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There are those who say, with some validity, that Erie County Medical Center will be devastated if County Executive Joel Giambra doesn't give the hospital an additional $9 million in county subsidies next year. But it is just as accurate to say that unless the hospital changes the way it does business, no amount of money will protect this valuable institution from disintegrating under its own weight.

Giambra has agreed to give the hospital the extra money if its employee unions agree to support the transformation of the facility into a public benefit corporation, which would give the institution more flexibility in containing costs and increasing revenues. Giambra's ultimatum should not be seen as an effort to break the unions, but rather an opportunity to save the hospital.

ECMC says it needs the extra $9 million - it got $20 million this year - to cover its deficit. But without a change in governance, that subsidy will only increase until it eventually reaches the point where it will cause major tax increases or cause the county to get out of the hospital business altogether. Neither alternative is acceptable.

While all hospitals are legally required to provide emergency treatment to the poor, none of the hospital systems in Erie County would embrace that mission as ECMC does. Moreover, the hospital's proximity to those who need its services makes it the logical choice to provide those services.

By turning itself into a public benefit corporation, the hospital would be able to collaborate more closely with the other two hospital systems in Erie County, the Catholic Health System and Kaleida. Although some collaboration is possible now, state constitutional prohibitions against using public money for private gain make dramatic consolidations such as joint ownership of programs problematical.

Giambra tried to get the necessary State Legislature approval for the transformation last year, but lobbying by the unions foiled that attempt. That is why Giambra has linked the extra money to a union agreement to participate in the transformation of the hospital to a public benefit corporation.

For their part, the hospital unions are only looking after their members' interests. No one can blame them for that. However, hospital officials already have promised there would be no layoffs of union employees for the first two years after the corporation's creation. In addition, Giambra said he is prepared to go over any conditional language the unions seek to gain their support for a public benefit corporation

It's possible the county might be able to get the State Legislature to approve the necessary legislation even without a formal agreement of cooperation from the unions. But that would set up a confrontational atmosphere that would be harmful to all concerned - the county, the hospital, the employees and the patients.

Giambra has a responsibility to do whatever he can to make sure that ECMC has a long-term future. If he gives this subsidy without an accompanying agreement by the unions to cooperate in changing the way the hospital does business, he could be dooming the institution. At some point, and sooner rather than later, the county simply won't be able to afford the hospital. That would be a loss of tragic proportions.

A society can be judged by how it treats the needs of the less fortunate. And there are few more important needs than quality medical care. Moreover, ECMC has no equal in Western New York as a burn treatment and trauma center.

But with a fiscal crisis bearing down on both the state and county, it is imperative that ECMC be given the ability to help itself. So far, no one has come up with a better idea than turning the hospital into a public benefit corporation. Without that, the county will simply be throwing good money after bad.

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