The Gotham Gazette examined inspection reports, complaints and court records to take a close look at five of the city’s lowest-rated nursing homes. This is the last of five parts.

When Harold Beer entered Bishop Henry Hucles Nursing Home, he gave his prosthetic leg to an aide while being fitted for a wheelchair. He says they never returned it.

“They also won’t tell me when they’re letting me go,” complained the 73-year-old Beer. “I can’t get a straight answer around here.”

Complaints about Bishop Henry Hucles are not uncommon. The facility, located in the Bedford-Stuyvesant neighborhood of Brooklyn, ranks as one of the lowest-rated nursing homes in the city, according to state inspections and Medicare records.

Bob DeVito, administrator of the 240-bed nursing home, rejects the findings of state inspectors who assigned the facility several poor scores in categories used to measure its performance.

“Those scores must be either outdated or wrong,” he said. “This nursing home takes great care of its residents.”

The Centers for Medicare & Medicaid Services (CMS), which evaluates nursing homes, gave Bishop Henry Hucles an overall rating of two stars, which the CMS assigns to nursing homes that provide a “below average” level of care.

DeVito would not allow a Gotham Gazette reporter to tour the facility, citing instructions from new owner, Michael Melnicke, whose company operates several nursing homes. Meinicke didn’t respond to requests for an interview.

The CMS gave Bishop Henry Hucles a one-star rating in the all-important staffing category. The CMS equates a one-star rating with a “much below average” level of care. The rating is based largely on the amount of time nurses and certified nurse aides spend each day with residents.

Arthur Edey, a former employee, claims that staffing problems began in 2011 when Episcopal Health Services, the non-profit that operated the nursing home, transferred ownership of Bishop Henry Hucles to Melnicke. The nursing home reduced staff to three certified nurse aides (CNA) for every floor, which have as many as 40 residents, he said. 

“That’s a lot of people to cover, and some of them need lots of help,” Edey said. “It also means people have to wait longer to get the help they need.”

Staff also was asked to clean two floors per person, which “is an impossible thing to ask one person to do,” he added.

Bishop Henry Hucles admits many residents who need long term care and suffer from Alzheimer’s disease and dementia. A nurse who asked that her name be withheld because she feared that she could lose her job for commenting, said that when staff gets squeezed, “the care of the patients sometimes suffers.”

A typical nursing home needs an average of 4.4 hours of direct care staff time per resident per day to see positive outcomes, said Richard Mollot, a consumer advocate for nursing homes.

“If you dig into how CMS computes data, 4.4 hours translates to a high four- or a five-star rating,” Mollot said. “Three stars is significantly below average, and one star means you’re one of the worst in the country.”

At Bishop Henry Hucles, registered nurses spend an average of 18 minutes per day per resident, less than half the state average of 42 minutes and national average of 48 minutes. The facility’s licensed nurses spent an average of 59 minutes a day per resident, nearly 35 minutes less than the state average.

Unlike other states, New York does not have a mandated minimum staff ratio or a minimum amount of hours that nursing staff is required to devote to nursing home residents (although there is a proposed bill that aims to change that), Mollot said.  

Staffing deficiencies can lead to patient neglect. For example, a resident walked out of Bishop Henry Hucles undetected on Dec. 18, 2012, according to a state inspection report. The resident typically strolled inside the facility at about 7:30 p.m. and nursing aides assumed she was on the first floor, the report says. It is unclear how long it took the home to locate the resident, but she wasn’t reported missing until 11:20 p.m., according to the report.

The facility scored low in several care categories. There has been a 41-percent increase in the number of long-term residents who need help with daily activities, according to CMS data. The statewide average is 15 percent. Nearly 36 percent of the residents exhibit symptoms of depression – three times the state average of 11.7 percent, the CMS data show. 

Health violations have also been a problem at the home. Inspectors cited Bishop Henry Hucles for 12 health deficiencies last year, more than double the 5.3 state average. For example, a licensed practice nurse (LPN) left medications unattended in a hallway while she went to the medication room. The LPN left the cart unattended again 10 minutes later. In another case, a resident with a skin rash was ordered to see a dermatologist, but didn’t see one until 16 weeks later because of multiple miscommunications among staff. 

On a recent visit to Bishop Henry Hucles, residents were dressed in tattered clothing. A few residents said the home’s food was extremely poor and wished there was more variety. 

“All they ever give us is gravy, gravy, gravy,” said Sally Norman, a longtime resident. “It’s not good for us.”

Some staff members at the home are also unhappy. Edey, a 15-year employee at Bishop Henry Hucles, complained that Melnicke instituted a few unwelcome changes when he took ownership of the facility.

“They had added changes to our union contracts,” he said. “And they weren’t good.”

The changes included fewer overtime hours and lower disability benefits, Edey said. Melnicke was unwilling to compromise on the changes, said Edey, who was the union representative.

“We voted the changes down,” Edey said. “But Melnicke said no one had ever voted against him, and we had to vote over.”

The next vote was an even more resounding no.

Edey, 61, had spent six months on disability after spraining an ankle and tearing an ACL on the job. He said that after the union vote Melnicke went to his supervisor and said he didn’t think Edey was healthy enough to continue working, even though Edey’s doctor had advised him to go back to work.

“I’ve been on disability ever since,” he said.

Alex Eidman filed this report while attending the CUNY Graduate School of Journalism.

The "Quality of Staffing" pie chart uses data obtained from the Centers for Medicare and Medicaid Services.

The Gotham Gazette examined inspection reports, complaints and court records to take a close look at five of the city’s lowest-rated nursing homes. This is the third of five parts. 

Citing a pattern of serious problems, federal regulators placed Marcus Garvey Nursing Home on an exclusive watch list of the worst nursing homes in the country in 2009 and again in 2011.

