Ellis Hospital President and CEO James Connolly saw his worst nightmare materialize this year.
On June 16, St. Clare’s Hospital closed, becoming the second of Schenectady County’s three hospitals — Bellevue Woman’s Hospital being the other — to surrender its operating license within the span of less than 12 months.
Their closures have left Ellis the sole provider of medical services to around 150,000 county residents and others.
To Connolly, the nightmare was not that two hospitals had closed, although that was bad enough. It was they would close before Ellis was adequately prepared to handle an increase in patient visits as people shifted their care from St. Clare’s and Bellevue to Ellis, he said.
In short, Ellis wasn’t ready, Connolly said, and the hospital has paid the price in complaints to the state Department of Health over exceedingly long wait times in its Emergency Department; in a blizzard of negative publicity; and in anger among its nurses union, which has filed a grievance over how management unilaterally granted seniority rights to St. Clare’s nurses. It also is facing a grass-roots organization that wants to see St. Clare’s reopened.
Ellis found itself in this position because the St. Clare’s Board of Directors decided earlier this year to close the hospital rather than move ahead with a state mandate that they work together, according to both Connolly and Dr. Brian Gordon, a member of the Schenectady County Legislature and an orthopedic surgeon.
Connolly said St. Clare’s decision “happened a lot faster than we anticipated and faster than we liked.”
Gordon said Ellis was expecting to have another six months to plan for the transition of services to its facility. “The extra time would have given Ellis more time to get rooms ready and to make changes to its Emergency Department,” he said.
St. Clare’s Chief Financial Officer Ed Gasparovic said St. Clare’s board surrendered its license after realizing that Ellis and St. Clare’s could not reach agreement on forming a joint board. He said Ellis, along with the state Department of Health, was fully involved in its discussions to close. St. Clare’s informed the DOH of its decision in the first part of this year, he said.
“The decision to close was made by the St. Clare’s board, but the board did not make it a vacuum,” Gasparovic said.
Gasparovic said St. Clare’s agreed to surrender its license in return for three guarantees: that the state would fund St. Clare’s pensions; that St. Clare’s employees would receive payment for their vacation and sick time benefits; and that Ellis would continue St. Clare’s mission of providing care to the community’s poor and underinsured.
“Ellis was in the loop the whole time,” he said.
When St. Clare’s future became uncertain, the hospital began to experience staff and financial problems: Around 13 percent of the hospital’s staff left to find employment elsewhere, and St. Clare’s saw patients go elsewhere for treatment.
The campaign to keep Bellevue open also affected St. Clare’s volume, Gasparovic said. Bellevue was supposed to close completely as part of a recommendation in 2006 by the New York state Commission on Health Care Facilities in the 21st Century, also known as the Berger Commission for its chairman, Stephen Berger. The recommendations became state law in 2007.
Instead, local and state politicians rallied behind efforts to keep it open, primarily because it was a nonsectarian hospital providing a full range of women’s health services, including abortions. The state health department worked out an agreement with Ellis to allow it to use the Bellevue campus until Ellis could construct a women’s and children’s health center on its own campus several years from now.
Ellis does not have maternity services. It decided to locate all maternity services at Bellevue, including those from St. Clare’s, as part of efforts to consolidate medical care in the county.
At the same time, the commission recommended that Ellis and St. Clare’s create a unified operating structure for both hospitals. Under this structure, both Ellis and St. Clare’s would remain open as hospitals, but they were to streamline services to avoid duplication in an effort to save money.
The two hospital boards then worked together under this assumption to come up with a joint governance plan. They announced their plan in April 2007 but could not come to full agreement, and so St. Clare’s decided to close, Gasparovic said.
Connolly said St. Clare’s based its decision in part on its weakening financial picture. It lost $7 million in 2007 and was losing between $600,000 and $1 million a month this year, he said.
St. Clare’s decision forced Ellis to scramble to get services, beds and trained staff online in a short time, Connolly said. “We did in three months what most institutions would take eight to 10 months to do,” he said.
And Ellis did it during the summer when most staff take their vacations. “No one in their right mind plans a transition during the summer,” Connolly said.
When St. Clare’s announced in June that it would close, many in the community believed the entire hospital would close, including its heavily used emergency department, said state Department of Health spokeswoman Claire Pospisil. “This is a problem because of the closure of St. Clare’s. People aren’t aware they can use St. Clare’s, that it still has an emergency department,” she said.
