The Commissioner alone has the final decision to approve or deny. Many expect a response sooner then later, possibly before year’s end. Unfortunately any anticipated result that completes the recent circle of support, has been assured a legal challenge by the opposition.

The effort to resurrect Pascack Valley Hospital’s phoenix from the ashes of bankruptcy has been a 4-year struggle. A process weaved amid a cast of competing priorities, business missteps, distorted information, industry uncertainties and political theatrics, all stirred in a brew where money is the prime ingredient.

The Department of Health and Senior Services’ staff submitted a 34-page report to the SHPB, recommending support for HUMC’s proposal to open a 128-bed hospital. It was discussed in the Board’s deliberations. The resulting 5 affirmative votes had one observation injected onto the record.  That caveat of opinion cited the travel concerns raised appeared overstated, based on a Board member’s view of travel times experienced in southern New Jersey.

That ‘caveat,’ while debatable, will surely be seized upon in any legal challenge, offered along with quotes from various reports citing too many area beds already.  The reports are ultimately opinions that the courts have previously noted do not preempt any legislated intent. But the arguments of travel time hazed with a mixture of hospital finance and politics, in a court room, could become molded into another obstacle in any environment of over confidence.

HUMC’s confidence clothes the hospital in waiting with large banner.

Valley Hospital and Englewood Hospital Medical Center have publicly stated they will file a legal challenge in an effort to stay any approval that reopens a hospital in Westwood. Why — because they stand to lose a projected 2-4% respectively, in their sales. They have suggested that that will be enough to undermine their financial health.

The reality to maintaining a strong health system, the intent behind a CN process, suggests that hard decisions are needed to limit the number of hospitals and assure the financial stability of the ‘system.’ The opposition will highlight the court has recognized that legislated intent is an “important protective tool in the management of the health of urban hospitals,” (Virtua, supra, 194 N.J. at 434, 945 A.2d 692). A tool that, in their view, shouldn’t be manipulated by the politics; unless it benefits them.

Without a legal stay of any affirmative CN decision, the investment by HUMC and Legacy will probably be expedited. History suggests that that capital outlay will most likely transform any further legal efforts by the opposition operatively moot. The point here is to note that this process isn’t over until all the legal challenges, whatever they may be, are put to bed; hopefully an HUMC North bed.

Related articles

• Pascack Valley Hospital Closer To Reopening (newyork.cbslocal.com)

At the 1st meeting, Oct. 19, the Board heard public comments overwhelmingly supportive of HUMC’s certificate of need application to reopen a hospital. It included two hours of declarations on the hospital’s need offered from area politicians, physicians, emergency personnel and residents; the time allowed for only a small representation to speak from the hundreds in attendance.

The only opposition emanated from two representatives from The Valley Hospital and Englewood Hospital and Medical Center. Opponents since day one of PVH’s closing — determined to protect their new captive market share. Their views, so narrow, they couldn’t spare a moment to listen to the concerns of residents – leaving immediately after citing their opposition.

One only needs to read the opposition’s prepared statements, previously presented to the Dept. of Health, to know their undeniable motivation – money. Valley’s presentation was an offering of their assessment of myths vs. blinkered facts. While all their various conclusions can be argued, some seemed ludicrous to even suggest as valid arguments.

They acknowledged that their current “Renewal” (expansion) investment is meant to address the fact that they are, “the site of New Jersey’s second busiest hospital.” That enlightenment comes after they suggest they’d lose about $14 million in sales if PVH is allowed to reopen – about 2% of their gross sales.

AND this apparently justifies captivating their market by noting, “that generally acceptable drive times are 30 minutes.” While such an argument may be relative in the outback of Australia or in low populated areas, Bergen County is densely populated with a poor public transportation infrastructure and is a congested traffic nightmare in bad weather during rush hour. To review their presentation CLICK HERE.

Englewood Hospital’s opposition paper to the DOH is certainly more comprehensive with a couple of hundred pages of exhibits, but it too is focused on their economic future, not public need in the north corner of the County. If you read their paper they cite a potential lost of $17 million in revenue compared to Valley’s assessment that EHMC would only see a lost of $9 million. Either way it’s less then 5% of EHMC gross sales; certainly not enough to suggest irreparable harm if the PVH site saw a small acute care facility reopened. To review their report, less exhibits, CLICK HERE.

There were also support comments presented to the DOH in the form of resident and politician letters, but the only independent support report of substance is provided by the Westwood Taxpayers Alliance, a group initiated by Bruce Meisel, a local banker and businessman. It offers an overview of the hospital site’s history and need. To review CLICK HERE.

Ultimately, the argument comes down, in my opinion, to one of geographic access need. Without a fair opportunity for access to trauma healthcare, people’s lives will suffer. Someone’s heart muscle will eventually die if travel time is to be placed second to dollars. Brain injuries will risk diminished function, if gambled in delayed traffic to accommodate what – a single digit percentage point in gross sales – over timely trauma access?

