During the past quarter century, more than a dozen New York City hospitals have closed. The causes of death have been many: changing economics, deregulation, less government support, a shift toward more outpatient treatment.
It seemed likely that University Hospital at Downstate in East Flatbush, Brooklyn, would soon join that casualty list, especially when state officials began formulating a plan last year for the hospital’s demise. After all, the medical center, part of SUNY Downstate Health Sciences University, had hemorrhaged money and patients for years. A far larger hospital sits directly across the street, ensuring that the neighborhood — plagued with high rates of diabetes, hypertension and kidney disease — would not be without medical care.
But then something unexpected happened. The state decided to commit $1.1 billion to University Hospital for renovations and a new outpatient facility, a stunning reversal propelled by fervent local opposition to the closing of the 342-bed hospital.
When the hospital’s future was in doubt, state legislators and community activists demanded that the state find the money to keep it open. Pastors spoke about it in their Sunday sermons. Rallies to save the hospital drew speakers including the Rev. Al Sharpton and Randi Weingarten, the president of the American Federation of Teachers, a major union.
And patients mobilized to save their hospital, even though the federal government gives it only one star out of five in its quality rating. By the end, the administration of Gov. Kathy Hochul enthusiastically came around to the idea of shoring up the hospital instead of shutting it down.
“Let’s say that again, it sounds so good: $1 billion,” Ms. Hochul, a Democrat, said at a news conference this month at SUNY Downstate, announcing the sum that the state was providing for improvements. The money is expected to go toward renovating the hospital and expanding cancer and cardiac care.
It remains to be seen if $1.1 billion will be enough to turn around University Hospital. That will require attracting more patients, including pregnant women choosing where to give birth and cancer patients deciding where to receive treatment — two groups hospital administrators hope to increase after the upgrade.
But annual losses at the hospital could hold steady or grow even after the investment, according to a report by a government advisory group appointed to make recommendations regarding the hospital’s future.
The hospital’s economics will significantly deteriorate if Congress takes steps to slash billions in Medicaid funding. That would mean less revenue for University Hospital and other hospitals that primarily care for people with low incomes, who often rely on Medicaid. The annual deficits that have long beset University Hospital could balloon if Congress goes forward with major cuts, the chancellor of the State University of New York, John B. King Jr., cautioned in an interview.
“That is a disaster scenario, not just for SUNY Downstate, but for all New York hospitals and the health care of all America,” he said.
Mr. King was a driving force behind the proposal last year that would have meant the end of University Hospital as a full-service hospital. After taking the SUNY system’s top job in 2023, he quickly zeroed in on University Hospital, which was losing about $100 million a year. In addition to dozens of colleges, the State University system operates hospitals in Brooklyn, Long Island and Syracuse, each affiliated with a SUNY medical school.
But the hospital in Brooklyn stood out, both for its deficit and for concerns “about the quality of care,” Mr. King said in an interview.
“I started sounding the alarm,” he said. “The financial situation was such that to keep operating Downstate would only be possible if you are taking resources from the other 63 campuses.”
In a video address in early 2024, Mr. King said the losses could not continue. Nor was it realistic, he said, to expect the state to spend billions modernizing the hospital building, which had fallen into disrepair, or building a new one.
Instead, he proposed a “transformation” that involved building a new urgent care center and outpatient surgery center. But the plan would mean the end of inpatient care at University Hospital. Most hospital care — along with the doctors who provided it — would be transferred to other medical centers, including the one across the street, Kings County Hospital.
Mr. King spoke of creating a “SUNY Downstate wing at Kings County,” with perhaps 150 beds. To many doctors and patients, any plan that ended inpatient care at University Hospital effectively meant the hospital’s closure.
That was not a new idea. For decades, the conventional wisdom has been that eventually the two hospitals on Clarkson Avenue would combine.
“No one who thinks about this carefully thinks there should be a separate University Hospital and a separate Kings County,” Dr. Richard Schwarz, the acting president of SUNY Downstate at the time, told The New York Times in 1994. “It just doesn’t make any sense in the long run.”
But that view overlooks a central fact: Many Brooklyn residents feel they get better and more personalized care at University Hospital than elsewhere.
“You’ll find the best doctors there,” said David Gallimore, 55, who has had 13 strokes, some of them major, and open-heart surgery, and has relied on University Hospital for much of his care. “The level of care at Downstate is much better than I’ve gotten at other hospitals in Brooklyn.”
