Anyone in Charge ?

Mr. John D. Wren
Business Week

Mr. Stanley Brezenoff

The Brooklyn Paper/Tom Callan

The law requires a board of a not-for-profit corporation to be in overall charge. No matter how many executives and other employees there may be, it is the Board, and nobody else, that is charged with the fiduciary duty to preserve and nurture the organization. In the case of LICH, that would be the Board of Regents, whose chairman is Mr. John D. Wren.

Mr. Brezenoff, who has made all the policy statements more or less on his own, has certainly given the impression that it is he, and nobody else, who is in charge. But, at least in form, he is but a paid servant of LICH, with but one seat on the Board. Where in all this is the legally-responsible Board ? Where is Mr. Wren ? What does Mr. Wren have to say about the important policy decisions that lie ahead for LICH ?

Yes, Mr. B., there is so a Plan B

Not long ago, on September 22 of this year, Continuum boss Mr. Stanley Brezenoff pounded a table for emphasis and, he thought, laid down the law: I will cut out obstetrics at LICH, and, for good measure, I will cut pediatrics as well. That is my plan. There is no plan B.

Well, local officials, local activists, the medical staff of LICH, and many others organized to tell the State government that LICH should remain whole. And what do you know, the State listened, and decreed that yes, Mr. B., there is so a Plan B: the hospital will retain the services that Mr. B. had decided he would not.

For the text of the NYC Department of Health decision, click here.

Dr. Licht replies to Murray Adams

Mr. Cohn

Murray Adams has a personal view based on his feelings for what is best for LICH. However, he gives the wrong impression by characterizing the medical staff as being fractionated. All of the steps both leading to what is referred to as "the Doctor's Plan" as well as our public postures represent the nearly unanimous position of the Organized Medical Staff of LICH as voted on at our monthly Medical Executive Committee Meetings.

Murray makes it seem as if the LICH Medical Staff has no interest in a relationship with Downstate. That is not true. However we believe that any relationship with another institution including Downstate must include the Medical Staff as a full assenting partner. Murray's plan has LICH being handed over to Downstate as so much chattel without negotiation and without the involvement of the Organized Medical Staff. More bizarrely Murray's plan would have the current Continuum Board select the members of a new LICH Board. We have had 10 years of governance by a Continuum Board and cannot imagine having them appoint our new governing body.

There are indeed some physicians who, for whatever reason, are not in agreement with the majority opinion but they speak as individuals and not as representatives of the Organized Medical Staff and it's elected officers.

You may post this on your blog if you wish.

Arnold L. Licht, MD
President of the Organized Medical Staff
Long Island College Hospital

Some Doctors Have a Different View: Additional Comments from Murray Adams

Murray has sent me some additional comments regarding yesterday's posting (see below):

All of us owe a vote of thanks to Borough President Marty Markowitz for convening the hearing held at Borough Hall on Monday night. Inexplicably no one from the NYS Department of Health showed up. Fortunately, all of our local elected officials or their representatives were there to hear so many of our neighbors, our doctors, LICH’s employees and others who testified movingly and forcefully about the necessity for preserving Long Island College Hospital as an Brooklyn-managed major community hospital having all its present services, especially including Obstetrics and Pediatrics to serve our growing neighborhoods and the many young families with young children who crowd our sidewalks.
Unfortunately the top elected officials of the medical staff, Dr. Licht and Dr. Sorra, and other physicians such as Dr. Ricciardi, all of whose medical practices are office-based and who rarely if ever admit patients to LICH, do not agree with the plan I outlined to immediately affiliate LICH with SUNY Downstate. The Medical Staff Plan submitted to the Department of Health proposed that LICH re- establish itself as an independent hospital. Drs. Licht and Sorra however acknowledge the long-existing academic affiliation between the two institutions and agree that ultimately to enter into a management affiliation with Downstate or another large system might make sense.
On the other hand, I, several of the Brooklyn-based LICH trustees, including Rev. Dr. Paul Smith, Dr. Mike Avram, Joseph Broadwin and Lou Valentino, and most of the doctors whose practices, like Ciril Godec’s in urology, depends heavily on LICH’s surgical suites or, like Deborah Reade’s in radiology, depends heavily on LICH’s specialty equipment, do not believe that LICH can survive and rebuild as an independent hospital without affiliation with a major medical center such as SUNY Downstate.
I emphasize, however, that all of us are in full agreement that Continuum’s management of LICH must be terminated. Our major problem now is getting the Department of Health to turn down Continuum’s plan to close OB, inpatient Pediatrics, and Dentistry, bringing LICH’s management back to Brooklyn under a Brooklyn-based Board of Regents, and getting the DOH and our local elected officials to help us get Downstate to take over the management of LICH and its OB beds and getting help from them and HUD to make the takeover financially possible for Downstate. And it better come soon, or with Continuum continuing to shut down programs such as the school based clinics and the rape crisis intervention program and to fire large numbers of LICH employees, there will be nothing left of LICH to salvage.
C. Murray Adams

Cobble Hill Association: Have SUNY run LICH ! Submission by Murray Adams.

