Document ppdbv5zVzNbX7nXNZw9x43QjD

HEALTH - PAC HEALTH POLICY ADVISORY CENTER INSTITUTE FOR POLICY STUDIES Bulletin No. 2 July 1968 DO WE HEAR FOOTSTEPS? Steps - h alting, unpublicized - are apparently now being taken by Mayor John Lindsay, through his aides and through his Health Services Administration, to exert some leadership, to induce agonizing reappraisals, and to avoid certain narrow courses of City policy with regard to the health services crisis. There are recurrent signs, according to knowledgeable sources, of the following: (1) City determination, led by the Mayor, to achieve Federal - State designation of a primarily Mayor appointed - , consumer - oriented City agency for Comprehensive Health Planning Authority (P.L. 89-749). A Mayoral showdown is scheduled soon with Health and Hospital Planning Council officials. (However, the present City proposal calls only for a City coordinating agency with limited or no professional planning staff. This would probably leave most of the actual planning and data gathering - process to the private, voluntary hospital establishment - oriented Planning Council.) An open door is being left for the creation of neighborhood health boards as part of such an agency and its advisory council, but there is not a firm commitment about whether, when, where and how these would be created. (2) Pressure from the Mayor's Office, reflected in slashed Health Services budget requests (blamed on State Medicaid and Federal grant cut backs - and overall City fiscal tightness), for firmer program planning and clearer priority setting. As one Mayoral aide puts it: " We want to see some clear sense of direction from Health Services before we can turn on the spending. " (3) Mayoral snubbing, reflected in a loud silence, of proposals for a Health Services Corporation or Authority " carved out " of the Health Services Administration for independent or privately contracted operation of City owned - hospitals and health facilities. But There's A Long Way to Go... The fiscal, administrative, and political realities of It is time for action, not words. " New York City's health services still run against the (3) The most dynamic and potentially progressive latest limited City leadership efforts at the top: energy in the health services system is frequently (1) So long as the scarce public funds for health at the " bottom, " among the most neglected health leak away to loose funding of private institutions and workers and among consumers of health service at services, needed public action, for example, for neigh- the low income - neighborhood level. Hospital employee borhood health centers, will be stymied. The City's organiations (such as Local 1199 and District Council overall municipal hospitals budget for 1968-69 shows an actual decrease over the previous year, blamed 37 of AFSCME) are winning more new career training and upgrading and a direct role in institutional change primarily on the Medicaid cutbacks. But specific af- as well. filiation contracts with voluntary hospitals and med- The insurgent actions of neighborhood organizations ical schools within the budget, though so widely con- are challenging many of the assumptions of the smugly demned, are being increased $ 13.4 million. over centralized - , privatized, and narrowly professional- (2) Few signs are being shown of specific new ized existing health establishment. City administrative leadership in the nitty gritty - func- The question is no longer so passive as whether tions of (a) regulating private sector use of public the people can find government leaders responsive funds, beyond certain Medicaid quality audits, and to their needs. Can government leaders catch up with (b) expediting specific municipal institutional reforms, the new demands and interest being expressed by beyond scattered city hospital " crash programs. " As these new worker and community forces? Can they the recent detailed report of the State Investigating be credible as coordinator, planner, ombudsman, and Commission, critical of City Hospital affiliations on expediter, and agent of change in the most pressing the most elementary level of administrative proce- public interest? dures and performance, demands: " It is time for the Department of Hospitals to direct and not to'suggest. ' -Robb K. Burlage Director, Health Policy Advisory Center Eastside Story... GROUPS SEEK SEEK MAJOR ROLE Can the citizens of one of the most politically active and or- ganized low income - neighborhoods in the nation make health services accountable to their needs and open to their policy- making participation? This is the challenge in the Lower East Side South - (Manhattan). (1) It successfully mobilized almost a decade ago to prevent City closing of Gouverneur City Hospital without building a model community hospital in its place. Today residents are still pushing for rapid construction of such a facility. The project is almost still at ground - zero and there have even been reports that a chronic care facility would be substituted, although community residents say they would fight such a proposal to the death. (2) The Gouverneur service area was targeted for one of the first national Office of Economic Opportunity neighborhood health services programs. It is based on the old Gouverneur facility, co funded - by the City, and operated by Beth Israel Medical Center. (Beth Israel, a private voluntary hospital, member of the Federation of Jewish Philanthropies and affil- iated with the new Mt. Sinai Medical College, serves primarily as a community hospital for the lower East Side area with a wide array of public subsidies for providing service in this area.) The Gouverneur program, now in its third year, is re- portedly lacking in certain aspects of services coordination and outreach for the whole area and, even though a neigh- borhood health council exits, especially in meaningful com- munity participation in the direction of the program and in the development