The game is afoot again. A series of recent articles in the media described a series of cases whose mysterious interrelationships Sherlock Holmes might have appreciated.
The Purloined Bequest
A singular article in the Wall Street Journal, entitled "Judge Rules in Case of Fortune Tied to Buffett," first made this case explicit, but some background is required to understand it.
The story focused on Long Island College Hospital, in Cobble Hill, Brooklyn, New York. [Full disclosure: this story got my attention particularly because I grew up nearby in Brooklyn, and was born at that hospital, which was also the local hospital my parents often used.] LICH has long been the major community hospital for downtown Brooklyn.
The story appeared to begin in 2011, per the WSJ,
The merger was supposed to keep LICH in operation as a community hospital and provider of acute care to the poor. However, things did not work out.
This year, however, Downstate announced plans to shut the hospital, leading to protests from Brooklyn residents and local politicians.
The judge also discovered that hospital management had been raiding an large endowment fund intended for other purposes,
Apparently,
New York Times and Brooklyn Daily Eagle articles focused on the question of whether SUNY/ Downstate intended to close the hospital so it could sell its apparently valuable real estate assets in a now fashionable neighborhood, but not on how the hospital fell into these dire straits.
There seem to be some lingering questions -
- If the losses and borrowing began in 2000, or earlier, who was responsible for them, given the current owners have only been in place since 2011?
Note that the phrasing in the article above ("the hospital argued that the money was necessary to keep the hospital afloat") suggested that before SUNY took over, the hospital was independent. However, the article mentioned, albeit only briefly in passing, that the hospital had a previous owner, Continuum Health Partners Inc.
- How were the losses explained when they occurred, and what was the rationale for borrowing from restricted endowment as a response, instead of, for example, direct efforts to minimize losses or increase capital and revenue?
Note that the article implied that when SUNY acquired LICH, it acquired some very valuable real estate. Why did the previous management of LICH not consider selling off some of this real estate to resolve its debts?
- Did mismanagement of the hospital lead to excess losses, and did borrowing funds from the principle of the hospital's endowment to offset these losses amounted to more mismanagement?
Meanwhile, a second even more bizarre story about another New York City hospital almost simultaneously got media attention.
The Resident Heiress
The case first made it into the media in 2012, when the tabloid New York Post reported,
This case also seems to be about wealthy donors and hospital executives. Yet what makes it most bizarre are the circumstance of Ms Clark's hospital stay. As a former intern, resident, fellow, and teaching hospital attending, I can attest that most hospital administrators are concerned, if not obsessed, with discharging patients quickly. Hospital stays are currently paid by most insurers according to the patients' diagnoses, but not their length of stay. Long stays cost hospitals money. Furthermore, unnecessarily long stays use up resources that could better serve acutely ill and injured patients. Yet Ms Clark stayed an astounding 20 plus years, without any obvious medical rationale. No hospital official contested the fact that Ms Clark stayed that long in the NY Post article.
Furthermore, in a 2013 New York Times article, the hospital's lawyer, defending a parallel attempt to recover the money donated to the hospital, wrote
Furthermore, a member of the Beth Israel fund-raising staff wrote in a memo disclosed during litigation,
Never mind that the fundamental mission of the hospital is to provide acute care for the sick and injured, not to provide comfortable retirement housing. But hospital managers are apparently on record acknowledging that the hospital was basically providing Ms Clark with services that are normally available in a retirement community, not services that acute care hospitals normally provide anyone There is no evidence that the hospital ever provided similar services to any other patients.
The obvious mystery, then, is
- why no one at the hospital, no doctor, nurse, or manager, or no visitor, regulator, accrediting agency, insurer ever questioned why the hospital was providing a long-term residence to a former patient?
No answer to the question has appeared in any coverage I have seen of this case, including a September, 2013,.NY Times followup article on the occasion of the case nearing trial.
In the absence of a creditable explanation for this strange distortion of the hospital mission,
- is there any other conclusion than that its purpose was to extract a large amount of money from a vulnerable, rich, but no longer acutely ill former patient?
This would suggest an unusual but monumentally unethical kind of hospital mismanagement.
So we have two recent stories about major, unusual, apparently severe mismanagement by hospital executives. These stories were reported as if they were independent.
However, buried in the original NY Post article, but unmentioned in either of the major NY Times articles, however, was a hint of how this case and that above of the purloined inheritance appeared to be linked.