Murray Adams
photo by Werner Cohn

Murray Adams, a prominent personality in Cobble Hill and former president of the Cobble Hill Association, has presented a plan to save LICH at a public hearing last night. Here is his submission:

TESTIMONY OF C. MURRAY ADAMS, ON BEHALF OF
THE COBBLE HILL ASSOCIATION
November 10, 2008

My name is Murray Adams, and I speak on behalf of the Cobble Hill Association, a civic association which represents the interests of the residents of Cobble Hill, Brooklyn, where The Long Island College Hospital has been providing medical care for 150 years. The people of our community believe that the real reason behind Continuum Health Partners’ announced plans to close LICH’s Obstetrics and in-patient Pediatrics services, its Dentistry program and its school based clinics program is to close LICH entirely so they can sell off LICH’s valuable real estate to benefit Continuum’s Manhattan hospitals. This must not be allowed to happen!
Late in August, 2008, the Medical Staff of LICH filed a plan with the New York State Department of Health to revitalize LICH without closing any of these services and by returning LICH’s management to an independent group of Brooklyn-based trustees. That plan is a good plan, but it must be supplemented because it does not provide working capital which LICH must have in order to finance the transition and the rebuilding of the Hospital. Although the Medical Staff leadership has retained an investment banking firm to help obtain financing, given the present collapse of the credit markets, we do not think it likely that they will obtain loans for the necessary working capital in the very short time remaining to save LICH. To make the Medical Staff plan feasible, in our opinion, it needs to be supplemented in three respects:
First, the Medical School at SUNY Downstate and the Department of Health must agree that the management of LICH must be moved to Downstate and LICH’s Obstetric beds must be moved under Downstate’s operating certificate. This would mean New York State would bear the losses and the malpractice premiums which now burden LICH. Continuum wants to close Obstetrics, because, according to Continuum’s figures, this would save LICH more than $13 million per year. It would cost the State about half that much because the State does not have to pay malpractice premiums. Obviously, if Downstate continues to operate the Obstetrics beds at LICH where they are, there will be no need to close inpatient Pediatrics or the school based clinics program or the Dentistry program.
Second, the Medical School at Downstate and the Department of Health must agree to Downstate’s entering into leases of several LICH buildings so that Downstate can move much of its medical school as well as its clinical practices over to LICH. These buildings are LICH’s Polhemus building, where until 1953 Downstate had its medical school; LICH’s Clinic Building; and much of LICH’s 97 Amity Street building. This would answer Downstate’s need to expand its medical school facilities. An annual lease rental of $15 million will offset $15 million of LICH’s annual debt service, and so take care of the second part of what Continuum’s “plan” says needs to be done to put LICH on a stable financial basis.
Third, we need our elected officials’ help in getting the federal Department of Housing and Urban Development to defer for a reasonable period LICH’s debt service payments of about $2.5 million per month in order to provide LICH with working capital essential to LICH’s effort to restore itself. Also, LICH needs time to reconstitute and expand its primary care clinics, as the Medical Staff plan contemplates, and thereby rebuild LICH’s volume and its cash flow, which will probably take up to two years.
For the better health of all Brooklyn residents, Long Island College Hospital must be saved and restored as a premier Brooklyn health care institution. Brooklyn’s public health care standing is below New York City standards in almost every category, such as infant mortality per 1000 births, prevalence of asthma in children, incidence of heart disease, strokes, etc. The State would save money by setting up a Borough wide system of primary care clinics which would treat asthma, high blood pressure, breast cancer, high cholesterol conditions, nutrition problems, substance abuse and other common medical conditions that early intervention can treat much less expensively than if the patient arrives months or years later in a hospital emergency room and requires inpatient treatment because the untreated condition has become a major threat. We believe that what Brooklyn needs, as the Medical Staff Plan contemplates, is the establishment of a chain of Primary Care Clinics in the medically underserved areas of Brooklyn, such as Bedford-Stuyvesant, Brownsville, Mill Basin and East New York, and the linking up of existing clinics in those and other underserved areas, such as the BHS Clinic in East New York and the Red Hook Health Center in Red Hook, with the combined tertiary care capabilities of Downstate/University Hospital and LICH. We believe federal funds can be obtained to help establish this network of clinics.
We understand that Continuum and Downstate are in negotiations which we hope will result in LICH’s management being returned to Brooklyn under Downstate’s management and supervised by a new Brooklyn-based Board of Regents. We urge the Borough President and all our local elected officials to take every step in their power to make this come about and save our hospital for the entire Brooklyn community.
Thank you.