of new program plans. What Is HEALTH - PAC? ... an independent, non government - center for the public, serving as a Health Ombudsman, Health Information Ser- vice, Social Analysis Laboratory, and Technical Assistance and Communications Center. It monitors public policy in this monthly BULLETIN and in other publications. It conducts workshops for neighborhood, health worker, and community - oriented professional leaders on organization for improved com- munity services. It assists research and reporting about the problems, issues and power forces, particularly in the changing metropolitan New York health services setting. Its commitment is to the basic principles and overall social analysis articulated in the Institute for Policy Study's report on New York City's Municipal Hospitals (the Burlage Report) in 1967, with eyes open to the revolutionary changes being demanded in the urban services and environmental setting today. HEALTH - PAC aims for the redirection of health services as part of general community social change toward a true public accountability and excellence for all citizens. HEALTH - PAC is an urban research and advisory center of the Institute for Policy Studies (a non profit -, research and education organization based in Washington, D.C.) with a supporting project grant from the Samuel Rubin Foundation, operating according to the policy direction of the HEALTH - PAC staff and advisory committee. Published monthly by the Health Policy Advisory Center of the Institute for Policy Studies, 305 Broadway, Room 1109, New York, N.Y. 10007. (212) 227-2920. Staff: Robb K. Burlage, Director; Maxine Kenny, Assistant. Copyright 1968. (3) The Lower East Side is now the scene of plans, involv- ing variously Beth Israel Medical Center, the City Health Services Administration, and Mobilization for Youth (a) to create a unified City Health District, based in Gouverner- Beth Israel; and (b) to create a neighborhood multi service - referral system for the entire area, based in Beth Israel, with Federal funding. Neighborhood groups insist, however, that any such comprehensive services coordination should be accountable, responsive to, and controlled by a broad based - community coalition. A major force in the drive to improve community control over health affairs in this area is the Lower Eastside Neigh- borhoods Association (LENA). LENA actually lost private health establishment - associated foundation grant funds in recent years for its tenacious fight, along with many other neighborhood groups, to win a new Gouverneur Hospital. This fight was against the wishes of the Hospital Review and Planning Council (now the Health and Hospital Planning Council), the voluntary hospital leadership, and even the then- City Commissioner of Hospitals. More recently, LENA has devoted the time of staff organ- izers to assist the Lower East Side Neighborhood Health Council - South, which also serves as the community health council for the Gouverneur Neighborhood Health Services Program. An immediate goal of the Health Council with regard to the Gouverneur program is to strengthen par- ticipation of recipients of service in the area (generally south of Houston Street and east of Third Avenue) in the policy- making and control of the program. Negotiations are now under way with Beth Israel and the Office of Economic Oppor- tunity for an independent grant for a staff person, hired directly by the Council, for community organization and health education. The Council has also discussed seeking community representation on the Board of Trustees of Beth Israel. Beth Israel has launched a proposal to lodge powers and jurisdiction of the District Health Officer of the City in the Gouverneur - Beth Israel facility to serve under the general direction of Beth Israel in cooperation with the City Health Services Administration. A goal discussed by some neighbor- hood groups is that the District Health Officer should have strong public administrative powers and independent staff to serve as, in effect, an Assistant Health Services Administrator for the district, rather than being, in effect, a ward of the private medical center. With this position he would be able to carry out and to induce in all the health facilities and services of the area the plans and program priorities of a broadly - based, consumer controlled - Neighborhood Health Board. Another Beth Israel launched - proposal, for a " Neighborhood Multi Service - Center " program, in cooperation with Mobiliza- tion for Youth, is also probably to be based at Beth Israel. It is also being challenged by the Health Council, LENA, the North East Neighborhoods Association (NENA), and other neighborhood groups. They are demanding that such a pro- gram be related to a broad based - community coalition of groups and be administered directly by community - based organizations, not to be essentially the administrative ward of the externally owned and controlled private hospital. (2) NENA to Open When a small boy almost died because he could not get to Bellevue Hospital during the 1966 transit strike, Lower East- side mothers protested vehemently and petitioned Mayor Lindsay. ". Last month the Federal Public Health Service funded the first community - owned, comprehensive health cen- ter in a low income neighborhood in the nation. The North East Neighborhood Association (NENA) health center was not a quick response from the City Administration, however. In fact, according to the co chairman - of the NENA Intergroup Health Committee, the community coalition spon- soring the project, Mrs. Gloria Martinez, " As an answer [to the petition] we were referred from one office to another without getting anywhere. " When the NENA Health Center opens in January, 1969, at 290 East 3rd Street, New York (Manhattan), its policies will be set by a board of neighborhood residents - the traditional " re- ceivers " of services. Because the Committee is a section cross - of the community (although