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August 7, 2008

Public Officials, Community Members Rally 'Round LICH

lichrally_0808.jpg

About a week after Long Island College Hospital announced that it would sell off two more buildings and shutter its maternity ward, city officials (including Councilmember Bill de Blasio, above) and community folk rallied to urge Continuum Partners, LICH’s parent body, to select another strategy to pay off its $170 million of debt. The question no one seems able to answer is why they made obstetrics the victim, when child rearing is the new black here in Brooklyn, and maternity wards are closing elsewhere in the borough—Victory Memorial Hospital in Bay Ridge lost its labor and delivery unit in December because of money troubles, and Interfaith Medical Center in Bedford-Stuy lost its maternity ward in 2004. State Sen. Marty Connor made a suggestion, since many of these Brooklyn neighborhoods are growing younger. “Maybe instead, they should have cut gerontology,” he said.
Officials Urge LICH to Reconsider [Eagle]
LICH Selling Off More Buildings [Brownstoner]
LICH Sales: Real Estate Roguery? [Brownstoner]
Photo by William Alatriste.




Posted by lisa at 9:05 AM | Comments (24)
Categories: Cobble Hill

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Actually, the NY Sun answered that question quite well. To quote: "the obstetrics department accounts for 33%, or $11 million, of the hospital's annual losses and racks up $8.8 million each year in medical malpractice costs, an amount that represents 40% of the hospital's total malpractice costs."

This problem is by no means unique to LICH, just look at the other obstetrics departmens closings and the dismal rate that medical schools produce ob/gyns. The result? The US has the second worst infant death rate among developed countries. Our health care system is broken.

Posted by: Guest_04 at August 7, 2008 9:25 AM

I agree it's broken, but my question is why does an obstetrics department lose 33% and why are the malpractice costs for that department so high at LICH. Or are those numbers in line with the obstetrics departments of other hospitals?

Posted by: bxgrl at August 7, 2008 9:33 AM

Interesting, Guest 04. I heard on WNYC yesterday the statistic that a hundred years ago 1 in 5 children in the U.S. died before the age of 5; now it's less than 1 in 100. That's neither here nor there as far as LICH goes, but i just thought it was interesting.

Posted by: Atlantic Frantic at August 7, 2008 9:34 AM

I'm not 100% sure on this, but I believe the issue is that ObGYN malpractice insurance is by far the most costly. This is because the doctor is liable for any developmental issues until the kid hits 18 years old. So, there are a lot more lawsuits in the ObGYN field than in other specialties. The premiums that obstetricians pay is also very high. This is one reason why many medical students do not go into the specialty.

Posted by: jkg11218 at August 7, 2008 9:44 AM

20 years ago LICH was considered a good hospital -- had top OBGYN and urology docs. Now the place is a joke. Record-keeping - they could find no record of me being there and seeing the head of a dept. even though I had been there twice. If you need to go to the ER -- go anywhere but LICH.

Posted by: BH76 at August 7, 2008 10:11 AM

That is an interesting statistic, Atlantic Frantic, and great that we've made progress over the last 100 years, but I wonder what the comparable numbers are for other developed countries. Still very sad if your child is that 1 in 100.

Posted by: Guest_04 at August 7, 2008 10:13 AM

Doctors are absolutely NOT liable for developmental issues, unless the doctor caused the issue by his or her own incompetent treatment. The tort system is not a substitute for national health insurance.

In tort, there is no liability without negligence (i.e., carelessness) and fault (unreasonableness). Doctors are only liable for MALpractice. That means the victim needs to prove that the doctor did something wrong--not only that the patient suffered some injury, but that the injury was the result of the doctor not taking ordinary care and not acting in a professional manner.

If the doctor treated according to standard procedures in the community, the patient loses, regardless of how bad he or she suffered or was injured, and even regardless of whether a better equipped doctor in a better hospital could have prevented the injury.

Tort recovery rates, despite what the insurance companies and tabloids repeat constantly, are actually quite low--most injured patients don't sue, and most of those who do, lose.

So, if the LICH ObGyn department has extraordinary tort liability, there are basically two possibilities: (1) they are not treating patients competently; or (2) their insurance company is settling cases they shouldn't be (i.e., they have incompetent lawyers).

Epidemiological evidence strongly suggests that smaller departments have worse results. Practice makes perfect, apparently. So leaving aside tort liability, there is a great deal of sense in folding small departments into a smaller number of larger ones. It isn't hard to get from downtown Brooklyn to Park Slope or Manhattan.

