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The State is Making The Wrong Assessment on SUNY Downstate

The state is demonstrating a lack of appreciation of the nature, scope, and far-reaching impact of the hospital's clinical operation.
SUNY Downstate Medical Center.

It is with extreme concern that the Department Chairs at the SUNY Downstate College of Medicine have learned of the SUNY proposal to transform University Hospital at Downstate (UHD) into a facility without any inpatient services.

Assurances that this will improve the care received by the residents of central Brooklyn, that the College of Medicine’s educational mission will be unaffected, and that the residency and fellowship programs sponsored by the institution will be able to continue their role in training physicians who in large numbers remain in New York City and New York State, demonstrate to us of a lack of appreciation of the nature, scope, and far-reaching impact of our clinical operation in central Brooklyn, and our mission for educating, training and developing our healthcare workforce.

Rather, we believe that these vital functions of Downstate will be drastically compromised. Even the announcement itself was a disruptive and destabilizing force, with immediate, far-reaching repercussions on students and trainees considering whether to launch or continue their careers at Downstate.

We are concerned that the core missions of Downstate—to address health care disparities that disproportionately affect our community in central Brooklyn, and to diversify the health care workforce—threaten to be undermined by this change. We wish to make it clear that we are committed to working with SUNY to address the very real issues affecting UHD.

However, we urge Governor Hochul and SUNY to reconsider this proposal in its present form, and to provide the support UHD requires to continue its multiple, critically important missions.

First, the Chancellor’s office has stated that the hospital is operating with a $100 million deficit. We believe that this is a transient event, due to the designation of UHD as a COVID-only hospital by governor Cuomo. We were denied the ability to operate in a normal fashion and it is anticipated that UHD will approach break-even status this year (which is better than most hospitals in our vicinity).

It is important to note that UHD continues to provide outstanding care. In our most recent survey by The Joint Commission (TJC), we did not receive a single citation, which is extremely rare. Additionally, we are projected to receive a grade of B on the upcoming Leapfrog report, which would place us in the top three hospitals in Brooklyn.

The suggestion that the hospital is crumbling and would cost $4 billion to repair is questionable. Numerous improvements have already been made with one floor of seven completely renovated to state-of-the-art standards. The Chancellor’s office has failed to release an engineer’s report to back up what improvements are required and at what cost. Interestingly, the larger new H+H Ruth Bader Ginsberg Hospital, formerly Coney Island Hospital, a state-of-the-art 350 bed facility, was built at a cost $923 million. We feel that all options for improving the facility should be considered.

Third, the Chancellor’s office has stated that half of the beds in UHD are usually vacant. It is disingenuous to claim that our daily census represents a fraction of our bed capacity. It has been stated that UHD has over 350 beds with an average daily census of only 150, with the implication being that we are only half full. However, the number of originally certified beds bears no relationship to the actual current number of staffed beds; we are staffed for the number of beds that can be occupied which is about 180 not the 350-bed figure. Importantly, without any inpatient beds our hospital would lose 50 million dollars a year in revenue due to the inability to obtain Medicaid reimbursement.

Fourth, SUNY proposed to transfer in-patient care to a wing of Kings County Hospital, the NYC hospital across the street from Downstate. This proposal is entirely unrealistic; KCHC simply does not possess the bed space to accommodate these patients. At a time when Brooklyn hospitals are operating at capacity, where are these patients to go? Also, Kings County has not agreed to this plan.

Fifth, we have been assured that the College of Medicine will be unaffected by the proposed restructuring of UHD. We strongly disagree. The effect on both undergraduate and graduate medical education will be devastating. Given that our students spend up to 30% of their clinical rotations at UHD, this assertion seems highly unlikely. We are at distinct disadvantage when attempting to place our students at neighboring affiliate hospitals, in large part due to the outsized footprint of offshore medical schools, which can afford to pay hospitals significant sums, up to $50,000 per year per student, to obtain clinical rotations. Supervising physicians at local affiliates do not always have the same commitment to education that our own physicians have, and in fact many local hospitals have specifically excluded education from their mission statements. Importantly, UHD clinicians play a large role in the education of our students during
the foundation years (the first two years of medical school).

Last but not least, the incalculable medical benefit and service to the underserved people of central Brooklyn that makes UHD invaluable at a time when the surrounding hospitals are overwhelmed.

Signed by:

Cynthia L Benson, DO, MPH, MBA
Director of Quality, Emergency Department, Interim medical director, Emergency Department
Interim chair, Emergency Department

Sydney C. Butts, MD, FACS
Interim Chair and Associate Professor, Chief-Facial Plastic and Reconstructive Surgery
Department of Otolaryngology
SUNY Downstate Health Sciences University

Camille A. Clare, MD, MPH, CPE, FACOG
Chair, Downstate Health Sciences University (DHSU)
Department of Obstetrics and Gynecology
Tenured Professor of Obstetrics and Gynecology, DHSU College of Medicine
Professor of Health Policy and Management, DHSU School of Public Health

Sharon A. Glick, MD, MS
Chair, Department of Dermatology
Program Director, Department of Dermatology
Professor of Clinical Dermatology and Pediatrics

Panogiotis Kougias, MD, MSc
Chair, Department of Surgery
Clarence and Mary Dennis Professor of Surgery
Chief, Division of Vascular Surgery

Jenny Libien, MD, PhD
Chair of Pathology, Downstate Health Sciences University
Chair of Pathology and Laboratory Medicine, Maimonides Medical Center
Professor of Clinical Pathology and Neurology

Deborah L Reede
Professor and Chair, Department of Radiology

Christopher Román, Ph. D.
Associate Professor and Chair, Department of Cell Biology
Associate Professor, Department of Medicine
Unit 3 Director: Foundations 1
Academic co-Director, Bridges-To-Medicine

Daniel M. Rosenbaum, MD
Distinguished Service Professor and Chair
Department of Neurology

Moro Salifu, MD, MBA, MPH, MACP, Chair, Department of Medicine
SUNY Downstate Health Sciences University

Roman Shinder, MD FACS
Interim Chairman of Ophthalmology
Professor of Ophthalmology, Otolaryngology
Director of Oculoplastics
SUNY Downstate Health Sciences University

Ramaswamy Viswanathan, MD, DrMedSc
Professor and Interim Chair, Department of Psychiatry and Behavioral Sciences
Senator, SUNY Faculty Senate
State University of New York Downstate Health Sciences University
President-Elect, American Psychiatric Association

Stephen Wadowski, MD
Professor and Chairman, Department of Pediatrics

Jeffrey P. Weiss, MD, PhD, FACS
Professor and Chair, Department of Urology
Director, MD-PhD Program, School of Graduate Studies

David Wlody, M.D., Fellow of the American Society of Anesthesiologists
Past President, Society for Obstetric Anesthesiology and Perinatology
Chair, Department of Anesthesiology, SUNY Downstate College of Medicine
Professor Of Clinical Anesthesiology

Robert K. S. Wong, PhD
Distinguished Professor and Chair
Physiology and Pharmacology