Those actions occurred while the state attorney general’s office pursued a civil lawsuit accusing Ruby Weston, the facility’s owner, of using money intended for resident care to enrich herself and her family. A 2012 settlement of the lawsuit required Weston to forfeit $821,000 in deferred compensation and pay $50,000 to cover the cost of the AG’s investigation.

The 295-bed nursing home in Brooklyn’s Crown Heights neighborhood is now named the Marcus Garvey Residential Rehab Pavilion and operated by new owners. Yet it remains one of the worst in the country.

Current administrators say they are working to solve the problems but seem to have a lot to overcome.

In 2009, the federal oversight agency for Medicaid and Medicare designated Marcus Garvey a Special Focus Facility (SFF) after an investigation found that its staff was failing to properly administer patients’ medications. The nursing home was fined nearly $55,000.

The facility landed on the SFF list the following year after regulators found that Marcus Garvey staff failed to report a resident’s high potassium levels, body numbness, and trouble breathing. The resident was hospitalized and died. Soon after that, the state fined the facility $20,000 for delivering sub-standard care.

When Marcus Garvey was placed on the SFF watch list, its administrators were told they need to make significant improvements to continue to receive Medicare funds. They needed to hire more competent staff, for example, and make clear policies to ensure patients receive the proper medications, according to Medicare documents. But the problems persisted.

“People are suffering and our tax dollars are paying for this,” said Richard Mollot, leader of the advocacy group Long Term Care Community Coalition.

Substandard nursing homes such as Marcus Garvey are supposed to lose their Medicare and Medicaid money if they fail to correct serious problems, Mollot said. Government agencies are failing to enforce their regulations, he said.

Quality of care measures

Despite the fines and additional oversight, Marcus Garvey remains among the lowest ranking nursing homes in the city. One of the most troubling problems fueling its poor ratings is the large number of patients on antipsychotic drugs.

Aproximately 40 percent of the long-term patients at Marcus Garvey receive antipsychotics — more than twice the state average, according to state Health Department records. And 4.6 percent of the facility’s short-term patients take the drugs, well above the 2.7 percent state average.

Elder care advocates and doctors have said antipsychotic drugs, which include powerful tranquilizers such as Risperdal and Seroquel, are often overused in nursing homes as chemical restraints.

Marcus Garvey Medical Director Pierre Brutus said he is trying to reduce the number of patients on antipsychotics. However, doing so is difficult because the nursing home receives many patients from Gracie Square Hospital, a psychiatric and substance abuse facility in Manhattan, he said.

Hospital adminstration said it could not provide information about the number of patients transferred to Marcus Garvey.

Two-thirds of Marcus Garvey’s long-term residents display symptoms of severe depression, federal records show. That’s nearly six times higher than the state average and 11 times higher than the national average. Brutus said that for many of these patients, there is nothing the facility can do.

“Some have major depression, and we cannot reverse that,” he said.

Federal inspectors routinely found problems at Marcus Garvey that could be reversed. A Gotham Gazette review of federal inspection reportds from 2011 to 2012 found many other violations, including the failure to:

• Properly administer medications (one insulin-dependent resident’s chart showed no evidence that she had received insulin for three days in a row);
• Provide proper dental services (during the state inspection, a resident told an inspector that she was missing her front teeth because of a fall and hadn’t seen a dentist during her year-long stay at the facility);
• Address “critical and aberrant” lab results;
• Do an accurate assessment of each patient and keep each resident — along with his or her doctor and family — apprised of any changes in health status (one resident’s health care manager told inspectors that the facility “does not always inform him about changes in the resident's medication or treatment”).

Yoga instructor Daniela Bella discovered how frustrating it could be to try to improve conditions at Marcus Garvey. Once a week, she guided a classroom of residents in “chair yoga,” in which the elderly participants go through a series of stretches and poses while seated in chairs.

“They were happy, they loved the music and they loved me,” Bella recalled. “I got close with a lot of them,” she said.

Despite the patients’ enthusiasm, Marcus Garvey administrators often forgot to tell residents about scheduled classes or failed to clear the classroom of furniture, she said. It simply wasn’t a priority, she said.

“You could tell they had just forgotten,” Bella said.

The Marcus Garvey website prominently features a photo of the facility’s visitor lounge. “Visitors welcomed and encouraged everyday,” reads the photo caption. But a visit by the Gotham Gazette was clearly unwelcome; its reporter was escorted out of the building.

An apologetic Gloria Gasper, director of social work at the home, said a few days later that interviews with residents and staff are not allowed.

 “I just think this is a place that has its own culture,” she said. “I would suggest you not waste your time here.”

Erin Brodwin filed this report while attending the CUNY Graduate School of Journalism. 

The Gotham Gazette examined inspection reports, complaints and court records to take a close look at five of the city’s lowest-rated nursing homes. This is the second of five parts.

When Wayne Padgett’s aunt ended up at the Mary Manning Walsh Nursing Home on the Upper East Side last spring, he never imagined that he would eventually need to fly across the country to rescue her.

His 86-year-old aunt, Geraldine McCandless, had been sent to recover at the nursing after being hospitalized for a stroke. Padgett was not happy with what he saw when he flew from his California home to visit her.

“When I arrived in New York, I was horrified,” he said. “The place is dirty and run down. The staff do not really care and they have attitudes against asking for help.”

To document his point about the cleanliness issue, Padgett photographed the stained carpets and walls at the facility. He also said that he saw residents left in their wheelchairs in the hall all day, lined up in front of the nursing station with nothing to do.

“They were left in the hall to rot,” he said.

Mary Manning Walsh is one of the lowest-rated nursing homes in Manhattan, according to the federal Centers for Medicare & Medicaid Services (CMS). It is one of the two nursing homes in Manhattan rated one star (out of five) in the health inspection category. The CMS equates one star with "much below average" care. The average health inspection rating for the 18 nursing homes in Manhattan is 3.5 stars.

