The Nassau University Medical Center is critically ill.
The 530-bed hospital's revenue failed to cover expenses even before it approved a four-year labor agreement with 3,000 union employees in November that provides 8% total raises and a no-layoff clause. The contract is causing consternation at the county's financial control board, which is clamoring to step in. NUMC's industry ratings have plummeted. Its board oversight is lacking. And a board meeting Thursday night at which the role of chairman was passed to a new leader turned into a nightmare of labor/special-interest muscle-flexing.
Yet NUMC can't simply be written off. Its responsibility as the county's only public mission hospital, charged with caring for patients regardless of their ability to pay, is too crucial. County taxpayers are on the hook for $188 million in bonds. And many of the specialized clinics at its East Meadow site do good work for hundreds of thousands of patients each year.
So dramatic action is needed to address overwhelming problems that include:
- Patient safety: For Fall 2018, NUMC received a score of D from the Leapfrog Group, a Washington, D.C.-based nonprofit that focuses on hospital quality and safety, just as it had for Spring 2018 and all of 2017. Patients at hospitals with D or F ratings are 92 percent more likely to die from "avoidable medical errors" than those at A-rated hospitals. And the ratio of NUMC patients who died from serious, treatable complications after surgery, at 215 per every 1,000 patients, is the highest of any of the 2,000 hospitals in the nation evaluated by Leapfrog. That's outrageous.
- Finances: From 2014 through 2018, NUMC lost $153 million. The fact that 80% of its patients are on Medicaid, on Medicare or uninsured means low reimbursement rates. But NUMC is also underpaid for serving the 20 percent of its patients covered by private insurance, because it has no leverage to bargain for higher rates. In June, auditor Grant Thornton said it had substantial doubt about NUMC's ability to continue as a going concern.
- Physical plant: NUMC has a 19-story building and 75 acres that are underutilized and poorly allocated.
- Leadership and governance: The top job has been a revolving door. When interim chief executive and NUMC board chairman George Tsunis left both positions Thursday, he was the fourth chief executive to move on in five years. The hospital board is stocked with appointees who have too often been chosen only because they appease various political constituencies.
Leadership might be the most crucial issue, and on this count the news Thursday was mixed. At his last meeting as chairman, Tsunis, who has been commended for reducing patronage and improving the financial operations of NUMC, introduced his successor: Robert Detor, a 72-year-old career health care administrator from Port Washington. Detor ran South Oaks Hospital in Amityville, where his turnaround of the facility has been cheered and where behavioral health and addiction treatment are the focus. That's also a strength at NUMC, and building on that further has to be part of the hospital's future success.
Detor also chaired for six years the county's federally qualified health centers under NUMC's sister organization. There he earned kudos for his leadership, and learned a lot about serving many of the same clients NUMC must help.
But at the same Thursday meeting local Civil Service Employees Association President Jerry Larrichiuta assailed the hospital's relationship with Northwell Health as a sound truck outside blared "Keep your hands off, Northwell." And the board, over the objections of Tsunis, voted to name the hospital's chief medical officer, Anthony Boutin, interim chief executive while a search for a permanent chief executive is conducted. County officials say only Nassau County Executive Laura Curran and Detor, not the board, have that power, and Detor said he had been likely to pick Boutin himself. But the circus in the first few hours of Detor's tenure put him in conflict with the board and the CSEA, and Curran and Detor must be prepared for these disruptive tactics going forward.
Detor is saying all the right things. He wants to see his board strengthened by new, knowledgeable and dedicated members, and Gov. Andrew M. Cuomo filled two of the five empty seats Friday. Detor also said he welcomes the help of the turnaround specialist the Nassau Interim Finance Authority is hiring. He knows the hospital needs a strong emergency room, and that it must build on the medical specialties where NUMC does have patients and provides quality care, while getting out of the areas where it does not. He's ready to deepen NUMC's crucial partnership with Northwell. He knows NUMC's physical plant must be reimagined. And he recognizes the difficulty of making big changes the CSEA may oppose.
Nassau County has to be able to provide quality health care to its most vulnerable residents, and it must do so without that being a financial drain. If it can't find a sustainable path, the hospital is likely to close, which would hurt the union and political scavengers far more than helping to make the critical changes needed to allow the hospital to thrive.