The rhetoric of the political status quo failed to produce an outcome that meets the public’s need. What a surprise. Effective today—Pascack Valley Hospital’s (PVH) extended ‘certificate of need’ (CN) tentatively expires.
A few sarcastic words on the municipal leadership could easily be justified but they wouldn’t assist in bringing back the hospital. The fact is, if the expiration stands then the complexity to reopening a hospital has only become more problematic and uncertain.
As has been noted before, the Department of Health (DOH) is charged with carrying out the legislature’s public health policy. Its actions are expected to recognize, “that hospital and related health care services of the highest quality, of demonstrated need, efficiently provided and properly utilized at a reasonable cost are of vital concern to the public health.” (C.26:2h-1) It has been reported that the DOH Commissioner, Heather Howard, rendered a decision not to intervene in PVH’s CN expiration, regardless of any outside interests to maneuver otherwise. Certainly it sends the message that a demonstrated need for a small accessible hospital does not exist in the Pascack Valley area.
Unfortunately, nothing has been offered that defines a substantive basis for not reconsidering an extension. It leaves only assumptions to be conjured within the realm of imaginative thought. For example, it could be that since no active application existed for the DOH to consider, other than the possibility one might be offered in the future, compelled a negative outcome. The CN had initially been extended with the clear declaration that a new facility had to be opened within that extension. Who knows, maybe a consideration might have been granted if a foreseeable endpoint had been definable.
That’s where an aggressive local municipal government might have played a constructive part. I dropped my lawsuit this past summer without prejudice. It was made very clear to me, that even though the municipality hadn’t followed appropriate land use procedure for changing a master plan, the governing body had no intent to change the ordinance outcome.
They bought into their municipal attorney’s rhetoric that they could always change the ordinance in the future. A true enough fact but then many attorneys aren’t businessmen; they only see what’s in front of them as framed by the parameters of law. The law doesn’t make business decisions.
The same attorney had advised against my putting the bankruptcy court on notice, during my tenure, that the municipality would seek property taxes if the hospital’s emergency room closed. I listened but decided against the advice. That action contributed to the municipality obtaining close to a half million dollars in additional 2008 tax revenue. My decision had sought to seek leverage in possibly keeping the nonprofit ER open without interruption for the public, while the hospital bankruptcy played out. And to make it clear that the municipality had a stake in the hospital’s future.
The current municipal leadership chose to change the hospital’s site ordinance such that only a hospital ‘application’ would garner a certificate of occupancy and expansive development rights. Had the ordinance stated a hospital under the extended CN, clear and simple, was a requirement to the future development of the property then an argument could have been made under the “Permit Extension Act of 2008” that the hospital’s CN was a quasi permit. The Act notes its legislative intent was to extend permits and ‘approvals affecting’ the physical development of property. The CN was an extended approval to reopen a hospital that required significant physical re-development investment.
It was an idea proposed by HUMC for themselves, to use the Act in arguing an extension of the CN. They may have interpreted relevance since the State’s CN statute notes, “No health care facility shall be constructed or expanded, … except upon application for and receipt of a certificate of need.” (C 26:2H-7). They believed that the recent extension of two long-term acute care CNs were supportive of their concept. Only that presumption disregarded an outstanding invitation for CN applications from 2006 for long-term care services. That’s a different consideration than currently held toward new acute care hospitals. In addition they did not have an active application to reopen the hospital.
Ultimately the ‘certificate of need’ program is complex. It attempts to determine public needs in lieu of letting a free market determine need. It’s a myopic effort to control costs. The DOH appears to believe that the monetary concerns of Englewood and Valley Hospital have a preceding need. It seems to ignore the diversity of considerations represented in the State’s report on hospital rationalization.
Hopefully, if this CN expiration stands, we will learn whether any current data was considered. Whether the bankrupt St Mary’s, which is considered part of the State Report’s so-called Hackensack, Ridgewood, Paterson market area with excess beds, was given the same scrutiny over bed capacity before its recent financial taxpayer support. Whether the extent of Englewood Hospital’s organizational inertia or the importance of local connections were factors. Or whether the reduced competition will increase efficiency and result in time sensitive trauma deaths, within the Pascack Valley, at a reasonable cost.
