July 13, 2020

Commissioner Howard A. Zucker, M.D.

Members of the NYS Public Health and Health Planning Council
NYS Department of Health
Corning Tower, Empire State Plaza
Albany, NY 12237

Dear Commissioner Zucker and PHHPC members:

We greatly appreciate the Department’s efforts to bring New York’s COVID-19 crisis under control,
especially given the lack of federal leadership. At the same time, we are deeply concerned by the
dramatic racial and ethnic disparities that have been so starkly exposed by this pandemic. As the Public
Health and Health Planning Council resumes its important work on July 16, we urge that pursuit of
health equity be at the top of your agenda. Below, we recommend concrete steps to begin to address
this critical need.

The Problem: Racial and ethnic inequities in distribution of health care

As the Department’s own data have vividly demonstrated, Black and Latinx New Yorkers have suffered
far higher rates of infection and death from the novel coronavirus than have white residents in our
state. Many of the neighborhoods where Black and Latinx New Yorkers live and seek medical care are
also the very places where hospitals have closed or downsized in recent years, or where more closures
have been proposed. A new study by the Community Service Society of New York1 has reported that
Queens, an epicenter of COVID-19 where the majority of residents are people of color, has only 1.5
hospital beds per 1,000 residents, compared to 6.4 beds in Manhattan. The second hardest- hit
borough, the Bronx, which has a predominantly non-white population, has 2.7 hospital beds per
thousand residents. Even within Manhattan, there are disparities, as mid-town and the Upper East Side
are home to multiple major health care institutions, while residents below 23rd Street (many of them
immigrants and LGBTQ people) have lost St. Vincent’s Hospital and now face an extreme downsizing of
Mount Sinai Beth Israel.

1
Dunker, A., and Benjamin, E., How Structural Inequalities in New York’s Heath Care System Exacerbate Health
Disparities During the COVID-19 Pandemic: A Call for Structural Reform, Community Service Society of New York,
June 2020, accessed at https://smhttp-ssl-
58547.nexcesscdn.net/nycss/images/uploads/pubs/Covid_Healthcare_V1.pdf
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Pending health system proposals would only worsen these inequities. For example, consider the
contrast between these two proposed projects:

 The Montefiore Health System would close the only hospital in Mount Vernon, a city that is 64
percent Black and has suffered the third highest rate of COVID-19 cases in Westchester County.
Residents would be left with only a freestanding ER and ambulatory care and would have to be
sent out of the city for COVID-19 treatment and other inpatient care. This project would be
funded with $41 million in state health facility transformation grants.

 The Northwell Health System would spend more than $2 billion on upgrading and doubling the
size of Lenox Hill Hospital in the Upper East Side – a largely white, affluent community with low
COVID-19 case numbers. The complex would boast a 516-foot main tower, single-occupancy
patient rooms and luxury amenities designed to make it a destination hospital.

What can be done?

In a March letter to the Governor, we urged that the Department institute an immediate moratorium on
hospital closings and downsizings, including pausing those actions that already have state approval to go
forward. We further urged that the Department work to re-open some of the hospitals and floors within
hospitals that have been closed in recent years, in order to increase bed capacity. We noted that many
hospitals did, in fact, increase their capacity to meet the COVID-19 challenge. Mount Sinai Beth Israel
reopened floors it had closed, just months after winning PHHPC approval to shut the existing 600-plus
bed hospital and replace it with a 70-bed facility. Governor Cuomo declared that all hospitals (public and
private) would work as one system to share information, supplies and patients during the pandemic. 2

With the number of COVID-19 cases subsiding and hospitals reopening for non-COVID-19 care, we fear
that health systems, the Department and PHHPC will now go back to business as usual. As a result, our
state will fail to make the significant structural and policy changes that are needed to prevent further
erosion of the already frayed health care safety net in the Black and Latinx communities hardest hit by
the pandemic. Therefore, we urge the Department and the PHHPC to take the following initial steps to
proactively address racial and ethnic inequities in the ways that health care facilities are distributed and
funded across our state:

 Introduce a Health Equity Impact Assessment into the Certificate of Need (CON) process.
Existing CON review procedures are simply inadequate to determine whether proposed facility
transactions will truly fulfill the statutory “public need” criterion. New Jersey has instituted a
health equity consideration in its CON review process, and New York should do likewise. We
applauded the introduction in 2018 of New York’s requirement that certain CON applicants
describe how their transactions would fulfill Prevention Agenda priorities, but we have
concluded it does not go far enough. We urge that:

