SUNY spits in the face of NY State Supreme Court, by Kimberly Gail Price

“They are not taking anymore ambulances at the emergency room at LICH. If that’s the case, that’s a violation – that’s a clear violation of my order,” Kings County Supreme Judge Johnny Lee Baynes commented during the June 19 court hearing for a lawsuit filed against the State University of New York Downstate Medical Center (SUNY) and the NY Department of Health (DOH). “That is shameful – on the day they are coming to see the judge. Does it get any worse than that?”

Since that time, SUNY continues to do everything in their power to halt all services at Long Island College Hospital (LICH), despite multiple court orders.

After setting an initial date of July 15 for the contempt hearing, Judge Baynes set a conference date for the following Monday, June 24 to ensure that SUNY did not discontinued ambulatory services at LICH. The hospital was to be restaffed and running as it had been the day he originally issued the temporary restraining order (TRO) on February 20, 2013.

Contrary to the court’s order, SUNY not only diverted ambulatory services, but also discontinued all admissions to the hospital effective at 6 am Thursday morning. Walk-ins to the emergency room (ER) would be treated and stabilized. If patients needed to be admitted, they would be transported to other nearby hospitals. According to a letter released from SUNY on June 20, “The diversion is indefinite.”

By 9 pm Thursday night, Brooklyn Hospital, Lutheran Medical Center and Methodist hospital were cracking under the weight. According to the admissions department at Brooklyn Hospital, all ER rooms were full and one or two patients were waiting on stretchers outside of every room. Patients at Lutheran Medical Center reportedly had 8-9 hour wait times. The ER staffs were describing the conditions as “total chaos,” disorganized,” and “overcrowded.”

One ambulance picked up a 60 year old male in critical condition in Coney Island who needed a bed in Intensive Care Unit (ICU). The patient was transported to Richmond County Hospital in Staten Island because every available ICU bed in Brooklyn was filled – except LICH.

Downstate’s claims untrue
SUNY claims the move to divert ambulatory services and discontinue admissions at LICH was due to inadequate staffing. DOH requires one nurse for every two ICU patients. While ambulances were overcrowding other Brooklyn hospitals, seven ICU nurses and two resident doctors were working at LICH with only ten ICU patients. The fifteen bed unit could have taken up to four more patients. But because of the diversion, ambulances were forced to take ICU and emergency patients across bridges and through tunnels into Manhattan, Staten Island and Queens.

Several Brooklyn hospitals requested temporary diversions because their patient loads were too large. But 911 services refused to grant the diversions because all of the hospitals were under the same duress. In less than 24 hours, the LICH diversion had created crises at nearly every Brooklyn hospital.
In addition, SUNY also began transferring patients out of LICH. In another letter also dated June 20 from George Caralis, Interim Chief Executive Officer from SUNY, stated, “Effective immediately, patients will be transferred out of the critical care units (ICU/CCU) and for the foreseeable future, no further patients will be admitted to those units.” Critical Care patients were being transported as far away as New York Presbyterian at Columbia University – nearly 15 miles away. The first patient was relocated Thursday afternoon.

SUNY released a public statement to the public on Thursday, June 20 citing, “A dire situation is developing at LICH […] We have almost daily resignations.”
Julie Semente, a LICH registered nurse and NYSNA member, wrote, “I can tell you first hand that NO NURSES are fleeing LICH […] The emergency room manager did leave. However, there is a qualified candidate ready and willing to take the job, but Downstate won’t fill the position. It serves their purpose to leave it empty.

“There is no ‘exodus’ of physicians either. SUNY Downstate is trying to give the impression that these doctors left LICH of their own choice when in fact SUNY Downstate forced the interns and residents out of LICH in defiance of a court order, and without implementing a plan to replace them with other qualified professionals to continue services.”

DOH confirmed what doctors and nurses have been saying all along. They reported back to the Kings County Supreme Court that LICH is staffed up to appropriate levels and should resume all services. They have been assessing staffing levels on a daily basis since June 19. LICH continues to be fully staffed – with the exception of the residents SUNY pulled back to their downstate campus late last week. In fact, the ICU unit was staffed with five nurses for only three patients.

That same Thursday, James Karkenny, acting COO of LICH and representative from Pitts Management, tried to give ICU nurses and award they had won in March for exemplary care – the same day SUNY told the nursing staff, “we’re emptying the place out.” The Vice President of the nursing staff warned him that his timing was inappropriate.

Like an abusive husband
ICU nurses described Karkenny’s presence as being “like an abusive husband” and “belligerent.” Nurses were forced to have their picture taken with the banner. One nurse was in tears. Karkenny told them to “remove yourself if you can’t understand that you are employees first and union members [NYSNA] last.”

