Will the recommendations of a state commission to close two hospitals and downsize others in Western New York improve quality and efficiency?
Even if the plans are worthwhile, will they leave hundreds of workers without jobs and thousands of patients waiting longer in crowded emergency rooms?
And even if they are worthwhile, will the state provide funding to do them right?
Those were some of the questions about 100 people wrestled with Tuesday night in Trinity Episcopal Church during a forum on the changes proposed by the Commission on Health Care Facilities in the 21st Century. The event was sponsored by the Coalition for Economic Justice, a labor, academic and clergy group.
The changes, which the State Legislature approved at the end of 2006, include recommendations to consolidate Kaleida Health and Erie County Medical Center and close Millard Fillmore and St. Joseph hospitals.
"People are concerned and justifiably scared about the commission," said Dawn Mele, a pathology assistant at Millard Fillmore.
She warned that emergency room wait times, which already are often far too long, will become longer unless there is adequate planning and funding to accommodate patients when buildings close.
And she voiced a common criticism of the commission that it was a group largely unanswerable to the public that met and made most of its decisions behind closed doors.
"They were not elected by the voters," she said.
Research by Alan Sager, a professor at Boston University School of Public Health, shows a weak link between the supply of hospital beds and hospital costs. Sager contended the commission, by focusing on hospital beds, failed to identify and suggest solutions for the health care system's real troubles.
"The commission misdiagnosed the problem, treated the symptoms and treated them badly," said Sager, who added the state should concentrate on reducing waste and encouraging use of evidence-based medicine.
Bishop Edward U. Kmiec called the commission's work courageous and noble but questioned the process, especially the decision to close St. Joseph, a Cheektowaga hospital in the Catholic Health System.
"Even ignoring the previous rightsizing efforts by the Catholic Health System, the targeting of St. Joseph Hospital for closure makes no sense, leaving one to perhaps question the criteria in general used to recommend closure and merger of other hospitals," he said in testimony read by the Rev. Ronald Sajdak, pastor of St. Martin de Porres Catholic Church.
Michael Osbourne said hospital closures can cost far more than expected, citing the 1998 closing of Our Lady of Victory Hospital in Lackawanna.
"In the end, it cost us $54.3 million," said Osbourne, vice president for regulatory and government reporting in the Catholic Health System. "It makes us wary that there is enough money to close the hospitals the commission wants closed and retrain those workers."