Ongoing speculation around the closure of State University of New York (SUNY) Downstate Health Science Center hospital and university, one of Brooklyn’s primary health resources, has spurred locals and officials to action amid decades of disinvestment and a projected $100 million deficit in the current state budget.
Hospital closures in New York City have been a fear-inducing sore spot for residents. Sites like Kingsbrook Jewish Medical Center in Brooklyn, which stopped taking emergency patients in 2021, and Mount Sinai Beth Israel in Manhattan, slated to close this summer, are foundational for the nearby communities that rely on their services and care. Predominantly Black, brown, immigrant, and low-income communities have historically been at the whims of severe health inequities and hospital closures.
In Brooklyn, “the largest capacity and access gaps” in healthcare are found in ZIPcodes with higher Black and Hispanic populations, according to a state health study released in January 2024. Hospital quality has deteriorated borough-wide and is lowest in communities with a large proportion of Black residents, according to the report. Black residents have a lower life expectancy, and are less likely to receive mental health treatment if they’re an immigrant. Black mothers are eight times more likely to die across the borough.
SUNY Downstate is a university campus with an attached hospital covering 13 acres, and has been located in East Flatbush on Clarkson Avenue since 1956. It’s a Medicaid Disproportionate Share Hospital (DSH), meaning it serves a large number of those with Medicaid and without insurance.
The campus was notably the first teaching hospital in the country when it first opened, and marked several milestones along the way, including launching the nation’s first federally funded dialysis unit in 1964, and establishing the first academic emergency medicine department in New York City in 1991. Now the hospital specializes in kidney transplants, operates a regional perinatal center, provides outpatient services for Alzheimer’s patients, and is considered a national leader in training doctors from underrepresented communities.
Several resident-driven rallies, where groups have gathered from Brooklyn to Albany, have brought together supporters who have spoken out about the need to save the hospital from closing and reject the state’s proposed plans for the campus.
“You have the temerity, the audacity, the guts, to tell us you want us closed? How dare you,” said Senator Zellnor Myrie, who’s been an outspoken advocate for SUNY Downstate for years, to a crowd of protestors in Albany on Feb. 6. “We will not stand for it anymore.”
In March 2020, Downstate was named a COVID-only hospital, diverting all other inpatients to other facilities and canceling elective and emergent surgeries, under a directive issued by former Gov. Andrew Cuomo. This pushed the hospital into a deficit of about $159 million. Prior to COVID, Cuomo also made cuts to state Medicaid spending in an effort to balance the budget.
When Myrie was diagnosed with COVID in 2020, he stayed at SUNY Downstate. He has voted to increase Medicaid reimbursement rates and sponsored legislation to improve the financial standing of all safety-net hospitals. He also sponsored a bill (S. 6956) that would require the health commissioner to develop a sustainability plan for Downstate.
The state’s proposal
Gov. Kathy Hochul’s proposed plan has four parts: Keep the medical school and student support services at Downstate, expand access to primary care and urgent care resources at Downstate and its clinics, build a new Brooklyn Institute for Health Equity center at Downstate dedicated to researching systemic health disparities, and lastly, move current inpatient services at Downstate to a wing at Kings County Hospital across the street and to other partner hospitals. The intention behind the controversial move is to reduce financial strain on SUNY while preserving the current levels of inpatient care the community uses. Once services are moved, SUNY Chancellor John B. King, Jr. said the SUNY building may potentially be used for affordable or supportive senior housing.
The state has pledged a $300 million capital investment towards this “transformation.” The state will cover the hospital’s deficit with $100 million this year and $100 million next year, and also invest $20 million annually to support outpatient services and the health disparities institute, said King. The plan needs to be approved in the state’s higher education budget by April 2024.
“The hospital has deeply serious financial challenges and has for the better part of 15, 20 years,” King said in an interview with the AmNews. A Flatlands native, King assumed the position of chancellor in 2023. “If there is no additional support in this year’s budget we will run out of cash to continue to operate.”
King said that the hospital’s facilities are antiquated and in need of infrastructure upgrades that require over $3 billion in capital and at least 8-10 years to replace. There’s been issues with flooding, plumbing, temperature control, the ventilation system, lack of showers for expectant mothers, and erosion of facilities overall. He said the level of “renovation in place” that would be required is “difficult,” as is finding sufficient funding. There are also 1,500 inpatient beds, and about 700 are in regular use, said King.
SUNY Downstate plans to engage in public outreach with a series of surveys and sessions, but the community is already complaining that there isn’t sufficient communication about them.
“This is a community I grew up in. I appreciate the history,” said King. “When I was eight years old, my mom passed away at Kings County. When I was a kid, the word hospital evoked an image of Kings County. So [there’s] a set of healthcare challenges that I deeply understand. I think folks are right to be frustrated with a history of disinvestment in Central Brooklyn. They’re right to be frustrated that the state for many years did not invest in the building.”
The impact
“Frankly, Black and brown people have been victimized by a lower level of medical equity and this is just another case of that,” said Executive Director of Kings Against Violence Initiative (KAVI) Ramik Williams, who collaborates with Downstate and also has a violence interrupter team at Kings County. He thinks a closure would impact community-based groups’ access and quality of care in the neighborhood and city. The lack of communication from SUNY Downstate is causing confusion and anxiety, he said.
