Behind a shrub on the corner of 135th Street and Lenox Avenue, a plaque with a gold Columbia crown reads, “Affiliated with Columbia University since 1962.” It’s attached to the entrance to Harlem Hospital Center, a public hospital in East Harlem where the Columbia University Medical School has essentially been in charge for the last 48 years. Columbia hires and fires, pays physicians’ salaries, and runs the residency program.
But come Jan. 1, 2011, that entire relationship will change.
In response to the city’s current financial situation, Columbia is in the process of significantly decreasing its involvement with the neighborhood hospital—leaving some employees and neighborhood residents concerned about the fate of this more than century-old medical institution.
A diminished role for Columbia
At the center of this shift are the current budget woes of the city’s Health and Hospitals Corporation—the agency that operates 11 public hospitals, including Harlem Hospital.
Those public hospitals have always borne the cost of treating the uninsured, but during the recession, with reduced state and federal Medicaid funding, the city Health and Hospitals Corporation’s budget deficit reached a high of $1.2 billion.
The city is now in the process of a major restructuring of its hospital system in response to the budget concerns—an effort announced in May that includes reducing the workforce and streamlining its affiliations with the city’s medical schools to cut costs.
Part of the transition includes breaking some ties with Columbia, a shift which has left employees at Harlem Hospital—known for its burn, trauma, and asthma centers—questioning the long-term implications.
Columbia’s affiliation will soon become academic only, with the University playing a much smaller role in Harlem Hospital’s administration.
And this changing affiliation with Columbia is just one of many adjustments coming to Harlem Hospital, which has become a neighborhood institution, an oft-cited example of Columbia’s commitment to the local community, and a safety net for the thousands of uninsured patients it treats every year.
Additionally, 593 people employed by the Columbia affiliation will experience a change in employment as of 2011, according to a notice that Columbia filed with the New York State Department of Labor on Aug. 30.
Evelyn Hernandez, spokesperson for the city’s Health and Hospitals Corporation, said that decisions about the work force are still pending, since negotiations with a potential new partner are still in early stages.
She said she could not confirm the 593 number in the filed notice, but said that employees facing change will generally be employed by the physicians group that will eventually take over operations at Harlem Hospital Center.
Though the total impact remains unclear, what is certain is that Harlem Hospital, separate from the Columbia transition, will face layoffs as part of the overall restructuring of the city’s hospital system.
“We expect that 42 out of 150 affiliate staff will be lost due to work force reductions at Harlem specifically,” Hernandez said. “Thirteen of those are doctors.”
Skepticism and tension
Physicians and other employees were told about the imminent transition away from the University on Jul. 27, and regardless of potential layoffs, the concept of a lesser affiliation with Columbia has some feeling cold. The New York Times reported earlier in September that the neurology department of Harlem Hospital has threatened to quit en masse.
Coney Bae, a third-year Columbia medical student, said that her time at Harlem Hospital has been colored by talk of the transition. “Some doctors are leaving because they want to stay with Columbia, because of the benefits and what it entails to be a Columbia professor. Some felt like they had to choose between Harlem [Hospital] and Columbia,” she said.
Bae blamed that movement for changes in the program, including only having one attending doctor to oversee the medical students in situations where previously there were two available.
CUMC issued a statement emphasizing that physicians will not lose their faculty appointments with the Columbia University College of Physicians and Surgeons. Rather, they will just be employed by a currently unknown affiliate of the Health and Hospitals Corporation instead of Columbia in 2011. “HHC [Harlem Hospital Center] and Columbia University are working together to ensure a seamless transition that maintains continuity of patient services and hospital operations,” the CUMC statement said.
Yet conversations with medical professionals at Harlem Hospital indicate that much of the staff is unclear about the impact of the transition. Many said that they weren’t sure where they stood in the new system or hadn’t heard about it at all.
“People are not very happy. They don’t think it’s being done fairly. People came here to work with Columbia University, and think that now they won’t be able to ... People feel like they were left in the cold, just left out to fend for themselves,” said a Harlem Hospital employee facing termination, who requested anonymity.
Hernandez could not immediately comment on whether or not there had been any further communication with the staff about the changes initially presented to employees in July.
Doctors Council SEIU, the union that represents doctors at Harlem Hospital, is holding a rally on Oct. 13 to protest what they call the “short staffing of doctors, with 10% unfilled positions, nearly 10% of doctors being laid off and another potential 15% or more doctors who may leave due to layoffs, removal of services and fear of declining patient standards.”
In response to doctors’ concerns about the weaker relationship with Columbia, Hernandez said, “We’ve had a long historical relationship with them and we anticipate that this transition will be as seamless as possible, and patient care is not going to be affected in any way.” She declined to comment further.
Harlem Hospital’s chief of staff Sylvia White said that the hospital had no comment on the transition.
Behind the finances, restructuring
The changes afoot at Harlem Hospital Center were initiated by the city, not by the University.
Columbia’s current affiliation with Harlem means that the city—through the Health and Hospitals Corporation—gave Columbia the money to pay all of Harlem Hospital’s physicians and much of its staff. Part of the city’s cost-cutting plan was to renegotiate those agreements as they expired, which the Columbia-Harlem affiliation did this year.
With an academic-only affiliation, Columbia faculty will continue to teach medical students and oversee the residency and fellowship programs at Harlem Hospital, which is a similar relationship that CUMC has to St. Luke’s-Roosevelt Hospital in Morningside Heights. Responsibility for the administrative and other duties that Columbia once performed will be transferred to a physicians group in the short term, as negotiations with potential long-term affiliates continue next year.
As for the layoffs that are confirmed, Michelle Duffy, spokesperson for the New York State Department of Labor, said that the state’s rapid response team is reaching out to affected parties to provide support.
Harlem Hospital, moving forward
At a neighborhood meeting Monday night on 126th Street, Dr. Carol McLean-Long, a Harlem Hospital doctor and union representative, said that employees need clarification from Columbia about their new employer and the shift on the whole.
“There are concerns that Columbia has yet to address,” she said. Layoffs will impact the way the hospital operates, she said.
“We really feel as if we cannot be cut any more without sacrificing patient care,” McClean-Long said.
Many of Harlem Hospital’s doctors have worked there for a long time, and have made strong bonds to their community and to their patients, McLean-Long added.
But, she said, the weakened connection between Columbia and Harlem Hospital is eroding confidence at the hospital, which is why it is critical to “keep Harlem Hospital viable.”
“Harlem Hospital is one of the few hospitals where doctors stay,” she said.
Abby Mitchell contributed reporting.
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