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.

We also have nothing but sincere thanks for Mayor Bloomberg, who allocated $350 million to the Health and Hospitals Corporation to help offset its $1 billion operating deficit during the current fiscal year.

However, we have nothing but disdain for decisions that deny the citizens of Harlem timely access to neurosurgery and rehabilitation medicine services– decisions that directly threaten the trauma center and stroke center designations awarded to Harlem Hospital, centers that treat the very conditions that occur in greatest number in our community. We also decry the shortsighted financial decisions to limit support for graduate medical education–since it will cost the Health and Hospitals Corporation nearly $500,000 to replace each resident trainee with far less comprehensively trained physician extenders.

Last, we find it nothing less than a disgrace that public officials are determined to disregard irrefutable evidence that medical services rendered by Columbia doctors at Harlem Hospital were indeed provided, and to deny that repeated requests to fill vacant positions in our Division of Cardiology were made, yet went unheeded, year after year, resulting in the large backlog of unread echocardiograms sensationally reported in the press–decisions we believe could only have been made for the purpose of terminating the relationship between the Health and Hospitals Corporation and Columbia University, despite nearly sixty years of honorable service to the community, and vast improvements in the health of its residents.

In Columbia’s place, we are told, a nonacademic affiliate will be retained to provide patient care at less cost. But for how long? The leadership of the Health and Hospitals Corporation cannot really believe that a physician group representing as many as 2,000 physicians across seven of its eleven acute care hospitals will.

not be in a much stronger position than its current affiliates when it enters into collective bargaining. It also cannot truly think that a small physician group with an untested track record can take on such added responsibility within as short a time as a year, as is currently planned. Surely, it cannot justify retaining two other academic institutions–the New York University and Mount Sinai Schools of Medicine–to provide medical services at Bellevue, Woodhull, Elmhurst, and Queens Hospital Centers, when its stated reason for terminating its Columbia affiliation is that academic affiliations are too costly.

If the Health and Hospitals Corporation were seriously interested in developing viable accountable care organizations in its facilities, logic dictates that it would turn to recognized experts in medicine, nursing, public health, law, and business to help it achieve this goal. Few institutions in New York City can provide such a depth and breadth of expertise across so many disciplines–Columbia University is one of them. We must therefore ask: what sense does it make for the Health and Hospitals Corporation to entrust the future of its medical operations to a small, inexperienced physician group, rather than an institution with the resources, and multiple levels of expertise, to find the best way forward–particularly when that institution has been part of the very fabric of the City it serves for over two hundred fifty years?

It makes no sense at all. Thus we ask, in the name of the people of Harlem–those who will surely suffer most from the irrational decision to end the relationship between the Health and Hospitals Corporation and Columbia University–that you reverse this unwise decision before it is too late. Do not take us back to the past. We have already been there. It has taken very many years of hard work by the Health and Hospitals Corporation and its medical school partners to engineer the remarkable success that recently has been realized. Do not destroy the very engines of that success–the partnerships that make it work.

Respectfully yours,

Medical/Dental Board of

Harlem Hospital Center