The CMS gave the facility only two stars (out of five) for overall quality, whereas the average rating in the borough is four stars. The CMS equates two stars with below average care.

A higher-than-average percentage of short-term residents at the 362-bed nursing home suffer problems with bedsores, according to data compiled by the New York State Department of Health. The data show that 2.2 percent of residents at the facility have bedsores that are "new or worsened," compared to an average of 1.4 percent statewide and 1.3 percent the nationwide.

Leonard Rosner, a former patient at Mary Manning Walsh, is suing the nursing home for what he says was a failure to prevent and treat his bedsores. Nurses neglected to treat him even when his bedsores began to emit an odor.

“All you need to do is use your nose,” said Rosner’s attorney Jonathan Fairbanks, suggesting that his client’s condition was easy to detect. “In Rosner’s case, they waited three weeks before making a referral.”

In another health-related matter, Mary Manning Walsh was fined $6,500 last year for excessively hot water in the sinks in residents’ rooms. State inspectors measured water temperatures as high as 136 degrees – hot enough to blister the skin after 10 seconds of exposure, according to safety guidelines.

The hot water hazard was first reported to the administration in April 2012, but it still had not been fixed when the inspectors came to the nursing home the following year.

Other deficiencies reported by CMS and state Health Department in the past three years include errors in administering medication, failure to report medication errors and failure to store and cook food in a safe way. Inspectors also reported that 15 percent of the residents at Mary Manning Walsh exhibit symptoms of depression, compared to an average of 12 percent statewide and 6.6 percent nationwide.

Jon Goldberg, the spokesperson for ArchCare, the health care ministry for the Archdiocese of New York, suggested that the facility’s low rating by CMS is not indicative of the care it has provided in the past.

“Historically, the Mary Manning Walsh Nursing Home has had five-star ratings,” he said.

Administrators and the owners of the facility didn’t respond to several requests for an interview.

The problems at Mary Manning Walsh are indicative of the substandard quality of care prevalent in nursing homes across the state. New York ranked 45^th out of all states this year in Home Report Cards, a ranking compiled by Families for Better Care, a Florida-based advocacy group.

“The blame really starts with individual owners first,” said Brian Lee, the organization’s executive director.

But he added that the lack of appropriate legislation with regard to staffing levels on a state level exacerbates the problem. Unlike some states, New York has no specific staffing requirement and instead allows nursing homes leeway in deciding how many staff members they employ.

“Far too many people are left in danger,” Lee said.

In Wayne Padgett’s opinion, leaving his aunt in Mary Manning Walsh posed a danger to her health. He decided to move her into a home in California. That proved unnecessarily difficult because administrators at Mary Manning Walsh couldn’t locate such important documents as power of attorney, he said.

When his aunt was finally transferred, her new home discovered that a deep cough she had developed was a symptom of bronchitis which the staff at Mary Manning Walsh had failed to diagnose, Padgett said.

His aunt is doing better at her new nursing home, Padgett reports.

“People here are sweet and they care,” he said about the staff.

___

Agata Blaszczak-Boxe is a freelance journalist and graduate of CUNY Graduate School of Journalism.

Quality care in nursing homes is largely defined by the nurses and nurse assistants on staff. They perform such critical tasks as feeding and bathing elderly residents, dispensing medications and ensuring that frail residents avoid bedsore wounds. A comprehensive federal study conducted in 2006 concluded that staff shortages dramatically impair the health and safety of nursing home residents. Yet 61 percent of New York City’s nursing homes fail to provide a sufficient level of staff care to be ranked as an average facility, according to Medicare data. And 41 percent are rated “much below average.”

The Gotham Gazette examined inspection reports, complaints and court records to take a close look at five of the city’s lowest-rated nursing homes. This is the first of five parts.

Robert Ruiz was designated one of the unsafe smokers at the Mosholu Parkway Nursing and Rehabilitation Center.

But when he lit a cigarette in the home’s smoking room three years ago, the staff member assigned to supervise the smokers wasn’t there.

Ruiz, a 56-year-old resident diagnosed with mental and physical impairments, placed the burning match on the side of his wheelchair seat. A bed sheet on the chair ignited.

Three residents in the room watched in horror, screaming, but unable to help. A security video shows that flames engulfed Ruiz for more than four minutes before the fire was extinguished.

Ruiz was hospitalized in critical condition with burns over 60 percent of his body. Doctors had to amputate his legs. He was administered a continuous intravenous line of painkillers until he died a year later.

A judge awarded the estate of Robert Ruiz a $2.45 million settlement last year while the state filed criminal charges against Mosholu and its administrator, Issac Shapiro.

Unsurprisingly, state Health Department inspectors cited the nursing home for seven fire safety deficiencies three months after the fire. They noted that 24 residents were seen smoking unsupervised just two days after the fire. They also noted that during an unannounced fire drill two months later the staff failed to evacuate 15 residents.

The home was fined a total of $55,575 that year, according to federal records.

The fire is a tragic consequence of shoddy oversight and what can happen when a nursing home fails to enact or enforce policies to ensure the health and safety of its residents. Mosholu continued to have problems after the fire, but currently holds a three-star rating for quality of care (out of a possible five stars), according to the federal Centers for Medicare & Medicaid Services (CMS), which evaluates nursing homes.

However, the 122-bed facility in the Bronx managed to rate only one star for the amount of time its nurses and staff devote to residents’ care. One star, the lowest possible rating, is considered “much below average” for nursing homes, according to the CMS.

On average, a licensed nurse at Mosholu spent one hour and four minutes per day with a patient, according to CMS records. That’s about 30 minutes less than the state and national averages. Registered nurses spent an average of 18 minutes per day per resident – less than half the state and national averages, the records show.