The ICU charge nurse eventually told Karkenny to leave, saying, “Take your plaque. Take your coffee and donuts, and get out.”

This was not the first year LICH nurses had won this award. ICU nurses told stories about a fancy dinner wearing corsages, and the pride they felt in earning the recognition. A banner and plaque were awarded for the nurses to proudly display. But this year’s award was an insult to injury.

By Saturday evening, only three patients remained in ICU, while CCU had completely been dissolved. The 5th floor CCU unit’s door had been padlocked. Six nurses in ICU were capable of taking care of twelve patients. CCU nurses were moved down to help out in the ER.

Over the weekend, LICH’s emergency room remained busy. Walk-ins came from other hospitals via taxi, buses or on foot to avoid the outrageous wait times at other hospitals. One woman said she waited in an ER for 36 hours without being seen before going to LICH. Five cardiac patients that came to LICH’s ER all had to be transferred out. One was sent to Queens, and his family had to track him down.

Saturday was also the last day resident doctors were still in place. One resident expressed concern about beginning her third year in a new hospital. Others seemed distressed about being transferred back to the SUNY campuses and worried about the effectiveness of their training.

Monday afternoon, Judge Baynes held a conference with SUNY, LICH and DOH lawyers. The meeting was closed to community resident, nurses, doctors and media. However, LICH lawyers met with multiple media outlets after the conference with concerned optimism. Judge Baynes insisted SUNY remove the diversion immediately and begin readmitting patients at LICH. He gave SUNY a noon deadline the following day, Tuesday, to report back that services had been fully restored.

By this time, the residents had already been relocated and SUNY expressed concern of doctor shortages. SUNY would need to have physician’s assistants (PAs), intensivists and nurse practioners (NPs) in place before they could fully reopen the doors of LICH. They anticipated this would take until Thursday, Friday, or even as late as Monday, July 1.

SUNY released a statement prolonging the ambulatory diversion, continuation of patient transfer and no longer scheduling elective major surgeries. Admissions, the memo said, would be allowed only through the admitting office, not the ER.

The statement also said that “Obstetrical patients will no longer be admitted to LICH.”

The following day, Dr. Comrie, OBGYN Chief of Staff at LICH, received an email from David Wlody, Downstate’s Anesthesiology Chief of Staff. “Due to significant decrease in delivery volume, (three deliveries in the last 72 hours), effective tomorrow June 27, the anesthesiology department will no longer assign an anesthesiologist to provide 24 hour dedicated care.”

After closing the unit and refusing admission to patients, SUNY then turned the tables and blamed lack of patients for the unit closure.

Another memo from George Caralis, Interim Chief Executive Officer, stated all inpatient admissions to “require review and authorization by the Chief Medical Officer, Dr. Michael Lucchesi. No patients will be admitted unless approved by the Chief Medical Officer.” To date, not one patient has been “approved” or admitted by Lucchesi.

Tuesday night, CCU was still closed. ICU had only three patients remaining with six nurses and one doctor on the unit. Walk-ins continued to keep the ER busy with more than 60 patients a day.

On Wednesday, DOH announced that they were continuing to allow the diversion, but were slowly lifting it in a controlled way until the residents had been fully replaced.

Thompson Sr. appointed as mediator
On Thursday, June 27, Judge William Thompson, Sr. was appointed to oversee hospital operations at LICH. Judge Baynes appointed Thompson to ensure compliance with his court order to restore services and restaff the hospital as they were on February 20, 2013. There has also been talk of the residency program being restored under Thompson’s authority.

Thompson is a retired Appellate Court Judge, and has also served in the New York State Senate and the New York City Council.

Brooklyn Supreme Court Justice, Carolyn E. Demarest ordered SUNY to account for all LICH property, assets and funding they have received since taking over then hospital in May 2011. The Court approved the merger under the condition that SUNY would continue to operate LICH “as a hospital.”

The financial records are being called for because of the “acknowledgement by SUNY Downstate of its intent to close LICH,” as well as SUNY’s “continuous efforts to close LICH in spite of injunctive relief prohibiting such closure.”

Other area hospitals are still reporting overflowing emergency rooms because of the ongoing diversion from LICH. According to one emergency room employee, “Even SUNY is complaining.”

In the meantime, SUNY has closed multiple more units in the hospital each day. One nurse commented it would be easier to list the floors that are still open. On Friday, June 28, three more units – Arrhythmia, the Coronary Catheter and EP units were shut down. Patients that were scheduled for procedures within those departments had to reschedule elsewhere.

