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An Open Letter to Mayor Michael Bloomberg, Comptroller JohnLiu, Chairman Michael Stocker, President Alan Aviles, and theDirectors of the New York City Health and Hospitals Corporation

4/12/2011, 5:32 p.m.

Medical/Dental Board of

Harlem Hospital Center

Dear Colleagues:

On behalf of the 350 physicians, dentists, and allied health personnel that comprise the Medical and Dental Staff of Harlem Hospital, we write to deplore the recent actions of the Health and Hospitals Corporation in moving to terminate its long standing financial affiliation with Columbia University.

For nearly sixty years, the Columbia doctors of Harlem Hospital have labored to provide high quality health care for the citizens of our community. We have come to this hospital to be part of both a great enterprise in care for the poor among us, and a great University that seeks to find solutions to the very problems that lead to material and social poverty, through delivery of health care to the Harlem community. Although much work remains to be done, much has already been accomplished. A partial list follows:

Harlem has the lowest risk adjusted mortality rate of all six Health and Hospitals Trauma Centers. Harlem's Injury Prevention Program has decreased the rate of injuries to children by sixty percent. Harlem's Stroke Center has won several major awards for its innovative early recognition program. Harlem has the only Baby Friendly Hospital, recognized for breastfeeding success, in New York City. Harlem's Bariatric Surgery program has the lowest mortality rate among all New York City hospitals. Harlem's Plastic Surgery program is among the best in New York City, yet is by far least the costly.

Needless to say, these impressive achievements, and others far too numerous to mention, will be jeopardized when the Columbia University faculty who brought them about are terminated at the end of this year. Sadly, the air of uncertainty created by the impending disaffiliation has already led to the exodus of many committed Columbia doctors who are rightly dismayed about the future of Harlem Hospital and the community it serves under medical leadership that is more concerned about profits than patients.

Indeed, due to the untoward effects of the recent economic downturn, we are told that the Health and Hospitals Corporation can no longer afford the investment in healthcare that brought us the above triumphs. We are told that further education and

research on the conditions that lead to the suboptimal health outcomes experienced by impoverished communities are luxuries that must wait until another day. We are told that physician groups affiliated with the Health and Hospitals Corporation must reconfigure to become "accountable care organizations" that share the financial risk with the hospitals in which they practice. Yet, they can hardly do so, when they are already paid less than half what they would earn in private practice, and practice plans associated with municipal hospitals have been able to collect no more than about ten cents on the dollar. This is not a road toward recovery; it is a march toward

mediocrity.

We have nothing but great praise for those in the Health and Hospitals Corporation who have worked so hard to find a way for our municipal hospitals to escape the $1 billion structural deficit brought about by the perfect storm of skyrocketing pension costs, vanishing revenue streams, bankrupt state government, and Federal healthcare "reform" that denies reimbursement for routine health care of undocumented immigrants, while at the same time rightly mandating that they receive far more expensive emergency health care when the regular care being denied them results in deterioration in their medical conditions.