The Hidden Hospital System
The NY Post article referred thus to the Beth Israel CEO who allegedly pushed Ms Clark for contributions,
Quick Watson, did you see that?
Continuum Health Partners was the "parent organization" of Beth Israel Hospital during at least some of the time Ms Clark was in residence there. Continuum Health Partners also was the "previous owner" of Long Island College Hospital during at least some of the time it apparently was suffering large losses and its endowment was being depleted. So were both these stories really about the same organization, the same hospital system?
Digging a little further, per its own LinkedIn page,
So while the hospital system did not exist when Ms Clark first entered Beth Israel Hospital, the heiress' "care" was under the control of the organization apparently from 1997 to the day she died.
Furthermore, as noted in a 2011 Chronicle of Higher Education article, available from Innovative Resources Group Inc,
So the hospital system called Continuum Health Partners took over Long Island College Hospital in 1998 and held it for 13 years. Furthermore, apparently LICH was part of Continuum Health Partners during the time when its losses rose and the Othmer bequest was depleted. For example, from the CHE article,
Also in 2008, the Brooklyn Heights Blog reported this response to a question about finances from the Continuum Health Partners CEO, Stanley Bazenoff,
Denis Hamill, a columnist for the New York Daily News, made this accusation in a February, 2013, editorial:
It's appropriate to conclude with this, a video of Jeremy Brett in A Scandal in Bohemia, from the first season of the show as first shown on PBS.
The Purloined Bequest
A singular article in the Wall Street Journal, entitled "Judge Rules in Case of Fortune Tied to Buffett," first made this case explicit, but some background is required to understand it.
The story focused on Long Island College Hospital, in Cobble Hill, Brooklyn, New York. [Full disclosure: this story got my attention particularly because I grew up nearby in Brooklyn, and was born at that hospital, which was also the local hospital my parents often used.] LICH has long been the major community hospital for downtown Brooklyn.
The story appeared to begin in 2011, per the WSJ,
In 2011, Judge [Carolyn] Demarest approved the merger of LICH and SUNY Downstate on the condition it would keep the charitable hospital going. As part of the deal, the hospital transferred properties to Downstate estimated to be worth as much as $1 billion collectively, according to a previous court order.
The merger was supposed to keep LICH in operation as a community hospital and provider of acute care to the poor. However, things did not work out.
This year, however, Downstate announced plans to shut the hospital, leading to protests from Brooklyn residents and local politicians.
'It is clear that the premise upon which this Court authorized the transfer of assets has been defeated,' Justice Demarest wrote in her Aug. 20 decision, adding that Downstate had breached its contractual obligations. She cited a 'legal and moral responsibility' to correct her earlier error in approving the merger.
She directed Downstate to return all assets to the hospital's previous owner, Continuum Health Partners Inc., which subsequently said it couldn't take the reins. The court is expected to review other proposals.
The judge also discovered that hospital management had been raiding an large endowment fund intended for other purposes,
A New York state judge ruled this week that a struggling Brooklyn hospital must repay tens of millions of dollars it borrowed from an endowment set up by early investors with billionaire Warren Buffett.
The ruling aims to rectify the previous use of the money by Long Island College Hospital, which is hurting financially and was scheduled to close. Mr. Buffett in July told The Wall Street Journal that his late friends, Donald and Mildred Othmer, would have felt 'betrayed' at the way the funds were spent.
Apparently,
The Othmers, natives of Omaha, Neb., who later lived in Brooklyn, were longtime friends of Mr. Buffett's, and each invested $25,000 with the billionaire in 1961.
When they died—he in 1995 and she in 1998—they gave away a fortune estimated at $780 million, including the $135 million permanent endowment for the hospital. The Othmer wills stipulated the interest on the endowment could be used for operating expenses but the principal should be held 'in perpetuity.'
In a series of court-approved transactions that began in 2000, the hospital borrowed from the funds repeatedly to meet short-term obligations and cover debts.
The hospital argued that the money was necessary to keep the hospital afloat, which it said the Othmers would have wanted. The transfers depleted most of the endowment, a result that came to light after the Journal wrote about the situation in July.
New York Times and Brooklyn Daily Eagle articles focused on the question of whether SUNY/ Downstate intended to close the hospital so it could sell its apparently valuable real estate assets in a now fashionable neighborhood, but not on how the hospital fell into these dire straits.
There seem to be some lingering questions -
- If the losses and borrowing began in 2000, or earlier, who was responsible for them, given the current owners have only been in place since 2011?