In December of 2007, at the certificate of need closing meeting, only one voice spoke in support of the license extension in Trenton. This time one voice won’t be enough. The Nov. 29^th meeting will end with a decision and that decision necessitates a clear display of public support.

UPDATE – Nov. 22nd – HUMC scores a victory (Click HERE to read article) – State health department staff recommend in favor of a reopened hospital in Westwood. The Nov. 29 meeting will apparently discuss that staff recommendation.

The public will be given an opportunity to speak. Naturally many politicians will offer their thoughts. Some will speak because they care; others will speak for a share of the spotlight. Those individuals you’ll be able to spot by their focus on jobs and economic concerns. They’ll want to cover the broadest range of voter favor in this election season. But those two aspects are superficial to the responsibility in the planning board members’ decision process.

The opening of any hospital has to compliment the overall State health ‘system.’ It was the premise of the Reinhardt Report that took center stage in the opposition’s first salvo at keeping Pascack Valley Hospital (PVH) closed. Too many beds in the area were cited over and over; and if the State doesn’t hear a passionate outcry of concern toward the ACCESS parameter, the bed argument could garner new weight.

Even if Westwood and the Pascack Valley are honored with an approval by the DOH commissioner, the fight will most likely not end there. Valley and Englewood Hospital haven’t come this far to simply throw up their hands and say, “Oh well.”  Barring any deal,  it’s probable that the opposition will file a motion in an attempt to stay any approval pending an appeal.

Consider the players and various grounds for such an action beyond trumped up research papers. It is my understanding that Commissioner Ms. O’Dowd is the first appointee who wasn’t a physician. It is therefore implied that her appointment was politically motivated, which is purportedly supported by her husband’s position as the Governor’s Deputy Counsel. And as many know, Governor Christie stood in the PVH parking lot when running for office and campaigned in support of the hospital’s reopening. Could there be a conflict of concern within Ms. O’Dowd’s decision process? Surely any attorney reaching for distractions could manipulate the idea into an argument.

Now add to the mix, John Ferguson, the former CEO of HUMC, an integral participant in the beginning of HUMC’s review and subsequent victory in acquiring PVH’s assets. He now works as a consultant for Englewood Hospital. He’ll be able to offer insight to HUMC’s for-profit partner deal. If anybody is going to derail the reopening opportunity, he could be a major asset to the goal; structural information in deal making can be useful for both pro and con motivations. It also isn’t a stretch to assume that Mr. Ferguson might be a little bitter against HUMC, for releasing him over political dealings that were originally for his employer’s benefit. Who knows, it could be an ego stimulant, assuming Mr. Ferguson has any narcissistic tendencies.

The point being is that the public needs to BE SEEN and BE HEARD. It cannot assume or expect HUMC to bring this hospital home without public support. Hopefully area residents won’t let weather or traffic be an inhibitor to being involved.

Recent articles leading to CN hearing:

- HUMC Submits Hospital Application [06/09] (Click Here)

- State Reviews PVH Application [09/04] (Click Here)

- HUMC Defends State Query [09/15] (Click Here)

- Public Hearing To Be Held [10/08] (Click Here)

Valley Hospital is seeking a major expansion in size and services, and their current licensed beds are fully staffed. Englewood Hospital is only staffing 63% of their licensed beds but operating within a very competitive market location. They use rhetoric over the number of licensed beds in Bergen County, as a substitute for defining the healthcare needs of the two Valleys. The specifics of to whom or what those beds represent in access need is missing in the argument

We hear little about internal ER data, admission rates, length of stays, readmission rates and the like, from the opposition as it might relate to the 100,000 plus residents of Pascack and Northern Valley. And if we did, it’s doubtful it would actually capture the results a change in access to care might truly generate. Yet they push a vision of doom without ever enumerating their financial concerns in real numbers, or its relation to Pascack and Northern Valley’s healthcare access in Bergen County.

When you analyze numbers there are always core facts and patterns that can be developed, or manipulated dependent on one’s motives, but they only offer a generalized view in complex concerns. The loss of a hospital necessitates questions not easily quantified. How do you calculate the needs of the elderly, children or the medically frail with a lack of available transportation? How might they ultimately affect hospital admission patterns or outcomes? Could a limiting access factor, distance decay, affect their evolving health conditions?

The locations of the licensed beds in Bergen County are quantifiable. 80% are in the southern area; it shouldn’t be a surprise if one wonders why the northeast should be subject to geographic isolation. Unless Valley and Englewood can start producing quantifiable reasons that relate to people, to access, to location, to healthcare needs, then their rhetoric is ultimately only about them and their ‘business’ of selling healthcare.

>>>

[Click Here] to see ad which ran in the Community Life, Suburbanite (north and South), back page of Hackensack Chronicle and Ridgewood News.

