Tag Archives: primary care

Proton Beams or Primary Care

Crain’s Health Pulse, the New York health industry rag, has been abuzz for the last couple of weeks with news about health services in Queens.  Specifically, there’s been a lot of talk about a proposed “proton beam cancer center” to be located on the former site of Mary Immaculate Hospital (“MIH”), and to be funded by “500 rich foreigners” (for real).  Readers of this blog will recall that we have been collaborating with a community-based coalition, Southeast Queens United in Support of Healthcare (SQUISH), for several years, first working with coalition members to keep MIH from shutting down and now partnering with them to advocate for health services to fill the void created by the hospital’s closure.  The question is: does a proton beam cancer center fill that void, even in part?

And the truth is we’re not really sure.  On the one hand, cancer is one of the leading causes of death in Jamaica, Queens, resulting in 3,636 potential years of life lost in the area according to the NYC Department of Health.  Proton beam therapy is basically a way to offer cancer radiation treatment that is more targeted and less likely to impact healthy tissue surrounding the cancerous cells.  Considering these facts, a proton beam cancer center would seem to be a good thing because it offers cutting-edge treatment for a disease that kills a lot of people in Southeast Queens.

On the other hand, no one knows if the proposed cancer center would actually be affordable or accessible to most of the residents of Southeast Queens.  Will it accept public health insurance plans like Medicare and Medicaid?  Will it have sliding fee scales for the uninsured and under-insured?  If not, then the proton beam cancer center will hardly fill the enormous gaps in health access that plague the neighborhoods of Southeast Queens, and will serve instead as a lily pad for rich foreigners who can hop in and out of Queens for their high-end treatment from nearby JFK airport.  Viewed from this perspective, the proton beam cancer center isn’t worth celebrating; what is needed is more primary care and hospital beds.  Indeed, just recently, Crain’s also reported that the intensive care units of hospitals in Queens are themselves in a state of acute stress — over-capacity by over 200% in some cases.

There is no doubt that the Southeast Queens community needs more health services.  As we’ve written before, in New York City and in other major metropolitan areas across the country there is a close relationship race, place and access to healthcare services, and Southeast Queens is a prime example of the mis-match between healthcare need and resources.  In the wake of MIH’s closure, it is unclear whether wave-of-the-future technology like proton beam cancer therapy is really what the doctor ordered, or if it would simply be better to have some old school primary and preventative care services that would help people avoid getting gravely ill in the first place.  In an effort to better understand the implications of the center on their community, members of SQUISH are considering reaching out to the State Department of Health to find out more about the proposal and make their concerns known.  We will keep you apprised of any developments, but, in the meantime, don’t be shy!  Let us know through your comments here if you live in Southeast Queens and have any opinions on the matter.  We look forward to hearing from you.

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Squeaky Wheels: Community Advocacy and Healthcare in Southeast Queens

This post is by Equal Justice Works Fellow Seth Cohen, an attorney at New York Lawyers for the Public Interest (NYLPI). Seth’s EJW Fellowship is sponsored by Johnson & Johnson and Patterson Belknap Webb & Tyler LLP.

As we have written about in previous posts, Southeast Queens is a low-income community of color that has long experienced some of the worst health outcomes in New York City across a variety of measures. Despite this, and despite the fact that this community—long designated a Medically Underserved Area—has experienced a continuing trend of healthcare disinvestment. Consider this: over the past year, three hospitals that served Southeast Queens have closed; there are only 48 full-time primary care doctors per 100,000 people in Southeast Queens, almost 2/3 less than in whiter neighborhoods in Queens. All the while, Southeast Queens has the unenviable distinction of having abysmal health outcomes, including some of highest rates of infant mortality, low birth weight, and diabetes in the City.

One might think that the New York State Department of Health (DOH), the state government entity that handles all things health, would move quickly to shore up health services in a community with such a critical shortage of services and such a critical need for them. To its credit, DOH awarded $30 million in HEAL NY grants to spur healthcare services development borough-wide. Southeast Queens United in Support of Healthcare (SQUISH), a community-led coalition, advocated for allocating part of those funds toward fundamental healthcare services that Southeast Queens needs most: primary care; emergency care; and inpatient beds. The DOH grant disbursements signaled a first step—over $5 million was awarded to two community health centers that serve Southeast Queens.

Nevertheless, the grants did little to directly address the community’s most critical needs. For an area that has seen a disproportionate share of hospital and clinic closures in the borough, Southeast Queens simply did not receive funding proportionate to the critical need and unacceptable health outcomes the community faces. Indeed, it ultimately received the least amount of HEAL funding as compared to other areas in Queens.

Part of the difficulty for Southeast Queens—or any low-income community of color in New York, for that matter—is the fact that New York lacks any meaningful, structured way for people who live in the community and who use healthcare services there to provide ground-level input to DOH as to what they see as the most pressing health concerns, and how to best address those concerns. As it currently stands, DOH seems to turn a blind eye to the very individuals who actually utilize healthcare services. This perspective, though, is questionable at best, and will certainly not lead to a reduction of health inequities any time soon.

According to the National Partnership for Action to End Health Disparities, an initiative launched by the United States Department of Health and Human Services, such ground-level input is essential to eradicate health disparities. Three of the primary actions the Partnership calls for include:

  • Create opportunities to engage stakeholders from all sectors in discussions and actions to ensure community responsiveness and accountability toward ending existing health disparities;
  • Create mechanisms for individuals (e.g., residents, advocates) who have been affected by, or concerned with, health disparities to share their stories with the public and decision makers at all levels
  • Develop or support efforts to educate legislators and elected officials about health disparities and the determinants of health

Notwithstanding these recommendations, DOH has continued to take a hands-off stance, maintaining that it is merely a “neutral” government entity unable to actively engage in or commit to correcting the systemic health inequities that persist in the community. As dispassionate and impervious as this may sound, DOH has indicated, however, that it was up to community residents to work with elected officials and other stakeholders to locate and negotiate with healthcare providers who would be willing to serve the community. Only then might DOH get involved.