Note that the phrasing in the article above ("the hospital argued that the money was necessary to keep the hospital afloat") suggested that before SUNY took over, the hospital was independent. However, the article mentioned, albeit only briefly in passing, that the hospital had a previous owner, Continuum Health Partners Inc.
- How were the losses explained when they occurred, and what was the rationale for borrowing from restricted endowment as a response, instead of, for example, direct efforts to minimize losses or increase capital and revenue?
Note that the article implied that when SUNY acquired LICH, it acquired some very valuable real estate. Why did the previous management of LICH not consider selling off some of this real estate to resolve its debts?
- Did mismanagement of the hospital lead to excess losses, and did borrowing funds from the principle of the hospital's endowment to offset these losses amounted to more mismanagement?
Meanwhile, a second even more bizarre story about another New York City hospital almost simultaneously got media attention.
The Resident Heiress
The case first made it into the media in 2012, when the tabloid New York Post reported,
Beth Israel Medical Center milked reclusive copper heiress Huguette Clark for more than $13 million in fees, donations and even a priceless painting during her 20-year stay as a patient — and greedy executives angled for $125 million more, her relatives allege in shocking new court filings over Clark’s estate.
The alleged shakedown was illuminated in an e-mail in which hospital board member and former CEO Dr. Robert Newman referred to Clark as 'the biggest bucks contributing potential we’ve ever had,' according to court papers.
He told a colleague her 'potential has been overwhelming[ly] unrealized.'
At one point, he suggested to Clark that she pay nearly one-third of her estimated $400 million fortune to keep the now-shuttered Beth Israel North on the Upper East Side open so she could keep living in the room she had refused to leave for 15 years despite being in good physical health, the papers allege.
But instead of addressing Clark’s crippling anxiety, hospital honchos played on her fears, engaging in 'a concentrated effort, orchestrated at the highest board and executive levels,' to get her money, court documents obtained by The Post allege.
Clark’s death last year at age 104 set off a battle over her estate. Her distant relatives claim lawyer Wallace Bock, accountant Irving Kamsler, private-duty nurse Hadassah Peri and the Beth Israel administrators manipulated the feeble Clark for her money.
The nurse, who received cash and gifts from Clark, stands to inherit nearly $34 million and Clark’s priceless doll collection in the now-disputed will. Beth Israel is to get $1 million.
The Paris-born Clark inherited her money from her father, William, a rail and mining baron and former US senator whose wealth rivaled the Rockefellers’.
She went to Beth Israel North in 1991, when she was 85, after a doctor found her emaciated and ill in one of her three sprawling Fifth Avenue apartments.
She spent the last two decades of her life in dismal hospital rooms with the shades drawn and door shut even though there was 'no medical basis for keeping her' past the first few months, documents show.
Clark was 'the perfect patient' for the hospital, her relatives charge, noting, 'She required no medical care, possessed enormous wealth, paid over $800 a day for her room, and became progressively more dependent on the hospital.'
'Beth Israel had a plan to subtly, but ever so persistently, court Huguette for the purpose of garnering gifts and ultimately do a will in favor of the hospital,' court papers claim.
This case also seems to be about wealthy donors and hospital executives. Yet what makes it most bizarre are the circumstance of Ms Clark's hospital stay. As a former intern, resident, fellow, and teaching hospital attending, I can attest that most hospital administrators are concerned, if not obsessed, with discharging patients quickly. Hospital stays are currently paid by most insurers according to the patients' diagnoses, but not their length of stay. Long stays cost hospitals money. Furthermore, unnecessarily long stays use up resources that could better serve acutely ill and injured patients. Yet Ms Clark stayed an astounding 20 plus years, without any obvious medical rationale. No hospital official contested the fact that Ms Clark stayed that long in the NY Post article.
Furthermore, in a 2013 New York Times article, the hospital's lawyer, defending a parallel attempt to recover the money donated to the hospital, wrote
Beth Israel had provided Mrs. Clark with 'a well-attended home where she was able to live out her days in security, relative good health and comfort, and with the pleasures of human company.' Besides, he said, the amount of money she gave to Beth Israel was “not very large considering her vast wealth.”
Furthermore, a member of the Beth Israel fund-raising staff wrote in a memo disclosed during litigation,
She was well enough by then to go home to her spacious apartment at Fifth Avenue and 72nd Street, overlooking Central Park, Ms. [Cynthia L] Cromer said, but 'she asked if she might stay in the hospital longer: she feels comfortable and safe, and her apartment is being renovated.'