Recent Record Articles: HUMC seeks hospital CN extension – HUMC files lawsuit to keep license – DOH denies request to extend CN license – HUMC’s options narrowed – PVH license expires.
I logged in to comment on your prior blog and was disappointed to read you dropped your suit. The whole hospital affair has been a catastrophe from Pascack’s management to Hackensack’s promises. I had hoped that somehow the mistakes would have been placed under a magnifying glass to show the whole system is run by money not our needs.
That scenario 4 seemed so logical that after thinking about it it makes you wonder why the other hospitals don’t think to do it. Wouldn’t it enhance the logistics of expanding health care services and contain costs?
How will the hospital get returned without that extended license?
Comment by Bobbi21 — December 28, 2009 @ 8:36 PM
An elderly gentleman sitting up in an ambulance notices he’s still lying down and looks at the attending EMTs. He’s disappointed to hear them say we’re losing him fast as they drive by HUMC North in transit to Valley Hospital. Recognizing his spirit is preparing to leave his earthly but pleasantly plump chalice he can only wonder, which schmuck thought an application was more important than a hospital.
Comment by Ciaran — December 31, 2009 @ 12:27 PM
What, are we looking for humor in this? How about two spirits are standing around in Valley Hospital’s ER hallway by their covered carcasses when one says to the other, “What’s yer thinking?” The other says, “nothing much but it would be nice if someone said, Look he’s moving.”
You know things are bad when you starting looking for a funny side. Been to a couple of Irish wakes. Last time I connected with this site was about 8 months ago. Then I kinda thought the hospital was a shoo-in regardless of the hurdles. Hopefully this carcass will be seen moving before its buried.
Comment by Riddler — January 1, 2010 @ 9:06 PM
The municipal leadership are like this week’s Giants and we’re the disappointed fans. It’s left up to HUMC, like the Jets, if we’re going to the super bowl in 2010.
Comment by foreverfan — December 29, 2009 @ 9:14 AM
Looks like a HUMC North hospital is on a respirator. Have to admit surprised Hackensack’s having trouble putting this thing together. Not because it’s them but because this thing is needed. Ferguson seemed so sure when he presented it at the Community Center.
Comment by Dirk — December 29, 2009 @ 9:55 AM
The paper said the license expired. Is it really dead?
Comment by Reg — December 29, 2009 @ 3:35 PM
Its not just merely dead. Its really, most sincerely dead.
Comment by Bad Medicine — December 30, 2009 @ 11:38 AM
Inspiring thought as the year closes for me; a new and bigger ER is ready and waiting at Englewood Hospital. Now all an elderly parent in Harrington Park needs, is just enough time to get to it. Happy New Year to Valley Hospital and Englewood Hospital. Hope at least their management is happy.
Comment by 2009 — December 31, 2009 @ 11:53 PM
One must wonder what will happen to the Hackensack EMS that has been housed down at Westwood’s Dpw. Will they stay? What may happen to the emergency room facility? Will it close? Going after Valley and Englewood Hospitals is easy pickens. They did not put Pascack Valley Hospital into bankruptcy. You could start with PVH board of trustees. The decisions the board made brought the hospital down. Could it be saved? Before it officially closed I believe in the correct hands yes. The governing body would not allow that to happen. So you have what you have now. Lets take it to court the American way. It was good for the community having PVH,but all things do change.
Comment by gary — January 1, 2010 @ 1:39 PM
I worked at PVH for 10 years and it was a fairly good Hospital. It had some issues as all hospitals do, but really was an asset to the community and a pretty good place. Everyone wants a Hospital there now but my one question is where was the community, physicians and political leaders three years ago? Where was the support when we were struggling and dying. I was working there and nobody came forward and said anything. I don’t live in the Pascack Valley but at the end the community is walking around calling it ‘death valley’ and beating it up so no one goes there, now everyone wants it? The community perception was horrid. In the end the people of the Pascack valley community ironically got what they deserved, the ‘death’ of ‘death valley’!