Dr. Niki Hurt has been hired as an intensivist. According to Dr. Leonard Navarro, head doctor of LICH’s ICU unit, Dr. Hurt is “perfectly capable” of overseeing the entire ICU department along with the fully staffed unit. However, patients are still being transferred out on a daily basis – most being sent to SUNY.

One patient required a surgery that LICH is capable of performing and always has, but SUNY is not. He was sent to Lennox Hill in Manhattan for the procedure.
By Monday, ambulatory services are supposed to be restored and LICH able to admit patients. Monday will also be Judge Thompson’s first day on site. However, SUNY spent most of the weekend closing floors, transferring patients, polishing the floors and repainting.

The Star-Revue received a letter from a LICH nurse who wished to be unnamed. In the letter, the nurse describes the current conditions of the hospital.
“Unfortunately SUNY Downstate rolls full steam ahead with no regard for judges or special masters. There’s maybe 60 patients in a hospital that had averaged about 240 every year for about 2 years. We are sitting in empty units 12 hours a day, but the nurses are coming to work every day.

“Only the DOH can close a hospital. They have found no deficiencies to warrant closure. They sent an affidavit to the judge stating that the ambulance diversions should be lifted gradually. SUNY refuses and continues to close down the rest of the hospital.

Hospital emptied of patients
“In the meantime, [Thursday] the 8th floor (medical), 9th floor (psychiatry), 10th floor (surgery), 11th floor (neurosurgery and stroke unit), St51 (step down cardiac), and Labor/Delivery are all emptied out of patients. Obstetrical deliveries have been banned except for emergencies. But the nursing staff are all still there. For instance, ICU had 6 RNs on duty with 2 nursing aides and just 3 patients (2 of them being prepared for transfer to another hospital).

“Pediatrics and maternity are empty and no further admissions are allowed. In 2008, when Continuum tried to close those units, the DOH refused to allow it, saying that the services were “vital” to the community. The pediatric and maternal population has exploded in the area since then. If those services were vital then, they are even more vital now. Yet, without the DOH permission or approval, and without regard for the needs/demands of the community, these services are already shut down.

“The cardiac unit is closed and has a padlock newly installed on the door. A PADLOCK! As a slap in the face to the chief of cardiology, a security camera was installed at the door of his office to keep an eye on him. They’re being installed all over the hospital too.
“The cardiac catheterization center, which had the best door-to-doctor times in the borough, is now closed except to in-house emergencies. Surgeries have been blocked too. The attending physicians cannot admit their patients, not through the emergency room and now not even through the admitting office.

“The attending physicians can’t work if they can’t admit their patients. So of course they will have to leave and go to another hospital to be able to take care of their patients – then SUNY Downstate claims there is a mass “exodus of doctors who have voluntarily left.”
“Armed university police are suddenly patrolling LICH.

“The entire in-patient hospital is basically closed. Only the walk-in ER and out-patient testing like the endoscopy lab (for things like colonoscopy) is being allowed. They have turned this 155 year old premiere medical teaching facility into a walk-in clinic practically overnight.

“They have not listened to the Supreme Court Judge ever. He ruled in February and they spit in his face with their defiance. They have not listened to the DOH either which said the ER diversion should be lifted. I don’t know what the esteemed Mr. Thompson is going to be able to do with them.”

More staff than patients
Every day the picture changes a little bit as SUNY defies court orders, ignores directives from DOH and manipulates LICH closer and closer to closure. But the hospital staff is not deterred. They are all still there, outnumbering the patients almost two to one.

Julie Semente sent an email in April detailing the necessity of LICH for the surrounding communities:

“Last week a 13 year old boy collapsed in his classroom. Quick action by his teacher and school nurse brought immediate attention by the Long Island College Hospital ambulance teams that cruise LICH catchment neighborhoods.

“The child was in full cardiac arrest, was brought back to life by LICH paramedics after shocking his heart 4 times and administering emergency medications. The child was in the LICH emergency room within 2 minutes, where the cardiology doctors and nurses took over, started hypothermia treatment and rushed him up to the 5th floor cardiac angioplasty center for cardiac catheterization. Afterwards, the child was stabilized in the LICH Cardiac Critical Care Unit before being transferred to a Manhattan pediatric unit to recuperate.

“He is alive because LICH doctors, nurses, staff, patients and neighbors in the communities it serves have been fighting to keep LICH alive. If SUNY had not been prevented from closing LICH, this child would be dead.”

Without these vital services in our communities, lives will certainly be lost. Every single one of the units and medical services provided that day have been discontinued by SUNY’s ultimate determination to destroy LICH.