Communication from LICH doctors

I have received this communication from the group of LICH doctors who oppose the current LICH management:

The LICH Medical Staff website now has links to sign a petition in support of LICH,
as well as to send a letter to Governor Paterson - please sign the petition!
In addition, there is a link to download flyers for distribution to friends, neighbors and patients - print these and distribute!

LICH MEDICAL STAFF

A friend of LICH has also established a "Save LICH" group on Facebook,
the link is below.

To see more details and confirm this group invitation, follow this link.

Thank you all for your support of LICH!

LICH Medical Staff

Pictures from a Demonstration

Rally for LICH

LICH in 1899

Members of the LICH medical staff and a number of local politicians are staging a rally at 1 p.m. on Tuesday, October 14, in front of the hospital.

Mr. Brezenoff Explains

As I write, Congress and the Administration are trying to find a way out of the current financial crisis. To many an innocent bystander, it was amazing to discover that the CEO's of the most mismanaged corporations took multi-million dollar salaries. How is this relevant to LICH ? Read on.

This last Monday (Sept. 22) was a remarkable day for LICH. The public was invited to a meeting at LICH, sponsored by Community Board Six, that featured a spirited, forceful address by Stanley Brezenoff. Mr. Brezenoff is the President and CEO of Continuum Health Partners, the non-profit management organization that is responsible for the executive functions of the hospital.

Mr. Brezenoff was blunt in what he had to say: 1) LICH is in a severe financial crisis (because there aren't enough patients); it is financially moribund. 2) It is my plan to cut out obstetrics and pediatrics, because these services lose money. Those steps will revive this near-death patient. 3) This is my plan. There is no plan B. Take it or leave it.

Mr. Brezenoff's remarks and those of his questioners are well reported on the website of the (dissident) medical staff. This site, highly critical of Mr. B. and his management, needs to be consulted by anyone interested in the hospital.

I sat in the audience, taking it all in, but my thoughts were on matters that nobody mentioned, although they had, indeed, been mentioned by the dissident medical staff before: if LICH is in such dire straights, why are the executive salaries so high ? According to the Daily News, LICH's doctors want cuts in executive pay.

Like everything else, executive salaries are relative. This blog has previously reported on the salary of the recently-resigned LICH president Ms. Rita Battles (whose name, curiously, was never mentioned at this meeting), and also, for comparative purposes, the salary of Alan D. Aviles, the man who runs the city hospital system. (see my postings of November 14, 2007 and others.) In brief, while Ms. Battles was paid approximately $700,000, Mr. Aviles, responsible for a far more extensive operation, earned but $291,000.

Continuum Health Partners manages several other hospitals in addition to LICH, so Mr. Brezenoff's salary, presumably, is not paid by LICH alone. Still, it is an interesting figure. Now like all other not-for-profits, Continuum is required to report its top salaries to the IRS on form IRS990. These reports are publicly available online, for instance on the site of GuideStar.

People should more often examine these reports about the non profits that they support. In the case of Continuum, the latest report covers the year 2006. In that year, Mr. Brezenoff was paid a total of $1,442,412, or, roughly, just about five times the sum paid to Mr. Aviles, whose job, remember, is far more extensive than Mr. B's.

Day of the Pols

Today outside of LICH. Local pols give speeches and all say: don't close LICH ! Ordinary folks lend an ear.

Going, going .... gone ?

LICH is "downsizing." The maternity ward is closing, and buildings are being sold, possibly to create condominiums on Amity Street. There is considerable internal dissent among the staff. The details are given in an article in today's New York Times by the reporter Anemona Hartocollis. Another take on the story is in today's Brooklyn Paper, in an article by Mike McLaughlin.

