare Island. Queens is the county of greatest need for additiona1—general care beds.

Morrisania Hospital Addition of 147 beds with modernization of plant. Facilities are over-taxed and greatly needed in the Bronx.

XXIII. Coney Island Hospital New general hospital of 500 beds. Replaces existing facilities which will be used for the care of chronic patients.

Gouverneur Hospital 138

New hospital of approximately 350 general care beds and 50 beds for tuberculosis. This is essentially a replacement of obsolete facilities. Lower Manhattan requires the construction of this hospital.

Bellevue Hospital Modernization of useful buildings and replacement of obsolete and non fire—resistive buildings. This project will result in a Bellevue Hospital providing approximately 1,200 general care beds, 400 beds for tuberculosis, 250 beds for psychiatric patients and 600 beds for long term patients for whom an active rehabilitation program can be carried out. These facilities provide valuable teaching opportunities for four of the medical schools in New York City.

Tuberculosis Hospital in Harlem New hospital of 500 beds would constitute a partial replacement of Sea View Hospital in Staten Island. Residents of Harlem urgently need beds for tuberculosis. New hospital to be located adjacent to Sydenham Hospital. It would be desirable that the hospital be affiliated with a medical school. 139

THE MUNICIPAL HOSPITAL SYSTEM IN TRANSITION

Presented as the Anniversary Discourse of the New York Academy of Medicine January 4, 1962 by Dr. Ray E. Trussell, Commissioner of Hospitals of New York City

The title of this presentation implies that changes are occurring in the New York City municipal hospitals, and indeed they are. Since the municipal hospitals are such an important segment of the health service resources of the community, it is timely to report to an audience such as this. For those who may not be familiar with the administrative structure of the Department, the four essential elements are the Commissioner and his staff; the Board of Hospitals; the Advisory Council of Medical Boards; and the individual hospital administrators, medical boards, staffs and their vast array of service, training programs and research activities. The Commissioner is appointed by the mayor and reports to him. The Board of Hospitals is appointed by the mayor and is the policy—making arm of the Department. The members of the Advisory Council of Medical Boards are elected by the medical boards of each institution. Except for those institutions where contractual arrangements with universities or 140 voluntary hospitals provide otherwise, all medical staff nominations, promotions, elections and time extensions must be confirmed by the Commissioner before they become final. Few people realize the scope and type of responsibilities of the Commissioner and the Board of Hospitals, as defined in the City Charter. The main points are quoted here as background for the discussion of current events which is the main theme at this meetings “The commissioner shall have all the powers and duties of the department except those vested by law in the board of hospitals.”

“The department shall: 1. Maintain and operate all hospitals, sanatoria, almshouses or other institutions of the city for the care of sick, injured, aged or infirm persons, except as otherwise provided by law, and shall have charge and control of the ambulance service provided by the city and, except as otherwise provided by law, over any psychopathic service for the examination, observation and treatment of persons and any other service maintained by the city for the care of sick, injured, aged or infirm persons as may be assigned to the department or the commissioner by law.

2. Visit, inspect and license in the discretion of the commissioner all private proprietary institutions where human beings are receiving or may receive medical attention and/or nursing care and/or custodial supervision, including private proprietary hospitals, sanatoria, nursing homes, conva1escent homes, 141 homes for the aged or for chronic patients, unless such institutions are non—profit corporations incorporated by special act of the legislature or under the general laws of this state or are maintained or operated by such corporations or are duly licensed under the provisions of the mental hygiene law or of section two thousand five hundred twenty of the public health law. Any such institution shall be subject to the jurisdiction of the department as provided in this subdivision, notwithstanding such institutions may also be subject to the inspection, supervision and regulation of the state department of social welfare. A license issued under this subdivision shall expire one year from the date of issuance thereof, unless, in the discretion of the commissioner, it shall be sooner revoked, and may be renewed. The Board of Hospitals, notwithstanding any other provision of law, is hereby authorized to promulgate and include in the hospital code necessary rules and regulations to carry cut the purposes of this subdivision to protect the public health welfare, which shall, before the same becomes effective, be filed with the city clerk and published in the city record for three days and shall thereafter have the force and effect of law. The establishment and/or maintenance of any such institution without a license therefore as in this subdivision 142

provided shall be a misdemeanor punishable by a fine not to exceed five hundred dollars, or by imprisonment for a period not exceeding one year or by both.”

“The board of hospitals shall have the power and duty to:

1. Develop and maintain long range programs of

hospital service for the care of sick, injured, aged and infirm persons who are the responsibility of the department.

2. Establish and promote the highest possible standards for the care of sick, injured, aged and infirm persons to be complied with by institutions under the jurisdiction of or subject to licensing by the department and by institutions which care for any such persons at the expense of the city.

3. Develop, establish and promote standards and methods for increasing the efficiency of operation, maintenance and management of facilities for the care of sick, injured, aged and infirm persons in institutions under the jurisdiction of the department.

4. Approve the capital and expense budget estimates of the department before submission thereof to the appropriate city agencies.

5. Review, within its discretion, any action of the commissioner with respect to the revocation of a license.”

“The board of hospitals is hereby authorized and empowered to promulgate a hospital code and 143 from time to time to add to and to alter, amend, or repeal any part of such code. Such hospital code shall consist of such rules and regulations, not inconsistent with the Constitution or the laws of this state or with this charter, as may be necessary to carry out the powers and duties vested by law in the department of hospitals and the board of hospitals.” “The board of hospitals may embrace in the hospital code all matters and subjects to which the power and authority of the department extends.” The charter also establishes the Advisory Council, the medical staffs and boards, and the medical house officers. “There shall be in the department, an advisory council consisting of one representative from the medical board of each hospital, or other institution under the jurisdiction of the department, who shall be chosen by such medical board, and seven members appointed by the mayor, who may or may not be physicians. The advisory council shall advise the commissioner in respect to all matters submitted by him and may on its own initiative recommend to the commissioner such changes of administration in the department or in any hospital or institution or service under the jurisdiction of the department as may seem to it advisable.” “There shall be a medical staff for each hospital or institution under the jurisdiction of the department. The medical staff shall be 144 appointed by the commissioner and shall consist of such number of attending and consulting physicians as he may determine. The medical staff of each hospital or institution shall organize and appoint a medical board of such hospital or institution, subject to such general rules as the commissioner may prescribe. Staff appointments may be terminated at any time by the commissioner after consultation with the medical board of the hospital or institution affected, and a vacancy in any staff or board may be filled by the commissioner after like consultation. Members of the medical staff who are serving on the in—service of a hospital as part—time clinicians shall serve without compensation for any service in the wards of the hospital, except that they may accept medical fees for services rendered by them to patients under the provisions of the workmen’s compensation law, or from patients who carry sickness or accident insurance which covers physicians’ fees, or from persons who recover damages from cases in tort, as provided in the regulations made by the commissioner. The commissioner may appoint medical house officers for any hospital or institution under the jurisdiction of the department on the nomination of the medical board of such hospital or institution, and may remove any such medical house officer after giving him an opportunity to be heard.” The medical board of each hospital or 145 institution under the jurisdiction of the department, in conjunction with the superintendent or other head thereof, shall propose regulations to govern the medical procedure therein which, when adopted by the commissioner, shall be observed and enforced by the superintendent or other head of such hospital or institution.” The Department coordinates its work with other departments or agencies through the Interdepartmental Health Council made up of the Commissioners of Health, Mental Health Services, Welfare and Hospitals. The Council has a full-time executive secretary, working subcommittees and advisory committees. Since Bellevue Hospital originally began as a six—bed infirmary in 1736, the various hospital services have gone through two and one—quarter centuries of development, expansion, change, progress, deterioration, reorganization and improvement. Certainly, the current situation is one of the more dynamic moments in medical history in New York City. Never has there been greater public and administrative awareness of the need for change. Never has the Department received so much he1p and encouragement in so short a time as during 1961. Nor is there any reason to believe that this favorable climate will not continue. The mayor’s platform not only covers this Department well, but orders have been issued since the recent elections to press ahead with implementation. Knowing that this is so places a great responsibility on the professions and the 146

