Looking up at Downstate

It’s early to say whether the precise plan to drastically shrink SUNY Downstate’s University Hospital in central Brooklyn is the right one; we’d like to hear more, and smart adjustments are always welcome. But what is beyond debate is that the time for lamenting decline while nibbling around the edges is over.

SUNY Chancellor John King is right that the hospital is dramatically undersubscribed and bleeding red ink, its physical plant dilapidated. Better to take a sharp turn toward aggressive restructuring than to keep throwing resources at a health care institution that hasn’t sufficiently evolved to serve New Yorkers effectively in the Obamacare, post-pandemic health insurance landscape of 2024.

University Hospital is a component of SUNY Downstate Health Sciences University, a vital incubator of New York care professionals. More than 2,000 students there are on path to get degrees in medicine, nursing, public health and more, and nearly 1,000 affiliated residents train there.

Two-thirds of the students at the university aren’t white, and more than a third hail from Brooklyn. Just like the people of the borough they serve, they speak dozens of languages. This is an essential training ground for local care professionals; it can’t be abandoned.

But the building, erected in 1966, is falling apart. Officials estimate it would cost $4 billion to fix and modernize, a job that will be complicated immensely by trying to rebuild the engine while flying the plane. Relatedly, the hospital is profoundly undersubscribed. Though it has 342 beds, an average of just 144 are occupied.

In some places, dramatically downsizing or shuttering a hospital means leaving a swath of the city high and dry, desperate for an ER or clinic or ambulatory unit. Though upheaval will certainly bring challenges for patients, most of whom are on Medicare, underinsured or uninsured, that’s not the case here.

Indeed, one element of the proposal is to move as many as 150 beds — which is about the typical number of beds now filled at the undersubscribed state hospital — to a special wing at right-across-the-street Kings County Hospital, run by the city. Medical students and interns and residents would do their rotations there and at other partner hospitals, as many already do.

It’s wholly understandable that the union representing most workers doesn’t want the change, given that United University Professions will see its membership decline. But qualified workers are hard to come by in this sector; we don’t worry about staffers’ ability to find new positions. Indeed, some may be able to keep doing their jobs in a different location and represented by different unions.

Books can and should be written about the long decline of University Hospital, just as they can and should be written about other publicly run hospitals’ failures to adapt to a fast-changing marketplace where inpatient treatment is increasingly yielding to walk-in care, and patients and therefore dollars must be chased in new and different ways. It is a special shame here that state officials over decades let the physical infrastructure deteriorate to the point that in some cases, it is literally crumbling.

Whistling past this crisis is not an option. Anyone opposed to the SUNY plan should present their own fiscally sustainable option that answers the core challenges at stake. Protests with posters won’t hack it.