Never mind that the fundamental mission of the hospital is to provide acute care for the sick and injured, not to provide comfortable retirement housing. But hospital managers are apparently on record acknowledging that the hospital was basically providing Ms Clark with services that are normally available in a retirement community, not services that acute care hospitals normally provide anyone There is no evidence that the hospital ever provided similar services to any other patients.
The obvious mystery, then, is
- why no one at the hospital, no doctor, nurse, or manager, or no visitor, regulator, accrediting agency, insurer ever questioned why the hospital was providing a long-term residence to a former patient?
No answer to the question has appeared in any coverage I have seen of this case, including a September, 2013,.NY Times followup article on the occasion of the case nearing trial.
In the absence of a creditable explanation for this strange distortion of the hospital mission,
- is there any other conclusion than that its purpose was to extract a large amount of money from a vulnerable, rich, but no longer acutely ill former patient?
This would suggest an unusual but monumentally unethical kind of hospital mismanagement.
So we have two recent stories about major, unusual, apparently severe mismanagement by hospital executives. These stories were reported as if they were independent.
However, buried in the original NY Post article, but unmentioned in either of the major NY Times articles, however, was a hint of how this case and that above of the purloined inheritance appeared to be linked.
The Hidden Hospital System
The NY Post article referred thus to the Beth Israel CEO who allegedly pushed Ms Clark for contributions,
Newman, former CEO of Continuum Health Partners, Beth Israel’s parent organization, took the unusual step of offering to help Clark complete a will so 'some faceless bureaucrat of the government' wouldn’t get his hands on her estate, court papers say.
Quick Watson, did you see that?
Continuum Health Partners was the "parent organization" of Beth Israel Hospital during at least some of the time Ms Clark was in residence there. Continuum Health Partners also was the "previous owner" of Long Island College Hospital during at least some of the time it apparently was suffering large losses and its endowment was being depleted. So were both these stories really about the same organization, the same hospital system?
Digging a little further, per its own LinkedIn page,
Continuum Health Partners, Inc. was formed in 1997 as a partnership of three venerable institutions — Beth Israel Medical Center, St. Luke's Hospital, and Roosevelt Hospital.
So while the hospital system did not exist when Ms Clark first entered Beth Israel Hospital, the heiress' "care" was under the control of the organization apparently from 1997 to the day she died.
Furthermore, as noted in a 2011 Chronicle of Higher Education article, available from Innovative Resources Group Inc,
If there was a honeymoon after the merger of Long Island College Hospital, in Brooklyn, with Continuum Health Partners, in New York in 1998, few remember it. The bickering began early and dragged on for years, but divorce didn’t seem inevitable until the doctors went public.
So the hospital system called Continuum Health Partners took over Long Island College Hospital in 1998 and held it for 13 years. Furthermore, apparently LICH was part of Continuum Health Partners during the time when its losses rose and the Othmer bequest was depleted. For example, from the CHE article,
Several physicians told a crowd gathered outside the hospital’s entrance in 2008 that Continuum had withheld money from the 150-year-old institution, needlessly cutting patient services and endangering the hospital’s future.
Also in 2008, the Brooklyn Heights Blog reported this response to a question about finances from the Continuum Health Partners CEO, Stanley Bazenoff,
LICH faces an immediate fiscal crisis. Unless action is taken quickly, he said, LICH will not have cash on hand to meet payrolls and other current expenses. He ascribed LICH’s problem to three factors. First, the hospital carries a heavy debt burden–approximately $150 million in long-term bonds financed through the New York State Dormitory Authority and $25 million in short-term commercial paper–which results in annual debt service (including interest and amortization) cost of approximately $22 million. Second, LICH has an operating deficit, presently about $40 million on an annual basis,...
Denis Hamill, a columnist for the New York Daily News, made this accusation in a February, 2013, editorial:
Under Continuum, the once-profitable LICH ran up $300 million in debt from pure administrative malpractice. And then Brezenoff brokered the smelly SUNY Downstate merger, with state taxpayers absorbing the $300 million debt.
It's appropriate to conclude with this, a video of Jeremy Brett in A Scandal in Bohemia, from the first season of the show as first shown on PBS.
The Adventures of the Purloined Bequest, the Resident Heiress, and the Hidden Hospital System
Reviewed by MCH
on
September 19, 2013
Rating:
Reviewed by MCH
on
September 19, 2013
Rating:
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