Department to make wise long—range decisions in the best interests of the community. It should be kept in mind that the discussion concerns 22 institutions with about 19,000 beds; a current operating budget of about 180 million dollars; a personnel roster, exclusive of house staff and student nurses totaling about 35,000 people; a direct service load of about 275,000 admissions, 2,600,000 clinic visits and 400,000 ambulance trips a year. The average daily home care census is about 2,100 patients. The psychiatric services at Bellevue and Kings County Hospitals admit as many patients each year as the 27 state mental hospitals. The Department collected through insurance, direct payments from individuals and agencies and from other sources about $52,000,000 in 1961. In addition, the Department certifies city charge patients in voluntary hospitals to the comptroller for payment for care from the charitable institutions budget. For 1960, such payments probably exceeded 40 million dollars. Such staggering figures are a sobering influence in overall community planning. Our voluntary hospital system is on the thin edge of solvency and the uncontrolled propriety hospital building boom may push certain of these voluntary hospitals into bankruptcy and force government assumption of more responsibility through direct service or mere subsidy. It is just because of such considerations that the Hospital Council has made its recent recommendations about the various ways in which municipal and voluntary 147 hospitals can and should work together for reinforcement and better service to the community. Little has been said so far about standards of care, yet this is the writer’s main concern —— not only in certain of the municipal hospitals, but in many proprietary institutions licensed by the Department, and in certain voluntary hospitals in which city charge patients are certified for care at public expense. A convenient starting point for review of the changing scene is the appointment by Mayor Wagner of his Commission on Health Services early in 1959. This group of 40 laymen, professionals and public officials was given broad authority to review the health services of the city and to recommend action. The commission had staff, an executive committee, and advisory committees. The executive committee met about 35 times, the full commission six times; there were many other meetings of working groups with advisory committees; a medical audit was conducted in a sample of proprietary nursing homes. Regardless of statements to the contrary, the commission never issued a press release or public statement of any kind. It did file a confidential report with the mayor, who released it intact to the press within two days. The main focus of attention was on the deteriorating situation in the unaffiliated municipal hospitals; problems of house staff recruitment for some; problems of loss of approval of training programs; problems of personnel, maintenance, and coordination of services for all. 148

Serious shortages of house staff were predicted as a result of the examinations given by the Educational Council for Foreign Medical Graduates (ECFMG). The Commission recommended full-time directors of services; affiliations financed by the city; closing or converting to other uses certain institutions; and various other steps to improve the overall situation. Mayor Wagner assigned the Commission’s Report to the City Administrator’s Office for follow—through in the fall of 1960. A number of positive actions were taken in the next several months. The board of hospitals rescinded the “grandfather clause” under which certain nursing homes with less than adequate physical facilities had been licensed, and plans were drawn up in the Department for a Directorship program. In January of 1961 some of the Commission’s predictions came true in a most dramatic way. As a result of failing the ECFMG examination, a substantial number of house staff physicians at the Harlem Hospital were restricted to non—patient care activities. This action came at a time when due to weather conditions, a high accident rate prevailed in a community which normally makes extensive use of emergency room services. The result was an acute manpower crisis and an extremely distressful patient care situation developed. Let us hope that there will never be another. In a city as rich in resources as New York, injured people should not have to sit on benches for lack of stretchers; should not have fractures left unset for five days 149 for lack of physicians; should not lie on stretchers on the floor for lack of beds—yet all this and much more occurred in those gainful days a year ago, largely due to insufficient physicians and technicians. Urgent measures were instituted at Harlem to increase coverage of the emergency room. The administration, looking to the future, supported the Rappleye Plan for installing full-time directors of service in unaffiliated municipal hospitals. The attacks on this proposal are a matter of public record and need not be recounted here, except to say that some of the vested interest issues are still with us. Nevertheless, the Board of Estimate took action in providing funds early in 1961, which the mayor augmented in his 1961—1962 expense budget and for the first time in the history of New York City, the Department of Hospitals was ready to move on a basis of money in hand to realistically finance direct appointments or affiliations. Much credit is due to my predecessor, Jr. Morris A. Jacobs and Dr. Willard Rappleye, member of the Board of Hospitals, for their leadership in this new venture. Earlier in 1961, Mayor Wagner also appointed a Task Force to further expedite necessary changes. The Task Force is a sma1ler group than the Commission and has larger representation from the local governmental units essential to progress. The Task Force meets twice a month, has consultants, reviews problems and recommendations, 150 and arts accordingly. As a mechanism for bringing together department heads, key members of the mayor’s cabinet, laymen and professionals interested in health services, the Task Force serves a very useful purpose. When the writer became Commissioner of Hospitals on an interim basis on March 1, 1961, he was assured of strong support by the mayor, who simultaneously announced a program of action he wanted to have implemented. The events of the past ten months speak for themselves and are a credit to the mayor’s determination to get the medical and hospital problems in New York City squared away. His recent announcement of the writer’s reappointment again affirmed his strong support and the cooperation of those key elements in governmental progress—the City Administrator, the Budget Director and the Personnel Director, all of whom have been exceedingly helpful. The critical problems facing the Department in March of 1961 had been illuminated by its annual reports, the Visiting Committee of the United Hospital Fund, the Commission on Health Services, minutes of the medical boards of the various hospitals, inspection reports of the State Department of Social Welfare, and special reports and studies of various interested agencies. The number one problem, of course, was an adequate supply of physicians in the unaffiliated hospitals. Seven of the municipal hospitals are manned by universities and the public is fortunate that this is so. This group, on an overall basis, has relatively few medical manpower problems. The remaining 15 hospitals have been experiencing varying degrees of difficulty in maintaining adequate numbers of attending staff and/or house staff. New York, which was once the largest center on which young physicians converged from all over the world for training in both municipal and 151 voluntary hospitals, now must compete against a national network of approved graduate training centers in the face of a relative shortage of national and foreign graduates to fill the available openings. Not a single American—trained intern has been recruited by an unaffiliated municipal hospital through the matching plan for several years. However, the Department does not hold the view that all of its institutions must be manned by interns and residents, no matter what their background. In the writer’s opinion, the so- called house staff shortage for the average hospital in America is a myth; patient needs should be met by the attending staff taking turns being on duty or by physicians with adequate training paid to be house physicians. New York City’s problems have been compounded by the large number of institutions it operates. No other city has gone so far in making municipal hospitals available so close to local communities. It is paradoxical in the face of so much effort to provide service that the forces of history were eroding standards of care. At any rate, it is quite clear that New York City should not build any more unaffiliated municipal hospitals, aid that the present system needs reorganization in the interests of improved patient care. Certain steps have been and are being taken by the Department to deal with the medical manpower problem. First, the mayor made $1,200,000 available beginning last May 1, to employ part—time 152 physicians for ward service. Each unaffiliated hospital was authorized to recruit as many as necessary. Coney Island, Fordham, and Harlem appointed between 40 and 65 each. Altogether, more than 250 were employed in the entire system. As a result, only one department in one hospital was forced to stop admissions for a few days in July. At least three hospitals are now served entirely by voluntary and paid attending staff without any attempt at maintaining an intern and resident training program. Since it is a policy of the Board of Hospitals that such physicians must have completed an approved residency training program, it is not surprising that comments have been made about the sudden improvement in patient care. In those hospitals where qualified physicians, interns and residents are working the same ward, each hospital is experimenting with its own method of administering the program. The Advisory Council of Medical Boards has been asked to evaluate the various schemes. Looking ahead to the next training year, certain hospitals which are still unaffiliated but attempting to maintain a house staff training program are exhibiting what is now regarded in the Department as the first symptom of a fatal organizational disease. Not only will they have no interns, but recruitment for the first year residency in medicine and pediatrics is not at the level of previous years. There is no difficulty in recruiting residents for surgery or in obstetrics and gynecology, although few are graduates of 153