2
Governor Andrew Cuomo, press release, Amid Ongoing COVID-19 pandemic, Governor Cuomo Announces
Statewide Public-Private Hospital Plan to Fight COVID-19, March 30, 2020, accessed at:
https://www.governor.ny.gov/news/amid-ongoing-covid-19-pandemic-governor-cuomo-announces-statewide-
public-private-hospital-plan
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o Health facilities be required to specify in CON applications how their proposed projects
would improve health equity, such as by filling geographic gaps in access to care and
proposing measurable and enforceable benchmarks in terms of increasing access to
services and improving outcomes for Black and Latinx New Yorkers, low-income
communities, women, LGBTQ people and people with disabilities.
o Preparation of these Health Equity Assessments must include meaningful engagement
of community leaders and residents through public hearings and other means.
o Claims to improve health equity that are made in these CON applications should be
subjected to scrutiny by experts within the DOH (such as in bureaus of social
determinants of health and minority health and the AIDS Institute) and/or by outside
experts selected by the DOH to do such reviews, which would be funded by the CON
applicants.

 Pause any further consideration of proposed hospital downsizing or closings, or major

construction projects that have no obvious health equity benefit. A moratorium on such
transactions should be maintained until the Department has conducted a thorough evaluation
of the true need for inpatient bed capacity in the event of COVID-19 resurgence or other public
health emergencies. Such evaluation should include robust engagement of communities most
affected by COVID-19, especially those where there clearly were too few hospital beds to serve
patients in need. We urge that the results of such an evaluation be made public, and then
inform future DOH and PHHPC decision making.

 Appoint more consumers to the PHHPC, to counter-balance the current over-representation of

health industry executives. Governor Cuomo in December of 2019 ordered the Commissioner
of Health to appoint two consumers to the PHHPC. To our knowledge, these appointments have
not been made. We urge speedy appointment of two representatives of statewide or regional
health advocacy groups who can speak to the specific needs of low-income consumers and
communities of color. We note that both houses of the Legislature have passed a bill to add two
consumer seats to the PHHPC, which would ensure that vacancies are available to be filled with
consumer representatives. We urge the Governor to sign that bill and further increase consumer
representation on this important review board.

We are a growing statewide alliance of community and health advocacy organizations working to give
consumers a greater voice in determining the future of their local hospitals. Participating organizations
include the Center for Independence of the Disabled-NY, the Children’s Defense Fund-NY, the
Commission on the Public’s Health System, the Coalition to Save and Transform Mount Vernon Hospital,
the Community Service Society-NY, the Empire Justice Center, March of Dimes NY, Medicaid Matters-
NY, Metro NY Health Care for All, Neighbors to Save Rivington House, the New York Immigration
Coalition, the Statewide Senior Action Council and the Women’s Health Program of Community Catalyst.
All of these groups support this letter, and some organizations have signed on individually, as well.

We are nonprofits that represent and serve many people in communities that already were medically
underserved, and who have been especially affected by the COVID-19 epidemic. We stand ready to
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provide insights from affected communities that we believe can inform government action to address
the crucial need to work for health equity in our state.

We appreciate your attention to our concerns.

Sincerely,

Lois Uttley
Women’s Health Program Director, Community Catalyst
luttley@communitycatalyst.org

Lara Kassel Heidi Siegfried

Coordinator, Medicaid Matters NY Director of Health Policy
Center for Independence of the Disabled, NY
Ben Anderson
Director of Poverty and Health Policy Max Hadler
Children’s Defense Fund-New York Director of Health Policy
The New York Immigration Coalition
Elisabeth R. Benjamin
Vice President, Health Initiatives Mark Hannay
Community Service Society of NY Executive Director
Metro NY Health Care for All
Kay Webster
Coordinator Kathryn Mitchell
Neighbors to Save Rivington House Director, MCH Collective Impact
March of Dimes

cc: NYS Assembly Health Committee Chair Richard Gottfried

NYS Senate Health Committee Chair Gustavo Rivera
NYC Council Hospitals Committee Chair Carlina Rivera