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Editorial: Emergency at top of Nassau public hospital

Nassau University Medical Center in East Meadow. (Nov.

Nassau University Medical Center in East Meadow. (Nov. 20, 2013) Credit: Barry Sloan

More than two months after party politics foolishly upended the leadership of Nassau County's public hospital, there appears to be little movement toward putting a new team in place.

This lack of urgent care could be fatal.

Arthur Gianelli's contract as the chief executive was not renewed in November after county Republican Party chairman Joseph Mondello determined the facility could yield more patronage under a new leader. Now that the highly regarded Gianelli has announced he's leaving on Feb. 7 to become president of St. Luke's Hospital in Manhattan, part of the Mount Sinai Health System, reportedly tripling his salary, the question is: Who will run the Nassau University Medical Center? Meanwhile, top talent is running out the door. The chief medical officer, Dr. Steven J. Walerstein, is reportedly joining Gianelli's new team, and two top officials on the business side have given notice. More departures are expected.

Although the hospital is an independent entity with its own trustees, the county executive and his political party exercise control through their appointments. County Executive Edward Mangano acknowledged as much in November when he told Newsday he was the one who called for a change in leadership and wanted a nationwide search. "We wanted to explore the brain trust to see what other ideas there are for making this hospital solvent," he said.

The county executive's office now says finding a replacement for Gianelli is the responsibility of the board and Craig Rizzo, the chairman Mangano appointed. Rizzo said through a spokesman that "the search for a new CEO continues and will conclude in the near future."

It must be real soon and a real search. The public hospital, which takes all patients and is a top-level trauma hospital, has more than 75,000 emergency-room visits a year, 530 beds and a critical firefighter burn unit. It is irreplaceable.

The hospital is going to the bond market as early as tomorrow to borrow $40 million in short-term debt to cover its pension payments. But that's a small hoop to jump through. The complicated strategic plan Gianelli leaves behind is the health care world's equivalence of a high-wire act. His successor will need perfect timing and balance. The new CEO will not have much of a safety net. The 2014 budget includes $20 million in cuts. Without exacting oversight, the hospital can slip into the red very quickly if admissions decrease. And those beds will go empty if the perception in the community is that the quality of care has declined.

In 2015, the hospital faces another $30 million in risk because of contractual raises to civil service union members, principal on debt coming due and Nassau's planned elimination of its traditional "mission" payment of $13 million. Another threat is whether Gianelli's departure impedes the ability of NUMC to participate in a complex federal and state health plan to encourage new health care delivery focused on outpatient services and preventive care. Success could be worth millions to NUMC and ensure its future viability. Meanwhile, a game-changing managed-care contract with the North Shore-Long Island Jewish Health System to boost insurance reimbursement rates, a Gianelli innovation, appears to have stalled in the current leadership vacuum.

Not too far to the west, New York City Mayor Bill de Blasio and Gov. Andrew M. Cuomo are struggling to come up with a solid plan to keep three Brooklyn hospitals open. The prognosis there is not good. Let's hope the lack of vision and poor leadership that is plaguing those facilities isn't contagious.