EMERGENCY

Before Ramona DeRienzo landed an office job last April, the 43-year-old Levittown resident had worked as a diner waitress for 23 years without any health benefits. A single mother of two, she had used the Nassau County Medical Center in East Meadow, along with its Community Health Center clinics, for herself and her children. Through the county-run hospital, she had received gynecological exams and counseling, gave birth to her daughter, received dental care, pediatric visits and, most dramatically, was treated for a serious blood disease with a two-mile-long name abbreviated to ITP. It's a disease that, if not monitored closely and treated with intensive drug therapy, can be fatal.

Last Aug. 19, DeRienzo went to a public meeting because she was worried about the health of the hospital she depended upon. The meeting concerned an $82-million sale that would turn over the hospital and its clinics to a "public benefit corporation."

"I went to the meeting because I was worried that poor people, and I've been poor all my life, wouldn't get good medical treatment," she said. DeRienzo is a feisty woman who, when she speaks, refuses to be ignored. "My kids and I stayed healthy and, with the ITP, my life was saved because of the care we got. Sometimes I was only making $800 a month. The Medical Center cost us nothing. We struggled, but we had a life."

What she saw at the meeting turned her worries to fear. Eric S. Rosenblum, 50, was announced as the new corporation's chief operating officer. DeRienzo knew him as a lawyer and Levittown Republican boss. "When I saw him," she recalls, "and he's up there smiling, saying, 'Oh, yeah, the hospital's going to be the same, the clinics will still be for the poor,' let me tell you, I didn't buy it for one minute."

She is not alone in her worries of what can happen to the hospital, seven clinics and the A. Holly Patterson Geriatric Center in Uniondale, which are all part of the sale, along with 50 acres of property around the hospital. Health-care advocates across Nassau fear a catastrophe in the making. There are well over 200,000 uninsured people in the county, with some estimates as high as 300,000, who depend on charity care from the publicly owned medical center. If the new corporation runs into financial difficulties, it can close clinics, sell the nursing home or shut the hospital itself-cutting off the lifeline for some of Nassau's neediest residents.

"We are in critically serious danger of losing our public health services," says Donna Kass, from Great Neck, a retired physical therapist and health-care administrator who now leads the Long Island Coalition for a National Health Plan. "There is absolutely no guarantee or assurance that services to the indigent or under-insured will continue to be given. And certainly no assurance that they'll be given at the same level, with appropriate quality."

All hospitals, whether public or private, are required by law to provide emergency care even to people who have no insurance at all. But a county-owned facility like Nassau's is supposed to strive to fill gaps in services, rather than just being willing to take car-crash victims, says Jack O'Connell, executive director of the Health and Welfare Council of Long Island. He says the Nassau County Medical Center has been the only place to get certain treatments other LI hospitals deemed too expensive to offer, even to patients with full coverage.

O'Connell says the danger is that the Nassau facility's new owners are starting out with so many millions in debt they'll decide to jettison some services just to stay afloat. The hospital can't block the uninsured from seeking help there, but management could whittle away the offerings. "The fear would be that they would eliminate a burn unit or a trauma center that would be very important for that population," he says. "With all this debt, the fear is if they're behind the eight ball from day one, what kind of services are they going to present?"

WHOSE LIFE IS IT, ANYWAY?
In the past 25 years, more than 400 public hospitals have either gone out of business or been sold to become private or quasi-private. Of the nation's 1,300 remaining public hospitals, more than a third are on the critical list. A Consumer Union study released in April showed that when medical centers are sold or merged, care for the poor is the first casualty.

Nassau's public health system has never been ideal, but it is at least functional. Now the taxpayer-owned network could be in jeopardy, both because of the way the deal was structured and because the public has been almost completely shut out of the process.

Getting shut out of government is nothing new in Nassau, where for decades Republican administrations have been not democracies but autocracies. Nor is the selling of public hospitals unusual, in an era when politicians tout the benefits of turning community assets into private holdings.

What's out of the ordinary is how Nassau County constructed such a shaky deal. From the beginning, in picking a board, setting a price for the hospital, fumbling to put together a workable financial system and getting community opinion, the newly created Nassau Health Care Corporation seemed to be shipwrecked before it had set sail.

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