The Master Plan: We Want a Hospital

The pro and con forces are currently battling the legal nuances of which court has jurisdiction over the tentatively expired certificate of need (CN). Its’ expiration was an administrative decision made by the former Health Commissioner Heather Howard. A decision made through the intentional failure to act on authorizing an extension to the Pascack Valley Hospital’s CN. She chose not to accommodate Hackensack University Medical Center’s (HUMC) request as it seeks to reopen a small hospital, placing politics over people.

Ms. Howard, an aide to Corzine since his days in the U.S. Senate, used a decision process that was obviously viewed through a set of Corzine blue colored glasses. Her support for respecting his wishes was rewarded with a three-year appointment to the State Board of Medical Examiners, helping to secure her place at the State’s public pension trough. The message portrayed—a reopened hospital is in the hands of politics and hope. Public need, at least in the Pascack Valley, is a bystander.

Even the Westwood governing body, instead of being a participant in the effort to bringing the hospital back, by actively appealing Ms. Howard’s decision, is relying on the HUMC stratagem—and political hope. The HUMC CEO recently sent a letter to 60,000 residents, asking for renewed public support. It underscores the use of politics in giving hope while seeking to influence political decision makers.

HUMC is in court to determine whether the denied CN expiration extension should be heard in the Bergen County Superior Court or the Appellate Division of the state Superior Court in Trenton. The central focus—whether the State’s Permit Extension Act of 2008 applies to the CN.

The opposition, along with the Department of Health, believes the Appellate Division is the proper venue. It should be interesting to see how HUMC’s legal team argue the ‘State’s’ definition of development permits, translates it into another ‘State’ agency’s definition of a CN—and then—how it should all fall under the jurisdiction of a ‘County’ court. Here’s a potential decision that in and of itself may find itself appealed.

In the meantime, while everyone is positioning for the white knight of politics to intercede, the people are placed at risk. The opposition says we don’t need this hospital because of excess bed capacity (translated as competition) and as such, forms the basis for each step in their legal efforts.

Hospitals are patient oriented businesses, a quality of life destination, and therefore an economic driver to a host community and surrounding areas. Their operations are capacity motivated whereby resources require a management that is performance driven. This requires effectively managing the facility, equipment/technology and staffing resources that prioritizes quality while considering service mix characteristics and demographic demands, cost efficiently.

The State’s report leaves the connecting demographic factors of a hospital’s size, location and operating structure (teaching or non-teaching component, profit or non-profit) out of their analysis; suggesting instead the oversight authority would consider those parameters. Bed distribution is a factor in capacity demand. Hospital profit is a factor in management performance. Title 8 notes that, “components of quality care … include access to care” (NJAC8:43G-1.1b).

Politics, i.e. Ms. Heather Howard’s political bias, has allowed those details to be lost in the discussion of individual hospital profits. If politics is to be the guiding force, then the host municipality should be laying the path, prioritizing the public need. First on the health demands of timely care for traumatic events that may affect the most vulnerable; and then adding the economic concerns on a broad base analysis in these times that consider jobs, business and associated people needs.

HUMC has shown itself to be a, albeit slow in coming to the altar, willing partner; who’s past political hubris is in a state of evolution. Possibly a more involved municipal partner might have opened options to assist in a returned hospital. We’ll just have to hope that the process hasn’t incurred to many missteps to encumber a successful conclusion. With any luck, the political hope and change so many counted on in Washington won’t be a forecast to results here.