“I was born in this hospital 90 years ago,” Katherine Nickson exclaimed as she rose to make her point at an emergency town hall meeting held at Harlem Hospital Center’s main auditorium Saturday morning. Nickson’s emotional declaration summed up the feelings of many in the Harlem community, who have depended on the hospital for over a century — and who gathered there this weekend because of a spate of rumors that it was about to close.

Hospital management, City officials, Doctors union, elected officials and community board representatives gather to address community concerns. Photo by Zahra Raja/Northattan.
Called by the hospital’s Community Advisory Board and the four community boards of Upper Manhattan, the meeting was an effort to squelch the rumors and calm fears. A bevy of local politicians — State Sen. Bill Perkins, Manhattan Borough President Scott Stringer and Rep. Charles Rangel were on hand to add heft to the message: “Harlem Hospital is not closing.”
But the rumors reflect well-placed concern. While it may not be closing, the hospital faces a host of problems both complex and controversial, all of which share the same root: New York City’s Health and Hospitals Corp.’s $1.2 billion budget deficit caused by Medicaid cuts, rising expenses and an increasing number of uninsured patients. This has threatened to cause a reduction of medical services and their quality at Harlem Hospital, forming the backdrop for the concerns within the local community.
Harlem Hospital has taken nine cuts to its budget in 36 months, resulting in 41 layoffs – including 13 doctors – by the end of this year and possible reduction in services, in particular rehabilitation and neurosurgery. Second, HHC has started cutting costs by restructuring the affiliations of the hospitals it oversees: it has ended Harlem Hospital’s 48-year contract with Columbia University Medical Center, causing uproar amongst doctors who marched in protest against the disaffiliation in October. Thirty doctors (out of a staff of 200) are reported to be threatening to leave, and the doctors’ concerns have fed into wider community concern about the future of the hospital.
On this chilly Saturday morning, those affected may have gathered to quell the rumors, but it was these concerns about the future of the institution that brought the 80 or so residents together.
The chairman of Community Board 10, Franc Perry III, said that while the meeting was necessary, turnout was far from desirable. “It’s a shame that a lot of the people who need to know the answers aren’t here,” he said. “You already know the answers, you already know that Harlem Hospital is not closing.”
The panel included the senior management of Harlem Hospital, New York City’s Health and Hospital’s Corp., the doctors unions, elected officials and community board representatives. The session began with a standing ovation for Rangel (D-N.Y.), who was censured by the House of Representatives last week.
Rangel reminded the audience that he was not a “Johnny-come-lately” to the troubles of Harlem Hospital, and stressed the importance of allaying community fears. “We’ve got patients in this hospital, and we don’t want to scare the hell out of them,” he said.
Criticizing continued tax cuts for the wealthy, Rangel predicted rough months and years ahead. “There are people who truly believe that whatever they get from the federal government is theirs and whatever poor people get should be cut back,” he said.
The hospital’s executive director, Dr. John Palmer, highlighted the main cause of Harlem Hospital’s troubles.
“The important thing is that Harlem Hospital is at the center of this particular concern, but we are not at the epicenter. The epicenter, of course is the budget of this country, and the budget deficits of the state of New York, the Medicaid cuts that have ensued since then and the negative impact that has on our ability to provide service.”
He took care to explain the situation to those present: “As you reduce funds coming in and revenues coming in, you can no longer provide the staffing and services you need. Part of HHC’s plan is to reduce and consolidate services, preserve necessary medical services and create centers of excellence to improve the quality of care provision.”
Apart from layoffs, 10 percent of the doctor positions at Harlem Hospital have been vacant and unfilled for over a year. The disaffiliation from Columbia, however, remains the thorn in the side of Harlem Hospital’s doctors. Perkins’ analogy seemed most fitting: “There was a marriage and if there’s going to be a divorce, what’s going to happen to the children?”
The divorce between Harlem Hospital and Columbia, carried out by HHC, marks the end of the arrangement that had allowed Columbia to employ and manage the hospital staff since 1962. The Harlem Hospital doctors will lose all benefits and privileges of association with an Ivy League university, except their academic titles. (Benefits include reduced college tuition for physicians’ children, and access to Columbia libraries and e-mail, among others.)
“The way they did it was extremely precipitous,” said Dr. Matthews Hurley, president of the United Doctors Association and second vice president of Doctors Council, both doctors unions. “That is, they only gave us four months. It should have been graduated.” The contract ends Dec. 31.
HHC has awarded the contract to manage the Harlem Hospital staff to the Physicians Affiliate Group of New York, a multipractice physician group practice, which as one physician put it is a “young, inexperienced entity,” adding that it could compromise their professional lives as well as the quality of healthcare provided.
The change in affiliation will allow the HHC to get one step closer to becoming an accountable care organization, a new type of arrangement proposed in the federal health care reform law, that proposes to save fledgling health institutions vast amounts of funds by better managing the doctors within. All this is part of the wider adjustment being made in a “post-healthcare reform” world.
A few doctors in the audience said the town hall had not addressed the root of their grievance: the loss of the financial managerial arrangement with Columbia. Hospital management has been very nervous about press coverage of the disaffiliation issue and does not allow its doctors to speak to media. As such, the physicians cannot be identified.
“Columbia is Columbia University,” explained one physician. “It has a whole lot of implications to be part of the academic setting rather than a private organization, especially a private organization which is a new creation.”
“We’ve been hired by a different entity, and that’s made a whole lot of people leave.”
One of the physicians said he will be joining what he said is the “large number” of senior physicians who have already left. Numbers cannot be confirmed as the hospital management will not give reasons for departure.
“They wouldn’t read my controversial question,” another doctor complained. “It said, ‘Why has Harlem Hospital always been the stepchild of the HHC? Why are we always at the back of the HHC bus?’”
This is how he explained trying to run the hospital after the disaffiliation: “Essentially they towed our car by mistake, but then they said, ‘Oh, I’m sorry! You can have it back, but someone took the wheels.’”
Still, that doctor said: “We will beg, borrow and steal, we will go around the corner. We’ll get someone else’s wheels. And stay in business. We’ll do it like we’ve always done, which is basically circle the wagons to make it happen.”
This doctor says he’s not leaving. “Just like we’ve been fighting for our resouces here, we will continue to fight for them.”
The HHC representative on the panel, senior vice president LaRay Brown, spoke in favor of the new contracts the doctors would be getting, in an effort to garner more support. A few of the doctors in the audience shook their heads at her comments. Hurley, apparently aware of the political sensitivities, especially in the presence of the local community, did not press the issue further.
Raybblin Vargas, a community organizer, was the main organizer of the meeting. She was keen to stress the significance of the issues at hand to the wider community.
“When you go to Washington Heights and Harlem, you see a lot of people wearing scrubs, because the healthcare industry is the largest employer in Northern Manhattan.”



















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