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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, multiethnic residents who demanded the maintenance of a communitybased hospital threatened to be permanently closed. After twentyfive 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
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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
1
planning,” 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 lowincome 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
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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
1
expense.”
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,
1
“Without Beth Israel there would be no Gouverneur,” 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
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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
1
the public sector.” 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.
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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
1
Israel. 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 wellorganized 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.
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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.
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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.
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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
1
of Chinese bi-lingual staff at GH.
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
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for hospitalization. The argument was that BI was earning money
on patients who should be in GH. In fact, Beth Israel was expanding
1
its facilities at a time when Gouverneur was contracting its services.
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
1
on the boards of directors of hospitals.”
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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.
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“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
1
was well publicized and gained the respect of HHC.
Furthermore, the Health Fair led to a series of community
health initiatives including the Chinatown Health Clinic, a wellestablished 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.”
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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
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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 coalitionbuilding 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
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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.
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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
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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!
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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
th
live in the community and many can trace their roots below 14
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
th
Bowery, between Canal and East 14 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
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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
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$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.”
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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’
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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.”
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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.
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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
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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
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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 wellbeing 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.
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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 widearray 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.
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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.
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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.
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The Asian Bicultural Clinic: This clinic is staffed with an interdisciplinary 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 multidisciplinary 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
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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.
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The 44 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,
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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,
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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
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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
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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
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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
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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
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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
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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.
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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
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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 onsite 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:
LOCATION OF HOSPITAL
AND AREA OCCUPIED:
1885
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
Staff
O.P.D.
Staff
Medicine
Surgery
42
43
Fracture &
Orthopedics
Pediatrics
Urology
Otolarygology
Ophthalmology
Neuro-Psychiatry
Dermatology
Hematology
Obstetrics
Dentistry
Anesthesis
Roentgenology
14
9
9
19
5
4
6
2
4
10
2
5
3
0
1
7
3
2
1
0
1
12
0
0
41
21
129
VISITING STAFF:
Consultants
Visitings
Assoc. Visitings
Asst. Visitings
Clinical Visitings
18
18
49
94
126
305
HOUSE STAFF:
Rotating Interns
Asst. Residents
Residents
Interns (Dental)
Fe11ow
C1inic Clerk
6
6
4
2
1
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
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
Avg. Days’ Stay
13
13.6
14.7
19
16
Total Patients’ Days
64,136
57,993
60,391
57,868
51,009
Deaths
250
282
334
383
379
Autopsies
57
61
31
36
54
Autopsy %
18%
18.8%
12%
12.5%
20.5%
Total OPD Visits
179,045 140,505 103,863 92,002
81,879
1946
165
16
60,163
435
43
14%
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 outpatient 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 Maintenance, 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. 15152 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,
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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
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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 socalled 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
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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
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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 inpatient 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
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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
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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.
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REMARKS FOR THE OFFICIAL DEDICATION
1
OF GOUVERNEUR HOSPITAL
2
By Dr. Gustavo DeVelasco
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 neighborhood 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
2
Official dedication of Gouverneur Hospital, September 21, 1972.
Executive Director of Gouverneur Hospital
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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
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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
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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
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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
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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 children 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
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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
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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 community, and elected public officials saved these vital services. But, by the
end of 1975, through further arbitrary budget reductions, attrition and layoffs, 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
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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.
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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!
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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.
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By: Dr. Gustavo DeVelasco
Executive Director
169
Health/PAC Bulletin, Summer 1993
Coming Full Circle: Lessons from Health Care Organizing
XXIV.
Terry Mizrahi
th
What a wonderful opportunity to use the 25 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
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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
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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
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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. According 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,
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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
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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.
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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
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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 activities, 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
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most modem physical plants can be found at such places as Bellevue, 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 shortcomings, 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.
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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 hospitals. Purportedly, this is to save $130 million of the city’s tax levy
contributions to the HHC system. The state health planning commission 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.
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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 threequarters 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
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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.