BC Reviews

“We understand the very future of the Greenwich Hospital is at stake.”

Statement of Lee Hanley, then-president of the Board of Trustees of Greenwich Hospital, February 1990.

“The future of this hospital is at stake.”

Statement by Frank Corvino, president and CEO of Greenwich Hospital, May 5, 1994.

Mr. Hanley made this crisis statement in the midst of a massive campaign that would see the hospital given zones of their own by the P&Z with the announced purpose to “…promote comprehensive planning of a major hospital in conjunction with supporting facilities.”
 
Mr. Corvino’s crisis statement came as the hospital, reversing by 180 degrees the announced plans of four years earlier, sought approval to demolish 80 percent of the hospital, including the historic Thomas Hastings-designed Benedict Building, saving only the south wing for administrative offices.

Why? Why, specifically, is this demolition deemed necessary? No facts have been produced which show that the present facility is, indeed, anywhere near a condition where the only answer is demolition. Only four short years ago, Greenwich Hospital was touted as being state-of-the-art, and the plan proposed at that time was to turn it into a major facility. Apparently only a few people in the upper echelon of the administration can answer the question, and they have yet to spell out, point by point, the architectural deficiencies which make this radical surgery the only alternative.

The plan now is to replace the hospital with a smaller, supposedly more efficient facility at a total cost of $117 million. During the past four years the Greenwich Hospital has been alive and well, more than adequately serving the medical needs of this community, as has been its custom since it was given to the town by Commodore Benedict in 1917.

In dedicating it, Commodore Benedict stated, “This is not my hospital nor any other person’s hospital. It is everybody’s hospital, particularly the poor.” And it has remained so from that time to this date, maintained in large part by the contributions in both time and dollars of Greenwich.

We all have a stake in the success of our hospital. A cloud over any aspect of its operation sooner or later effects ALL aspects of its operation. If “the future of the hospital is at stake,” then it’s time to start asking questions as to how our donations are being spent.

As to their new plan, two questions cry for answer:

• One, where is the documentation used to justify the demolition of the original hospital building, and 80 percent of the fully functional, state-of-the-art, existing hospital? By what reasoning are the buildings proposed for demolition to be replaced by an expensive smaller facility that will encroach on an established, fragile residential neighborhood?

• Two, given the state of flux health care services are expected to be in for the next few years, and given a present facility more than adequate for the needs of the community, is it prudent to tear down and build anew, not knowing the flexibility that will be required five or even three years from now? If this was an ordinary private stock company, I wouldn’t be able to ask these questions. It would be strictly the company’s own business and none of mine. The company’s fortunes would rise and fall according to its ability to compete in the marketplace. But this is a “not-for-profit” corporation, care-taker and the holding company for the Greenwich Hospital. The law says that a non-profit corporation isn’t obligated to reveal as many details of its operation with the specificity of a private stock company, in general only the long-term goal, purpose and service that it is expected to offer the community it serves.

However, as supporters of the hospital and after waiting four years for a hint of a long-term, or even a short-term plan, it would seem that a few questions regarding contemplated resources are in order, the number one being, “Why is this demolition necessary?”

There is a substantial degree of accountability that goes with the territory. Obviously, that accountability rests heaviest on the officers, the executive committee, and the directors of the corporation, those making the decisions to implement a long-range plan of growth.

As supporters of our hospital, we should be allowed to share in the plans, the cost, its effect and impact both short-term and long-term, its feasibility, as well as any risks involved. We need full disclosure, not just vague, promising headlines without the reasoning of supporting facts. Without these, it is impossible to make responsible evaluation and judgement in offering support, whether as volunteers or in dollars.

For example, from the standpoint of financial feasibility, the out-patient focus of the proposed “new” plan is not without risks. More and more, those procedures termed out-patient are being performed in doctor’s offices. While no reporting as to the volume of these procedures is yet available at the state level, reliable local estimates indicated that 50 to 80 percent of these procedures are being done in doctor’s offices instead of in the hospital. The Commission on Hospitals and Health Care confirms this trend and states that it is expected to grow over the next five years.

The benefit to patients is more than medical convenience; it has major financial impact as well. In one instance, a patient seeking a colon polyp removal would have had to pay $1,500 for the one-day stay in the hospital. He had it performed in a surgeon’s own office instead, and the price tag was only $300. Will a brand new $117 million facility, counting on out-patient procedures for a large portion of its income, be able to compete with the cost savings, the convenience, and the trust of a personal physician’s recommendation to use his own facility rather than that of a hospital?

I come back to the original question, “Why demolish a fully functional hospital?” The hospital says their “…updated Master Plan will emphasize new construction rather than costly renovation.” I solicited comment on this subject from Bruce Costella, currently executive in charge of White Plains Hospital’s planning and building program and no stranger to renovation and the costs involved. Among the projects Costella has been involved with are St. Luke’s/Roosevelt Medical Center ($242 million, new construction), Columbia Presbyterian Medical Center (variety of projects, new construction and modification, total cost all projects over $230 million), Eye Institute (renovation), New York Hospital Medical Center (new construction and associated infrastructure, estimated total cost $750 million).

Mr. Costella stated that “expansion and renovations are enormously popular and far outstep replacement building programs.” He cites “Modern Healthcare’s” recent survey of hospital construction (March 21, 1994) which reported 2,231 expansion or renovation projects and only 34 replacements of acute-care hospitals. He further states that for a complete gutting, the renovation costs can run as high as 85 percent of the price of new construction.

The entire process of deciding on whether or not to demolish and build anew (or renovate/modify) is almost always a subjective decision, and each case must be studied separately. No two cases are alike, according to Mr. Costella. One thing that all projects should have in common is thorough long-range planning. A second important consideration is “infrastructure assessment.” Given the scarcity of information coming from the Greenwich Hospital concerning their decision on demolition, it was impossible for Mr. Costella to offer other than generic answers to questions on any one aspect of the project.

It all boils down to this: The administration has decided that, despite their praise of the hospital four years ago, it has now quite suddenly outlived its purpose, that there can be no room for growth in the present functional facility. Subjectively, they have decided that the only answer to growth for Greenwich Hospital is radical downsizing, reducing the optimum flexibility present with renovation of the current facility to a minimum. This scheme casts a shadow before it – it can only leady to expensive additional building in the future.

This just goes to show that if you talk to enough consultants, have them make more and more presentations, sooner or later you will find one that comes up with what YOU want to hear, logic and reason be damned.

Thursday, September 8, 1994
By Brooke Taylor