Assemblyman Robin Schimminger today issued the following statement:
Governor Pataki has transmitted the final report of the Commission on Health Care Facilities in the 21st Century to the Legislature for its consideration. After reviewing the recommendations contained in the report; assessing input from my constituents, the impacted facilities and their employees; and listening to many hours of testimony from Western New York residents at an Assembly Health Committee public hearing yesterday, upon careful consideration, I am recommending to my colleagues in the Assembly and Senate that we reject the recommendations of this Commission.
Four compelling reasons prompt my decision to urge rejection, any one of which would be a sufficient basis for opposing the Commission’s proposal but which together make an overwhelming case for rejection.
PROCESS. The work of the Commission occurred behind closed doors with little, if any, public awareness or solicitation of public input. For the work of such a Commission to be accepted by the people of the state, the process and considerations which shaped its work product deserved at least some measure of transparency and openness. Instead, the Commission operated in a wholly clandestine fashion. Even when in its final days the Commission’s recommendations were finally voted upon and adopted on November 20, the recommendations themselves were kept secret from the public for more than a week.
The Commission Members with the best knowledge of our region – the six Western Regional Commission Members – gave the recommendations only mixed support at best and their votes for the recommendations were considerably less than unanimous.
The net effect was that out-of-region Commission Members carried the day and imposed hospital closures and realignments on the Western Region despite only marginal support from the Western Regional Commission Members.
PRODUCT. While recommending specific facility closures and realignments, the recommendations do not assign specific cost savings to those closures and realignments. The recommendations assume that health care personnel will readily move as beds are moved and does not account for likely choices by health care personnel to move out of the area or otherwise leave the area workforce. Indeed, the Commission’s report contains disturbingly little in the way of substantive information about the data, benchmarks and other criteria supporting its individual recommendations.
Certain larger hospital facilities (Buffalo General and Erie County Medical Center) escape definitive action by the Commission and are advised to work things out over time, while less well-connected facilities are to be summarily shuttered before the larger hospital issues are resolved. No recommendations should be implemented until the entire picture is complete.
COMMUNITY. The recommendations were initially formulated through the Regional Advisory Committee process involving hospital system administrators and subsequently by statewide Commission Members with specific targets in mind. The result of such insider-driven decision-making is that the recommended closures create new gaps in service for particular communities which happen to have been served by a targeted facility. Long-standing community support for and utilization of certain facilities, sometimes over many generations, was left out of the decision-making equation.
It is the proper role of the Legislature to consider the impact of the recommendations on communities, as there is little reason to believe such consideration factored into the recommendations of the Commission.
AN OPPORTUNITY FOR A BETTER COURSE. January 1, 2007 brings into office a new Governor and Health Commissioner. Anomalously, the task of implementing the recommendation of the previous Administration’s Commission will fall to the new Governor and his Health Department. Given the aforementioned flaws in both process and product, the start of a new administration provides an opportunity to re-start the Commission process in such a manner as to increase transparency and produce a more complete and publicly palatable work product. A fresh start and fresh look will cost some time, but having already had some groundwork laid, will not unduly delay the process and will certainly bring a more acceptable and achievable result.
The cost and quality concerns that formed the impetus for the creation of the Commission on Health Care Facilities in the 21st Century are real and demand attention. Keeping in mind the admonishment to physicians widely attributed to Hippocrates: “First, do no harm,” we should devote the requisite time and effort to building a broader understanding of and stronger agreement on specific strategies for improving health care for all New Yorkers.