Advocates for the elderly often point to staffing deficiencies as a root cause of many problems that threaten the health and well-being of nursing home residents.

One problem cited by inspectors during the past two years has been the incidence of physical confrontations among Mosholu residents.

In one altercation in 2012, two roommates teamed up to assault a third, according to CMS records. The assailants landed a few punches while the attacked man struggled to retaliate before staff intervened. Each of the three men had a care plan that mandated that they be monitored for violent behavior, but the nursing home staff failed to document the assault as required by the care plans, CMS records show.

A few months after that incident, a resident used his walker to hit his roommate in the chest, CMS records show. The victim wasn’t injured and was transferred to another room five days later. The CMS faulted the facility’s director of nursing for failing to draft a plan to protect residents against such attacks.

“She was unable to provide any explanation as to why a care plan had not been developed to prevent further resident to resident altercations, resident abuse and possible injuries,” the report says.

Two residents nearly came to blows last summer when one accused his roommate of stealing a wristwatch, according to CMS records. Staff intervened to separate the two, made a note on a chart and left. The two men continued to room together for a week until the home’s social worker insisted they be separated.

Medicare inspectors cited Mosholu for 11 deficiencies in health care in 2012, twice as many as the average nursing home in the state. The inspection identified several preventable problems. For example, in a rush to clean up after a meal, a nurse threw a resident’s hearing aid into the trash. The facility did not replace the device. A patient who catheterized himself daily was never taught proper technique for handling waste or for installing and removing his catheter. Another resident received a sedative six times in one week even though it wasn’t prescribed.

Administrators at the home corrected problems and last year’s inspection uncovered only three deficiencies in health care.

Still, 12 percent of Mosholu’s residents suffer from bedsores, double the national average, and worse than 32 of the Bronx’s 45 nursing homes.

Last summer, the facility neglected to treat a 73-year-old resident with a bedsore on his left leg that festered for three months. He did not see a doctor during that time because a nurse failed to deliver a note from the patient’s physician to the administrator charged with lining up doctor appointments, according to Medicare records. The note said the resident needed to see a vascular surgeon as soon as possible. The resident received treatment only after a Medicare inspector intervened.

State law requires every nursing home to have its federal and state inspections prominently displayed and readily accessible. Mosholu’s are not. On two separate occasions the receptionist did not know where to locate them. The reports were located in a long hallway beyond the reception desk, through a set of double doors and around a corner.

Mosholu has not had a full-time administrator since the indictment of Shapiro nearly a year ago. Instead, Suzanne O’Connell, the administrator from nearby Wayne Nursing and Rehab Center, lends her services to Mosholu. (Wayne has had no fines in the past 11 years and fewer complaints and citations than the state average. However, 22 percent of Wayne’s residents suffer from bedsores – the worst in the Bronx – and its staff rating is as low as Mosholu.)

State law requires every nursing home with more than 40 beds to employ a full-time licensed administrator.

O’Connell did not return a request for an interview, and messages left at Mosholu were not returned.

Paulette Gordon, Mosholu’s director of admissions, and Iyabo Yusuf, director of nursing, declined to give a reporter with the Gotham Gazette a tour of the facility. Yusuf said she ran the facility in the absence of a full-time administrator. She said the facility wanted no media coverage.

While the reporter was there, a woman from a service that transports the elderly to doctor appointments arrived to pick up a resident. However, no one in the nursing home seemed to know that the resident had a scheduled appointment.

“It’s always like this,” she said. “How is it that an appointment is made, my company is hired, I’m sent here, and nobody in the home knows about it? Crazy, right?”

Nearby, a wheelchair-bound patient in a surgical mask pounded in vain on a patient coordinator’s office door. Nurses and staff laughed and joked as they passed by, but no one asked the resident what she needed.

In the lobby, a double amputee sat hunched over in his wheelchair. Yusuf looked at him and then turned to the receptionist.

“What’s he doing here?” she asked.

The receptionist shrugged.

Jordon Davidson is a freelance writer and graduate of the CUNY Graduate School of Journalism.

Despite protests from area residents, and pushback from major elected officials, SUNY Downstate appears set to sell the Long Island College Hospital in Brooklyn to a condominium developer. Mayor-elect Bill de Blasio's flagging campaign was bolstered when he was arrested while taking part in a protest to save LICH this summer. He also clashed publically with the Cuomo administration about the state's handling of the hospital. 

De Blasio has been quiet on the matter since his election and opoonents of the LICH's sale have noticed and tried to pressure de Blasio back into the fray. 

*Update* The de Blasio camp issued this statement today:

“Through months of legal rulings and community activism, we have managed to secure an acknowledgement from SUNY that there must be a significant and enduring health care presence on the Long Island College Hospital site. That has been no small accomplishment—but it is by no means enough to meet the needs of this community. We are troubled SUNY is poised to give preliminary approval to a plan that will replace so much of LICH’s vital healthcare capacity with luxury condos, while failing to preserve essential services like emergency care. We will continue to fight any plan that fails to provide critical health care for surrounding neighborhoods."

Residents are concerned that their growing community will face a healthcare crisis without LICH's emergency room to serve them. Emergency room wait times in the area have reportedly shot up as LICH began winding down services. 

Opponenets of the sale say the request for proposal process was carried out behind closed doors and a number of Brooklyn officials sent a letter to Gov. Andrew Cuomo yesterday asking him for a do-over with the process being transparent. 

The group of officials asked Cuomo for the following: 

• We request the public release of all information on the existing proposals and applicants of the RFP, as well as a full list of the RFP requirements and selection criteria.

• We request that the entire RFP process be handed over to the court system and that the courts administer the process moving forward.