American medical schools. While we have an international obligation, a real question can be raised as to whether we discharge it in a satisfactory manner by maintaining intern and residency programs rejected by graduates of our own medical schools. This appears to be an unintentional form of segregation. Within the past few weeks one director of a major service in an important but unaffiliated hospital has advised the Department that he expects to have no house staff next year and has submitted a table of organization for full-time and part—time specialists to man the service 24 hours a day. This positive approach unmarred by false pride is refreshing and will receive the whole-hearted support of the Department. It can be anticipated that more of this type of coverage will be required. A second approach to reducing house staff requirements has been to close or change the functions of certain hospitals. The Gouverneur Hospital on the Lower East Side of Manhattan was the first to close its in-patient service. An obsolescent plant, loss of affiliation, loss of residency approvals and loss of accreditation, together with staffing problems raised serious questions as to the wisdom of maintaining the in- patient services. After intensive study by a panel of consultants and a decision by the medical board not to go on, the in-patient services were closed. However, the clinics, emergency room, home care and ambulance services are essential in the area 154 because of its cultural and economic characteristics. The Department and the writer are deeply grateful to the Beth Israel Hospital for assuming the responsibility for these services on a contractual basis for a three—year period. The residents of the area are fortunate in this guaranteed arrangement whereby all services will be rendered by qualified specialists and by residents in approved training programs under a full-time director who has been appointed by Beth Israel to supervise the services which began on December 1, 1961. We will have cooperative services with the Health Department and the entire approach to comprehensive local care carefully integrated with good general hospitals offer an interesting, opportunity to assess total care needs. Almost nine months have passed since Gouverneur was closed. It is reassuring to note that there is no lack of hospital beds to service the people on the Lower East Side. Yesterday morning Bellevue Hospital had 579 empty general care beds, Beekman Downtown Hospital 27 empty ward beds, and Beth Israel 61 empty ward beds, to name only three of several hospitals serving the area. Furthermore, Beekman Downtown Hospital is planning an expansion program. Another facility where changes have been in the making is Sea View Hospital. A monument to progress in the control of tuberculosis, Sea View today is a collection of old empty buildings together with one excellent facility and supporting services. The hospital has been 155 combined with Farm Colony into the Sea View Hospital and Home and admits chronically ill and nursing home type patients. Medical care is provided by a substantial team of qualified specialists, largely from Staten Island. Somewhat similar changes are underway at Goldwater Memorial Hospital where an outstanding “homestead” care demonstration has been going on under the auspices of Dr. Howard Rusk and his associates. It is planned to expand this type of care. The writer considers Fordham Hospital to be on probation and will assess its progress periodically. On another note, several activities are concerned with other changes in the services for which the Department or other departments making up the Inter-departmental Health Council are responsible. For many years the Health Department has been involved in standard—setting activities under the crippled children program, the medical rehabilitation program, the maternity and newborn program, etc. More recently, the Interdepartmental Health Council has had an advisory committee on amputee services which has recommended thirteen institutions as the first to be designated as approved amputee services. 156

REMARKS FOR THE OFFICIAL DEDICATION OF GOUVERNEUR HOSPITAL1

By Dr. Gustavo DeVelasco2

Honorable Mayor Lindsay, Dr. English, Distinguished Guests and Members of our Staff and Community: We are assembled here this morning to render homage and tribute to the people of the Lower East Side. The New Gouverneur Hospital is today a happy reality, and stands as the symbol of the people. It is the culmination of a long period of struggle by our community to build a hospital for the people of the Lower East Side. This Hospital begins a new day in the era of community health care for our community and for our nation. It is a time of hope, of joy, and a time to renew our energies for the job to be done in the years ahead. As the Executive Director of Gouverneur Hospital, I solemnly pledge to serve you and your families and to develop and promote programs to improve the whole spectrum of health services in the Lower East Side. This I can only achieve with the support, cooperation and assistance of this community, whose faith, devotion and tenacity is a milestone in the history of our country. Together we will demonstrate that only an Institution with strong roots and involvement in the community will be able to develop a system of health care which recognizes no barrier, entertains no excuse, and pursues every avenue to the betterment of our people, our neighbor- hood and our community. You should look upon me as the servant of the people, as the protector of the patient, and as the advisor, friend and developer of the staff. The community and I will form an alliance as I commit my allegiance to the people. We, at Gouverneur, will offer to our community much needed

1 Official dedication of Gouverneur Hospital, September 21, 1972. 2 Executive Director of Gouverneur Hospital 157

medical and social services, employment opportunities and economic improvement. No one will be turned away from our door and we will serve everyone regardless of race, creed, color, national origin or economic circumstance. We, on the Lower East Side have a right to be proud of our untiring effort. Our community has fulfilled the highest ideals of a democratic country by demonstrating that people of different backgrounds can come together to pursue a common goal. Our hospital, therefore, is truly a people’s hospital. Gouverneur symbolizes the dawn of a new community spirit, and the health care of our people will be our first and foremost concern. Working together we will not seek either personal glory or material riches, but to paraphrase a famous saying: we will test our progress, not by adding abundance to those who have too much, but by providing enough to those who have too little. My deepest appreciation to all of you for your attention. May God stand by us and grant us success.

GOUVERNEUR HOSPITAL: A NEW PHILOSOPHY July 31, 1972 heralded the beginning of a new era of community medicine in the City of New York. After a twenty-year struggle to secure responsive and quality comprehensive health services for the people of Manhattan’s Lower East Side. Gouverneur Hospital opened its doors to its community. Established specifically by the New York City Health & Hospitals Corporation as a model community hospital, Gouverneur serves a diverse ethnic population that had suffered too long from inadequate health services.

Gouverneur brings forth a new era of consumer medicine, which fosters communication, understanding and a spirit of cooperation between the providers and consumers of health care services, inviting the participation and involvement by the community in 158

decisions which affect them, recognizing that quality health care is a right to be had by all — regardless of race, color, national origin, creed or economic circumstances. Gouverneur, since its opening, has worked to achieve a partnership for change with its community. Not only does Gouverneur invite community participation in the decision-making process, but actively pursues participation through both formal and informal communication channels. Gouverneur has drawn upon the community’s historic ethnic diversity to mold common solutions to common problems. Mechanisms have been established through which community residents, professional staff and other health related personnel can come together to improve the area, not only in health relates tasks but in a multitude of socially desirable endeavors. Although it is realized that Gouverneur cannot deal with all the problems of the multi-ethnic Lower East Side, the hospital directs its programs within the concept of a total health scheme, hoping to treat the cause of the disease and not just the symptom. Gouverneur Hospital is dedicated to the Lower East Side Community and strives to forge, through the cooperation with other community institutions and individuals, mechanisms for the improvement of services and conditions on the Lower East Side.