Patients started shifting their care to Ellis, overburdening an already overused emergency room, Pospisil said. As a result, the state has been working with Ellis to increase the number of inpatient beds available and to relieve waiting time in the emergency room.
“We have weekly calls with their staff and we have over this time period made several unannounced visits to the hospital,” Pospisil said.
The state is not investigating any other complaints dealing with quality of care at Ellis, she said.
The St. Clare’s emergency department sees more than 38,000 visits annually while Ellis’ sees 33,000. Last year, Ellis was seeing around 100 patients per day at its peak; after St. Clare’s announcement, visits jumped to a peak of 120 per day, said Emergency Department Nurse Manager John Voight. After its announcement to close, St. Clare’s saw its emergency visits drop to 90 per day and inpatient admissions drop to around 50 patients a day when it had been seeing 80.
Also, Ellis started seeing patients who are sicker and required more intensive treatment, further complicating wait times, Voight said. He added that Ellis has not diverted patients to other facilities because of wait-time problems.
Connolly said Ellis started working in March to prepare for St. Clare’s closure.
Ellis reopened the old C Wing, renovating several floors into patient rooms, and it has nearly doubled the number of treatment areas in the emergency department.
Voight said that since March he has added eight registered nurses to the emergency department staff as well as other support positions in an attempt to ease wait times.
Peter Capobianco served as interim CEO of St. Clare’s from 2004 to 2005 and was a member of the regional advisory committee attached to the Berger Commission. He also was the longtime CEO of St. Mary’s Hospital in Amsterdam.
He said he had a five-year plan to turn around St. Clare’s financial problems, which would have staved off the need to close it. He wanted to remain CEO but the board conducted a search and ended up hiring Robert Perry for the post.
“They could have financed a bond issue through the [state Dormitory Authority] and they could have survived,” Capobianco said.
Capobianco, like many others, thinks that Ellis was responsible for closing St. Clare’s.
“The commission clearly said the idea was to close Bellevue, but they decided to keep Bellevue open. That put a death wish on St. Clare’s. They should not have been so quick to shut down the inpatient rooms until they were ready to accept them,” he said.
Connie Ciervo, head of the 200-member Schenectady County Citizens for Hospital Choice, is trying to get St. Clare’s reopened. She said Ellis is wasting taxpayer dollars with planned additions to the hospital when “there is a perfectly good hospital that sits half empty” in the community, referring to St. Clare’s.
The state gave Ellis nearly $60 million to help close St. Clare’s and to open up more beds. Most of the money went to fund St. Clare’s pension plan. St. Clare’s never funded the pension, instead putting money into health care for the poor, hospital officials said.
Ciervo called “detestable” the use of the state funds to help close St. Clare’s. “We do not want our tax dollars wasted in this manner,” she said.
Ciervo added that her group has collected at least 1,000 signatures on petitions protesting the closure of St. Clare’s. The petitions will go to state and local officials.
Connolly said St. Clare’s can never be reopened as its former self. Its configuration as a hospital, however, is Ellis’ decision, said Gasparovic.
Ellis has already closed down St. Clare’s inpatient services with the intent of converting the campus into an urgent care facility.
Gordon said he expects the problems with the transition to eventually go away. “It is no different than any other business merger. The transition was very quick and had to happen before the infrastructure developed at Ellis,” he said.
Ellis has a plan in place, and the clinical staff remain intact, Gordon said. “They are just working under one umbrella and it will take some time for the old feelings to change,” he said.
“The common goal is still the same and that goal is to provide the best care possible for people in the region,” Gordon said. “I do feel in end we will have a stronger health care system.”
Gordon, nonetheless, said that Ellis “has a ways to go in order to get the facility in position to take care of the numbers of patients they need to take care of, and they will eventually occur.”
Gordon said that the Democratic majority on the Schenectady County Legislature could help Ellis with the transition. “I can’t do anything at all until the doors are really opened for us to come in,” he said.
County Legislator Joseph Suhrada also said the county Legislature should be more involved, but for a different reason. “Not one of us stood up to ensure the hospital would have enough beds. All it takes is for one emergency to create a health care disaster,” he said.