Now — Valley and Englewood go for an end run at the jugular of a new hospital call; they take their drama to the State’s highest court. And not to worry, the residents aren’t going to be left to wonder if anyone is having second thoughts as to goals. The players will continue to try and influence public perception, distorting the lines between opinion and reality.

About a week ago, Englewood Hospital took out a full page ad, listing their subjective facts to highlight their concerns against a new hospital in Bergen County. Not to be outdone, HUMC paid for a full page ad this past Sunday. It was portrayed as a letter – to itself – from the Pascack and Northern Valley Mayors Associations, properly endorsed of course, thanking itself for opening the new ER and pursuing plans to meet the need for a new hospital in Bergen County.

I was disappointed that HUMC’s ad was theirs. It would certainly have been more impressive if a politician had seen the marketing value to such an endorsement styled ad – paid for by the public in some form. After all — the argument IS that WE, the public, need a new hospital. Therefore we should be arguing it with the same intensity as the opposition.

Valley and Englewood Hospital reiterated their arguments against a new hospital in their denied motion briefs. They just added some modification to focus on the new call aspect.  They noted they saw no obvious facts to justify the DOH issuing a new call, therefore they believed the call was outside the authority of the Commissioner. Ultimately, in legal jargon, prima facie or ultra vires, it didn’t matter; the court appeared to agree with the Department of Justice’s brief. The new call is an administrative decision whereby the opposition will have an opportunity to oppose in due course.

Was travel time a factor in her death?

If you’d like to read the briefs, click and download a PDF file. They’re offered without their appendixes.

DOJ Brief

HUMC Brief

Valley Hospital Brief

Englewood Hospital Brief

Hopefully the opposition’s arguments will seem as ludicrous as they appeared to me when they’re presented to the State’s Supreme Court. Of course my view is bias. But then again, we are dealing with politics and bureaucracy too, and interpretations within that setting can be subject to whims. It’s possible that is what the opposition is counting on in any final declaration — absurdity.

Yet aspects of their argument may at some point carry weight. They dispute HUMC’s suggestion that area economics have any bearing in the statuary guidelines for a CN — a valid point. Their argument implies any affirmative decision would be political shenanigans to accommodate a campaigning Governor’s promise — a plausible point.  However these arguments and others have been thrown around like cooked spaghetti, as if to see what might stick.

Valley and Englewood argue that HUMC’s petition for a new hospital exaggerated area health deficiencies, such as ER diversions. They highlight the expansions of emergency facilities have led to a “drastic” decline in ER diversions. Words that in themselves acknowledge they have NOT eliminated them. Pity the individual trauma patient diverted that didn’t fall within their decline parameters.

It’s ironic how the opposition arguments have shown flexibility. In their opposition to HUMC’s PEA appeal, they argued the DOH’s administrative right. In opposing the DOH’s call for a new CN, they argue the DOH’s administrative right was arbitrary and capricious.

Arguments are always based upon one’s vantage point. An outcome can be influenced by the quality of a presentation rather then facts. This issue of a hospital has been bantered around 3½ years with a lot of subjective perspectives. Commissioned reports and white papers have been nitpicked for quotes to avoid any honest discussion. The participant’s legal briefs have interpreted case law and analogized their meaning. Public policy is debated by local politicians in limited parameters, seemingly more for show then substance. And all while the actual public trauma care needs of a 100,000 plus residents are sidelined.

HUMC’s application for a CN to open a new acute care hospital is required to be in for DOH review by June 1st. After that the DOH will tentatively set two public hearings, one in Westwood and one in Trenton. Considering the catfight that has been displayed to date – it will take a strong articulated argument from the Pascack Valley municipalities, and the public, to solidify a credible argument substantiating our need.  If not we shouldn’t be surprised if the opposition wins by a default.

HUMC, Valley Hospital, Englewood Hospital and the Department of Justice (DOJ) have each submitted briefs in that lawsuit. The DOJ filed theirs on February 9, completing the quadruple bypass of the public’s only concern — when will the acute care needs of the Pascack Valley residents be reinstated? Oral arguments will begin May 17th.

The briefs are dry reading. Unfortunately from a layman’s perspective, they portray HUMC’s arguments as shallow, a shotgun attempt to overcome a series of missteps in formulating their goals. All this debate over interpretations dealing with a certificate of need, a bankrupt hospital’s operating license and HUMC’s attempt to reopen a small general hospital

HUMC seemed conflicted as far back as 2006 when they signed a memorandum of intent to purchase PVH. A deal then that may have been difficult for them to assimilate economically while juggling another major construction project’s financing. If nothing else their process of uncertainty hastened PVH’s anticipated demise.

HUMC then partnered with Touro University College of Medicine’s financial strength, apparently seeing parallel goals. It resulted in them submitting the winning bid in PVH’s bankruptcy proceedings. But it also necessitated their advising the Deputy Attorney General that they were NOT purchasing PVH’s license to operate an acute care hospital. A statement obviously meant to expedite the transfer of PVH’s assets and avoid an extended CHAPA review. The expedited condition was necessary to meet Touro’s goal — acquiring and setting the foundation for obtaining State approval to open a medical school.