If his heart — and pacemaker — were to skip a beat at night, his doctor, who monitors it, would call him the next morning and tell him to come in right away, Mr. Gallimore said.
Mr. Gallimore, who uses a motorized wheelchair, has been a frequent presence at meetings where community members fought to save University Hospital.
By early 2024, the Hochul administration had directed about $300 million to fund SUNY’s plan to close inpatient care and expand outpatient care. But State Senator Zellnor Myrie, whose district includes the hospital, along with other legislators, insisted on a more deliberative process, with public hearings and input from experts.
“Instead of coming with a solution of how to invest properly going forward, they initially came with what was a convenient solution, and that was to close us down,” said Mr. Myrie, who was treated for Covid-19 in University Hospital’s intensive care unit in 2021 and, as a child, would be taken to its emergency room during asthma attacks.
“We had to fight and reject the premise that there was no path forward,” Mr. Myrie said.
The state created a community advisory board to provide recommendations to the governor on options for University Hospital. And the Legislature authorized up to $750 million in funding for any resulting plan.
The fight to preserve the hospital came as racial health disparities received renewed political attention amid the pandemic. East Flatbush, with its large Caribbean-American population, has one of the highest infant mortality rates in the city, and one of the highest rates of unmanaged diabetes.
The research at University Hospital and Downstate medical school has often reflected the neighborhood’s health needs. In the 1990s, Downstate researchers helped study patients whose diabetes seemed to combine features of both type 1 and type 2 diabetes. They called the illness “Flatbush diabetes.”
Dr. Sumanth Suresh, the head of the hospital’s kidney transplant program, calls central Brooklyn the “E.S.R.D. capital of New York,” referring to end-stage renal disease. That reflects the high prevalence of diabetes and hypertension, which ravage the kidneys. SUNY Downstate has the only kidney transplant program in Brooklyn, providing new organs to about 60 patients a year.
Downstate’s transplant program and its cardiothoracic surgery program have a mixed record. Former surgeons, in lawsuits, have claimed that various lapses and low staffing levels compromised patient safety. The hospital has temporarily suspended these programs at points over the past decade.
But the kidney transplant program has been a lifeline for patients like Leslie Taylor. Lupus, an autoimmune disease, damaged her kidneys, leading to a succession of transplants, all at University Hospital. The first two transplanted kidneys failed, but not the third. She has also had a heart attack and bouts of cancer, receiving much of her care at University Hospital.
“It’s top-notch,” Ms. Taylor, 53, said of the care. “I have good relationships with my doctors. Any time I have a problem, I can call them,” said Ms. Taylor, who worked as a social worker at a SUNY Downstate dialysis center.
Were the hospital to close or cut back its services, she said, “it would be traumatic for me.”
Over the course of 2024, legislators and union officials said, Ms. Hochul came to embrace the idea that University Hospital should be propped up, rather than phased out. “The governor came around to basically abandon the chancellor’s plan for closing the hospital,” said Frederick Kowal, who was on the community advisory board and is the president of the Union of University Professions, which represents SUNY employees.
The advisory board’s report, which was released this month, recommended that the hospital retain inpatient services and focus on attracting more patients, especially some with employer-based insurance, which reimburses hospitals at higher rates than Medicaid.
To that end, the advisory board recommended renovating patient rooms, which are double-occupancy. Turning them into single rooms with private bathrooms and showers could appeal to patients who have avoided the hospital.
While the specifics of how the money will be spent remain unclear, the state’s willingness to invest $1.1 billion in an ailing hospital surprised health care executives and policy analysts, who have watched the state steer hospitals toward closure time and time again. They wondered if it might signal a new approach to safety net hospitals, whose patients tend to be poor or working-class.
“It was on the chopping block for closure just a year ago, and it’s remarkable the state is now going to spend a billion on it,” said Elisabeth Benjamin, who leads health initiatives at a major antipoverty organization, the Community Service Society of New York, and recently co-wrote a report examining hospital closures in New York.
At the news conference this month at SUNY Downstate, Ms. Hochul, whose administration had once threatened to close the hospital, sounded like its champion.
“We got it done,” she said.
Joseph Goldstein covers health care in New York for The Times, following years of criminal justice and police reporting.
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