‘Hands off our hospital’ is the new normal

One hospital tried to close a campus and got hauled into court by disapproving locals. Another attempted to expand, but neighbors said no way.
When it comes to health care, community activism is now standard operating procedure, no matter the case’s merits. There was a time when the fate of a failing hospital was decided by its own trustees or a bankruptcy judge, not politicians. If an institution wanted to expand, it contended with state regulators, building codes and land-use rules, not protesters.
But communities found their voice in the backlash against the 2010 closure of St. Vincent’s Hospital in Greenwich Village. Since then, neighborhood groups have expertly aligned with politicians, taking their grievances to social media and to court.
“Everyone’s fighting to protect their communities from the encroachment of these corporations, these nonprofit corporations that just don’t care,” said Constantine Pantazis, whose father owns a property next to a Bronx building project proposed by Montefiore Medical Center.
The hospital’s plan to build a 93,000-square-foot, 11-story outpatient medical facility in the wealthy Riverdale neighborhood has met with tremendous pushback from local residents. They argued that the traffic generated would overwhelm Riverdale’s narrow streets. So Bronx state Sen. Jeff Klein slipped a proposal into the state budget—a move that blindsided the state’s powerful hospital lobby—to block the project.
Shrinking hospital

In Park Slope, Brooklyn, New York Methodist Hospital’s proposed seven-story expansion on the site of several of its brownstones has languished for nearly a year in the planning phase, owing to local opposition. A group called Preserve Park Slope labeled the project too big and ugly and threatened legal action.
“It’s about a hospital being a developer,” said Bennett Kleinberg, a member of the group. “This could impact real estate [values], and put a great strain on infrastructure. I think they have a duty to be a participant in the neighborhood that has helped them get to where they are.”
The most publicized recent clash between a hospital and a community, of course, is the protracted and ongoing fight over Long Island College Hospital. The State University of New York acquired the Cobble Hill, Brooklyn, facility in 2011. When SUNY tried to close the money-losing hospital last year, a coalition of community groups and unions—joined by then-mayoral candidate Bill de Blasio—successfully sued to keep it open while they haggled over a possible new owner.
One example of the tone of this new activism: a tweet last month by Jeff Strabone, a member of the Cobble Hill Association, one of the plaintiffs. “As the powers that be continue dismantling our public institutions, the people that be will rise up and oppose them,” he wrote.
Hospital executives have long had to answer to a broad range of constituents, including trustees and regulators. Increasingly, they must answer to their neighbors. Health care is influenced by politics because it is viewed as a public good. The state’s regulatory process for the construction or expansion of hospitals was designed with that principle in mind.
Major projects by hospitals and nursing homes are subject to a certificate-of-need process. A facility files a CON application with the state Department of Health to build a wing, expand or end services. The CON application describes a project’s scope and budget. DOH determines if the change is appropriate to the health needs of the community, and hearings are held. Opponents can write to DOH or speak at a hearing—but that’s all.
“If a hospital is trying to acquire a facility or expand its service, there’s very little room for other parties to contribute to the CON,” said Sascha Murillo, an organizer for public health with the nonprofit New York Lawyers for the Public Interest. “There are gaps in the process.”
A community board’s opinion is advisory, but the approval process allows local input. The board in Park Slope approved Methodist’s project after imposing conditions, including shrinking the building’s size.
Methodist is revising its plans based on input from the community board. Hospital spokeswoman Lyn Hill said, “We felt it was important to please the community.”
Ms. Hill witnessed a similar situation in the early 1990s, when Methodist built a facility for physicians’ offices that was opposed by some of the same residents.
“Now we have email, and we have social media,” she noted. “That has very much changed the pace and the level of noise that’s being made. Now you’re reading about [a community meeting] on a blog while the meeting is still going on.”
Preserve Park Slope’s lawyer issued a subpoena for the hospital’s records on the expansion; the city’s vote on the project was postponed to this week to allow for a hearing.
Montefiore’s proposed facility can be built as of right because it complies with zoning laws. The facility does not need a CON because the state DOH classifies the project as a physician practice. Still, neighbors are poised to sue.
“Riverdale is not medically underserved. There’s over 1,000 medical providers in these two ZIP codes,” said Jim Grossman, who formed the Committee to Protect Riverdale. He believes that Montefiore, which serves many poor Bronx neighborhoods, is “trying to get into an area where more people have health insurance.”
Hospitals are bracing for heightened activism. New York state is about to implement an $8 billion Medicaid reform initiative funded by the federal government. Providers will form new networks focused on outpatient care. That means some hospitals will downsize, change services or close. The state’s goal is to transform the health care delivery system—a goal some communities will misinterpret or reject.
“We will see more LICH-like situations as health reform takes hold,” said one industry consultant who asked not to be named because of the politics involved. “Much of health care does not need to be provided where it is offered now.”

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