HUMC & Touro - so happy together?

Ultimately that effort resulted in nothing more then a sign with Touro following another avenue, purchasing a medical school in New York. That situation then opened other opportunities and challenges for HUMC. They were fully engaged in the construction of their new state of the art cancer center, dealing with a public distraction from a political/business regression — and needing to seek another financial partner to replace Touro.

That process allowed rival hospital interests to exaggerate a narrow image of excess beds as a cause and effect for New Jersey’s hospitals’ financial difficulties. They discount poor management, weak business models, outpatient ambulatory center competition and an evolving national healthcare delivery system, setting up a false belief that the answer to hospitals ‘health’ is an oligopolistic market structure.

I originally believed that HUMC, having been ultimately required to purchase PVH’s ‘license’ by the DOH — with its Certificate of Need (CON), a transactional document required for a hospital license to exist — had inchoate rights that should have allowed them to transfer the license with less drama.

When you consider the Muhlenberg Hospital lawsuit (City of Plainfield v. Dept. of Health, 2010), Commissioner Heather Howard denied a two-year extension for that hospital’s license. She acknowledged that the only purpose was to facilitate a transfer of a license. She believed instead, there were sufficient regulatory procedures to determine Plainfield’s perceived need and allow a future potential interest to open a hospital. That concept seems to imply that the DOH in requiring HUMC to purchase PVH’s license, reaffirmed it had at the very least an implied certificate of public need.

That CON ‘need’ seemed further reinforced in the analysis of the Stratford Nursing & Convalescent Center Bankruptcy (Case No. 08-27733-JHW) where it was noted; “the regulatory framework makes clear that CON’s and licenses are two different things. CON’s are transferable if no additional beds are added. A license to operate is not transferable, but the right to apply for a license is transferable. An application for an operating license must be accompanied by a right to operate the specified number of beds. A license cannot be transferred without transactional documents demonstrating the right of the prospective licensee to operate the facilities.” HUMC was not seeking to add beds and therefore with its undisputable qualifications, a transfer similar to what the Medowlands Hospital in Secaucus recently met through its sale and transfer to MHA LLC, a private investment group, should have been sufficient.

The push and pull of HUMC’s competing priorities is, in my opinion, reflected in the legal arguments by their law firm’s representation of their interests. Why, if HUMC believed the PVH license/CON was subject to the 2008 Permit Extension Act, which is the basis of their suit, didn’t they raise the specter sooner?

The law firms representing the opposition are consistently focused – prevent the potential reemergence of competition in the Pascack Valley. The DOJ focus fulfills its duty to defend the Commissioner’s decisions, whether or not it’s in the best interests of the public.

Click below on your participant of choice to download a PDF copy of their brief (less appendixes). My preference was the DOJ brief as the best read.

* Hackensack University Medical Center / DeCotiis, Fitzpatrick & Cole, LLP

* Valley Hospital / Giordano, Halleran & Ciesla, P.C. and Wolff & Samson P.C.

* Englewood Hospital and Medical Center / Wilentz, Goldman & Spitzer P.C.

* Dept. of Health and Senior Services / N.J. Attorney General’s Office

* HUMC’s Brief in response to the DOJ’s Brief / DeCotiis, Fitzpatrick & Cole, LLP

Interesting expenditure numbers for all hospital legal services by the facilities noted: Contract review, Financial document reviews, land use dealings, insurance & collection issues, market share challenges, etc. It's not a lot when considered in relation to gross sales of each facility, just interesting.

It should be noted that with the DOH’s new Certificate of Need call, the Valley and Englewood Hospitals’ have started yet another legal challenge. (Click HERE to read.) They’ve filed a motion in an attempt to quash the new call. It shows that the opposition continues to remain focused; investing nonprofit funds, not in the health of people, but rather to strengthen their market share.

In the meantime we read the financial environment of New Jersey’s hospitals continue to show signs of a debilitating financial virus. The Record, reporting on a Moody’s Investors Service Report in a Nov. 19, 2010 article, noted, “New Jersey’s hospitals are chronic financial under-performers.” (Click HERE to read.)

It appears New Jersey hospitals lack a comprehensive and flexible business model capable of adjusting to an industry in structural change. It’s not unusual for some struggling managements to focus on narrow concerns, discounting the bigger picture. Take for example the 2007 development of Hoboken University Medical Center where a prior two-year effort culminated in the creation of state legislation that permitted a private-to-public transfer, allowing a municipality to own and operate a hospital.

Hoboken University Medical Center

Here you have a situation where a hospital in financial collapse was saved by a municipality bonding $52 million, preserving what was the former St. Mary’s Hospital. It was an action that lacked a strategy. Like most government solutions, money and rhetoric weren’t able to solve the hospital’s problems.

