I’d like to ask Sean — going back to this issue of hospital capacity, over the last
few decades, and certainly during the period that Governor Cuomo has been in office, the
number of beds available per patient in the United States in many states has declined
dramatically, mostly because hospital managers see empty beds as not money-making, so they
want to reduce the number of empty beds as much as possible, so they staff fewer and fewer beds.
Could you talk about these past policies and now, with this sudden crisis, how the chickens
have come home to roost in terms of this maximum bottom line for hospitals?
Yeah, absolutely.
And I would just add that it’s just not hospital managers.
It’s actually all of our — all of the people who are making political and economic
decisions around public health in the city and the state.
So, for instance, I would call Governor Cuomo probably the single most important person
in terms of the drive to close down hospital beds in this state over the last 20 years.
In New York state, we’ve gone from 73,000 beds to 53,000 beds from the year 2000 to the present time.
So, specifically because of policies that Governor Cuomo has pursued, we are now 20,000
beds behind where we need to be in terms of trying to scale up our capacity to these unprecedented levels.
Governor Cuomo estimates, I think, this week that we need 140,000 hospital beds to have
enough capacity to treat patients that need oxygenation and hospitalization during this crisis.
So, we’re starting at 53,000 instead of 73,000 to scale up to this, to scale up to
the need that is being estimated.
So, the way Governor Cuomo did that is he came up with a hospital bed closure commission.
It was called the Berger Commission.
And he also has had now two rounds of Medicaid cuts.
The first — they’re called the Medicaid Redesign Teams.
The second Medicaid Redesign Team just made a recommendation for massive Medicaid cuts,
including specific cuts to the city hospital system, where we work, just in the last two weeks.
So Governor Cuomo is currently trying to reduce Medicaid spending in the state by almost $2.5
billion during this pandemic.
And this will absolutely result in a decrease in healthcare capacity and keep the state
from getting matching federal dollars for Medicaid spending.
So, it’s unfathomable to somebody like myself, somebody who has worked in a public hospital
for 12 years and has seen these cuts, seen the resulting decrease in staffing, seen the
resulting decrease in services.
We had to fight a couple years ago just to keep our pediatric trauma center open in the
Bronx, the only pediatric trauma center that serves the entire borough of the Bronx and
southern Westchester County.
We had to fight to keep it open because of these Medicaid cuts.
We thankfully won that fight, but we have been at a severe state of precarity when it
comes to having these services available over the last decade going into this pandemic.
And these are because of these specific policies of Medicaid cuts and hospital closures that
have been explicitly pursued.
And it’s very easy to find all of the quotes from Governor Cuomo, from the Medicaid Redesign
Teams, from the Berger Commission, about these hospital closures
in New York state over the last two decades.
I think a really big message here is that we have to remember that a lot of the issues
that we’re seeing come up now, they’re not new issues.
So, prior to coronavirus, we were already holding patients in our emergency room for
days at a time, not just our emergency room.
I know that this happens across the country in several hospitals, because hospitals have
always been stretched to their limit.
So now we’re just adding the stress of a pandemic to it, and it’s pushing us to new
places we’ve never seen before.
So, we have opened up new spaces in the hospital.
Prior to this, we had advocated for that space before for the previous patients that we were
holding in the emergency room.
And now that space is being used by shuffling other patients in the hospital to that empty
space in order to make more rooms on the floors for more ICU patients.
I know there’s been conversions of different units into — that are specifically going to be for ICUs.
Yesterday, our waiting room started — they started construction in our waiting room to
expand an area for where these patients will be taken care of.
Like, they are building a wall within our waiting room,
because we have to do it one way or another.
Like, to increase 50% capacity, it’s making us do the craziest things.
We’re putting patients together that perhaps we wouldn’t have put together before.
We’re trying to put people — the biggest issue right now is space, lack of equipment,
lack of ventilators, but we’re trying to — we know that the surge is going to happen,
and all we’re trying to do is best prepare for it.
And unfortunately, it’s making us make some really hard decisions.