A GLIMPSE INTO THE PAST Gouverneur Hospital has deep roots and a long history entwined in the Lower East Side community. Originally founded in 1885, Gouverneur’s first home was an abandoned police garage on Gouverneur Slip at South Street. The hospital has since grown from the time one visiting physician and surgeon, one consulting surgeon and a house staff of three interns comprised its medical staff and since the days when the out-patient department cared daily for 150 patients. Even before fire destroyed the first Gouverneur, the 159

community’s swelling population made necessary the construction of a new larger hospital in 1895. Construction began three years later, on Cherry and Water Streets, and the main part of the building was opened in 1901, with a bed capacity of 100. Construction continued until 1908 when two additional wings were added with a central connecting building which enabled the hospital to double its bed capacity, and a new three story out-patient facility was constructed across the street from the hospital on Gouverneur Slip. However, as time progressed and the Lower East Side community grew, the need for a comprehensive modern facility became increasingly evident. The community joined forces in a determined campaign, which was to last twenty Iong years, for the building of a new facility, and finally, after great frustration and struggle. Gouverneur Hospital was conceived. The construction contract for the present thirteen-story building was awarded in May 1967. Joyously, on July 31, 1972 the New Gouverneur opened its doors for emergency and out-patient services to its people, becoming the eighteenth municipal hospital to join the municipal system and the first hospital opened by the Health and Hospitals Corporation.

IN RETROSPECT: THE FIRST FIVE YEARS The new Gouverneur did not enjoy an easy, painless birth. Political expediency and self-serving vested interests attended its delivery. The original plans had been redrawn more than a dozen times and with each new draft, it seemed that some very necessary and desirable service was eliminated. When the hospital was opened for in-patient services on November 8, 1972, it boasted 206 beds for Rehabilitation Medicine, Medicine, and Pediatric services. The 160

greatly needed surgical and obstetrical services which remained the focus of an intense campaign for the next four years and would enable Gouverneur to fulfill its role as a “total” hospital, had been omitted. While Gouverneur did not enjoy an easy birth, neither did it enjoy a fruitful and flourishing youth. Rather, three and one-half years of our first five were haunted by pitfalls and obstacles, intensified by the financial crisis that beleaguered our city. These three and one-half years changed the face of our hospital considerably, although it did not daunt our spirits or dampen our hopes. In fact, the determination and unity of staff, community, community board, community leaders and elected public officials, bolstered Gouverneur to survive the many uncertainties that were to eventually befall it.

THE SUCCESSES: THE STRENGTH OF COMMITMENT Although characterized by uncertainties, Gouverneur’s accomplishments during this time testify to the determination and spirit of its staff, community and avid supporters. The establishment of Gouverneur Hospital’s Community Board, on June 6, 1974, culminated over a year of planning and enabled Gouverneur to fulfill its role as a true community hospital. The election brought more voters to the polls than any other municipal Community Board election and insured direct participation and involvement from the community in hospital activities. A total of 7,296 votes were cast, which doubles the highest number attained in any other city hospital with a much larger population. Among the most impressive and rewarding accomplishments was Gouverneur’s earning a full two-year accreditation by Joint Commission for Accreditation of Hospitals, awarded after the inspection conducted in July and August 1975. As only 45% of new 161

institutions receive full accreditation on the initial effort, this award was truly a recognition of the outstanding performance and high standards of care maintained by Gouverneur. New programs became available during this time, to the benefit and well-being of Gouverneur’s patients. Among the expanded services was the WIC Program. Inaugurated in April 1974, Gouverneur was the first municipal hospital to develop the program. Funded by the Department at Agriculture, women, infants and chil- dren were able to receive free supplemental food allowances for staple necessities such as juice, milk and cereal. By December 1975, the program had received additional funding so that 3,200 participants in our community could benefit by this program. Although economy was of the essence, Gouverneur still possessed the ability to respond to the needs of its community. In record time, Gouverneur opened its Skilled Nursing Facility on the tenth floor, which at the time accommodated 40 patients. Later, upon the termination of in-patient services, the Skilled Nursing Facility was expanded, again in record time, to its present 194-bed capacity. The efficiency and ease of the rapid expansion of this unit is once again an accurate reflection of the high caliber and commitment of the Gouverneur staff. To further testify to the success of the SNF, a recent N.Y. State Department of Health inspection awarded Gouverneur a “Good State” rating, the highest achievement possible. Perhaps the most far-reaching success born out of the turbulence of the times was the new and welcomed professional affiliation with New York University Medical Center, effective July 1, 1976. All services not offered at Gouverneur would be available for our patients at Bellevue Hospital by direct referral from Gouverneur. This new arrangement has made available to Gouverneur’s patients enhanced and improved health care services and brought to Gouverneur, a new, intense spirit and unity. At long last, Gouverneur 162

was now one hospital united by one staff.

A TRUE COMMUNITY HOSPITAL For the first time since its birth, Gouverneur was about to assume its true function as a community hospital. Stabilization, after years of setbacks, was a welcomed relief. Although out-patient visits had declined amidst rumors that Gouverneur would be closed, gradually Gouverneur’s patients returned and surpassed those levels achieved in previous years. New programs were developed and implemented that further integrated Gouverneur with its community, bridging a health care gap in our schools, settlement houses and other community institutions. A school health screening program brought health care closer to our community’s young by arranging directly through the local schools a program which includes vision, speech, audiology, pediatric and dental screening. Since implementation of this new program in March, until Summer recess, over 300 children visited Gouverneur. The need for this type of health care was evidenced by the fact that over 350 follow-up visits were recommended for these students by Gouverneur’s health care team. This is only the genesis of an ambitious outreach into our community. As a result of Gouverneur’s sensitivity to the needs of the community, numerous Lower East Side organizations and settlement houses now benefit from the services of trained Gouverneur staff who assess the health needs of the organization’s membership. Liaisons disseminate health education literature, discuss services, and answer inquiries. Staff provides direct physician appointments, the convenience of pre-registration and assistance for transportation and streamlines other aspects of the health process. At long last, Gouverneur services are readily accessible to its community. Free health programs have also brought accessibility of our 163

health care closer to our community. A free vision screening and glaucoma and cataract testing program held by Gouverneur in Chinatown recently introduced over 200 patients to our Ophthalmology services. Gouverneur’s participation at the Henry Street Festival included free blood pressure testing and tine testing to the festival participants, as well as the opportunity to learn more about our Social Services, Mental Health Department, Podiatry, and Dental Services. Gouverneur Week festivities were highlighted as well, with Health Day, where free chest x-rays, vision screening, and blood pressure testing were made available to our population.

