The new setup insulates the PBC from public opinion or heavy questioning, because the county has no Board of Health or independent panel overseeing hospital operations. Koubek, Kass and O'Connell and a host of other community organizations from the League of Women Voters to the Families and Children Association say they have been essentially shut out of the process. They've been trying to get the county to create a community-based advisory board to provide some measure of meaningful oversight, but their fight has led nowhere, they say, except to greater boorishness on the part of Eric Rosenblum.

Dr. Rosemarie Guercia, former deputy commissioner of the Nassau County Department of Health and a leading health-care advocate, says she asked Rosenblum about an advisory board. "He was very candid," Guercia says. "He told me he already had enough people looking over his shoulder."

At the public meeting in August, Rosenblum and his pals were ready for citizens to show up and demand involvement in the new Nassau Medical Center.

"There was a rehearsed question and a rehearsed answer," recalls Richard Koubek. "I didn't pick up on it until after the meeting was over. The Health and Social Services Committee chairman, Vincent Muscarella, asked a question of Mr. Rosenblum. Something like, 'Will the board meetings of the PBC be public?' And I thought, that's an innocuous question. Rosenblum said, 'Oh, absolutely. Absolutely yes.' Someone told me later, 'There goes your advisory or oversight committee. They're on record about public involvement.' You see, the public meetings aren't the real meetings."

One week after Republicans lost control of the county legislature to Democrats, they at last created something that looks a lot like a public advisory board for Nassau's health-care network.

Activists are delighted at the approaching rise in power of the Democrats, since the party has at least argued that the public should be included in discussions about the medical center. "If you look at the national parties, the Democrats have a greater interest in health-care issues for poor people," Koubek says. "For example, look at the Patient Bill of Rights, which the Democrats are in favor of. I assume there will be some overlay on the county level for the Democrats."

Yet by hastily creating an advisory board, the Republicans bound the Dems to an oversight committee that has no teeth. The Community Health Council will have seven members, five of whom will be picked by the county legislature's presiding officer, two by the minority leader. The chairperson will come from one of the five picked by the majority leader. The bill that created the council was a curiously worded document with phrases like "whereas, the County of Nassau is contemplating the transfer of the Nassau County Medical Center."

Since the sale has been a done deal for months, was this thing drafted, forgotten and filed away only to be resurrected in a time of election defeat and after blithely ignoring health-care advocates, with a public meeting looming on Nov. 22?

"It's a sham proposal," says Kass. "This so-called Community Health Council serves at the pleasure of absolutely no one. There are no term limits. There is no mission statement. No rights are assigned to this council, no responsibilities assigned. The composition is completely political. A sham, pure and simple."

The composition of Nassau's PBC board appears to be just as political as that of the advisory council. In the Westchester deal, board slots were filled by people who have experience running huge and complex enterprises, like the executive director of the Port Authority, a vice president of J.P. Morgan and Company, executives of investment firms, a former lieutenant governor. But in Nassau, the seats are held by longtime party contributors and politically wired lawyers, like Chief Rosenblum.

CEO Jerald Newman is pulling down $200,000 to run the hospital, but the closest the ex-chief of the Bowery Savings Bank has come to the health-care field was a stint as an executive at Slim Fast Foods Inc, according to hospital documents.

Activists point out that running a diet company is hardly preparation for the vast complexities of managing a health-care network. "Running a hospital today is an extraordinarily difficult and complex task," says O'Connell. "You're in competition with not only other hospitals, but you have HMOs, third-party payments, there's an enormous amount of problems. You see people like Jack Gallagher at North Shore, David Dantzker at LIJ, you see people at the Catholic health institutions, and what you have are people with an incredible amount of talent, who have been doing this for a long time, who have evolved through a system and who know how to run an operation. This is not a job for novices."

The relative newcomers in charge of Nassau's hospital will face some high hurdles right out of the starting blocks. In addition to keeping up with the debt payments, they'll inherit a labor arrangement that is cumbersome and politically fragile.

In Westchester, the county struck a deal to have the hospital's new management negotiate directly with the unions, giving the PBC crucial flexibility.

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