• We request that a comprehensive public review process be held regarding the RFP and that a community committee be created to evaluate all proposals that meet the minimum RFP requirements.

• We request that the RFP be re-opened should no viable, existing applicants include a full service hospital.

We cannot stress enough the seriousness of this issue in our community and hope that you share our values of transparency, impartiality, and community inclusiveness. Thank you for your consideration.

Sincerely,

Stephen T. Levin, NYC Councilmember

Nydia M. Velázquez, Member of Congress

Marty Markowitz, Brooklyn Borough President

Daniel Squadron, New York State Senator

Joan Millman, New York State Assemblywoman

Brad Lander, NYC Councilmember

NEW YORK — Angie Welfare worked at John F. Kennedy International Airport for more than a decade, often carrying as much as 70 lbs of boxes for a major airline. In 2006, when she found out she was pregnant, a doctor told her to lessen her workload to 10 lbs.

Welfare asked her supervisor to put her on lighter duty. Her boss refused. She took an eight-week leave of absence — without pay and without medical coverage — when she was eight-months pregnant. Welfare said she applied for food stamps for the first time in her life and her home in Jamaica, Queens, was put into foreclosure.

"I planned to work," said Welfare, now 45. "I've always worked to take care of myself. And that was taken away from me."

Stories like Welfare's, said City Council Speaker Christine Quinn, led to today's bill to expand the city's Human Rights Law to prevent employers from discriminating against pregnant workers. The bill was approved 47-to-0, with one abstention, at the Council’s stated meeting.

"No woman should ever have to be forced to choose between the health of herself or her baby and her job," Quinn said in her prepared statement.

{pullquote}No woman should ever have to be forced to choose between the health of herself or her baby and her job -- Council Speaker Christine Quinn{/pullquote}

The speaker said one-fifth of discrimination charges made to the federal Equal Employment Opportunity Commission are pregnancy-related. Over the past decade, Quinn said, those complaints have increased 35 percent.

Mayor Michael Bloomberg’s office affirmed this afternoon that he supports the bill.

The outgoing mayor has been a staunch defender of the business community and unsuccessfully vetoed a recent bill that made it illegal for employers to discriminate against the unemployed because it would "damage lots of small business.”

The sponsor of the bill aimed at prohibiting discrimination against pregnant workers, Bronx Councilman James Vacca, explained how the law's main purposes are both to enshrine protections for pregnant employees and to provide employers with a full understanding of the new law as a preventative measure.

"I think the aim of the legislation is very clear: We want to reduce the cases that end up going to court or to the Human Rights Commission," he said. "We want clarity, though, and that's what employers will be getting."

Vacca said he hadn't heard of any opposition to the bill from the business community.

Under the new law, women can bring actions against employers in civil court for damages and for other remedies, including requiring the offending business to reform its practices.

Similarly, women can bring a complaint to the city's Human Right Commission, which can order the employer to halt its practices, hire back employees, require back-pay for said employees or provide compensatory payments for damages.

Those employers that the commission finds a fault who fail to comply with the commission's orders can be fined anywhere between $50,000 and $250,000. Willful violators can be found guilty of a misdemeanor with possible jail time and more fines.

Welfare still works for the airline. Currently on a medical leave of absence, her civil case against the airline has been on hold since the company filed for bankruptcy in late 2011. But her baby, Arnetta, was born healthy in 2006, and she found out she was having another child soon after.

This time, Welfare, who first shared her story with the council's Committee on Civil Rights in June, said that she hid it "so that this would not happen again."

"I does not feel good when you wait years hoping justice ill be one but having no guarantees," she said in her testimony. "I hope this law is passed and future women in my situation will be helped."

ALBANY, N.Y. — On July 7, Public Advocate and Democratic mayoral candidate Bill de Blasio joined a group of protesters demanding Long Island College Hospital in Brooklyn be saved from closure. “Our message to Governor Cuomo today is: ‘Don’t let this happen on your watch, don’t let us lose more hospitals. You can be the difference maker,” De Blasio said.

Three days later, police escorted De Blasio into the back of a police van, hands zip-tied behind him. He had intentionally disobeyed police orders at another protest to save LICH.

The scene was unique for two reasons — not many Democratic lawmakers have the guts to tell Cuomo to do anything, and De Blasio has been one of the only elected city officials to truly focus on the fact that Brooklyn is facing a hospital crisis.

For over a year, advocates and legislators have been struggling to get Cuomo publicly involved in the issue as LICH and Interfaith — both roiled by financial problems — have begun winding down service in preparation for closure. In the meantime, hospital emergency rooms across Brooklyn have become crowded and wait times have gone up.

Healthcare experts and public officials say the situation in Brooklyn is a microcosm for hospitals around the city and state that have been impacted by lowered reimbursement rates from Medicare and Medicaid while continuing to serve an indigent population.

As the mayoral race heated up with scandal, De Blasio has taken on the Brooklyn hospital crisis as his headline issue, highlighting the fact that the city has mostly ignored a series of hospital failures and increasing the pressure on Cuomo to act.

Cuomo oversees the State University of New York system and has a great deal of influence over what it does. LICH is run by SUNY Downstate; Cuomo appointed 15 of the 18 members of the board that voted to shutter it.

De Blasio recently proposed a plan that would create a super-authority to oversee Brooklyn hospitals that would be led by the governor and mayor. This week, he issued a report on the ability of residents to access convenient and safe healthcare were LICH and Interfaith were to close. The report estimates that 250,000 people will be affected by the closures of both hospitals and that the nearest hospitals are already nearing or at full capacity.

He’s also written to the state Department of Health urging them to accept a restructuring plan from Interfaith Hospital and to help them fund the plan to avoid a major disruption in service to the community. On top of that, the mayoral candidate secured a restraining order against the closure of LICH, even if it isn’t clear whether it is doing any good.