In the meantime, this Blog has obtained the memo that was sent yesterday to the LICH staff by Stanley Brezenoff, president of Continuum Health Partners. Here is the text:

Date: Wed, 30 Jul 2008 09:20:36 -0400
Subject: MEMO FROM STANLEY BREZENOFF RE: RESTRUCTURING EFFORTS AT LICH
DATE: July 30, 2008

FROM: Stanley Brezenoff

TO: The Long Island College Hospital Physicians and Employees

RE: Restructuring Efforts at Long Island College Hospital


Over the past year, the Board of Regents and our senior leadership have
carefully examined the challenges that have long faced Long Island
College Hospital and have developed a strategy that will allow us to put
the hospital in a more sound financial position so that the hospital can
continue to meet its mission.

This memo outlines the strategy that we expect to implement as quickly
as possible. At its core are steps that will bring LICH into a more
viable financial position. Specifically, we need to eliminate services
that have long been huge financial burdens and reduce the size of the
campus.

Reconfigure the medical and surgical services to a smaller and more
efficient size. Although LICH has an official operating license for
approximately 500 beds, we presently have approximately 350 beds
actively in operation. This may still be too many given present demand
and need. Together with our clinical colleagues, we are going to
carefully examine what LICH's optimal operational size should be in
order to secure an optimistic future for the institution.

Discontinue Obstetrical services.
These services are associated with many of the operating costs that
have caused financial distress at LICH, including escalating malpractice
insurance premiums. Last year, the OB/GYN service accounted for 33%, or
$11 million, of the hospital's total losses. In addition, OB
malpractice accounted for $8.8 million of the total $22 million in
malpractice insurance costs for LICH; this represents 40% of the
hospital's total malpractice costs. Yet OB accounted for only 2,845
discharges, or 12%, of the hospital's total discharges of 22,830.
Obstetrical services are no longer viable for us. In addition, the loss
of OB services will have implications on Pediatrics. We will carefully
examine what those implications will be to determine the future
configuration of Pediatrics at LICH.

Reduce the size of the hospital's campus.
The elimination of clinical services allows us to include in our
strategy the sale of real estate, specifically the Polhemus building and
97 Amity Street. This will provide us with much needed cash to help
reduce the hospital's debt.

One of the most important issues will be the impact of these changes on
all of you. To this end, we have already begun to meet with the unions
representing LICH staff employed under collective bargaining agreements.
Our goal will be to maintain as many of our present staff as we can and
eliminate positions through attrition and other means. One of the
benefits of being part of a larger hospital network is that we also can
look to where we might be able to move displaced staff to one of the
other Continuum hospitals.

In addition, we will communicate all clinical changes with our patients
and work hard over the coming months to ensure a smooth transition for
them to other care providers. And we will assist LICH-affiliated
physicians impacted by these changes with any transitional issues
related to their practices.

This strategy also will affect our residency teaching programs. To
this end, we have discussed our restructuring strategy with our
colleagues at SUNY Health Sciences Center at Brooklyn, and will work
closely with them on the transition of affected residents to other
teaching programs.

We have shared this strategy with the New York State Department of
Health whose approval is necessary to move forward with our plans. We
also have had discussions with the Dormitory Authority of New York State
and the U.S. Department of Housing and Urban Development, which insures
much of our present debt.

We recognize that these changes are not going to be easy for many.
Unfortunately, in the difficult environment in which we operate, the
choices are hard and the options few. Yet I am confident that this
strategy is the best course of action for our future. I look forward to
working with Dominick Stanzione, John Byrne, and, most importantly, all
of you, on its implementation.

Internal Turmoil at LICH, ct'd

President Rita Battles of LICH, without warning, is gone; President no longer. The LICH statement says that she prefers to pursue "other endeavors."

Rita Battles

Moreover, there will not be another president at all, at least not for the moment. Instead there will be a Chief Restructuring Officer ("a title with great portent," according to the Brooklyn Paper), Mr. Dominick Stanzione.

Dominick Stanzione

And what does the staff of LICH think ? The medical staff, at least, seems to dissent, once again, from management, according to the Brooklyn Paper:

“[It] is another indication that Continuum Health Partners, a management company that now thinks it owns LICH, is moving to downsize and possibly ultimately close Downtown Brooklyn’s most prominent medical center,” Dr. Arnold Licht, president of the hospital’s medical staff, said in a statement.

Internal Turmoil at LICH

Ruby Washington, New York Times

Dr. Arnold Licht addressing a protest rally

Some weeks ago I was invited to a breakfast/pep rally at LICH. President Battles was there, pouring out the charm, and so were other dignitaries. One Hasidic rabbi, unable to contain his enthusiasm for LICH, reported that his male congregants complain to him that they cannot take advantage of the great infant delivery services of LICH.