Last week, 3+ years after the intervention, Hoboken is divesting itself from a financial albatross. It announced a proposed sale to the owners of Bayonne Medical Center, a for-profit entity, which will complete its due diligence before finalizing any closure for Hoboken’s taxpayers. A due diligence that may make the sale less then a happy ending to the original effort of Hoboken’s elected officials.

Hospitals nationwide struggle to assert revenue streams from core services while simultaneously trying to protect their inpatient / outpatient market share. They attempt to standardize and automate best practices in delivering care while seeking ways to improve charge captures, and third party resources for indigent patient costs. All operational factors that require effective management to drive long-term financial sustainability.

HUMC, Valley and Englewood Hospitals are each dealing with there own challenges for growth. So too is the challenge to bring a hospital back to Westwood. It requires a comprehensive perspective to appreciate, that sometimes, opportunity requires a strategy ― and a proactive approach.

Hence while HUMC, Valley and Englewood butt heads for their future, Westwood residents are offered words of hope from their local leaders. Mimicked words that echo the updates fed to them by the interests of others. Hopefully this blog doesn’t ultimately end citing a leadership that accepted a fate solely dependent on those interests. The loss of a Pascack Valley hospital, ― or the character of the Westwood community as a tradeoff, ― is not acceptable.

Related Articles

• State extends consultants’ deadline to analyze healthcare provided by 3 Hudson County hospitals (nj.com)
• New Jersey’s largest health insurer campaigns against Bayonne Medical Center (nj.com)
• Tensions rise between nurses’ union and Hoboken Hospital Authority, still mum on sale of HUMC (nj.com)

It’s nice to read of residents with conviction. It’s nice to see Valley meet an opposition similar to their own push back on Westwood’s goal for Pascack Valley Hospital’s renewal. Fortunately there are those who put their concerns into actions; who dissent, not to be confrontational, but rather to foster change that can respect differences with better decisions—and solutions. Maybe the “Concerned Residents of Ridgewood’s” opposition will inspire dialogue and opportunity for both Ridgewood and Westwood. (Click HERE to read an interesting article on the value of dissent.)

In the meantime, HUMC’s legal appeal has shown some life. On August 18^th a scheduling order was issued whereby HUMC has to file its’ appellate brief by 09/20/10 with counter briefs being completed by November. Hopefully HUMC will take a more direct approach in their argument, and stop wasting time worrying about Valley and Englewood. Its obvious Valley has no legitimate grievance, and Englewood management’s delusional rhetoric is only worthy of a time-share in Bergen Regional’s psychiatric ward.

The delays to the reopening of a hospital in Westwood have been unconscionable but not unusual in a bureaucratic political environment like New Jersey.  They’ve been fanned by two hospitals determined to nurture an oligopoly. Exasperated in the DOH by the narrowest interpretation of a State report that focuses on a health care “system” that doesn’t yet exist.  And complicated by HUMC own convoluted approach to cultivate opportunities in what one might assume, was an elaborate scheme to expand ‘efficiently’ while dealing with a major multi-million dollar cancer center expansion.

HUMC bought a hospital site, obtained a CN to open a satellite emergency room and commenced core hospital services, applied for a hospital license, then purchased the PVH ‘extended hospital license’, and tried to negotiate away opposition while dealing with a politically motivated health commissioner. Now it’s in the courts trying to define an extended license within the context of New Jersey’s Permit Extension Act.

Over the many months HUMC made a generous offer to the opposition presented by a financially challenged Englewood Hospital. They offered to assist in Englewood’s efforts to be profitable. Their proposals would have generated “quantifiable savings/revenues” of $3.8-$6.4 million per year to Englewood’s bottom-line. (Click HERE to read a letter dated Sept. 18, 09 from HUMC to Englewood Hospital.) Alas you can drag a donkey to water but you can’t make it drink. Englewood Hospital’s struggles are of their own doing and should have no bearing in any discussion revolving around PVH.

In a December 16, 2009 letter by HUMC’s legal representative to the DOH Director; they pointed out various delays initiated by Valley and Englewood. The sampling of Valley/Englewood delays included:

> Dec. 15, 2008: They filed a copy of a letter sent to the DOH, which attempted to stop the CN process to reopen PVH, with the Bankruptcy Court. The effort was to get an automatic stay under Section 362 of the Bankruptcy Code to disrupt the process, threatening to file a motion for injunctive relief if the Department didn’t refuse to process HUMC’s CN application.

> Jan. 07, 2009: They filed a joint action to assert the PVH’s operating license was a saleable asset of the Bankruptcy estate.

> Feb. 06, 2009: They filed another motion for a Section 362 automatic stay to assert HUMC didn’t try to reactivate PVH without having clear control of a ‘saleable’ asset of the bankruptcy estate.

> Feb. 13, 2009: They filed another motion attempting to take depositions of HUMC and its partners and their intentions to reactivate the license.