While fellow Democratic mayoral candidates Comptroller John Liu and former Congressman Anthony Weiner were at the protest when de Blasio was taken into custody, both obeyed police and avoided arrest — leading some political observers and reporters to see De Blasio’s intentional arrest as a move of desperation by a mayoral candidate who had up to then been eclipsed in the polls.

It’s fair to say that none of the mayoral candidates has been more vocal on the issue of ailing Brooklyn hospitals than De Blasio. City Council Speaker Christine Quinn, also a Democratic hopeful, has been criticized by Brooklyn residents for not getting more involved in the hospital crisis. However, the Council passed a resolution to save LICH in April and released a statement urging the federal government to release funds to buoy Brooklyn hospitals. Liu has not used his position as comptroller to focus on the hospital closures. De Blasio has strong ties to labor and has been endorsed by SEIU 1199. The national union has donated $4,950 to his 2013 campaign for mayor.

De Blasio’s staff has sought to emphasize after his arrest that he has been engaged on the issue for years, even when he was a City Councilman. The hospital is in his old district.

As if to prove naysayers wrong, De Blasio has continued to roll out statements, reports and make appearances to call attention to the Brooklyn health crisis.

In his role as public advocate — commonly considered a platform for being a watchdog over city government that rarely engages the state — De Blasio has announced a plan to save failing hospitals that calls for the establishment of an authority to oversee spending of health funds and stopping hospital bankruptcies.

As mayoral candidate, he has launched a “Save Our Hospitals” tour that kicked off on Wednesday at Interfaith Medical Center in Bedford-Stuyvesant, which could close under financial duress by Aug. 15. On Wednesday, De Blasio visited Wyckoff Heights Medical Center while touting a plan to create a state and city super authority to oversee hospital service in Brooklyn. The plan would allow the authority to fire hospital CEO’s who aren’t successful.

Wyckoff CEO Ramon Rodriquez told The New York Daily News he welcomed the authority. “I don’t feel uncomfortable saying Wyckoff should be helped by the city and the state,” Rodriguez said.

But other elected officials wonder why, even after all the noise that he has been made, De Blasio has been all but publicly ignored by Cuomo.

State Sen. Kevin Parker, who represents parts of Brooklyn, has sent Cuomo letters since last summer requesting an audience about LICH and took to the Senate floor this year to protest what he saw as a lack of interest from the Cuomo administration in the LICH situation.

He said it was odd to see the cool reaction from Cuomo’s office about De Blasio’s arrest. When asked about De Blasio’s arrest, a Cuomo spokesman responded stingingly to a query by The Daily News that “the people of New York deserve an honest dialogue from those hoping to represent them — not political gimmicks.”

“Look, Bill de Blasio and Cuomo are supposed to be good friends,” Parker said, “and if Bill hasn’t been able to talk to the governor about this what does that tell you?”

When asked Tuesday at a campaign event whether he had discussed his plan with Cuomo or the state, De Blasio indicated state officials haven’t responded as quickly as he would like them to. He lobbed criticism at Mayor Michael Bloomberg.

“We have had some initial discussions with state officials on the kinds of changes we need...But I think at the state level there's some cognizance of the fact that hospitals closing without any kind of plan, without any kind of provision for healthcare for the future of this borough and this city is unacceptable. I don't think they're acting aggressively enough, but I think they get the point.”

Cuomo and De Blasio do have longstanding ties: In 1997, Cuomo was appointed to head the Department of Housing and Urban Development under President Bill Clinton. Cuomo then named De Blasio — who had worked for the Clinton/Gore campaign in New York — to represent HUD in New York and New Jersey. In 2002, Cuomo helped negotiate Cuomo’s exit from the governor’s race and the pair were reportedly close after Cuomo’s divorce from Kerry Kennedy. In 2010, De Blasio helped negotiate Cuomo’s relationship with the Working Families Party.

Cuomo administration officials indicated that the governor has not spoken directly to mayoral candidates about the Brooklyn hospital crisis, but that there may have been discussions between intermediaries. They acknowledged that a larger plan for sustaining the hospital system in Brooklyn is needed and that something is being discussed.

A source in the Cuomo administration who requested anonymity because negotiations were ongoing said that some sort of plan would likely be rolled out in early September. “No one is going to step foot in Brooklyn for the West Indian Day Parade without addressing the hospital situation,” the person said.

In May, Cuomo wrote U.S. Health and Human Services Secretary Kathleen Sebelius asking for $10 billion in funds to save four Brooklyn hospitals — LICH, Interfaith, Brookdale Medical Center and SUNY Downstate. Cuomo proposed that the $10 billion would come from the $17.5 billion the state says it will save from restructuring the state’s Medicaid program.

“Due to a rapid deterioration in the financial status of essential components of the health care services system in Brooklyn, if nothing is done within the next 12 months, the outcome will be disastrous,” Cuomo wrote, adding: “Access to care will be compromised and the remaining health care providers in the borough will be destabilized.”

The Cuomo administration is still waiting to get approval from HHS for the funding. Federal officials recently visited the four hospitals named by Cuomo in his letter with DOH officials.

In 2011, SUNY Downstate took over LICH’s assets with permission from a judge on the condition that it keep running the hospital but SUNY has not honored the ruling. SUNY has closed its residency program at LICH as well as a number of specialty departments including the maternity ward. It banned ambulances from delivering patients to the emergency room. SUNY has also begun sending patients elsewhere. A SUNY spokesperson said they were taking the steps for patient safety because the hospital is short-staffed.

LICH staff are concerned that the company hired to process LICH’s bills, Continuum Health Partners, has failed to collect payments. Some staff estimate the company has failed to collect nearly $15 million.