THE STRUGGLE RENEWED Gouverneur opened triumphantly in 1972 under a very supportive leadership, but by early 1974 a change in administration at the Health and Hospitals Corporation brought a change in tide for Gouverneur Hospital. Since then, Gouverneur has been continually faced with adversity and harassment. Decisions thereafter were made by the corporation, not on sound economic and financial basis, but strictly political and discriminatory, with consideration to need and utilization levels, aimed at eliminating Gouverneur Hospital. By the end of 1974, Gouverneur had been penalized with a severe budget reduction imposed by the Health and Hospitals Corporation and suffered a loss of Mental Health Funds and a reduction in the HEW grant. Barely six months afterwards, the onslaught had moved into full swing, plagued by repeated attempts to reduce services and slash Gouverneur’s operating expenses, albeit increased revenue due to higher utilization. Among the services slated for elimination were the highly utilized and effective Podiatry and Dental clinics. However, combined action taken by Gouverneur’s executive director, the community board, leaders of the com- munity, and elected public officials saved these vital services. But, by the end of 1975, through further arbitrary budget reductions, attrition and lay- offs, Gouvemeur had been deprived of over 3 million dollars in its operating expenses. However, the nightmare had just begun. On January 22, 1976 the Board of Directors of the Health and Hospitals Corporation 164

approved the three year plan presented by its then president. The plan called for the elimination of Gouverneur’s In-patient and Emergency Room Services. Although a 7.49 million dollar savings as projected by the Health and Hospitals Corporation, in reality only 1.2 million dollars could actually be realized. Nothwithstanding the numerous studies, in-depth analyses and reports submitted by Gouverneur proving the irrationality of this proposal, or the recommendations of committees appointed by the Health and Hospitals Corporation advising that these services be retained, the Health and Hospitals Corporation proceeded with their plan of devastation. While the emergency room was an integral component of the well-being of the community, and in-patient occupancy averaged at 80% utilization, forces were bent on eliminating these services. By July 1, 1976, the in-patient service was no longer operational and the Emergency Room was converted to a general care clinic operating 24 hours, seven days a week. Still the hounding would not cease. While Gouverneur looked to the new fiscal year with hopes of stabilization, new threats soon haunted us. Now Gouverneur was faced with the elimination of laboratory and radiology services, and plans were initiated to turn Gouverneur into a satellite of Bellevue Hospital. However, the combined efforts of Gouverneur’s Executive Director. Community Board and community supporters and elected public officials once again averted tragedy.

A TURN FOR THE BETTER! A NEW LIGHT Gouverneur’s constant efforts for support and understanding were realized in May 1977, when a new dynamic leadership assumed the reins at the Health and Hospitals Corporation. Gouverneur was the first hospital visited by the new leadership, and since then, meetings with Health and Hospitals Corporation have proved promising and 165

rewarding. That the new leadership has realized that the attrition of another 1.5 million dollars for Gouverneur is unrealistic and destructive is a most welcomed success. The Health and Hospitals Corporation has now guaranteed Gouverneur’s continued existence and its effective support to the extent of reassessing our true needs to provide ambulatory services and skilled nursing care with appropriate resources. Concurrently, Gouverneur’s hopes are slowly being bolstered, reinforced by the recent approval to replace greatly needed professional staff and the prospects of the re-awarding of an HEW Grant, in support of our Out -Patient Services.

AS WE LOOK TO THE FUTURE Perhaps Gouverneur’s greatest enemy has now been conquered. Three and one-half years of regression, hardship and sacrifice have finally yielded to a welcomed and needed stabilization. Great effort and pain bore this stabilization, and it is greeted with relief and optimism. Stabilization is a time to muster energy, to assess and plan for future. Just as it required great strength and fortitude to achieve, it takes great strength and fortitude to maintain. Gouverneur has achieved what many might deem the impossible. But Gouverneur has not yet accomplished what it is indeed most capable of achieving. This is Gouverneur’s future: to continue to conquer, to continue to build. From stabilization, will spring progress and growth. For it is Gouverneur Hospital’s dream —and commitment — to provide for the people of the Lower East Side, a total comprehensive health care facility. 166

Speech delivered August 3, 1977 commemorating the Fifth Anniversary of the Official Opening of the new Gouverneur Hospital

Hon. Mr. Sutton, Dr. Imperato, Honored Guests, and distinguished friends and colleagues: I am indeed honored to accept these Proclamations from our Honorable Borough President, Mr. Percy Sutton and from the esteemed Commissioner of Health; Dr. Pescal Imperato, on behalf of the Hon. Mayor Beame and City Hall; and thank you both for honoring Gouverneur with this celebrated distinction. Your participation this morning fills us all with pride, and the Gouverneur staff and community are privileged to be able to share our fifth anniversary with such distinguished friends. I accept these Proclamations for all of us here today, for we all, together, have worked incessantly so that Gouverneur can achieve this fifth dedicated year of service to our community. Your presence here today makes this special occasion even more significant and meaningful. It is a pleasure to welcome you this morning to our hospital, and I am enthused that you were able to join me to usher in the beginning of our sixth year of dedicated service. We have come a long way, and have traveled a winding and hazardous road, pitted with obstacles and detours. But, finally, after five years, we now glimpse the light at the end of the tunnel. Hopefully, the darkness, which has shrouded us and plagued our existence will be replaced by renewed light, challenge and hope. And may today—a day shared by trusted friends, be the beginning of our new era of stability. May we continue to work together so that the stability we now expect to enjoy will burgeon to growth and progress. For twenty arduous years, the people of our community have labored and struggled for Gouverneur Hospital. Today we have five years behind us, which testify to this incessant struggle for survival. And of this lustrum, three and one-half years have certainly been marked by bitted battles so fierce that not even budget slashes, deletion of our in-patient services and closing of our emergency room, and staff lay-offs could not force us to yield. Our strength has been derived from you—our trusted supporters, our devoted patients, our dynamic elected representatives, our stalwart community leaders, our concerned and assertive community board, and as a special citation, our devoted and dedicated staff. Gouverneur’s success is your success and each one of you can take pride in helping Gouverneur reach its fifth birthday. Throughout the past years, we have guided Gouverneur through its painful growing stages and infancy so now to reach our flowering adulthood. As we approach full bloom, may the memories of our past and the lessons they bore, remain vivid and guide us. Our future, as demonstrated by our past, lies in our undaunted determination and commitment to soar to its greatest height, and elevate us, proud that success has no alternative but to be ours! 167

This morning commemorates that day five years ago, on July 31, 1972, when the new Gouverneur officially opened its doors to all the people of the Lower East Side for comprehensive Ambulatory Health Care Services. As we approach the upcoming month, we mark another significant event, which we expect to celebrate with even greater fervor—our re-dedication. On September 21, 1972, Gouverneur Hospital was officially dedicated by the Mayor of the City of New York, and became the first hospital opened under the auspices of the New York City Health & Hospitals Corporation, with a strong community base and participation. We look forward to this event—and plan our rededication ceremony on Tuesday morning, September 20, 1977, followed by a week of cultural—health-related—activities commemorating our official birthday. I hope as we rededicate ourselves to serving the people of our community. Today, I am especially proud to be the Executive Director of Gouverneur Hospital. I am proud, that over five years ago, the people of this community demonstrated their faith to entrust me with their hospital—the fruit of their twenty years of sweat and labor. Today, I am proud that, with your constant support and cooperation, I defied those who threatened to destroy us, so that we may survive to celebrate this day. Today, all the long hours of struggle, all the frustration and crisis, all the defiance and uncertainty have been rewarded. Today is a day of our complete satisfaction, that has made my every effort and sacrifice worthwhile. For today is our triumph and today we celebrate a shared victory in which we all may rejoice. We may also rejoice in that, finally, a new very promising leadership has emerged at the Health & Hospitals Corporation, which has guaranteed Gouverneur its continued existence and its effective support to the extent of reassessing our true needs to provide ambulatory care services and skilled nurses care at Gouverneur, with appropriate resources. This Administration will give Gouverneur a new life, comforted by a welcome stabilization and invigorated by the opportunity to march ahead to growth and progress. For this is Gouverneur’s year of decisive action, and together, we will regain momentum and surge onward into a new era of prosperity, aimed at attaining our noble goal to serve all the people of the Lower East Side. We have surpassed survival only through the dogged persistence, perseverance, and personal sacrifice of those who envisioned a comprehensive health care service for our people. It is a commitment that will pave our future. May this commitment burn within us always, inspiring and motivating, so that Gouverneur will be infused with a spirit of rebirth and renewal, so that our patients and community will continue to be served with compassion and dignity, and so that together we can offer a shining example of courage and determination to our city. May 1, once again, thank you—you who made these five years a reality—you who built and saved and preserved Gouverneur Hospital. 168