So, this is exactly what SQUISH has started to do.

SQUISH has initiated conversations with Addabbo Family Health Care to prepare for leveraging any future federal dollars from healthcare reform to bring additional Federally Qualified Health Clinics (that serve predominantly Medically Underserved Areas like Southeast Queens) to the neighborhood.

SQUISH also recently met with elected officials—including Assembly Members William Scarborough, Michelle Titus, Barbara Clark, and New York City Council Member Leroy Comrie—to begin to hammer out a plan to effectively address healthcare needs in the near-term and also to craft a long-term plan to ensure quality healthcare delivery in Southeast Queens.

There is also the matter of figuring out how to influence next steps at the site of Mary Immaculate Hospital, the now-defunct hospital in Jamaica that went bankrupt and shuttered its doors approximately one year ago. The current owners of the site have indicated they “envision[] several options for redeveloping the Mary Immaculate site, including an educational facility, nonprofit organization use, government operations or a religious facility.” No doubt you can see what redevelopment option is curiously absent from this list: reusing the site to provide health services to the community. While reopening a hospital may prove a challenging enterprise, it is not unheard of. The communities of Watts and Willowbrook, low-income communities of color in Los Angeles, California that are similarly medically underserved, were recently successful in forging a pact with various stakeholders to reopen their community hospital, the King/Drew Medical Center, using federal stimulus funds. As put by one community resident affected by the lack of local healthcare services put it,

“The fact that we are in the richest and most affluent society in the world yet don’t have health and medical infrastructures in key urban cities to take care of potentially life-threatening situations is the reason we should have hospitals in communities, particularly underserved communities with large populations of uninsured.”

Three thousand miles from Watts, this sentiment is equally applicable  in Southeast Queens as SQUISH continues to advocate for healthcare for its community.

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Place Matters

A recent article in the American Prospect about the De-Facto Segregation of Health Care has been getting a lot of attention, at least in the media that we read, and for good reason.  It points out the uncomfortable truth that race matters in health care, which means, in part, that place matters too.  As the article notes:

Ongoing de-facto segregation has a profound effect on the quality of care to which people of color — insured or otherwise — have access. While the health-care bills being debated in Congress would expand access to and quality of care for people of color, ultimately racial health disparities can’t be eliminated without better distribution of health resources.

Consider a community in which we do a lot of work: Southeast Queens.  Take a look at this map, lifted from a website developed by our friends at the Opportunity Agenda:

SEQ

This is a slice of Queens that represents the dividing line between the Northwest and the Southeast of the borough.  The darker an area is shaded, the higher the percentage of people of color living in that area.  De-facto segregation, anyone?  Now check out those little plus signs, which represent hospitals.  Notice how few–i.e. none–of them are actually located in the darker-shaded portion of the map.  And, in fact, one of the hospitals right on the border recently closed — a common occurrence in communities of color across the country.

Now compare the availability of hospitals and the demographics on the Southeast side of Queens to the east side of Manhattan:

bedpanalley

The absence of hospitals in Southeast Queens, and their over-abundance in white communities of the city, would be less of a problem if people in the area could actually access the primary or preventative care they need to prevent hospitalizations and trips to the emergency room.   But, of course, the lack of hospitals isn’t the whole story.  The New York State Department of Health recently issued a report on health care services in Queens, which notes that Southeast Queens has the lowest ratio of doctors to population in the entire borough.  There are 48 full-time equivalent (FTE) primary care doctors per 100,000 population in Southeast Queens compared to 132 FTE’s per 100,000 in the Flushing/Clearview area.  This report also indicates that there are 75 primary care clinics in Queens, but of the 75 clinics listed only 40 could be confirmed as primary care clinics available to members of the community at large.  Several of the clinics are for special populations only (e.g. children, women), and of the remaining 40 primary care clinics, only 22 are located in Southern Queens.

Pointing out geographic and resource disparities like this isn’t just a complaint about who-gets-what; it is a matter of life and death for many.  As the American Prospect piece notes:

Even when people of color are covered [by insurance], their access to quality care is diminished heavily by ongoing segregation and poverty; in nonwhite neighborhoods, it’s simply harder to find a primary provider than it is in white neighborhoods. The facilities that exist are often of lower quality and lack the resources institutions located in primarily white areas have. What this means is that even when minorities are covered by health insurance, they’re less likely to have quality care and less able to afford the associated out-of-pocket expenses — and the results are staggering.  Children born to black women are more than twice as likely to die within their first year of life as are children born to white women. This disparity is unaffected by income or education level.

So, what can be done?  Well, many things, but in Southeast Queens the most immediate action is being taken by a community coalition we work with called Southeast Queens United in Support of Health Care (SQUISH).  When the State Department of Health published its report, it also announced that $30 million would be available in grants to develop health care services in the borough.  SQUISH is reaching out to elected officials, community residents, local health care providers and the media to raise awareness about the need for some of that funding to be directed toward Southeast Queens.  For a list of SQUISH’s asks, check out their talking points.  Because green shouldn’t always follow white, and where you live shouldn’t be one of the primary determinants for how soon you die.

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