Should City Hospitals' Dialysis Be Privatized?

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In his final City Council budget presentation before stepping down, Alan Aviles, president of the country's largest public hospital system, brought plenty of bad news. There is a $430 million deficit in the coming fiscal year that is expected to triple over the next four years.

Aviles got an earful from the Council's Health Committee, but not about the deficit. Chairman Corey Johnson and guest interrogator Leticia James, the Public Advocate, wanted to know why the Health and Hospitals Corporation is privatizing kidney dialysis in much of its system.

HHC has approved, and a state panel is reviewing, a contract with Big Apple Dialysis to operate at four public hospitals: Harlem, Kings County, Lincoln and Metropolitan. The firm currently operates at Elmhurst Hospital in Queens.

James said she has fielded numerous complaints from nurses about infections and other medical problems related to substandard care.

"I am very much concerned about the compressed time for dialysis," she said. "I am very much concerned about the reduction in staff ratios."

But Aviles said outsourcing dialysis would save HHC $20 million dollars. And he said the firm, which was founded by former HHC nephrologists, performs well, according to government-generated statistics.

"That data over a number of years reflects a quality of care that not only exceeds the national average and the state average and the city average, but HHC's own average," Aviles said.

James and Johnson want the city to put the contract on hold — a decision that falls to Mayor Bill de Blasio.

In an emailed statement, a spokesman said, “The wellbeing of this city’s residents is a top priority for the Mayor, and the administration is currently reviewing HHC’s Big Apple Dialysis contract to find the best outcome for New York City’s dialysis patients.”

On a more conciliatory note, James and Johnson said they would do whatever they could to help HHC petition Albany for a large slice of the $8 billion New York is expecting from the federal government through a Medicaid waiver. Aviles said based on the high number of uninsured and Medicaid patients HHC serves, the system should receive $2 billion of that.

Aviles' nine-year tenure ends on March 31. He will be succeeded by Dr. Ramanathan Raju, a former Aviles lieutenant who currently runs Chicago's public hospital system.