“This community has been lied to,” said Mayor-elect Bill de Blasio. “At the same time [that] SUNY and the Governor promised everything possible was being done to save LICH, they were preparing to sell it off to the highest bidder.”
“SUNY is violating a court order to keep this hospital open, and we won’t let it stand,” de Blasio said. “The same luxury condos being put up over St. Vincent’s will soon rise over LICH if we don’t stop this in its tracks.”
One man stands leading that charge: SUNY Downstate President, Dr. John “Skip” Williams.
School Chancellor, Nancy Zimpher and the SUNY Board of Trustees have stood behind Williams’ decisions to close Long Island College Hospital. In a memorandum on March 19, 2013, Zimpher wrote to the board, “The proposed resolution expresses the Board’s approval and support for the President of SUNY Downstate Medical Center [Williams] having submitted a plan […] to cease operation of [LICH] as a full-service inpatient hospital facility.”
In a press release from the same day, SUNY said, “We commend Dr. John Williams and his team at Downstate Medical for their commitment to preserving and ultimately strengthening this hidden jewel of the SUNY system,” by closing LICH.
SUNY officials may have put plans in place long before Williams was hired, as suggested by Kings County Brooklyn Supreme Court Justice, Carolyn Demarest. In August 2013, she overturned her original decision to grant ownership of LICH to SUNY Downstate Medical Center (DMC). “The wave of enthusiasm for a solution that would preserve LICH may have blinded many to a more sinister purpose to seize its assets and dismantle the hospital,” she wrote.
In August, SUNY chose a man well seasoned in leading a medical school to the eventual closure of a university run hospital. For that purpose, the truth speaks clearly on why McCall considers Williams to be “precisely what we have been looking for.”
A CHANGE OF LEADERSHIP
Dr. John LaRosa preceded Williams as President of DMC from 1999 until June 2012. Prior to that, LaRosa served as the chancellor of Tulane University Medical Center. From 1987-1991, he served as dean of clinical affairs, and dean of research from 1991-1994 at George Washington University (GWU).
During LaRosa’s time at GWU, Williams was working first as an assistant professor of anesthesiology, then as an assistant dean for admissions, and finally, as Associate Vice President for Graduate Medical Education and Special Projects at GWU.
On June 12, 2012, LaRosa abruptly resigned. According to a New York Times article printed on June 13, 2012, LaRosa “gave no explanation” for his notice, which took effect “immediately.”
The Times also noted “the latest disruption to face the institution” may have been the result of “an [April 2012] audit spurred by anonymous tips [that] revealed fake bids for construction contracts and other procurement problems.” LaRosa had also “criticized [the] recommendation” of the Medicaid Redesign Team to consolidate services into LICH, and was himself highly criticized in the Stromberg Report.
The day of LaRosa’s resignation, SUNY’s Chancellor, Nancy Zimpher met with the board of trustees to request a $75 million line of credit, “convertible later into a loan,” to support DMC’s restructuring and “ensure a successful transformation.” The letter states, “The campus may be provided with a one-time influx of cash to enable it to address a shortfall of operating funds.” The memo also goes on to point out that, “Downstate’s need for funds is not necessarily one-time or short-term.”
On June, 13, 2012, Dr. Ian Taylor was appointed officer-in-charge of DMC. In his acceptance speech, Taylor said he looked forward to working with SUNY “over the next several months” to continue “high quality medical care to our patients” as well as “top-notch educational services to our students.”
However, Taylor’s appointment was much briefer than “several months,” as he had anticipated as the process for replacing a major medical school president can be lengthy. Taylor held this position for 49 days – only 7 weeks – before Dr. John “Skip” Williams was hired and took the helm.
SUNY’s Board of Trustees held a special meeting on August 1, and voted unanimously to appoint Williams from “on or about” August 20, 2012 through August 20, 2014. Chancellor Zimpher said, “Dr. Williams has achieved all the important titles necessary for the leadership [at] George Washington University.”
