Queens Medically Underserved

Mt. Sinai Hospital of Queens. Photo Vinny DuPreIn contrast to Manhattan, Queens is woefully underserved with hospital facilities, a point which Borough President Helen Marshall, City Councilmember John Liu and Caryn Schwab, chief executive officer of Mount Sinai Hospital of Queens, each made in testimony at public hearings held Iby the Commission on Health Care Facilities in the 21st Century, New York City Region in Borough Hall last Tuesday.

Marshall did not mince words. Queens, she testified, is a borough with a growing population, a great part of which lacks any form of health insurance. "We are home to 2.2 million residents, half of whom are foreign born," she said. She added that 440,000 of those individuals lack any form of health insurance. Queens is also home to 375,000 people 60 years of age and older who represent 30 percent of New York City's elderly population; 36,000 of those people are above the age of 85. The borough has 11,000 nursing home beds, two of the nation's busiest airports, and is experiencing a massive growth in population due to its booming housing development.

"Manhattan-based institutions continue to use Queens residents to justify their services and beds," Marshall declared. "Here in Queens, five community boards have no hospital, while in Manhattan five worldrenowned institutions are located within 20 blocks of each other..." "Mary Immaculate Hospital serves much of this population in the Jamaica community," Marshall said. "It is a safety net hospital, accepting everyone regardless of ability to pay, much like our two public hospitals in Queens. Last year more than 50,000 patients came to the emergency room and every one of the hospital's 172 beds is presently occupied." ALevel 1 trauma center, Mary Immaculate has been designated by the Port Authority to receive victims of air disasters at JFK Airport.

But while Jamaica, Far Rockaway and Long Island City have been designated by the federal government and the city Department of Health and Mental Hygiene as medically underserved communities, "The health care delivery system in Queens is in a state of crisis," Marshall testified. "We have already experienced the closure of St. Joseph's Hospital with 200 beds. Currently Mary Immaculate Hospital, St. John's Hospital and Parkway Hospital are in bankruptcy." Boulevard and Physicians' Hospitals, both in Western Queens, closed decades ago. "Our remaining 10 hospitals are financially vulnerable to the changes that have already taken place within the health care industry," Marshall pointed out.

Caryn Schwab, chief executive officer of Mount Sinai Hospital of Queens stated: "The residents of Queens want health care close to where they live. We know this anecdotally and research proves it. Going to another borough for care creates significant isolation from family and friends..." The $1.2 billion annual cuts proposed for Medicare by Washington, D.C. and more than $430 million in annual Medicaid cuts included in Governor George Pataki's proposed budget can only heighten the vulnerability of health care in Queens, Marshall added. The cuts are likely to result in even more crowded clinics and overburdened emergency rooms, particularly in poorer communities, such as Far Rockaway and Jamaica, which already have higher rates of infant mortality and diabetes than the city-wide average.

"Manhattan-based institutions continue to use Queens residents to justify their services and beds," Marshall declared. "Here in Queens, five community boards have no hospital, while in Manhattan five world-renowned institutions are located within 20 blocks of each other. In a borough where our public transportation system is inadequate, this uneven distribution of facilities is particularly burdensome on patients and their families. Please do not misunderstand: I am not advocating for the closure of Manhattan-based hospitals. However, I am calling for the commission to fulfill its mission by correcting the misalignment of services in Queens."

"Closing weak hospitals to improve the financial standing of more stable ones will only shift the high costs of health care in New York, not eliminate them," City Councilmember John Liu (D-Flushing) testified. "If New York state truly wants to provide quality health care and be responsive to community needs, we must be willing to make the necessary investments to carry out this mission. Closing hospitals is a mistake we can ill afford." He urged the commission not to move in that direction.

State Senator Ada Smith (D-Jamaica) noted that the 18-member commission exists to evaluate which hospitals should be closed. Smith is co-sponsoring legislation on behalf of the Save Our Safety Net Campaign that would require the commission to consider healthcare needs, including ambulatory care, when conducting examinations into the supply of general hospital and nursing home facilities, especially in minority communities. "Any hospital closing has a divesting effect on a community," Smith said in a statement. "There needs to be consistent and fair consideration for how the commission chooses which hospital facilities to close."