A spokesman for Continuum Health Partners declined to respond to the charge. “While Long Island College Hospital was a member of Continuum Health Partners, we did everything possible to keep it financially solvent so that the hospital could continue its mission to meet the healthcare needs of all who turned to us for help,” the hospital said in a statement.

Meanwhile, according to a report by Comptroller Thomas DiNapoli, SUNY has transferred cash from LICH to other accounts.

Parker said it may be too late to save LICH. A combination of factors have led to the failure of Brooklyn hospitals, he said, including lower reimbursement rates, the large indigent population they serve and what he described as a failure of the state to acknowledge the change of how healthcare is provided in the country.

“Instead of coming in with a hatchet and closing hospitals willy-nilly the state needs to help manage communities through it,” Parker said, adding that he has worked closely with people at SUNY and feels that they simply don’t have the background in managing hospitals to make LICH a success.

He also said the people he has dealt with at SUNY regarding LICH are “feeling frustration over a lack of direction from the governor.”

All this is taking place as Interfaith Medical Center has filed for bankruptcy and the health department has rejected proposed restructuring plans. It plans to wind down on Aug. 15. Kurron Shares of America has been accused by many of mismanaging the hospital into bankruptcy. Kurron is a for-profit company that comes in when medical facilities are on shaky ground and replaces management. Just before Interfaith filed for bankruptcy in 2012, the hospital renewed a $3 million contract with Kurron to outsource its management. Hospital executives have defended Kurron, saying the hospital was doing well until cuts in Medicaid rates in 2011.

SUNY Downstate has been taking bids on the LICH property and Legislators, including Parker, have called on SUNY to reveal the ever one of them so that public can see how the decision process is working.

State Sen. Daniel Squadron, who is running to succeed De Blasio as public advocate, has pushed the Legislature to come up with a comprehensive plan to save LICH since last year. He said he wants another operator to come in and continue to provide medical service to the community but he says he thinks SUNY’s failure to manage LICH stems from the fact that “they have been allowed to think of it as $500,000 in real estate — not a hospital that provides an important service to the community.”

Community members are worried that LICH will be sold to developers who want to build condos rather than continue to provide health care.

Parker, Squadron and De Blasio all note that the hospital closures are going to mean painful job losses to one of the poorest areas in the state. “The governor wants to talk about job creation upstate well then how is he going to let us lose 2,000 jobs in an area with some of the most intense poverty in the state? Meanwhile he wants me to vote for SUNY Free or whatever it is called while he putting my constituents out of work,” Parker said.

Squadron said a solution could be hammered together, but it requires one thing: working together.

“Right now progress is not being made when it comes to LICH,” Squadron said. “If folks sat down together at a table to talk about it, I think it would be very clear what the answer is.”

City Government reporter Chester Soria contributed to this report from New York.

NEW YORK — Mayor Michael Bloomberg is far from accepting the bitter taste of defeat after a judge barred his administration from putting into practice its signature ban on large sugary drinks.

"We believe that the judge's decision is clearly an error and we will prevail on appeal," Bloomberg said in a press conference hours after state Supreme Court Judge Milton Tingling ruled against the policy on Monday.  

The limit on sugary beverages larger than 16 ounces, which was supposed to start on Tuesday, would have applied to any vendor that was inspected by the city’s Department of Health. But the rule had gaping loopholes: While it might apply to most restaurants, chains like 7-11 would still be able to sell wondrously large drinks because they are not regulated by the DOH but instead by state authorities. The rule also would not have applied to alcoholic drinks, or any drinks with more than 50 percent milk. And refills also would not be limited.

Recognizing the loopholes, Tingling called the limits “arbitrary and capricious.” In his 36-page decision, the judge said that the mayoral-appointed Board of Health, which promulgated the rule, had overstepped its authority as an administrative agency of the executive branch.

The City Charter, the judge wrote, does not grant the BOH the sweeping and unbridled authority to define, create, authorize, mandate and enforce the so-called “soda ban.”

"The rule would not only violate the separation of powers doctrine," Tingling wrote, "it would eviscerate it. Such an evisceration has the potential to be more troubling than sugar sweetened beverages."

Instead, he implied that such a sweeping mandate should be taken up by the legislative branch.

Bloomberg, who said his administration would not pursue any action through the City Council, argued that Tingling's decision is only the latest in a string of lower court rulings that would not stand upon appeal.

"There are many, many instances where a lower court decision has gone against us and then been reversed," the mayor said. "If lower court rulings had always stood, Grand Central Terminal would have been knocked down forty years ago."

One reporter asked Bloomberg at tonight's news conference if the recent string of court upsets against the Bloomberg administration shows a trend of overreach. Specifically speaking on court rulings on the city's restrictions for single adult homeless shelter eligibility and the mayor's taxi medallion plan, Bloomberg responded that the city would win on appeals.

The city’s Law Department said it was “confident” the rule would stand on appeal. “This measure is part of the City’s multi-pronged effort to combat the growing obesity epidemic, which takes the lives of more than 5,000 New Yorkers every year, and we believe the Board of Health has the legal authority – and responsibility – to tackle its leading causes.”

The lawsuit was brought against the city by a coalition of business groups, unions, merchant associations and beverage makers, who acknowledged the problem of obesity, the judge wrote in the decision. But he said the groups argued  “the link between sugary drinks and obesity are not as clear” as the city has asserted.

One of the groups that sued the city over the limits, the American Beverage Association, said in a post on its website applauding the judge’s decision that “the court’s decision upholds a principle that most of us believe in — freedom of choice.”

Democratic Councilwoman Letitia James of Brooklyn has been a vocal opponent of the mayor's ban on large sugary beverages from the get-go, and said she was pleased with the judge’s ruling.

"The mayor overstepped his executive power by not securing a vote in front [of] the City Council or the state Legislature," James said.

