A team of trauma specialists at Upstate Medical University Hospital in Syracuse gather in the emergency department to evaluate a woman with a severe head injury. A mother from the tiny town of Parishville near the Canadian border sits by the crib of her infant daughter in the pediatric unit, which for thousands of families is the only advanced medical care available to their children. In upstate New York's sole burn unit, nurses tend to high-risk, infection-prone patients.
Upstate Medical, along with University Hospital at Downstate Medical Center in Brooklyn and Stony Brook Health Science Center on Long Island, deliver extraordinarily specialized and high-level care to tens of thousands of patients a year, and educate hundreds of medical staff. This, despite the fact that all three public hospitals are operating on half of the state funding they received two years ago, on top of a gradual decline in state funding through the last decade.
The hospitals, part of the State University of New York system, shared only $60 million in state funding last year, down from $128 million the year before. Extensive public advocacy by NYSUT members had convinced state legislators to put funding back into the budget. Now the union, along with its higher education affiliate, United University Professions (UUP), is fighting that battle again — Governor Cuomo's budget proposal includes no increase for the hospitals.
"Public hospitals have a unique mission, which is to serve all New Yorkers, regardless of income or circumstances, with the highest level of advanced care possible," said NYSUT Executive Vice President Andy Pallotta.
"Very few people could take a 50 percent cut in their income and survive. Our SUNY hospitals have suffered just that, and I doubt anyone who has been a patient in these hospitals in the last two years would know how much funding they have lost, because staff members are meeting this challenge through a heroic effort. But this cannot and must not continue."
University Hospital in Brooklyn, which serves an impoverished area of New York City, faces the most urgent situation.
Governor Cuomo's Medicaid Redesign Team Work Group is calling on the hospital to eliminate inpatient services and transfer inpatient care to its recently acquired Long Island College Hospital.
"The severe impact this would have on the availability and quality of health care for those who live in Flatbush is totally unjustified," UUP President Phil Smith told members of the state Senate and Assembly during a recent budget hearing. "When it comes to our teaching hospitals, no one is turned away."
Poor will suffer most
That's the message UUP chapters at all three hospitals have been sending to lawmakers: Poor New Yorkers and working families will suffer unless the hospital funding is restored, and then increased.
"Other area hospitals would simply be unable to handle the influx of patients if the emergency room at University Hospital were to close," said Rowena Blackman-Stroud, president of the UUP Downstate Medical Center Chapter. "Patients seeking treatment for critical illnesses and life-threatening injuries would be diverted to distant emergency rooms. Travel times and waiting periods to see medical staff would increase dramatically."
More than 80,000 residents per year seek treatment at University Hospital's emergency department, Blackman-Stroud noted.
Despite state budget battles, SUNY hospitals continue to be a primary source of medical care for New York's most vulnerable populations: poor children; out-of-work adults with no insurance and families to support; immigrants and newly resettled refugees who do not speak English.
Upstate Medical and Stony Brook Health Science Center are struggling to deliver exceptional care on what could fairly be called a starvation budget. UUP leaders at both facilities worry that attrition of staff will lead to attrition of services, with a devastating effect on New Yorkers, especially lower-income families.
"Management says Stony Brook is trying to grow out of its budget crisis," said Carol Gizzi, Stony Brook's UUP chapter president. "What does that mean? You try to do more with less. So if you add a service, you don't necessarily add labor. You add more hours to services, but you don't add staffing. From my perspective as a union leader, the administration is growing the business for the betterment of the community, but they're not growing the support staff at the same rate."
Hospital employees, Gizzi said, are working harder than ever. They often delay or even miss breaks and meals, and their shifts are longer, in what Gizzi called a "workload creep."
"You can't walk away from a bleeding patient," she said. "We want everything that's good for our patients. We also want to have the right amount of staff so we can do our jobs."
NYSUT Vice President Kathleen Donahue, who oversees the union's health care and health and safety programs, underscored the need for support for those on the front lines of health care.
"We are aggressively advocating for appropriate staff-to-patient ratios in all our health care facilities," Donahue said. "The advantage of a public university hospital is that not only is it cutting edge, but also it is accountable to the residents of New York. It's imperative that our lawmakers be accountable to the hospital employees, who are being forced to do more with less."
Upstate Medical faces pressure from two fronts, said UUP Chapter President Carol Braund: A geographically huge service area as a Level 1 trauma center, which covers 17 counties and stretches from the Canadian border nearly to Binghamton; and an increasingly under-insured population of patients.
"About 55 percent of the people we see in our emergency room are either self-pay — meaning they have no insurance — or they are Medicaid," Braund said. "And no one will take the Medicaid patients because the reimbursement is somewhere from $9 to $11 for an office visit. So Medicaid patients come to the emergency department, which has become their primary care practice."
A new and more difficult recertification process for Upstate's status as a Level 1 trauma center is also generating concern. To save money, the state Department of Health recently, and very quietly, decided to stop handling the certification process, says Dr. Moustafa Hassan, a trauma surgeon and division chief of trauma, critical care and burns. The American College of Surgeons is now certifying the state's Level 1 trauma centers, and its certification criteria are stricter than the state health department's standards.
Upstate has just started the certification process, and the well being of thousands of New Yorkers hinges on the results, he said. "Expect the number of Level 1 centers to drop in the state of New York," Hassan said, dashing off to emergency to treat the woman with the head injury.
NYSUT Vice President Maria Neira, who oversees higher education services, also stressed the need for highly trained medical professionals.
"Public education extends all the way to the highest level, which a medical education most certainly is," Neira said, adding that SUNY's teaching hospitals attract a high number of highly educated young professionals who tend to stay in New York.
"A medical school flourishes when it includes all components: research; patient care and community outreach; and a first-rate faculty," Neira said.