Chairman of the Board, Carl McCall said, “Do whatever is possible to save Downstate.”
Williams called his new position a “daunting challenge” to “get this institution to the tipping point” of financial stability over a five to ten year period. He expressed gratitude to be back in his hometown of Brooklyn. “This is a very, very unique campus, and it’s one that has to survive,” he said. “And I pledge to make it survive.”
McCall followed his comments with optimism. “What we are looking for is not only for you to bring about the stability that Downstate needs, but also to show us the new model for delivering healthcare and education in this community,” he said. “We are with you all the way, and we have great confidence that you will show us the way.”
Despite the lack of a search committee for a new president, McCall also said in a press statement released by the university, “With his extensive experience at The George Washington University and its own medical center, Dr. Williams is precisely what we have been looking for to lead SUNY through its financial restructuring.”
Williams’ salary totals $650,000 plus amenities: $350,000 in state salary; $300,000 of “annual compensation from other sources;” up to $80,000 per year for housing costs; and use of a campus vehicle. In addition to the increased salary, Williams will be “eligible for two merit pay bonuses” of $25,000 each “after the conclusion of nine and eighteen months of service.” His contract, surprisingly, is only for two years.
LaRosa – after 13 years – was earning a salary of $605,000 annually, plus $66,000 a year for housing and use of a university vehicle. Despite SUNY’s financial woes, Williams’ annual paycheck included an extra $45,000 with a $14,000 housing increase for his first two years.
Before being hired at SUNY Downstate as President of the medical school, Dr. John Franklin Williams, Jr. spent nearly three decades at George Washington University (GWU). After completing his residency there in 1982, he quickly rose through the ranks, eventually becoming Provost for the school in January 2003. At the same time he also served as the Vice President for Health Affairs, professor of Anesthesiology and Co-Director of the Intensive Care Unit (ICU) of George Washington University Hospital (GWUH).
In 2009, The Washington Post reported that Williams’ income totaled $772,500.
In October 2008, GWU’s School of Medicine and Health Sciences (SMHS) was put on probation by the Accreditation Council for Graduate Medical Education (ACGME) for “being out of compliance on several standards,” The Washington Post reported. The article also noted that the evaluation placing the school on probation was the reason for the evaluation, but not the cause of the probationary status.
The ACGME is based on established guidelines and standards for post-MD medical training programs in the US. All graduating doctors must graduate from an ACGME accredited school to be certified. Probationary status means the school must correct any violation, or risk losing their accreditation.
The Post also reported that SMHS was the only school of 129 accredited programs nation-wide on probation – “only the fifth” in 15 years. Losing their accreditation was “a stroke that would effectively kill the program.” Williams is quoted in the article blaming the probationary status on “curriculum management;” “administrative processes,” and an “inadequate study lounge space.” He also noted that “some of the problems [had already] been corrected.”
On February 23, 2009, another article entitled, “Medical’s School’s Problems Were Worse Than Described” by The Washington Post said, “School officials said the reasons were mostly superficial matters.”
The Post had obtained “confidential evaluation documents and interviews” revealing SMHS had “deficiencies” that were “considerably more serious.”
“GWU has done an inadequate job of monitoring students’ time with patients and ensuring that those clinical experiences relate to classroom learning. Student debt levels are among the highest in the country. “Students complained of mistreatment. Problems flagged as long ago as 2001 still had not been addressed when the school was put on probation,” The Post reported.
The article also pointed to Williams’ “conflict of interest” of “focus[ing] on improving the hospital’s bottom line rather than investing in medical education, research and training.”
After more than fifteen months, officials announced the GWU medical school had been taken off of academic probation in February 2010. GWU’s accreditation “never lapsed” and credibility of the medical programs’ degrees did not suffer as a result.
Two years later, Williams was facing complaints about the residency program at LICH and would have to face another evaluation. By eliminating the residency program, investigation of complaints could not be evaluated. Downstate pulled the residents and did not replace them, manufacturing their own staffing shortage.