a breadth of income and edu- HEALTH - PAC is a strong advocate of health services decentralization in neighborhood health centers, where people can most easily use basic services and where they can be responsive to their demands and needs. HEALTH - PAC is also a strong advocate of meaningful consumer participation in shaping the direction of health services programs. Our information and advis- ing services are especially dedicated to serving these goals. In this month's BULLETIN are brief descrip- tions of two approaches to community influence in health affairs on the Lower East Side and a report on a new challenge for such influence in Harlem. cational levels are represented), low income - residents are the dominant force on the Committee and have been central to all the action - from program and facility planning to finding (and persuading) sources of private as well as public funding to recruiting a highly qualified staff. During the struggle an unusually strong partnership between professional and lay leadership developed. The neighborhood of 60,000 persons which stretches from 14th Street to Houston Street and from Avenue A to the East River is predominantly Puerto Rican (55-60 per cent) and > Negro (20-25 per cent). Even though the area is primarily low income - , the center will be open to all residents from all income levels. It will initially save 25,000 persons. Ana O. Dumois, project organizer, says the committee is presently designing a plan for reimbursement which will as- sure all residents the use of the center, as well as control cost, provide quality care and motivate people to use the services properly. The doctors hired for the Center will be paid competitive salaries, but their attitudes toward the poor will be carefully scrutinized by the lay board. Dr. David Zimmerman, graduate of Albert Einstein College of Medicine in the Bronx and a doctor of internal medicine at New York University Medical Center, will head the medical team and has already begun re- cruiting the seven doctors and four nurses who will initially staff the center. In addition, more than 40 neighborhood peo- ple will enter para professional - health careers at the center. Health Center The New York Infirmary, a small voluntary hospital in the area, will serve as the primary backup facility. All NENA group practice physicians will be allowed to admit patients and follow the patients while hospitalized, providing a real continuity of care. In cases where required services are not available at the Infirmary, New York University Medical Center will provide backup. Principles for operation of the health center are the op- posite of the traditional pattern of urban health services in low income - areas, whether in hospital clinics or in " satellite " health care clinics which are hospital sponsored - . The NENA center will provide comprehensive medical care by appoint- ment. All adults in one family will be seen by the same in- ternist and all children by the same pediatrician. Speciality clinics will be eliminated and specialists at the center will see patients only on a referral by the family doctor. Two special emphases of the NENA plan are to: (1) " Provide local residents with the chance, through train- ing programs and job opportunities, to enter into careers in the health professions and... to solve the manpower short- age in the health profession by a careful downward transfer of functions; (2) " Make the facility more responsive to the community and, as such, capable of having a more positive impact on the health of the community residents, by involving the local residents in the planning and operation of the health center. " Almost three years of determined struggle for the health center on the part of the community residents were preceded by many years of discontent with the inadequate health care care in the neighborhood. David Cook, Committee co chairman - , described the following scenes at Bellevue: A patient being operated on for the wrong ailment because of a mixup of records; a patient dying in the waiting room; or, waiting for hours in line at a clinic (there are over 200 clinics at Bellevue and the patient must literally diagnose himsel) only to find he must start all over again because he guessed wrong. Bellevue Hospital, though not far away in actual distance, is to many virtually inaccessible. There are seldom taxis in the neighborhood. The only transportation is the city bus, which runs approximately once each half hour during the day and stops running at midnight. Clinics are run only during the day, on a first come - first served basis, and a day spent at Bellevue means a day lost from work or family. It is not surprising the situation reached critical propor- tions during the transit strike of 1966. When the 500 mothers who petitioned the Mayor got no results, they told their story at a public hearing in the neighborhood, where NENA first heard of their frustrated efforts and offered staff services to contact and coordinate other interested groups. [NENA is a neighborhood association, organized six years ago by the Lower Eastside Neighborhood Association (LENA), which gained its autonomy last year.] The NENA Intergroup Health Com- mittee grew from this effort and now includes the support of 62 neighborhood organizations. " We never had difficulty getting community participation. They came to our meetings because they came to develop the plans for a health center, not to discuss the plans that had been developed'downtown,'" says Miss Dumois. (Continued Page 4) (3) Unrest in the Columbia Domain... HARLEM DEMANDS POWERFUL BOARD A " Committee of 100, " spearheaded by Harlem CORE and including representatives of HARYOU - ACT, the Harlem Neigh- borhood Association (HNA), Harlem Hospital employee unions, and Harlem community physicians and hospital staff, is de- veloping a program to demand that prime public authority be delegated for the creation of a " Harlem Community Health Board. " The