> Feb. 26, 2009: They filed an adversary proceeding for a declaratory judgment to assert HUMC had no right to acquire the license under the site’s purchase agreement.

> Feb. 27, 2009: They filed a motion to vacate and set aside the Court’s order approving the sale of the PVH site to HUMC. Further asserting that if the license was deemed transferable to HUMC upon its purchase of the property, then the sale should be vacated and the bidding reopened.

> Mar. 19, 2009: They attempted to derail the sale of the PVH license to HUMC by offering $2,000,000 for the license rights; aware that the DOH had already decided they had no right to acquire the license.

The upshot of all these high jinks is to produce a health care consumer surplus in the north corner of Bergen County for the opposition. Englewood hopes it will compensate for an inconsistent management, and Valley hopes it will speed their transformation from a community hospital to a regional facility. So, if Valley’s spokeswoman, Megan Fraser really wants to understand how a small group can attack and “delay a project that will serve so many people of our region for years to come,” she needs only to look in a mirror.

[The Concerned Residents of Ridgewood can use support. Click HERE to help.]

Related Articles

• Gov. Christie supports reopening of Pascack Valley Hospital (nj.com)

Is rhetorical verbal support considered “working real hard?” Was it a referral to the fruitless conversations with Democrats in opposition, like Sen. Weinberg, Sen. Gordon, Asm. Johnson, or former Gov. Corzine? Was it the approval of an extensive un-vetted change to Westwood’s Master Plan, without any reciprocating assurances? Or was it organizing a protest ‘walk’ to Valley Hospital to highlight proximity?

I’m sure the Mayor is doing all he can within the limits of the governing body and their legal professional’s imagination. Similar to the inquisitive thought process displayed in a recent article on a ‘setback’ encountered with the municipality’s $2.7 million Westvale Park improvement; a thoughtful and timely spending project. (After all, who could have foreseen residents would be struggling to meet a 10% increase in local property taxes during a recession in a State with a cost cutting Governor?)

The setback? A $187,000 cost overrun (charged to Westwood taxpayers) to meet field conditions different from those expected by the municipality’s engineering firm. In fairness, the engineer noted he used plans provided by Malcolm Pirnie, the firm that originally capped the landfill on which the park is built.

This project had Mayor Birkner exclaiming he was “beside himself.” He further emphasized, “It’s unexpected, and quite frankly if the project had been done right the first time we wouldn’t be having these problems.” Is this project like the hospital, where the governing body is “working real hard?”

Malcolm Pirnie Engineering's primary contract was limited to the landfill closure. In 2005 the administration revised the capping topography to provide preliminary "recreation field ready" grading. Future development of 'Westvale Park,' after a period for settling, was to be accomplished over 5 years within budget constraints, without new municipal borrowings.

The article in the Community Life, which reported on this Park’s ‘setback’ (click here to read), didn’t reference any thought provoking questions by the governing body as to reflect that “working real hard” concept. Maybe someone might have asked whether any consideration was given to the settling soil conditions. Certainly not a novel thought in association with a soil capped landfill. You’ve got decomposing garbage, covered with a capping system that includes 18 inches of a low permeability soil crowned with 6 inches of topsoil.

The full capping activity was completed in 2007. It was suggested back in 2005, that the municipality wait at least five years before seeking a final site upgrade at which time any park designs would need to consider “existing” conditions. An extensive overview report of the landfill that reviews its history from January 1998 through August 2007 is available in the municipal files for any governing body representative unfamiliar with the details. Useful reading if you’re going to spend taxpayer money.

The settling consideration is not a new factor and bears repeating. Over the last few years the recreation groups have been advised that the landfill would experience settling — that natural compression of the landfill’s composting trash and the soil covered cap. It was the premise to the current administration’s argument as to why a roller hockey rink was withdrawn from the park’s final offerings. It’s also a premise as to why no serious development to the park’s surfaces should be rushed; otherwise the municipality may see higher maintenance costs going forward. Any member of the local football organization can verify the settling they encountered in resurfacing their landfill perimeter fields in 2006. And those fields were capped well over a dozen years ago.

With just this tidbit of information and the setback described in the Community Life article, one might wonder if the engineering process considered landfill settlement. A layperson could walk the site a couple of months ago and see that settling was already occurring on the temporary fields and paved paths. Did any of that “working real hard” effort include ‘thinking’ through that aspect when planning the grandiose expenditures? Did the engineering firm considered that possibility when placing a 12″ drainage pipe call out in their plans? Or did they assume rolled capped soil compressed to an ASTM specification wouldn’t see any further natural compression? (A reminder, this is the same engineering firm that oversaw the 10 year firehouse construction debacle. After going 200% over budget it took a question from the prior administration to bring to light that a  Class ‘A’  structure design didn’t include a fire alarm system.)