Mount Sinai Hospital of Queens (MSHQ) is the only hospital in Western Queens, in stark contrast to Manhattan, "where hospital sits beside hospital", MSHQ's Schwab testified. The communities of Astoria, Long Island City and Sunnyside, which make up its primary service area, together are home to 225,000 residents. Only two hospitals, Elmhurst and St. John's, the last-named currently in bankruptcy, exist in the MSHQ secondary service area, which includes the neighborhoods of Jackson Heights, Woodside, East Elmhurst and Elmhurst, and where another 415,000 people reside. "The healthcare environment in Queens has never been so fragile," Schwab said.

The strain on those healthcare services that are available is enormous. Schwab cited MSHQ as an example. "Since Mount Sinai Hospital of Queens was purchased by Mount Sinai in 1999, we have been working hard to bring top quality care and service to our deserving residents, including renovating the Emergency Department; renovating and upgrading our diagnostic and imaging services; adding endoscopy suites; creating a patient resource center to help educate our community about how to stay healthy as well as seek information when they are ill," she explained. "Upgrading the quality of care has been paramount. Mount Sinai Queens was one of the first hospitals to be designated a Stroke Center by the [city] Department of Health. We have been a leader in providing palliative care in a community hospital setting. We brought highly qualified Mount Sinai faculty to provide anesthesia and emergency care in Queens. And, despite the pressures of today's healthcare environment, we have been financially healthy since we became Mount Sinai.

"We have worked hard to maximize the beds available in the hospital. Our length of stay has been reduced almost a day in the past few years. This has allowed us to accommodate the growing number of patients seeking care at our hospital. Yet despite these efforts, our current occupancy rate is 89 percent. With no ability to expand within the existing facilities, we will deplete our capacity next year. Our Emergency Department is already beyond capacity. And the operating rooms function with a great deal of overtime to accommodate a 17 percent increase in surgeries since 2000."

Schwab and Marshall concurred that there are too few hospital beds in Western Queens to serve the area's burgeoning population. "The five-borough average for the number of beds per thousand population is 3.6," she told the commission members. "In Western Queens, there is less than one bed per thousand. Just sit with those figures for a minute: 3.6 beds per thousand in New York City overall, less than one bed per thousand in Western Queens."

Just because a service is in Manhattan, and "Manhattan is close", or so it seems in terms of miles, the view is very different from the other side of the bridge, Schwab added, also agreeing with Marshall that healthcare services in Manhattan may well prove inaccessible to those residents of Queens who must try to use them.

"To most residents of Western Queens, when it comes to getting health care, the [Queensboro] Bridge is a gate, not a gateway," Schwab declared. "The residents of Queens want health care close to where they live. We know this anecdotally and research proves it. Going to another borough for care creates significant isolation from family and friends. It requires sick patients and anxious families to take a bus or subway, or it's an expensive car or taxi ride. The American Journal of Public Health reports that transportation issues affect 1 in 5 elderly patients' access to care. It has been shown that proximity is crucial to minimize barriers for culturally diverse and minority patients. Travel only compounds access issues."

"The issue isn't even about hospitals," Liu declared in his testimony before the commission. "It is about people and the need for people to be close to medical care-emergency and otherwise. [On February 26], a student at Francis Lewis H. S., Andrew Tsai, was seriously injured and nearly killed in a horrific car accident. Andrew, who lost one leg and is clinging to life, had to be transported all the way from Eastern Queens to a hospital in Manhattan. There is no good reason for this kind of hospital care disparity to exist."

"I have been in health care in New York for a long time," Schwab, who started working for the New York City Health & Hospitals Corporation in 1981 and served as a healthcare advisor to then Mayor Ed Koch, added. "I have worked on many sides of the fence-government, public and voluntary. I have worked with some of the best and brightest. Together, we have worked through very tough healthcare issues. Today we face the thorniest challenges of my career-a growing uninsured population; intense focus on quality and safety; maintaining and expanding research and biotechnology so they continue to function as key economic drivers in New York City and New York state; workforce shortages and a hospital system in grave financial trouble.

"If there is one message I'd like to leave you with this evening, it is this: a one-size solution does not fit all. Each borough and geographic area within the borough needs to be looked at unto itself."

"Last month when I wrote to the governor, I asked that the New York state Department of Health refrain from approving any action to reduce or eliminate any beds or services in the borough of Queens," Marshall concluded. "Instead, rather than closing the doors on the working poor and the uninsured, let's open the doors that will lead to a fuller and healthier life for our deserving residents."