Posted by: FinanceGuy at August 7, 2008 10:18 AM

And if you don't live in downtown Brooklyn or Park Slope? And depending on traffic and the time of day it can be very hard to get to Manhattan. Especially if you're in labor.

And having seen my sister make a trek, in labor, from the Bronx to LICH (the head of the department at the time was a renowned specialist in difficult pregnancies who went to LICH midterm in her pregnancy from Columbia Presbyterian), blithely waving aside the closings is certainly no answer. And according to her, no fun either.

I wonder if part of the problem isn't just insurance companies settling when they shouldn't but their policy of dragging out everything so they can up their billable hours. A friend's mother died from gross- and well documented- malpractice and the insurance company dragged it out for 5 years with various strategies before allowing the case to come to trail. The day they were to pick a jury the insurance company came up with an offer. And I won't go into some of the demeaning and insulting depositions my friend was put through by them as if she were the culprit, not the victim.

Posted by: bxgrl at August 7, 2008 10:32 AM

I know that Cuba has a lower infant mortality rate than the USA. But they don't pay their doctors as much.

Posted by: dittoburg at August 7, 2008 10:32 AM

I'm really curious what the explanation for that is, dittoberg? It goes beyond embarrassing.

Posted by: bxgrl at August 7, 2008 11:15 AM

Yes, they are CIA figures too, so it is pretty convincing. Its not like it is a self-reported "fact".

Posted by: dittoburg at August 7, 2008 11:27 AM

LICH has a great lactation consultant, and their maternity ward is no worse than any other, from the stories I've heard about others. That said, my own experiences with the hospital since haven't been so great. The last time I was there for a broken ankle they took 10 x-rays of my knee, just to show the new residents how to work the machine. When I complained, they wheeled me back into the ER and left me there in pain for an hour until I agreed to let them take more x-rays. Then they told me if I actually wanted any of my medical records to give to my orthopedist, I would have to show up in person and request them. Remember now, I couldn't walk... I want to like LICH, I really do -- or did -- they actually saved my daughter's life and that gives me some sentimental loyalty, but... something's definitely going on there. Something not for the better.

Posted by: Heather at August 7, 2008 11:37 AM

FinanceGuy:

While you have spent quite a bit of time defending out corrupt legal system, I will point out that your opinion is ultimately irrelevant. The numbers speak for themselves - no doctor wants to deliver babies for a living because it's just not worth the cost or hassle. There are plenty of other medical fields to pursue.

dittoburg:

1) Cuba is a totalitarian state. We do not have any way to verify or refute the claims presented by the Cuban government about anything, especially medical care - one of their celebrated causes. Go there and attempt to see for yourself first hand and you will be arrested.

2) We do know that Cuba does not count a child as alive until it has lived for a few hours. They also have a very high abortion rate. Women are often required to terminate pregnancies if there is a high probability the child will have health problems. There really is no comparison. In the US, we somehow have this policy where women are allowed to have as many children as they want at the expense of the state. This is not the case in Cuba.

Posted by: Polemicist at August 7, 2008 12:59 PM

dittoburg:

The CIA factbook reports data from the WHO in this instance. The WHO simply reports data given to them by member nations. There is no analysis, no verification, nothing.

Posted by: Polemicist at August 7, 2008 1:00 PM

Let them dump their buildings before the market hits bottom. Say no more. Guest 04 has spoken.

Posted by: DOW8000SP800 at August 7, 2008 1:44 PM

Polemicist, it is disturbing how you seem to equate a doctor choosing a medical specialty with the same cost benefit analysis as deciding between a Toyota and a Nissan. While there may be many more "easy" specialties, I'm certainly glad there are still doctors who feel that delivering babies and specializing in the care of women is a worthy profession, in spite of malpractice insurance and other "hassles". You remain a clueless, self centered young pup.

Your knowlege of Cuba is also quite flawed. Americans are quite welcome by the Cuban government to visit Cuba, and many do so, by going there from other countries which do not have an outdated and vengeful policy towards Cuba. (ie, most of the rest of the world, including our strongest and closet allies).