By: Dr. Gustavo DeVelasco Executive Director 169

Health/PAC Bulletin, Summer 1993 Coming Full Circle: Lessons from Health Care Organizing XXIV. Terry Mizrahi

What a wonderful opportunity to use the 25th anniversary of Health/PAC to reflect on my own 25 plus years of health organizing and comment on the opportunities and challenges that lie ahead. The Bulletin has provided sustenance to many of us; it keeps us going—and we use it to impart to a new generation our collective experiences and visions. While I remembered being there at Health/PAC’s “birth” in its very first office on lower Broadway, I was truly surprised when I reviewed my early Bulletins to uncover so many connections so early on with Robb Burlage, Oliver Fein, Dave and Ronda Kotelchuck, and Barbara Ehrenreich, among others of the early Health/PAC staff. As a young health organizer, I was one of the people whose work Health/PAC sought out as a “laboratory” to test their theories. However, Health/PAC was more than a think tank—it conducted action research at the same time that many of its members helped create and influence the direction of the health care debate. But the Health/PAC founders never pretended to be “organizers” in the elitist mode of moving into communities taking over campaigns, or supplanting the efforts of local organizers and activists. Rather, they were there as supporters, advisors, participants, and as learners. The relationship between Health/PAC and the community organizers and leaders with whom they interacted was one of reciprocity and exchange—each of us learning from and educating the other. I was a trained community organizer right out of social work school who went to work for the Lower East Side Neighborhoods Association (LENA) in late 1966. I was hired and mentored by Ana Dumois, a consummate organizer (who is quoted in the first Bulletin 170

in June 1968) with NENA (North East Neighborhood Association), an affiliate of LENA and the first community organization to receive federal funds to plan and operate a neighborhood health center. The NENA health center became a model for the country. (Several articles appeared in Health/PAC Bulletins about NENA’s development over time, beginning with one in its second issue.) It had great potential, but also had a rocky history over the years. Nevertheless it has survived and still provides needed health care to thousands of Lower East Side residents.

XXV. The Struggle for a New Community Hospital Although I lacked any prior interest in health issues, my first assignment was with LENA’s health committee to investigate why the building of a new Gouverneur Hospital on the Lower East Side—promised ten years earlier to replace an old inferior one that had been dosed by the city—had been stalled. My job was then to organize another campaign to obtain the new hospital, which had been promised the Lower East Side community first by Mayor Wagner and then by Mayor Lindsay. LENA had spearheaded that movement in the late 1950s. Ten years had passed, and there still was nothing but a hole on Madison Street with only a sign to indicate that it was to be the site of the new Gouverneur Hospital. In the next six weeks, I became an instant expert on health politics as well as health organizing, in ways I hadn’t anticipated. My personal reaction to the Gouverneur assignment provided a clue as to one of the primary difficulties inherent in organizing around health care: people don’t believe they can effect change. I had never been sick myself, and I thought that only doctors and other health professionals had the expertise to understand health problems. I learned that it is difficult to get people to identify with a health issue when they are healthy. It also became clear that it takes a great deal of community education to convince people that their familiarity with and stake in the health care system as consumers and as community residents gives them as much legitimacy and expertise as the bankers, businessmen, and other lay people who usually sit on the boards of directors of hospitals. Nevertheless, we were able to obtain 10,000 signatures on petitions, which we presented at a rally of several hundred people to then Manhattan Borough President Percy Sutton.

The Power Brokers The second major difficulty in organizing around health I uncovered 171

unintentionally; it is the veiled and private nature of the health power structure. It was still a few years before the appearance of The American Health Empire, and while a “two-class” system of health care was dearly evident in the Lower East Side community, it was not yet fully understood. In the course of negotiating for the new Gouverneur Hospital, we attended a meeting at the borough president’s office. We would also be meeting with the commissioner of hospitals, Howard Brown, a progressive leader in health care reform whom we expected would be an ally. When we arrived, the room was filled with several additional white men. They were from Beth Israel Hospital and from an organization I had never heard of then, but which, in fact, was one of the most powerful players on the health care scene: the Hospital Review and Planning Council of Southern New York. (The private, corporate nature of the HRPC was also discussed in the first issue of the Bulletin in relation to its desire to become the health planning agency for New York City.) It turned out that Beth Israel, as a voluntary hospital, had secretly been given control of the new Gouverneur facility. The HRPC had killed the plans for a new hospital and, unbeknownst to anyone in the community, approved the Gouverneur site instead for a long-term care nursing home facility. It was then that I learned, what Robb Burlage would soon expose in a Health/PAC report on the New York City municipal hospitals: namely, that through affiliation contracts, the private teaching hospitals controlled the public sector. Moreover, as a private body with quasi-governmental authority to approve new facilities, the HRPC was dominated by the private hospital interests and not directly accountable to the public for its decisions. This one meeting opened all of our eyes to the power of the so-called “voluntary sector” and the weakness of the public hospital system. Needless to say, LENA and its affiliates were outraged, and we began to organize a campaign to take back the 172

planning and direction of the facility. Enter Oliver Fein and Robb Burlage from the newly formed Health/PAC, to hold the historic first Chinatown Health Fair on Mott Street in 1971. This led to a series of community health initiatives, culminating in the thriving Chinatown Health Clinic that still serves the Chinese community in the greater New York area today.

XXVI. Forging Ahead Space does not permit me to go into detail about my third area of overlap in organizing with Health/PAC in the late 1960s: a city-wide coalition to ensure that the first comprehensive health planning agency established in New York City under the Comprehensive Health Planning Act was a public, community-based agency instead of the Hospital Review and Planning Council. This exciting and significant effort resulted in a partial victory, officially defeating the private sector but with limited ability to affect their power outside the Comprehensive Health Planning (and later Health Systems Agency) structure. From my history of professional organizing in health care, I have learned that several components need to be in place for successful health change to occur. First, competent organizers are needed who can mobilize people and sustain their involvement in health-related struggles. Funds must be available to pay organizers to assume this function; otherwise, other community agencies need to make staff available to fulfill that role. Second, we need competent and committed government officials who believe in consumer and community involvement in health affairs and who are willing to enforce or develop regulations that mandate an open process. The final component 173

is a few community leaders and patient advocates who understand the complex health system and are willing to challenge professional authority. The connection between the past and present continues to amaze me. So many of us continue in our own ways to advance the issues of social and economic justice. This country is on the brink of either real change in health care or missed opportunity—one more time. While the “grassroots” movement for health reform has been lead primarily by a coalition of labor and senior citizen organizations, along with some consumer and public interest groups, after 25 years it still remains extremely difficult to actively sustain the involvement of groups in low-income neighborhoods or communities of color around health reform. Yet we keep forging ahead in this era of cautious optimism.