In mid-July 2013, Downstate was placed on academic probation, again under the leadership of John Williams. The “unfavorable status,” as defined by ACGME was issued because SUNY is under contract for two residential sites; after removing residents from LICH, Downstate was only maintaining one.
In the ACGME Accreditation Decisions Report for the 2012-2013 Academic Year, SUNY Downstate is the only school in the nation listed as an “Institution with an Unfavorable Status.”
In a SUNY Board of Trustees meeting, Williams discussed the probation status. “The site visit actually went very, very well. In fact we thought we would have no difficulty whatsoever,” he said. “But because of the Concerned Physicians at LICH continuously calling [the ACGME], um… and, uh and, and really causing a lot of difficulties – they were threatening our residents; they were making it an extremely unsafe environment for our residents – we decided to withdraw our residency program. As a result ACGME did place the residency program on probation.”
A LICH staffer rebutted, saying, “[The] ACGME acts on facts, not phone calls,” and that Downstate’s removal of residents from LICH was the culprit.
However, as previously reported in the Star-Revue, SUNY Downstate did anticipate “difficulty” with the ACGME’s upcoming visit, and forced the heads of the three remaining residency programs to “voluntarily” withdraw their residencies temporarily. Once the withdrawal was complete, SUNY announced the withdrawal would be permanent.
An ICU nurse at LICH, who worked closely with residents, said medical residents and interns “have made similar complaints since Williams took over and started reducing the number of attending and faculty physicians at LICH.”
In addition, the National Resident Matching Program (NRMP) results for LICH in 2012 included four programs: Internal Medicine; Obstetrics-Gynecology (OBGYN); Medicine Preliminary; and Radiology-Diagnostic.
In 2013, SUNY did not register any NRMP positions for LICH. The deadline for an institution to change a quota for 2013 residents was January 31, 2013 – eight days before SUNY’s first illegal vote to terminate LICH. The Match results were announced on March 15, 2013. SUNY’s letters to residency programs to “voluntarily withdraw” were sent on May 20, 2013. Downstate had decided well in advance not to continue residencies at LICH.
The ACGME website also shows the voluntary withdrawal from the radiology department, but as of press time shows continued accreditation in the OBGYN and internal medicine programs. Combined, both programs show 78 approved and filled positions for the 2013-2014 academic year.
In addition to those residencies – for which SUNY did not apply in the 2013 NRMP match, LICH continues to be listed on the ACGME website as a required rotation site for at least 20 of SUNY’s 53 listed residencies.
Williams also announced over the summer that the Liaison Committee of Medical Education (LCME) also issued SUNY Downstate a warning. Graduates of LCME accredited programs are eligible for residency programs accredited by ACGME.
Dr. Ian Taylor, Dean School of Medicine at SUNY Downstate Medical Center, reported back to the Board of Trustees at the September 11 General Board Meeting concerning the LCME accreditation. “Although we were fully accredited at the meeting last February, [LCME] had two major concerns,” Taylor said. “They’re going to come in and look at the roll out of the new curriculum; that is one of the issues.
“The other issue they’re very focused on – and it’s clear from what the secretary requested for next week’s visit – the only standard they are looking at separately and which they’ve asked for twice the amount of time is the current financial environment and its impact on the educational program.”
Taylor went on to say, “When they visited, we sort of thought LICH was going to be sorted out one way or the other, either it was going to be state support to keep us going or some other solution. And obviously, that’s stuck in the craw. I think that’s going to be a problem for us because they’re going to come in and find out we’ve still got LICH and we’re still losing a lot of money around that.”
LCME has required SUNY to submit a full progress report to the Board by December 1, 2013, which SUNY anticipates will result in another “limited” site visit to look at the financial and curriculum statuses. For the time being, SUNY Downstate’s website claims the school “enjoys full accreditation” by the LCME.
