State, Nassau must work together to save NUMC

Almost a century ago, when East Meadow was still rural and Nassau County was on the cusp of defining the American suburb, its residents petitioned for a facility to take care of its sick. In 1931, the county purchased 70 acres of land in the center of Nassau, the start of what was to become Meadowbrook Hospital.

But the hospital itself started to fall ill in the 1990s with New York State eventually having to come to the rescue, removing it from direct county ownership and turning it into a public benefit corporation. Yet, the finances of the facility now known as Nassau University Medical Center remain unstable and another state intervention is critically needed for its survival.

Gov. Kathy Hochul, her close advisers and state Department of Health officials have spent months assessing the problems at NUMC, how its debt continues to rise, how its cash flow hovers at dangerously low levels, how its management and governance is weak and often politically motivated, how its patients and employees deserve better.

State officials now are on the verge of taking over the hospital’s operations. State law allows for the installation of a “temporary operator” when a facility is experiencing “serious financial instability that is jeopardizing existing or continued access to essential services within the community.”

NUMC fits that description.

COUNTY’S CONSENT SOUGHT

Hochul’s representatives met last week with Nassau County Executive Bruce Blakeman and Nassau Interim Finance Authority chairman Richard Kessel to discuss the hospital’s future. If everything falls into place, state officials could come to an agreement with Blakeman that would make the effort to install new leadership cooperative rather than adversarial.

That’s a goal both Blakeman and Hochul should embrace.

The role of NIFA — the county’s fiscal watchdog — also is key, since the authority oversees the county’s borrowing, including the hospital’s more than $100 million in debt, which the county backs. The oversight board’s powers and ability to institute a control period, which the county has fallen under since 2011 due to its shaky finances, requires NIFA to play an enormous role in contracts, labor agreements and borrowing.

As the NUMC-related discussions continue, it’s likely that the future of NIFA and its ongoing control of county finances will emerge as important issues. NUMC’s troubles have long been cited as one of the key reasons the control period and NIFA’s role remain necessary.

Blakeman wants to get the county out of the control period. That’s a worthy goal, but it can only come about with clear evidence of Nassau County’s fiscal stability. Unraveling that legal and financial relationship is extremely complicated, however, and tying it to NUMC risks paralyzing the effort to take the necessary immediate action.

A path forward should emerge quickly, especially for the benefit of its workers and former employees. NUMC’s debt to the New York Health Insurance Program, or NYSHIP, continues to grow, to the point where it could approach $400 million by the end of the year, since the hospital is paying just $2 million of the $9 million it owes each month. That puts employee and retiree health insurance potentially at risk.

The further NUMC falls, the tougher the climb out will be for its next leader. Again, a cooperative approach is the best path. If state and county officials can’t reach a timely deal, the state must act on its own.

NEW LEADERSHIP NEEDED

Under either scenario, a new operator who can make tough decisions and execute a plan for a sustainable future is needed. That person must be experienced and knowledgeable, someone who already understands the hospital and show quick progress. State officials can and should consider the best of today’s hospital leaders, including those who previously led NUMC well, such as former NUMC chief executive Arthur Gianelli. Ultimately, whoever the state chooses must be able to gain respect both within the hospital and beyond.

The new director must be given the ability to lead and act without restraints. That means removing the current leadership, including Chairman Matthew Bruderman and interim Chief Executive Megan Ryan, and the hobbled board. New leadership and new trustees are key to providing the guidance required to make the necessary big changes.

These new leaders must re-imagine NUMC at all levels, including the future of the A. Holly Patterson nursing home, how the hospital’s vast land is utilized and whether partnerships with other hospital systems are possible. NUMC’s new leader must also enable permanent changes in governance and vision to provide long-term stability and growth.

None of that will be simple. This is a saga years in the making as a public hospital struggles to adapt to the change in the delivery and financing of medical care and enormous competition from Long Island’s other health care systems. This is a moment state and county leaders must seize — for the health of the hospital, its employees, its patients and the region.