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On July 24, Al Gore visited Montefiore Medical Center in the Bronx and declared political war on asthma, a disease that plagues children in that borough at five times the national rate. "We have to fight to prevent and reduce cases of child asthma," said the vice president at the groundbreaking ceremony for Montefiore's children's hospital, a project that includes plans for an elaborate playground featuring video and audio links with NASA's space shuttle program and a rooftop planetarium.
But while the millennium is dawning at Montefiore, services are dwindling at North Central Bronx, the city-owned hospital across the street. In fact, the public hospital, which is connected by a tunnel to Montefiore, no longer has a childhood asthma center, having closed it along with the rest of its inpatient pediatric ward in March. Since then, NCB has also stopped providing inpatient rehabilitation and has begun to dismantle its high-risk OB-GYN department. Now, patients who would have received these services at NCB are sent to Jacobi, a public hospital three miles away.
The changes set off months of speculation that the Health and Hospitals Corporation, the city agency that runs the public hospitals, is trying to close NCB and sell its physical plant to Montefiore. And news that the city plans to temporarily house homeless families in the hospital's old rehab unit (the space has been ready as of last Monday, though so far no one has stayed there) has only intensified fears that the hospital is on the way out.
While HHC officials deny the city has any plans to get rid of NCB, the indisputable changes underway at the Bronx facility have rekindled a long-standing and seemingly irreconcilable clash over the public hospitals. On one side is the Giuliani-run Health and Hospitals Corporation, which has spent the last several years whittling services in various public facilities and defending these cuts as consolidation necessary to keep up with private hospitals.
On the other side, public health and union advocates, ever distrustful of HHC, find themselves fighting fiercely to preserve a public system that, in its current state, is failing the poor communities it is dedicated to serving.
"The advocates and the city are kind of locked in these old positions that they really can't move away from," says Howard Berliner, a professor of health policy at the New School. "The reality is the advocates don't trust the mayor's office and they're kind of stuck in this dance." Berliner predicts this stalemate will persist until "a more public hospitalfriendly administration" is in city hall.
In the meantime, public hospital defenders have good reason to distrust the current mayor. Giuliani has made no secret of his desire to get the city out of the hospital business. He has repeatedly called for privatization of city hospitals, and even tried to sell off Coney Island Hospital to a private management company (which has since gone bankrupt).
In the eyes of advocates, the shifts at NCB aren't steps toward efficiency or efforts to help out in a housing squeeze, as HHC officials argue, but part of a scheme to get rid of a public hospital. At a city council hearing on the fate of NCB two weeks ago, Councilmember June Eisland, who represents NCB's district, cited failures to adequately promote or staff NCB as "part of a self-fulfilling prophecy of ultimately shutting down the hospital."
And Judy Wessler, policy coordinator of the advocacy group, the Commission on the Public's Health System, argued that "the underutilization is being deliberately manufactured so that the hospital could eventually be closed." In that event, said Wessler, the city could ultimately give up the hospital and sell the land, "and that can count as privatization." Moving in the homeless, says Wessler, will speed up the hospital-emptying process: "It's a classic move to get patients out."
For HHC's part, spokesperson Jane Zimmerman insists it's the other way around: any changes are due to diminishing numbers of patients. She also insists that, rather than planning to close the hospital, HHC is investing $15 million to improve NCB over the next two years. As for the possibility that the housing of the homeless will drive away patients, Zimmerman says the homeless will be in a separate area of the hospital that has its own entrances, exits, and elevators.
"We don't believe that in any way this will affect the patients who come and go in our facility," says Zimmerman. Instead, she says, "It's the steady and perpetual drone of misinformation about the hospital from advocates and unions that scares our patients away."
Advocates, of course, disagree. "I don't believe HHC," says Jim Butler, the leader of DC 37's local 420, which represents public hospital workers. "North Central Bronx is in the intensive care unit and HHC doesn't give a damn."