prime target is control of Harlem City Hospital Center where widespread community unrest has been created by agonizing construction lags on the long heralded - new hos- pital building, jammed job opportunities, and a crisis of medical service confidence. A key element in this demand is community resentment of the domination of Harlem Hospital by the Columbia University College of Physicians and Surgeons and Columbia Presbyterian - Medical Center. This fiscal year they are receiving about $ 13.5 million, almost half of the City hospital's total budget, under a City affiliation contract for provision of professional services. This includes upwards of $ 1 million accruing directly to Colum- bia for " managerial overhead " under this contract essentially to assist in the recruitment of physicians. This movement of community organizations comes in the wake of protest, joined by striking Columbia University stu- dents late this spring, against Columbia University's use of City park turf adjoining Harlem for a college gymnasium, and of well publicized - charges by Congressman Adam Clayton Powell that black Harlem physicians have been ousted to make way for whites under the Harlem Hospital affiliation. Although Columbia hospital affiliation officials claim that there are more Negro directors at Harlem Hospital now then at any time in its history, leaders of black physician groups in Harlem contend that the most important positions in the hospital have, in fact, gone the other way and that there is widespread bitter- ness among black community physicians about being slighted. Says Dr. Arthur Davidson, a long time - member of the Harlem staff and of the Manhattan Mid - Medical Society: " When Columbia came into Harlem in the early Sixties, black phy- sicians were promised by Columbia that they would have full access not only to a revitalized Harlem Hospital but to full opportunities for themselves and their patients at Presbyterian, St. Luke's and at all medical facilities in the Columbia'medical HEALTH - PAC conducts a bi weekly - workshop for com- munity organizers and neighborhood leaders concerned with health issues, usually at different locations throughout the city where there are neighborhood health programs or interested health - community or- ganizations. For further information, call Maxine Kenny, 227-2920. family.'However, these promises have not been kept, and these physicians are now demanding more black ' power'or community control over what is rightfully the community's, because false promises of integration in the general system have not been met. " Victor Solomon, of Harlem CORE, notes that the Medicaid cutbacks are forcing Harlem residents again to rely primarily on Harlem Hospital because many have lost their coverage in more " integrated " private hospitals. Erutan Yoba, an organ- izer for Local 1199, Hospital and Drug Workers Union, which covers " Columbia - affiliated " technical, clerical, and service employees at Harlem Hospital, says that those who work in the heart of the Hospital know best how neglected it has been by both the City and Columbia and how new community power is needed to make positive changes. A memorandum calling for the creation of a Harlem Health Board states that a majority should be " lay members of the Harlem communities. " The Board would essentially control " all of the medical and mental health services and whatever such facilities exist in Harlem. " It also states that " any affiliation of any hospital would take place on the basis of contractual relation with the community... " NENA (From Page 3) In June, 1966, the group approached the New York Uni- versity Medical Center to ask that a satellite "" clinic of Belle- vue to be established in the neighborhood. Some officials there were receptive to the idea and suggested the use of mobile trailer units until the health center could be equipped and opened around October, 1967. With this assurance, the Com- mittee began the arduous task of preparing an application for a Federal grant. The group suffered a major setback, when they learned in May, 1967, that NYU had deferred the entire project, uni- laterally, and without consultation with the community. One member of NENA voiced the despair of the group: " We real- ized for the first time that the primary interest of the Medical School is to teach students, and not to service the patients whom they use. " By summer of 1967, the Committee overcame this blow and began making contact with interested social scientists, with Federal agencies, with political figures, and with City officials. Talks began with the New York Infirmary. The Com- mittee finished a working draft of a proposal to be used as a base and guideline for development of a final proposal. Many who worked closely with NENA Intergroup Health Committee during their struggle see this experiment in health care as an historic step. It is perhaps the first time a group of low income - people, the traditional recipients of clinic services, have taken the full initiative and leadership in direct planning for medical care and mobilized themselves to involve a major medical institution in their plans. Though they were not professionals, they agreed to a set of principles upon which to build the center which were not unlike those advo- cated by many progressive health professionals. It is unique similarly in the politics involved - it is community controlled. The Public Health Service of the U.S. Department of Health, Education and Welfare is providing the operating grant of $ 559,282 for the first six months and $ 1,108,382 for the first year. The grant application was prepared with a six month - planning grant from the Carnegie Foundation. An investment by the Samuel Rubin Foundation allowed the purchase and renovation of the building, which the community will pay back in rent - like payments, and within a few years the com- munity organization will own the health center facility. -Maxine Kenny ! (4)