Governing body chose to borrow $2.7 million now to redesign and bring fields up to premiere playing stature. They also decided to connect Westvale Park to the nearby County Park, recognizing the increased maintenance costs will be borne by Westwood taxpayers. When economic times take a bite out of your wallet, we all know that there's nothing like government debt spending to give you confidence in the future.

Mistakes happen. The governing body, lawyers, engineers, etc., anyone can miss a detail. I’m over stressing the above to amplify a point. Some situations need all eyes paying attention and occasionally participants do need to be “working real hard.” Not in a physical sense, but in a thoughtful sense. An oversight of one detail can in fact mean a setback, or failure, and can be costly. It doesn’t matter if it’s a park development project or putting the pieces together for the reopening of a hospital. In each case the leadership needs to be inquisitive for obstacles and alert to opportunity.

The situation for PVH’s operating license now lies in an undefined state. HUMC has it on life support pending a potential resuscitative judicial reprieve. Valley and Englewood seek to have it declared dead.  The new Governor and health commissioner are reviewing options but note the situation is weaved into a court action.  Collectively it appears to place PVH’s return into the arena of probability theory, where random more then rational events will shape its prospects.

What probability values do we know?—Public officials and the affected taxpaying residents ARE concerned. HUMC has a lot at stake, and Valley and Englewood ‘insinuate’ they do but offer no facts. And the PVH operating license has ‘technically’ expired. Vague details at best and some subject to change by future undetermined events.

What are the potential events or influences? We know that the Dept. of Health Commissioner Howard required the license to be purchased by HUMC before they could have their application to reopen a hospital considered. That license, once purchased, should have inchoate rights that need to be defined. We know that a hospital need exists and can be argued within the guidelines of the Reinhardt report. And we know that the Dept. of Health has no clearly defined health system plan, making everyone’s opinion—a subjective interpretation of facts. We therefore have a perfect storm designed for a judicial review, where the best argument wins.

Will the Westwood municipality be an observer or participant in that argument? When the hospital first began closing down, the prior administration was a participant in the court proceedings. It had an influence on the conditions of the Mobil Intense Care Unit sale that tied it to the hospital site. Since then, the current administration has been an observer and apparently “working real hard” at it!

Valley’s a good hospital, well managed with a baseline need to generate ‘positive’ cash flow, aka, profits. It’s an ambitious business under a non-profit umbrella that allows it to offset uncompensated charity care costs. Yet for all its good, it WILL impact Ridgewood for many of the reasons that have been cited in the papers by its residents. That includes a direct tax burden of police and DPW personnel costs that will be directly attributable to the hospital as a final destination for thousands of patients. Which facts will be reflected in Ridgewood’s Planning Board decision?

The same Record editorials, over many of the same months since Pascack Valley Hospital (PVH) closed in Westwood, have supported the rhetoric espoused by Valley Hospital’s opposition to PVH reopening. Rhetoric based on slanted press releases, cliff notes reflective of few facts. Add that to a public so busy trying to earn a living, support a family, pay property taxes, etc., and it easy to appreciate how an issue and its many complexities become muted over time. Look at how long Valley Hospital’s ‘renewal’ application has been ongoing. Only now has the crescendo of opposition grown, as the real cost to the resident’s overall quality of life is recognized.

It’s the same scenario with many public concerns. It’s the foundation to apathy. Piecemeal stories of ongoing  issues become filler between paid advertisements. It becomes difficult for those concerned about a matter to connect or appreciate complete facts. Facts that become misrepresented or diluted and eventually dismissed. A simple example is a local community newspaper report on the Westwood municipal budget. The article, referencing the borough’s budget presentation noted, “The borough’s long term debt, totaling $1,851,534, has decreased seven of the past eight years.” (Community Life, May 27, 2010). The statement is technically correct in some aspect, I guess, but with a misplaced comma and a reflection on the past, someone probably thinks municipal debt is currently still declining. Of course under the municipal’s present spending mindset, it would be an incorrect assumption. Westwood’s long-term debt at the end of 2008 was $18,810,981; at the end of 2009, it rose to $19,558,997, which doesn’t include over $8 million in school debt. (Source: Municipal annual debt statements)

It’s the same with Valley Hospital’s arguments to justify the size of their expansion. And it’s the same with the opposing hospital’s criticism for keeping PVH closed. They insinuate loose facts, cite competition to fill beds, occupancy rates and public needs. Rhetoric, built in a foundation of sand at water’s edge in low tide.

If you look at the charts below you’ll see 2 occupancy rates. One based upon licensed beds, the one usually cited to imply excess beds, and the other based upon maintained beds. These two bed types are important to appreciate when it comes to the rhetoric associated with PVH and community need, my primary concern.

Licensed beds are those beds for which annual fees are paid to the Department of Health (DOH). They represent the amount of beds a hospital may operate. By paying a license fee for each bed, it allows a hospital to hold the opportunity to operate those beds. If the beds aren’t needed at the current time, the license simply sits in a draw. It is the basis for which the occupancy rate is quoted to the press and for which the DOH considers area needs. Maintained beds are those beds actually staffed, based upon management’s projected need. It is the maintained beds that generate staffing cost and patient revenue. (The charts show the actual count of beds licensed and the count of maintained beds reported to the DOH, graphed to the percentage utilized.)