I'm not saying they are the best country in the world, for a lot of reasons, but they have a lot to teach all of us in terms of making due with less, relying on natural resources and innovative, make do technology to replace more "advanced" tech, and use of holistic, herbal and common sense medicines and practices to heal and promote health. In that sense, it is not surprising that their birth mortality rate could be in better shape than ours. In spite of generations of embargos and sanctions, Cuba has managed to survive. I am no fan of Castro or his government, or communism, but I greatly admire the ingenuity of the Cuban people.

Posted by: Montrose Morris at August 7, 2008 1:52 PM

My spelling and grammar suffered greatly in my last post, which I didn't proofread. I do know the difference between making due, and making do. We have closet allies as well as closest ones, too.

Posted by: Montrose Morris at August 7, 2008 1:57 PM

FinanceGuy is incorrect. Juries do award money when malpractice isn't proven. The reality is insurance companies put a limit on the number of deliveries. Exceed that number and the preium can more than double. Most doctors fill their quota by June. OBGYN loses money and Medicare, Medicaid and private insurance companies don't make up enough to cover the expenses, despite women being discharged from the hospital a day or two after delivery. Only here can the government tell an industry it can lose money. They don't buy cars from GM less than manufacturing price but do pay hospitals less than it cost them for certain procedures. For those in business, would you keep your biggest losing component or focus on the segments that keep you afloat?

Posted by: Iknow at August 7, 2008 4:32 PM

but the real problem is how do you then deliver quality health care because people are not going to stop having babies, getting sick or dying. And as long as everything is treated strictly as a business, then even necessary things fall by the wayside because they lose money. So who's got answers?

Posted by: bxgrl at August 7, 2008 4:40 PM

MM

Why don't you read my post again. I'm simply telling you the way things are, not the way I think they should be. I get my information on both topics from the source. I have numerous friends finishing their residencies right now and know quite a few Cubans.

Me thinks you are too easily disturbed, and seem unable to refrain from responding emotionally to objective facts.

Bxgrl:

That is a complicated question. The simplest answer is health care will have to be rationed. We simply do not have the resources to provide endless medical care to every person on this planet, let alone the US. How we decide who gets health care and who doesn't has to be decided in the political realm through legislation. It is clear lawyers and judges cannot sort out this mess on their own.

Posted by: Polemicist at August 7, 2008 6:40 PM

are you willing to leave it up to politicians? It's one thing to ration housing and food coupons- it's another to ration health care because you are actually dealing with life and death issues. I don't even mean endless health care- I'm referring to basic care and treatment. And in reality would you be comfortable denying health care to anyone on the basis of money. You can get into truly scary issues of who decides who lives or dies, and how they decide. What is a life worth?

I'll be the first to admit I can't even begin to wrap my brain around this. But lawyers, judges and politicians are not my first choice without input from ethicists and religious figures (and I NEVER thought I would ever find myself saying that). My other question is do we approach the question as a society that is based on equality (more or less) or as a capitalist society because I believe those ideas are conflicting in this instance.

Posted by: bxgrl at August 7, 2008 11:35 PM

We already ration health care in this country, just not rationally. We have poor outcomes and high infant mortality in this country because many women lack consistent prenatal care. Infants die at higher rates in poor neighborhoods.

At the same time, a newborn can receive tens, even hundreds, of thousands of dollars worth of care in a NICU. So, the money is there somewhere.

Posted by: EinFG at August 7, 2008 11:48 PM

Polemicist - I don't know why you are so cynical of the figures, The quality of healthcare in Cuba is pretty consistent, the quality of healthcare in the USA ranges from the best to the worst. The same applies for the lower infant mortality rates in countries like Canada and the UK with universal healthcare. Its not surprising.
Your "go there and get arrested" argument is juvenile.

Posted by: dittoburg at August 8, 2008 9:14 AM

dittoburg:

I'm not cynical about the figures, I'm telling you exactly how and under what circumstances they are derived and why they should not be trusted.

You are obviously of a different camp than myself and represent why civil war is imminent in this country.

Some really have no appreciation of the necessity of freedom of speech and thought in society. If you did, you would immediately disregard any data presented by a murderous, oppressive regime like that found in Cuba. The fact that you can overlook something so fundamentally contrary to a free and open society, even going so far as to label my comment (that wasn't an argument) "juvenile", indicates you obviously have a different value system.

I would be careful on this matter. I assure you, and history has taught us, that there are many willing to die over such "juvenile" ideals. Despite what you might think, universal health care will not work very well as a rallying cry.

Posted by: Polemicist at August 8, 2008 10:29 AM

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