Based on the revelations from The Washington Post during his tenure at George Washington University and his lack of transparency toward LICH, the concept that there may be more to the currently probationary status than Williams is revealing. However, ACGME does not release detailed reports for probationary statuses.
SUNY Downstate is still on probation under appeal with ACGME. As long as LICH’s residency program is discontinued – and the hospital still exists – SUNY Downstate remains in jeopardy of losing their national accreditation with ACGME and possibly LCME as well. Even if LICH is transferred to another operator, SUNY will still be obligated to have two residency programs: one at UHB; the other at LICH.
Because SUNY has contracts for residency programs at LICH – and did not maintain those contracts – they are in jeopardy of losing their accreditation with ACGME. In the NMRP, SUNY did not register LICH by January 31, 2013, and until the end of the 2013-2014 year, they cannot place residents at LICH. But the ACGME still has internal medicine and OBGYN residencies listed through 2014, putting SUNY in violation of their contract with ACGME.
The only way to avoid losing their accreditation with ACGME at this point is to close LICH.
In addition, SUNY has been issued a warning by LCME because of their financial situation. Because SUNY is not allowing services at LICH but cannot lay off workers, the medical school is losing even more money than when LCME first issued the warning. They are also in jeopardy of losing their accreditation with LCME.
Losing their accreditation with LCME or ACGME would effectively ruin the medical school. SUNY is in “unfavorable standing” with both agencies. This creates extreme urgency to close LICH, thereby salvaging SUNY Downstate.
The LCME and ACGME are both national agencies. State officials, including SUNY’s Board of Trustees and Governor Cuomo have no political room to maneuver agreements; either SUNY complies, or they lose accreditation.
ACGME’s review should occur approximately one year after the initial review in May 2014. For SUNY, everything hangs in the balance of those reviews. LICH may lead to the downfall of the medical school simply by staying open.
NEW 80% PROFIT HOSPITAL
George Washington University Hospital (GWUH) was founded in 1824. The hospital was partnered with the university for 173 years.
The Washington Post reported that GWUH experienced huge financial losses. “The facility was losing money and sapping the school’s endowment.” As a result, the hospital was closed, torn down, and a brand new facility was built – a state-of-the-art for-profit hospital. The old hospital, built 1949, was called a “tired old building.” The new facility opened in 2003 in a parking lot across from the old hospital site.
In 1997, GWU sold 80% of the hospital’s shares to Universal Health Services (UHS) during Williams’ tenure as Vice President for Health Affairs. GWU only maintains a 20% stake.
In January 2003, Williams was named Provost – or senior academic administrator – of GWU. On August 23 that same year, George Washington University Hospital closed the doors. The new facility housed 371 beds and $45 million of medical supplies. The hospital cost a total of $96 million to build, mostly funded by UHS.
During his reign as Provost, GWU’s medical center released a report entitled “Meet the Provost.” The article defines his role during the time GWUH was being sold to UHS as, “responsible for the administration and oversight comprising the academic health center,” including “the University Hospital, in conjunction with the majority owner of that facility, University Health Services, Inc.”
DUAL ROLES QUESTIONED
On February 6, 2009, The GW Hatchet published the article “Provost’s dual roles questioned.” At the time, Williams was serving as both University Provost and Vice President of Affairs, “the second most senior administrator at the university.” He was also on the Board of Directors of University Health Services. According to the article, Williams was paid $709,005 from the university and had also received more than $750,000 plus “valuable stock in the Fortune 500 company” since 2001 from UHS.
“His dual positions may have posed a conflict of interest because Williams is tasked with both improving the academics of the medical school and keeping an eye on UHS’s profits. Given his two roles, Williams could theoretically choose to ensure the hospital’s profitably and forgo investing in upgrades and training that could benefit medical students and faculty,” the article claimed.
Williams joined the Board of Directors of UHS in 1999, two years after GWU sold a majority of the hospital’s shares to the private company in 1997. In 2001, UHS was, according to the article, “instrumental in helping GW[U] build and equip an new hospital.”