While these charts are useful to compare the differences between the licensed and maintained occupancy rates; it’s more interesting to consider the charts in relation to how management decisions differ between the hospitals. Deciding how many beds are maintained with staff has a direct affect on efficiency and profits. And that operational decision offers a window to the number of beds required to meet a specific area’s need.

Valley Hospital has consistently ‘maintained’ 90%+ of its licensed beds and been consistently profitable. (Note: In 2005 it eliminated 15 psychiatric beds.) Englewood Hospital has cried about its inability to be consistently profitable, blaming competition and the over bedding in the county. Look at the fluctuation in the number of their maintained beds, and its affect on their occupancy rate. Now, if their licensed bed count was reduced to 275, the same as PVH had had, their occupancy rate over the 6 years would have averaged 80% (between 77-85%) and most likely would have generated more consistent profits. Instead each year is a surprise, with 2009 having been predicted last November as another year to add to the loss column. (Click HERE to read their explanation as reported in the Record.)

Now look at the emergency room visits to these same hospitals during the same 6 year period. Consider that between Englewood, Valley and HUMC, approximately 24-30% of those visits result in a hospital admission. The emergency visits have increased year over year but it hasn’t changed the result of which hospitals make or lose money. Englewood would need a lot more ER visits to use their reserved beds. It’s the management’s thumbprint on operational decisions that affect the financial success of a hospital, likewise the DOH’s palm print influences the success of a hospital system.

When you consider that perspective, you then need to ask how does the DOH determine where beds are needed? It would be interesting to read a Record article on how the DOH decides which hospitals should close and which are needed. At first blush, it certainly seems coordinated with the demographics of social needs and politics, not the equality of actual physical access concerns.

Yet, this aspect takes on more meaning when you consider the New Jersey statutes, the administrative codes, and the recently completed rationalization report. But that’s for another blog posting. I’ll end this post by quoting two state statutes, an administrative code, a response to one of several DOH OPRA requests and note an observation.

The statute, N.J.S.A. 26:2H-8 in part notes, “The State Health Plan may also be considered in determining whether to approve a certificate-of-need application.” Remember a certificate-of-need is required for opening, closing or expanding a hospital.

The administrative code, N.J.A.C. 8:33-1.2a in part notes, “Pursuant to N.J.S.A. 26:2H-1, to protect and promote the health of the inhabitants of the State, the Department shall have the central, comprehensive responsibility for the development and administration of the State’s policy with respect to health planning for all such health care facilities and services. Based on the particular needs of the State, this plan may include limiting the proliferation of certain health care services to preserve the viability of existing providers and urban hospitals, which play a vital role in the statewide health care delivery system.” Note the reference to a “plan.”

After three open public requests for this “plan” the following response was offered, “the Office of the Commissioner holds no government records responsive to Government Records Requests.” There is apparently no actual state health “plan.” That being the case, at what point are DOH Commissioner decisions arbitrary and capricious?

Now consider N.J.S.A. 26:2H-12d in conjunction with N.J.A.C. 8:33-1.2a above and N.J.S.A. 26:2H-1’s intent “to protect and promote the health of the inhabitants of the State.” — N.J.S.A. 26:2H-12d states, “The commissioner may amend a facility’s license to reduce that facility’s licensed bed capacity to reflect actual utilization at the facility if the commissioner determines that 10 or more licensed beds in the health care facility have not been used for at least the last two succeeding years.”

Now look back at the maintained bed count and the licensed bed count of Englewood Hospital and at what point does their financial success align with bed utilization. Now consider that 1,616 licensed beds exist within a 5-mile circle between HUMC, Holy Name and Englewood, of those, 1,270 were maintained. That’s 346 licensed beds, mostly Englewood’s, unused. Now, ask yourself how does the rhetoric justify keeping PVH closed when statuary law allows consideration of actual bed utilization need. The residents of the Pascack and Northern Valley are only asking that if you’re going to ignore a DOH sanctioned extended operating license, then consider 128 of those unused beds in the Westwood request to reopen PVH. After all, ER visits are growing, and traveling to accommodate a hospital’s finances seems a little unfair to a patient in sudden cardiac arrest.

Of course in Valley’s business “plan” it makes perfect sense. After all, once the public moves on from the PVH discussion, they’ll have the capacity to seek more beds and patients. Yes it’ll mean more traffic and more cost to Ridgewood taxpayers, but it makes sense. Close one hospital to ‘expand’ others, good plan. Apparently some politicians, monopolistic hospital managements, and the DOH, think the State “inhabitants” in the Pascack and Northern Valley have different qualifications to meet in regards to their health care access needs.