Terry Mizrahi is a Professor at the Hunter College School of Social Work of the City University of New York as well a Director of the Education Center for Community Organizing at Hunter, and co-chair of the Health Care Policy Network of the New York City Chapter of the National Association of Social Workers. 174

National Civic Review, June 1980 A Municipal Hospital System: Myths and Realities Jewel BelIush

Almost 20 years ago Wallace Sayre and Herbert Kaufman, in their monumental study of New York City, warmly praised its government as an innovator and provider of “indispensible facilities” and services for the community and its people. Among the special wards for living within its borders, the city provided free education from kindergarten through college; built an extensive park system, and subsidized world-famous museums, botanical gardens, a distinguished library system and three zoos. At the same time, needy citizens were assured common basic standards of health and hospital care through pioneering facilities in all five boroughs. While New York City is often considered unique—particularly its maze and scope of activities—it can also serve as a laboratory of ideas. It has on many occasions been a pacesetter for local and state governments throughout the country with experiments in decentralization of education and community planning, its system of higher education, and its innovations in health and public hospitals. The problems which have developed over the years are indicative of difficulties elsewhere—financial woes, suburbanization and the loss of the middle class, deteriorating services, changing neighborhoods, newcomers in need of support, and increasing numbers of senior citizens requiring attention. The public hospital system now suffers from increasing fiscal pressures which make the maintenance of high quality service difficult. What happens and how the problem is resolved in New York has relevance for many cities. For example, how are we going to provide decent health services for an urban population unable to pay and which is, increasingly, faced with the serious problem of doctors disappearing from neighborhoods? The conservative spirit now sweeping the country has enveloped New York, presenting a serious challenge to its many accomplishments and rich experience with innovative programs. One result has been an organized, but far from informed, attack on the public hospital system. The strategy of those leading the battle to curtail, if not destroy, the hospital facilities has been, at times, a subtle one. It has reached, all too successfully, into the media, creating confusion and undermining public confidence. The major 175

arguments against the municipal hospitals are largely based on five major fallacies or myths: (1) the city can do without its municipal hospitals; (2) city bureaucracy strangles the public sector; (3) municipal hospitals are physically inferior; (4) the proposed cutbacks will save money; and (5) the city has a long-range plan, based on organized research.

Myth #1: The city can do without its municipal hospitals. Accord- ing to Dr. Martin Cherkasky, director of Montefiore Hospital, a voluntary institution, and the mayor’s special advisor on health care and hospitals, “there is no reason for city-run hospitals any more.” The “charity” patient no longer exists since medicare and medicaid have “made everyone a ‘private patient.’” According to his argument, care is provided to the very “population the municipal system was designed to serve.” And the 10 percent not covered are purportedly picked up by Blue Cross and other third-party insurance plans. This is simply not true. A substantial portion of the poor will not be serviced if city hospitals are closed. In fact, these hospitals cannot deliver all the care demanded of them in the poor communities in which they operate. Day and night, their clinics or emergency rooms are often filled beyond capacity. Seventeen units make up the hospital system. These provided 6,843 beds, some 20 percent of the total in the city. The public use of emergency rooms and outpatient clinics, however, represents an exceptionally heavy demand. A portion of those serviced are the city’s poor. Another group, the “self-pay” patients, i.e., those working people who are medically indigent, with little or no insurance, will be hurt even more. There are at least 1.4 million of them. A good number earn just above the welfare eligibility level and simply are unable to pay hospital bills, often over $2,000. Even individuals eligible for catastrophic medicaid coverage must, initially, 176

pay a quarter of their yearly incomes on medical costs. It is no secret that the voluntary hospitals do not want them, since bill payment is a risky venture. And disadvantaged populations are not the only ones utilizing the system. Municipal hospitals provide care for a substantial number of middle class people, as well, including police and firemen hurt on duty, office workers and visitors to the city. In the outpatient departments, more than one-third of the users have little or no third-party coverage. For the emergency rooms, the figure is over 40 percent. The municipal system is for these people, then, the provider of last resort. All who need attention are admitted, which is not the case with voluntaries, which have been known to refuse patients who appear unable to pay. (These hospitals are required, by federal law, to provide a minimal amount of free or below-cost care in exchange for construction grants.) Municipal hospitals are not simply places for patients in bed. They are specifically structured to deliver ambulatory care for the poor and medically indigent, including x-ray and cobalt therapy, radium, blood banks, self-care units, a wide range of psychological services, family planning, genetic counseling, dental care and treatment for alcoholism. Having the city hospitals generating these particuIar activities is vitally important in light of the serious shortage of doctors serving the areas in which they are located. Between 1970 and 1976, there was an increase of 5.8 percent in emergency room visits and 24 percent in outpatient visits. A breakdown of these figures shows that the largest and most significant change occurred in outpatient visits, which increased by 1,600,000 visits or 53 percent in a six-year period. The closing of a municipal facility would put more pressure on the public and private institutions, which are not prepared to service this substantial clientele. Consequently, the proposals for reducing the size of municipal system simply do not encompass maintaining the services 177

it presently provides.

Myth #2: City bureaucracy strangles the public sector. Those who have voiced public criticism of the municipal hospital system contend that the structure of city government makes it impossible for the facilities to be first rate. Why? “The very nature of the beast,” writes Dr. Cherkasky, “makes it a dinosaur. The city-owned system is bound up by red tape; orders for equipment take an inordinate length of time to complete; assignment of personnel is slow; approvals often involve a host of bureaus and agencies; maintenance or emergency changes required in a hospital are even worse; and on and on it goes. Dr. Lowell Bellin, former commissioner of health, underscored these criticisms when he insisted that we ought to greet with cheers “any detectable trend toward abolishing charity medicine and all its attendant debasement of the human spirit in the municipal hospital…” Admittedly, bureaucratic organization often imposes frustrating and Kafkaesque processes of decision making on administrators— the medical profession not omitted. But both the public and private sectors suffer from this malaise. One can easily recount horrendous anecdotes of inefficiency, incompetence and unimaginative decision making at voluntary or proprietary hospitals. While recognizing and pinpointing frustrating and clumsy decisions resulting from bureaucratic gamesmanship, does this necessarily mean that the public system is useless and no longer worth preserving? Bureaucratic systems have grown in both sectors of hospital care, an inevitable consequence of a highly technical and extraordinarily specialized profession. Blame for slowdowns in service delivery, or a decline of quality care, most often is placed on the shoulders of government bureaucrats. This is too simplistic an explanation. Increasingly, city hospitals are frustrated in their endeavors to deliver adequate care because they are underfunded, understaffed, sometimes inadequately equipped, and suffer from a pay scale which is lower than that of their private counterparts. For example, nurses in private hospitals receive $3,000 more than those in the health and health and hospitals corporation (HHC). As a result, public hospitals have been obliged to hire many who are young and inexperienced. Usually, after three months of training in public hospitals, at public expense, the new nurses shift over to the private sector for the added income. 178

In-patients in municipal hospitals are increasingly without the services of many of the nurses needed on day and night shifts. In addition, because of critical shortages in support staff, registered nurses, as well as interns, have been forced to do clerical work and become messengers, and are pressed into housekeeping and escort assignments which, according to a recent annual report of the United Hospital Fund, “substantially reduces the time left for, patient care. Morale was described as “very low” throughout the HHC system.” For many years, the public system has been on the defensive. Increasingly attacked by leaders with “private” concerns, public hospitals have not only suffered severe budget cuts and planned attrition, but also ripple effects which have ensured a disastrous impact on staff morale and health care. Each successive blow further erodes the municipals’ quality of care. Pulmonary wards have been closed, not for lack of patients or staff commitment, but because of indiscriminate cuts and attrition. Patients at Kings County Hospital receiving renal dialysis are chronically underdialized because of lack of money and staff, not incompetence or neglect. Paring away such special services as laboratories means serious damage to effective patient care. The mere threat of closing down segments of the public system created havoc last year, not the least effect of which was that students graduating from medical schools refrained applying for internships with the HHC. These factors produce a sort of self-fulfilling prophecy of disaster: morale erodes, service slows down, fears mount, breakdowns of vital equipment are neglected or result in interminable delays. This climate of despair and frustration inevitably has an impact on the quality of care and the survival of patients. During the Lindsay administration, the city was pressured to adopt an affiliation plan between select voluntary hospitals and public institutions. The voluntary was, supposedly, to be responsible 179

for medical and administrative functions, including the supervision of medical staff and the sharing of updated educational techniques and developments. Behind this strategy was the belief that, catalyzed by voluntary leadership and supported by its advanced teaching ac- tivities, city hospitals would be infused with higher standards and improved quality. Affiliation, however, has not ensured the benefits promised by its proponents. At times, in fact, the reverse is true. For example, expensive equipment purchased by some municipals was removed for use at their voluntary “guardians.” Patients have been selected for “voluntary” care because of the challenging nature of their illness and/or because of their ability to pay. Red tape, inefficiency and waste constitute the barbs thrown at the municipal institutions. These shortcomings were supposed to be rectified by the affiliation plan. It continues to be the responsibility of the teaching affiliates to offer the leadership and manage the operations of their assigned municipal hospitals. Admittedly, the municipals do have some say over their affairs, but the whole thrust and sales pitch for affiliate arrangements was to ensure improved health care by the city hospitals. In sum, what is strangling the city hospital network is not so much the bureaucratic tangles as inadequate funding, underpaid and overworked staff, and an affiliation scheme which often undermines rather than strengthens the quality of care available at the municipals.

