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.