In the article, university spokeswoman, Tracy Schario said, “Since last summer  in particular, there has been a great deal of interest with this possible conflict of interest.”
University President, Steven Knapp, GWU’s Board of Trustees all asked Williams to step down from the position with UHS. Law professor at the school, Theresa Gabaldon told The Hatchet, “One of the problems is [Williams] was beholden to the management,” his friend and CEO, Richard Becker.
Richard Becker, served as CEO/Managing Director at GWUH from March 2004 until May 2008 and previously as medical director during Williams’ tenure on the for-profit board. Williams and Becker were colleagues at GWU and have been close friends for more than 30 years.
While Williams declined to talk to the press about the issue, he did resign from the board, giving up his “six-figure salary and stock options.” Becker, at that point, became CEO of Brooklyn Hospital, which would benefit greatly from the closure of LICH.
According to an anonymous email to the Star-Revue, “The first person [Williams] met with when he came to Brooklyn was Brooklyn Hospital’s CEO, Becker. They are friends from medical school. Maybe Becker found the SUNY job for him. Who knows? But when Williams came here, the first thing he did was try to close LICH, which would get rid of the competition for his buddy and the hospital Becker runs.”
On November 30, 2010, Emily Cahn of The GW Hatchet broke the news that Williams was resigning at the end of the year after “senior officials at the University pushed him out of his position,” after more than 30 years of employment.
The Washington Post reported Williams was “being removed from [his] position six months into a[n internal] university review” because the school “no longer wants him in that position.” They also reported that Williams, who had tenure with the university, “hired an attorney to negotiate an agreement.” According to the university’s 2009 tax returns, Williams earned $912,839 at the end of the fiscal year in June.
The Post article cited Williams’ previous problems with the academic probation and the conflict of interest with serving on UHS’ Board of Directors. The article also notes, “The university’s hospital was purchased by the for-profit company [UHS] in 1997; the facility was losing money and sapping the school’s endowment. It is rare for a for-profit company to run a teaching hospital.”
After being forced out of his position, Williams announced a year sabbatical from the university beginning January 1, 2011. In a press release posted on the university’s website, Williams said, “I believe now is the time to allow new leadership to guide the Medical Center during the next phase of its development.”
On December 2, 2010, one day after Williams announced his one year sabbatical GWU released a statement entitled “Dr. John Williams announces Transition.” President of the university, Steven Knapp said, “Dr. Williams led the strategic effort fifteen years ago to separate the medical school, the hospital and the Medical Faculty Associates (MFA), insuring the financial stability of all three entities.”
Williams must have suspected his position with GWU was vulnerable because on April 1, 2010 – nine months before he announced his resignation, the City University of New York (CUNY) announced him as one of four finalists for President of City College of New York (CCNY). The presidential search committee of CUNY originally chose twelve semi-finalists, before narrowing the search to four.
According to CUNY’s website, the each finalist spent a day at the campus. Williams attended on April 6, 2010. He was the first finalist to visit CCNY.
After his one year sabbatical, Williams was hired as Senior Vice President at Verras Health Care International in May 2012. Verras provides analysis and “risk-adjusted data” to hospitals to improve financial and clinical outcomes, according to their website. Williams only worked there for three months before accepting the position of President of DMC.
After working with GWU – under tenure – Williams was forced to resign. Under his leadership, the university faced academic probation, was forced to sell off more than three-quarters of the university hospital to a private entity, and Williams himself raised concerns about the hospital’s bottom line versus quality student investment.
Now, in the SUNY Downstate system, his focus remains on the bottom line, while he has again landed his residency program on probationary status, is trying to sell off LICH’s 18 essential hospital buildings to build a new hospital in Central Brooklyn, and is being examined about the business enterprise of SUNY.
In an address to the SUNY Board of Trustees on November 15, Jeff Strabone, Cobble Hill Association board Member said, “Public health decisions should be made on need, not greed.”
The plot thickens!