But thanks to Gulotta, Nassau's PBC won't have nearly as much room to move. Last year, Gulotta persuaded lawmakers in Albany to pass a law that would keep Nassau's hospital workers in the same union as county employees. Having long enjoyed profitable negotiations with the county, those workers give Gulotta and the GOP a loyal voting bloc, not to mention campaign funds.

In his few interviews with the press, Rosenblum has expressed optimism, telling one reporter, "We're looking to hold our own, pay our debt, pay our bonds, and provide top-quality medical care."

It's not lost on activists that the last item on Rosenblum's list is "top-quality medical care."

"I'm really concerned about this sale," says Sister Evelyn Lamoureux, parish outreach coordinator for St. Boniface in Elmont. "We met with Eric Rosenblum on several occasions. We were made promises. We asked that health-care services for the poor be maintained, and that they would get equal treatment, the same waiting time, the same physicians as people who can pay. Mr. Rosenblum said he didn't have a problem with that. But nothing like that, nothing close to it, is in the agreement. Just some stuff about 'historic mission.'"

The county legislature is about to undergo a massive restructuring, from a 14-5 GOP majority to a 10-9 Democratic majority. The PBC board, however, may be one of the new legislature's biggest stumbling blocks if it wants to make an impact on health care.

Seven positions on the PBC board have expired. Five of those are controlled by Gulotta and one by lame duck Presiding Officer Bruce Blakeman. Calls to Gulotta's office asking for a timetable on making new appointments were not returned. Activists expect these slots to be filled soon, rather than sitting empty until Democrats take control in January. The new appointees will serve five-year terms, so Rosenblum and Newman may have a rubber stamp board until 2005.

Nassau's Democratic boss, state Assemblyman Tom DiNapoli, promises to examine the appointments. "We're going to look closely at the assignments," he says. "Ours will reflect the historic mission of the hospital and health centers. The services to the poor will not only be maintained, but enhanced. We are committed to community input, community advisory boards that mean something. We have to stay close to the everyday people who are served by the PBC."

DiNapoli's stand has been encouraging for activists, but they question how much Democrats can get done with a Republican-selected board and advisory council. "What will have to happen is they're going to have to find their feet in a hurry," says O'Connell. "They've never governed. Some members have never been elected to anything. I would hope and expect them to remain open. I hope they remain open to ideas and suggestions to literally create a new system of delivering health services."

For some advocates, the threat of losing the old system looms large. Sister Lamoureux cites real services, like a mobile mammography van, that could be lost by real people if the PBC falters. "I'd say 50 percent of the women who use it are without insurance," she says. "What happens if that is taken away?"

People like Ramona DeRienzo, who have depended on care through Nassau's network for years, aren't hopeful about the new ownership. DeRienzo sees the end of an era, the end of doctors' offices and emergency rooms that provided treatment for her and her family that they couldn't have gotten elsewhere.

"That is a great hospital, and the clinics are great," she says. "They were good to me and my kids, kind and caring. Now they've got to make money. Who's going to suffer? You tell me. The hospital and the clinics will never be the same, I'm convinced of that."

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