She said that the city's decision to appeal is par for the course, and creates more opportunity to debate the subject.

"It's not over yet," James said. "So continue to drink your Big Gulp."

Image of Bloomberg at Monday's news conference, courtesy of the mayor's office. Photo Credit: Kristen Artz.

NEW YORK — After every meal, Betty Hitz would try to clean up the dining room of the nursing home where she lived.

When the staff tried to stop her, Hitz, a 78-year-old Alzheimer’s patient, became furious, screaming, and punching people.

This is the point where many New York City nursing homes would turn to powerful antipsychotic medications to control Hitz’s behavior. The drugs sedate patients so they’re unable to act out. But they also come with serious side effects. For decades, these medications have been known to increase the risk of falls, strokes, and death among people with dementia, which includes Alzheimer’s.

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The drugs are so dangerous they’re banned as “chemical restraints” under state and federal regulations. Still, they’re loosely regulated and commonly administered to New York City patients. An analysis of recent Medicare data reveals an estimated 9,400 elderly New York City nursing home residents — about one-in-four — are administered the dangerous drugs.

Some nursing homes have more than 50 percent of patients on antipsychotic drugs.

Officials with the state Department of Health say their inspectors are trained to look for the use of unnecessary drugs — not whether powerful antipsychotics are being prescribed legally and in accordance with best practices. The Long Term Care Ombudsman Program, a joint federal and state program, says antipsychotics are "outside their sphere of responsibility."

Not all nursing homes drug their seniors into submission. Some are on the other end of the spectrum, working to reduce the reliance on chemical restraints. And it is at those nursing homes where some of the best solutions to weaning dependence on the use of antipsychotics can be found.

Providence Rest Nursing Home, with less than two percent of residents on antipsychotics off label, is one of them. Susan Steinberg, administrator of Providence, said their staff avoids the use of antipsychotics and provides personal attention to address behavior problems. She also started a program where high school students help feed seniors dinner in the dementia ward every weekday.

Cobble Hill Health Center, a nursing home in Brooklyn, is also trying to reduce its dependence on antipsychotic drugs to control patients. Most nursing homes are institutions designed to provide acute care, which requires strict schedules, food guidelines, structured activities, and mandated physical therapy. That aggravates people with dementia, says Tony Lewis, administrator at Cobble Hill.

"A dementia unit has to teeter on the brink of anarchy but not slip into it,” Lewis said. “There has to be enough space for people to do their own thing.”

On the night Hurricane Sandy struck, many residents at Cobble Hill were upset. But instead of sticking to the institutionalized schedule, nurses allowed four patients to get up at 3 a.m. and eat peanut butter sandwiches.

"That was one of my proudest moments," Lewis said. "That's a situation that would never happen in most nursing homes, where strict rules govern sleeping and eating patterns for the convenience of the staff.” 

Lewis said simple things make a big difference. For example, during shift transitions, staff are silent, they don't say hi, goodbye, visibly put on their coats, or chat with each other. The commotion of people coming and going can upset and confuse residents with dementia, Lewis said.

It's not all simple. Sometimes figuring out individuals' triggers can take months while staff members compare notes. Every person brings different experiences, cultures, and habits that require interpretation.

"Each one [of us] has to become a little Sherlock Holmes to unlock the little mysteries,” Lewis said.

Lewis described a resident that yelled and screamed about dying babies. After some investigation, staff realized screeching wheels on the medication cart sounded like crying babies to her. They could have controlled the outbursts with antipsychotics. Instead, they spritzed WD-40 on the wheels.

There are times when limited use of antipsychotics are warranted, doctors said. Dr. Dilip Jeste, a professor of psychiatry and neuroscience at the University of California San Diego, who recently published a study of long term antipsychotic use said, “Antipsychotics should be used in shorter term, side effects monitored, low doses, and stopped when possible.”

That’s what happened for Betty Hitz, after Cobble Hill staff tried for several weeks to calm her down, according to her daughter, Carol Hitz.

The younger Hitz, a psychiatric social worker, reluctantly allowed them to administer a low dose of an antipsychotic medication that “helped take the edge off.” At the same time, the nurses, realizing that Hitz was a retired substitute teacher, decided to allow her to help clean up after meals. They also gave her simple administrative tasks like organizing index cards. Now they’re weaning her off the drugs.

“It was the social interventions that made the difference,” Hitz’s daughter said.

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Elbert Chu is a science and education journalist. He’s worked for The New York Times, Popular Science, Fast Company, and ESPN. His documentary photography has spanned Lubavitch Jews and Orphans in Nepal, to the devastation of Haiti’s earthquake and a school shooting. He and his wife live amazed by grace in New York City. www.elbertchu.com | @elbertchu

NEW YORK — The struggle to care for a loved one with Alzheimer's can lead family members to agree to heavy doses of antipsychotics.

Take the case of Abigail Dennis and her mother, Anita Dennis, 87.

The elder Dennis was given to arguing and screaming at her home health aide, so Abigail Dennis asked her doctor for help. He prescribed heavy doses of antipsychotics. Abigail Dennis said the doctor gave no warnings.

“I had no idea about the risks, I just wanted her to be nice and not cause trouble for the aide," she said. 

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Dennis admitted her mom to Cobble Hill Nursing Home in Brooklyn, a facility that’s reduced its percentage of patients on antipsychotic drugs to 13 percent. Cobble Hill’s caregivers were shocked at the high dosages of the drugs, said Liza Long, head nurse of the dementia unit. They weaned the elder Dennis off them entirely. The nurses added that the elder Dennis went from kicking, biting, and screaming when she came off the drugs — to laughing and hugging everyone after proper care.

“I asked the staff what drugs they gave her and they said vitamins,” Dennis said.

In this video, Abigail Dennis tells of her family's experience with antipsychotic medications.