Any problems at LICH ? None that were mentioned at this event. Continuum Health Partners, the owners of LICH who operate out of Manhattan ? Never heard those nasty three words mentioned at this affair.

So here is the New York Times of yesterday, with a long story about the troubles of LICH. It seems that Continuum may well sell this Cobble Hill prime real estate (the LICH buildings) to raise money. And, as reported on this blog previously, LICH's medical staff seems to be in revolt against Continuum.

Planters beautified on Hicks Street

LICH has effected some very nice improvements on Hicks Street between Congress and Amity. As I reported recently, the two planters on that block had morphed into garbage receptacles. LICH has now beautified one of these (see picture), and (wisely) removed the other one. Good work, LICH !

The Two Faces of LICH Management: Tulips and Trash

Two Cheers for LICH Landscaping

Look at the top picture. Beautiful magnolias, in full bloom, on LICH property on Henry Street. It's a sign of spring, of the Good Lord showing us his benevolence, but also of the creative lanscaping done by LICH. Thank you, thank you.


And now there is the second picture; a tulip that has also been planted by the good people of LICH, on Hicks Street, just below the LICH garage. But what is that garbage next to it ? Can't somebody keep the place a little neater ?

And here is one of the three new planters that LICH put on Hicks Street just a few months ago. It has been allowed to morph into a garbage pail. The same holds for the other LICH planters on the same block.

Moral: 1) Landscaping, no matter how good, needs to go hand in hand with some attention to garbage removal. 2) You can spend a lot of money on plantings, but if you don't show attention to cleanliness, the place will turn into a slum anyway.

Internal Dissent at LICH

A recent article in the Brooklyn Eagle tells a story of dissatisfaction with LICH's association with Continuum Health Partners. It provides more information on the story I published here previously. There is a related discussion on the blog McBrooklyn.

Graffiti Reappearing

All these pictures were taken on Tuesday, January 22, at about 5 p.m. They show new graffiti on the 300 block of Hicks on two buildings that belong to LICH. These buildings are just north of 385 Hicks, which had heretofore been the worst spot on the block. The new graffiti is not as conspicuous as the old, and the situation in not as bad as it had been. But all experts on graffiti warn that it must be removed immediately when spotted in order to discourage further vandalism.

As I have had occasion to say before on this blog, LICH needs to inspect its exterior surfaces daily. All self-respecting private homeowners, obviously, keep an eye on the appearance of their properties. Should requirements be lower for a not-for-profit hospital ?

The general neglect that LICH management has shown with regard to these buildings is also shown by the fact that neither of these two properties is properly marked with a street number. One door says "3", with the last two digits missing. The other building has no address signage at all. In an emergency -- say Fire or Police -- how could 911 be told where help is needed ?

Loose Lips from Licht, Tight Lips at LICH.

Readers will recall my report about LICH's strange inability -- or unwillingness -- to accept a modest financial contribution from me. Something funny about its IRS status.

Now more information about LICH's secretive financing has emerged in the media. Mike McLaughlin, a reporter for the Brooklyn Paper (largely quoting the Daily News), tells a story that LICH would prefer to keep quiet. It seems that Continuum Health Partners, which operates or owns LICH (I don't know which) favors Beth Israel Hospital, another of its holdings, over its little stepchild on Hicks Street. And apparently Dr. Arnold Licht, president of the LICH medical board, is unhappy; he wants more money for LICH programs. In fact, according to the Daily News story, LICH doctors have complained to Attorney General Cuomo. But LICH management will not talk to the media about this, according to McLaughlin.

Loose lips from Licht, tight lips at LICH.

Graffiti removed

The graffiti at 385 Hicks Street have now been removed.

The deplorable conditions in front of this building and on its walls have been a feature of LICH management for years. I began to report on this problem in August of last year. The tree pits were cleaned up fairly soon, and good new plantings were supplied. The ugly graffiti had to wait until now.

So far so good. But obviously, the underlying problem has been one of long-term neglect. The clean-up is welcome, but without constant attention and vigilance on the part of LICH, conditions can well slide back. As any conscientious property owner knows, to be a good neighbor requires daily inspection of your frontage.

2008 Starts Right for LICH !

Wednesday, Jan. 2, 2008, 11 a.m. Great ! The graffiti, or at least some oft them, seem to be in the process of removal. Was it pressure from the City ? Was it that good old LICH conscience kicking in ? No matter, it seems to be getting done. I do hope that they won't forget those ugly black doors ! Anyway, Happy New Year, LICH, Happy New Year, neighbor.