Myth #3: Municipal hospitals are physically inferior. The attacks on the public system during the past decade have fostered a feeling among citizens that conditions are pretty bad. Media often focus on sensational aspects, particularly at public institutions. Except for a few hospitals, municipal facilities are quite good, and, in fact, when compared to the privates, surprisingly superior in many ways. The 180

most modem physical plants can be found at such places as Bel- levue, Lincoln, Woodhull and North Central Bronx. On the other hand, deterioration at the privates is often conveniently hidden from public view. Many voluntaries were built during the nineteenth century and have inefficient layouts, are run by manual elevators and lack the basics for an effective ventilating system. Some voluntaries even have hundreds of unused beds. With such serious shortcom- ings, they are unable to meet state or federal standards. Recently, 13 voluntaries proposed renovation programs, which would require public expenditures running into millions of dollars. Anthony Watson, head of the health services administration, has estimated that, each year, private hospital requests total some $800 million worth of capital construction. Behind the strategy to pare down the city system is the expectation that superior public facilities will be taken over by private institutions. For example, the location of North Central Bronx, adjoining Montefiore, was conceived to serve such a purpose. And now, Woodhull, another municipal installation, is being promised to a voluntary hospital. It is unfair for the public to be fed the illusion that by shifting health care to the private sector the city would be not only improving physical conditions and technical facilities for patients but also helping the city budget. Anthony Watson expects that. “By the time all the construction that’s needed (in the private sector) is done, it will cost at least $2 billion of public money.” Often overlooked are services rendered primarily by the municipal system and performed at a high professional level. The debate over the number of beds has distracted attention from the non-general inpatient services that are rather unique in the city-run hospitals: acute psychiatric care, alcoholic and drug services, chronic care and sophisticated trauma units. 181

Myth #4: The proposed cutbacks will save money. Given the severity of the city’s financial crisis, it has been suggested that “demunicipalization” will help narrow the budget gaps. Mayor Koch’s plan called for closing, or disposing of, half of the municipal hospi- tals. Purportedly, this is to save $130 million of the city’s tax levy contributions to the HHC system. The state health planning commis- sion has drafted a plan which suggests a reduction of more than 5,000 beds in the city. The effects of both proposals have yet to be studied, or indeed justified, as ways of saving taxpayers’ money. We have yet to see a detailed analysis of the system-wide effects of these proposed reductions. Anthony Watson has challenged the plans, seriously questioning whether the substantial savings contemplated can be realized. For example, would free care and subsidized services end with the closing of those hospitals or be shifted to the private system? And then, Watson claims, the survival of the private sector could be secured only “if they receive additional governmental subsidies.” The very characterization of the “private system” is, in some ways, mislabeling the product. From a financial point of view, there is little or no distinction between the public and private hospitals depend on public moneys—city, state and federal—of their budgets. With third-party reimbursements income depends on public or third-party funds primarily insured patients, with some 15 percent paid by Medicaid. In addition, many voluntaries have been operating with a deficit despite the fact that the public system has picked up the tab for non-paying patients and handles the bulk of the city’s costly emergency operation. What will be the city’s saving if these expenses are added to the voluntary system? As noted above, modernization and renovation when undertaken by the private system, inevitably involves a substantial public expenditure. These facts are rarely publicized. 182

Despite the proposed cutbacks, certain costs for the municipal system simply will not go away. One area includes the fixed expenses assumed by HHC for long-term debt for leases and debt service, and short-term fixed costs for debt service and pensions. Another fixed cost includes the services purchased by the city for prisoners, the city’s uniformed services, mental health services costs. It is estimated that some $200 million of the tax levy in HHC’s budget could not be saved should the public system be shut down. Another aspect of the alleged savings concerns the fact that HHC is also a revenue-producing agency. For the public services provided, non-tax levy revenues flow to the city from federal, state and non-governmental sources. It is estimated that for every dollar the city puts in, three or more dollars come from outside. In other words, care for the medically indigent is not carried completely by the city. Furthermore, with this outside help, supported largely by non-tax levy revenues, dollars are introduced into the city’s economy, often targeted to low-income areas. Finally, another fiscal consideration which should be included in estimating the impact of the proposed closings and shrinkage is the ripple effects on the city’s economic conditions, on work force which will be eliminated, and on the neighborhoods in which the institutions are located. As an economic enterprise, health care is the nation’s largest employer. Because health care is labor intensive, almost 70 percent of the money allocated to the public sector is used for salaries. The city’s health industry is a major source of jobs for the very group which might otherwise be forced into unemployment and onto welfare. Women make up three- quarters of this labor force, in which minority groups are heavily represented. The HHC is one of the largest employers of New York’s diverse minorities, constituting 28,000 of some 41,000 employees, or 68 percent of the health force. Consequently, the mayor’s “plan” to eliminate at least six hospitals, reduce one and pare the central staff of HHC, could leave the city with some additional 9,000 blacks and Hispanics jobless. Having limited skills, and faced with scarce opportunities in other fields, unemployment would rise dramatically in communities like Harlem and the South Bronx. Inevitably, those thrown out of work by hospital closings will become a drain on government at all levels and further burden the city’s 183

heavy welfare load. What, then, will be the real savings to the city, state and nation?

Myth #5: The city has a long-range, integrated plan. The recently proposed cutbacks “appear” to be set within an overall scheme of city planning—dressed up as part of the city’s management program along with its determination to improve efficiency and increase productivity. Unfortunately, this is not the situation. While there are “plans” on various discrete aspects of health care, and some planning is being carried on in different agencies of government, it is fragmented, incomplete and ad hoc. For example, proposals to reduce bed capacity do not make adequate provision for maintaining services essential to the medically indigent. Proposals offer no evidence, as yet, that hospital closings or reduction of beds results in substantial savings. Objective data must be collected on such basic needs for health services; the character of the obsolescence; the capital needs of institutions; and the costs and savings of various options for changing the system. Minimally, the planning called involves a detailed, system-wide analysis of the entire hospital operation, both private and public, focused on two critical points: an estimate of the need for services, and how best to meet that should be conducted with three goals in mind: economy, quality care and services for all, including the medically indigent. In conclusion, the broadside attacks on the public hospital system are based on a good deal of misinformation, inadequate facts, false assumptions and unproven charges. The thrust of the attack seems to fit the times of scarce resources, taxpayer revolts and lower rates. It will be a sad day, however, if the unique services provided by New York City’s health system are undermined without an opportunity, beforehand, to examine truly the problems we face in terms of our commitment to quality care for all the people of the city.