One Brooklyn Health (OBH), a state-backed health care system, ended inpatient care at its Kingsbrook Jewish Medical Center at the end of June. The decision, which had been temporarily delayed due to the COVID-19 pandemic, has resulted in the loss of about 200 hospital beds in East Flatbush, a Brooklyn neighborhood populated largely by working-class African Americans and Caribbean immigrants.

The conversion of Kingsbrook, a 303-bed hospital, into a “medical village” proceeded despite protests from local residents and Kingsbrook staff alike. One Brooklyn Health claims that overall hospital beds and jobs did not decline due to the consolidation, with beds and staff transferred to its facilities at Interfaith Medical Center and Brookdale University Hospital Medical Center.

These assurances notwithstanding, the end of inpatient care at Kingsbrook Jewish Medical Center is part of a broader wave of consolidations and closures at hospitals in New York City’s working-class outer boroughs. Prior cuts left these areas even less prepared for the pandemic, contributing to the disproportionate deaths of poor New Yorkers during the first phase of the pandemic in spring of 2020, during which New York City was the global epicenter.

Moreover, with cases once again rising across New York City and with Brooklyn undervaccinated compared to the state average, New York City hospitals may once again be pushed beyond capacity in the coming months, making the shuttering of 200 hospital beds irrational at best and homicidal at worst.

Workers and patients at smaller hospitals like Kingsbrook, lacking the resources of the hospitals in the New York-Presbyterian and New York University Langone Health systems, have suffered greatly from the pandemic.

The New York Times found that there were staggering patient-to-staff ratios during the early stages of the pandemic at Kingsbrook and other under-resourced hospitals. Ratios in emergency rooms “hit 23 to 1 at Queens Hospital Center and 15 to 1 at Jacobi Medical Center in the Bronx, both public hospitals, and 20 to 1 at Kingsbrook Jewish Medical Center, an independent facility in Brooklyn,” whereas the recommended maximum is four patients per nurse. While wealthier hospitals did see spikes in patient-to-nurse ratios, they were not as extreme.

The conditions at Kingsbrook resulted in health care workers dying, with five workers dying just by April 2020, according to a tally collected by the workers themselves.

Kingsbrook has been regarded as a “safety-net hospital,” primarily treating patients on Medicaid or Medicare rather than private insurance. Because Medicaid pays only about 73 percent for care provided, and Medicare pays less than provided by private insurance, most hospitals rely on a “payer mix” to prevent losses. However, safety-net hospitals do not have enough patients on private insurance to remain afloat.

The result is continual losses, made up for by cuts to staff and periodic infusions from the New York state budget.

The plan submitted to the New York Department of Health’s Public Health and Health Planning Council by One Brooklyn Health makes clear that the consolidation will likely result in worse care for Brooklyn residents on public health insurance, especially those who currently rely on Kingsbrook, with the aim to capture more Brooklynites with commercial insurance, who typically go to better-resourced hospitals elsewhere in the borough or in Manhattan.

The proposal notes: “The three OBHS [One Brooklyn Health System] hospitals account for only 16.8% of total hospital discharges from residents in their service area, and studies have noted that this high degree of outmigration to other Brooklyn hospitals as well as to Manhattan hospitals, represents an opportunity for OBHS to recapture patients. Outmigration is particularly common for high acuity services that command higher reimbursement than more routine services. Outmigration is most prevalent for commercially insured patients, with 72% leaving the service area for inpatient care.”