Born and raised in Crown Heights, Khari Edwards was the first vice president of color of external affairs at Brookdale Hospital in Brownsville, from 2013 to 2020. He’s seen hospital closures and their impact up close, such as Caledonian Hospital in Flatbush, Peninsula Hospital Center in Far Rockaway in Queens, and St. Mary’s Hospital in Bedford-Stuyvesant. Brookdale was integrated into the One Brooklyn Health system in 2016 by the state, again under former Gov. Andrew Cuomo, to cut costs.
“Healthcare has evolved so much but when it comes to communities of color, it’s still pretty much the same,” Edwards told the AmNews. “Seniors use ambulatory services, undocumented folks still use emergency rooms. So no matter how we look at it, safety net hospitals are going to be in the red.”
The Affordable Care Act (ACA) changed the reimbursement model for the nation’s healthcare system to have an emphasis on outpatient care or primary doctors outside the hospital. The issue in areas with high Medicare or Medicaid use, which usually coincides with Black and brown neighborhoods, is that the hospitals are reliant on government subsidies for healthcare support as opposed to private or commercial insurance that pays more, Edwards said. That’s partly due to systemic under-resourcing, and partly because the understanding of the healthcare system in communities of color hasn’t really changed. Black and brown patients historically delay care until it’s severe enough to require a hospital or use the emergency room for most health issues, Edwards said.
According to SUNY Downstate’s data, the community surrounding the hospital has a “high disease burden” with “excess inpatient services and a high demand for primary and ambulatory care access.”
Edwards hadn’t wholly looked into the state’s plan for SUNY Downstate when he spoke to the AmNews, but he thinks realistically the solution can’t include closing another hospital. The closed Kingsbrook hospital is blocks away from Downstate and Kings County. “From a hospital administrative standpoint, knowing the stress that it’s going to take on that Central Brooklyn and Flatbush to East Flatbush corridor with two hospitals closing within a year of each other, it’s going to be people dead in the streets,” Edwards said.
NYC Health + Hospitals spokesperson Christopher Miller said they share SUNY Downstate’s goal of ensuring access to high-quality health care to Brooklynites.
“We have a long-standing relationship with SUNY Downstate, and we will continue to work with them as needed,” he said in a statement.
United University Professions (UUP), one of the four unions at SUNY Downstate, will undoubtedly be affected by any changes to the hospital. On behalf of its members, those who will be potentially fired or moved to other hospitals, UUP has gone on a crusade to oppose the state’s proposal– garnering some criticism from elected officials.
“The community is being abandoned,” said UUP President Fred Kowal, who testified at a state assembly and senate higher education hearing on Feb. 8. “The Medicaid patients in central Brooklyn are not going to go away. If you eliminate the hospital and you level it, and you put up affordable housing—they claim but I don’t believe it—where are those patients going to go? ”
King told the AmNews that the transformation plan aims to preserve at least “80 to 90%” of UUP member jobs. “ I understand it’s difficult for UUP to imagine reduction in their total membership, but we’re trying to make sure that all of the people who work at SUNY Downstate have roles at the end of this process,” said King.
Not everyone agrees on the plan
Because of potential firings UUP has decried and the impact to the community, some state elected officials are somewhat at odds in their approach to “save” the hospital.
Myrie and Assemblymember Latrice Walker believe that the hospital is closing no matter the assurances in the state’s plan and they have vowed to fight against it.
“The greatest impact would be on people of color with the highest concentration of poverty in all of Brooklyn,” said Walker in a video statement. Walker was a major voice for keeping Brookdale Hospital afloat.
Meanwhile, Assemblymember Brian Cunningham and Senator Kevin Parker are just as resolved in their decision to support the state’s plan. They both spoke to the desperate financial situation the hospital is in.
“Let me be unequivocally clear: Closing SUNY Downstate is not an option that is on the table or one that I would ever support. However, it’s no secret that Downstate, like many hospitals across
our borough and state, faces financial challenges due to Medicare reimbursement rates set by the federal government,” Cunningham said in a statement.
Parker said the state has been trying to shutter Downstate for decades. He reiterated that the hospital reimbursement model under the ACA has the hospital hemorrhaging money, and says he is frustrated with “the lie” that the hospital is closing as of now when the state’s plan and proposed funding is viable. He says he can sympathize with UUP because no one likes to lose jobs, he said, but he believes that this fight is about saving the whole institution.
Cunningham has introduced a bill (A7546), which is the assembly version of Myrie’s sustainability commission bill. He is also introducing the assembly version of Parker’s bill (S8523), which establishes the SUNY Downstate medical support fund to provide financial support for infrastructural upgrades and expansion. This bill will also facilitate research and development grants in medical and health-related fields, offer scholarships and financial aid, and support community health initiatives and outreach programs.
“As the Chair of the Council’s Committee on Hospitals and a registered nurse myself, I am deeply concerned about the proposed transformation plan for SUNY Downstate Health Sciences University,” said Councilmember Mercedes Narcisse. “This institution is not just one of the largest employers in Brooklyn, but is also a vital cornerstone of New York’s public health infrastructure.”
Ariama C. Long is a Report for America corps member and writes about politics for the Amsterdam News. Your donation to match our RFA grant helps keep her writing stories like this one; please consider making a tax-deductible gift of any amount today by visiting https://bit.ly/amnews1.