Comment by EJ — January 4, 2010 @ 11:45 AM
Your assumption is understandable but somewhat unfair. The PVH management was less then open to the dire crisis they were facing. Can you blame anyone for doubting the voices of their financial concerns? Here they were spending millions in expanding their facility while their market assumptions were collapsing in front of their eyes. Their ‘Do Not Resuscitate’ was self inflicted. You see the same scene developing at Englewood Hospital today.
The “death valley” trade mark was also of their own doing. The hospital had a procession of quality errors filtering out to the public, not only by recipients’ of the errors, but by employees who had witnessed mistakes and confidentially mentioned it to friends and family. Unfortunately getting the reputation is easier then repudiating it. PVH was working to address it, just not quickly enough.
The Pascack Valley community did not deserve misguided political responses to define their right to accessible health care. Consider the golden hour of care many physicians and other like to cite in responding to traumatic events. If a 911 call at 6 PM results in a local volunteer ambulance response within a window of 5-8 minutes, and we add another 8-15 minutes to triage, stabilize and load a patient onto the ambulance, then we add the PVH CN report’s analysis of a local travel time of 21-32 minutes to an area hospital, and finally add 5 minutes to transfer ownership of a patient to the hospital―you have a 39-60 minute best case window just to obtain access to required life-saving surgical intervention care; and that’s only from Westwood.
While PVH’s bankruptcy evolved the local political administration bowed to a projected savior and sat back and offered 24 months of rhetoric and dancing side shows. They should have taken some independent back-up action. They could have asserted their savior had considered the what-ifs and set up parameters to gauge for themselves. They could have appreciated that the NJ Administrative Code /Title 8/ has guidelines, which they could have utilized and at least attempted to secure a hospital CN extension opportunity themselves. They chose instead to be part of the audience, allowing the opposition to develop a stronger legal argument to keep PVH closed; one that politics will ultimately have to address if a hospital is to return.
Pascack Valley Hospital’s mismanagement undermined its service capabilities, precipitating its reduced use. The fact is that it still maintained a 38% foundation of use which should be sufficient to define a demonstrated need. HUMC understood that need and offered to replace THAT need. The political missteps, HUMC finances and the self interests of the opposition only clouded the water; it didn’t wash away the need.
Comment by riskaverse — January 4, 2010 @ 5:28 PM
Shame that it was left up to betting it all on politics. Didn’t have to go down that way. Many were asleep at the wheel or willing to take sloppy seconds. Your people deserved better.
Comment by Bad Medicine — January 5, 2010 @ 3:41 PM
Fair sounding argument but HUMC should have one last bite at the apple. Depending on the terms of their delayed application they may be able to get that CN extension reconsidered. Of course we have to assume that actual results may differ materially from historical or anticipated results due to many factors including, but not limited to the various forces of idiocy.
Comment by Stockbroker — January 5, 2010 @ 9:48 AM
If idiocy were an asset New Jersey would be solvent.
Comment by Bad Medicine — January 6, 2010 @ 2:34 PM
The way the rival hospitals talk they’re not playing to lose. You can’t blame anyone if a new hospital’s not to be. Things don’t happen because someone says they will. That’s life 8)
Comment by Cavis — January 5, 2010 @ 4:16 PM
Our new Governor said he supported this hospital’s return. Why can’t he just tell the department of health to let it open?
Comment by delta — January 5, 2010 @ 7:56 PM
Remember Ability is what you’re capable of doing. The governing body does not have the ability to open a hospital. Motivation determines what you do. The governing body is motivated to say anything to get elected. Attitude determines how well you do it. The governing bodies attitude will be blame someone else if it doesn’t happen. Someone has to have the key to put a stop to what has been going on. I hope they step up.
Comment by Grrr — January 6, 2010 @ 1:48 PM
You used the word tentatively so you must believe in the yellow brick road of dreams come true. Did you read in today’s paper HUMC reactivated their application?
Comment by Judy — January 6, 2010 @ 6:10 PM