While hospitals, nursing homes are eyed for closures, other changes –

State spares local health care facilities


Bob Ellis/staff photographer
Cortland Regional Medical Center radiologic technologist Mike Lynch examines a patient using the hospital’s C-Arm Portable Floroscope, or digital X-ray machine, in 2005. Area hospitals were spared from a state commission’s recommendations for closures, consolidations and downsizing, in part because their practices comply with the commission’s recommendations for health care across the state.

Staff Reporter

CORTLAND — Area facilities were spared from a state panel’s recommendations to close some hospitals and nursing homes and consolidate others.
Officials at the Cortland Regional Medical Center, Northwoods rehabilitation centers and Groton Residential Care Facility say they may be absent from the panel’s report because they are doing something right. The head of the Commission for Health Care Facilities in the 21st Century, which issued the report Tuesday, agreed their efforts played a role.
The report recommended closing nine hospitals and seven nursing homes across the state. Dozens more were recommended for mergers, downsizing, and conversions.
Brian Mitteer, president and CEO of Cortland Regional Medical Center, at 134 Homer Ave., Cortland, said the hospital’s financial stability could be one reason the state is leaving it alone.
Unlike some other facilities, the hospital has not lost money, he said. Over the last 10 years, the hospital has seen about a 1 percent profit annually, Mitteer said.
The hospital and its facilities have an approximately $70 million annual budget and 950 employees, he said.
“I was just looking at the full report and most of the hospitals they targeted for closure have lost money,” Mitteer said.
Mitteer said the Cortland hospital may be better off financially than other hospitals because it has a good balance of Medicare and Medicaid patients.
Other hospitals have a higher percentage of Medicaid patients, and that could count against them, he said.
“Medicaid is usually a lower payment,” he said.
Another reason the state made no recommendations for the hospital may be because it has grown its outpatient services, which are less costly to patients and insurance companies than inpatient services, he said.
“Well I think there’s more use of that, versus admitting a person into the hospital,” Mitteer said. “At one point we would admit a person for a test and now we don’t do that.”
Mitteer said the commission used data for its report that the hospital had submitted to the state. He said he attended a public hearing in March to testify on behalf of the hospital.
The public hearing was not well advertised to community residents, he said.
“One of the concerns being aired around the state was there really were no public hearings for the community,” he said. “It was mainly CEOs, and a couple of communities brought in a president of their chamber of commerce when they were very concerned about their future.”
Cortland Regional has 181 hospital beds, 80 of which are in its nursing facility, he said.
Jeffery Earle, president and CEO of the Groton Residential Care Facility, at 120 Sykes St., said it is likely his nursing home was not mentioned in the report because its occupancy is very strong.
Earle said that on a given day, about 97 to 98 percent of its approximately 80 beds are full.
“So clearly you know we are fulfilling a need here in Groton that appears to be well-founded,” he said.
Earle said he noticed in the report that a number of the hospitals recommended for closure or reconfiguration had many unused beds.
Groton Residential Care Facility, which has the nursing facility for the elderly and homes for people with developmental disabilities, has 120 employees and a $4 million to $5 million budget, Earle said.
Northwoods nursing homes, which include facilities at 28 Kellogg Road, Cortland, and 7 Keller Ave., Moravia, also were not mentioned in the report.
Lisa Cupolo, marketing director for Northwoods, said one likely reason is because the company’s facilities often cost insurance companies less money than hospitals.
Sub-acute care centers, such as nursing homes, are able to cater the amount of rehabilitation a patient receives to that patient’s needs, she said, whereas many hospitals require patients to receive a certain amount of rehabilitation — such as three hours each day, even if that is too much for them.
By ensuring that patients receive the care they need, money is not wasted, she said.
“We’re just trying to make sure they’re paying for what they get,” she said.
Cupolo said the Northwoods facility in Cortland has about 200 employees and the one in Moravia has about 50.
Dena Perry, director of rehabilitation for the centers, said the facility in Cortland has about 200 beds and the one in Moravia has about 40.
Neither woman could give the homes’ annual budget on Tuesday afternoon.
Dr. David Sandman, executive director of the Commission on Healthcare Facilities in the 21st Century, said Mitteer, Earle and Cupolo were correct in many of their assertions as to why their hospitals were left out of the report.
Sandman said the commission weighed six factors to determine whether a facility should be closed, consolidated or reconfigured: Its service to low income, uninsured and Medicaid patients, its scope and breadth, its quality of care, its occupancy rates, its financial viability and its contribution to the local economy.
“We looked at all those factors and other analyses of whether patients were successfully absorbed by surrounding hospitals within reasonable times,” Sandman said.
Sandman said it was determined that Cortland Regional Medical Center should not close or lose services as it is the region’s only hospital.
“Cortland County does only have one hospital and you can draw a pretty broad circle around that hospital,” he said.
Sandman said rural areas tend to have a smaller supply of nursing homes and hospitals, which partly explains why many of the facilities recommended for changes are in urban locations.
Sandman said the recommendations are just a first step for the state to improve the efficiency of its health care system.
“There are still additional opportunities,” he said.


Engineer: Dredge, reshape Otter Creek streambed

Subcommittee examines 2000 study that shows reduced flow

Staff Reporter

Otter Creek, which runs through the heart of Cortland, has a flow capacity nearly five times less than what it should be, engineers told the county subcommittee on flooding Tuesday, a likely cause of recent flooding in the city.
The current flow capacity of Otter Creek of 200 cubic feet per centimeter would only be able to handle a 2-year storm event, said Roy DeTota, senior project engineer for C&S Engineering. He was basing this assertion on a study C&S did in 2000 for the city of Cortland, the town of Cortlandville and Gutchess Lumber on flooding issues along Otter Creek.
Doug Wickman, DeTota’s colleague at C&S, recommended the subcommittee set a goal of reaching a capacity of at least 1,000 cubic feet per centimeter through dredging and restructuring of the streambed. He suggested the county aim for gradually reshaping the streambed to be able to handle a 25-year storm.
The 2000 study done by C&S compared the streambed at that time to a flood analysis done by FEMA that provided cross sections of the streambeds circa 1983.
“Basically the physical characteristics have changed dramatically since then,” DeTota said. “The growth in the area had encroached on the streambed to the point where the foundation of some houses served as channel walls.”
DeTota and Wickman recommended working gradually to both widen and deepen the creek, and also suggested installing detention ponds nearby, which would collect stormwater in the event of a major storm, and release it back into the streambed at a controlled rate.
Although the 2000 study is now six years old, subcommittee Chairwoman Carol Tytler (D-3rd Ward) said the information is still valuable.
“When I contacted them and found out they had so much information already in place, I thought it was important that we take advantage of it,” Tytler said.
The committee, which is made up of both county and city officials, agreed that the suggested changes needed consideration, and asked that C&S prepare a proposal for the cost of doing further analysis of the streambed.
But committee members cautioned that approval from the state Department of Environmental Conservation for work in the streambeds and finding available land for the detention ponds in an already crowded area would be difficult.
Wickman said a well-designed plan for working in the streambeds and a demonstration that the nature of Otter Creek has changed considerably with increased development would likely sway such regulatory agencies as the DEC.
“This watercourse is not what it once was,” Wickman said. “For whatever reason its capacity has dramatically decreased, and if you can demonstrate that to the various agencies, they’ll go along with your plan.”
Residents living along the creek bed would also likely be cooperative, according to Common Council member Susan Feiszli (D-6th Ward).
“I think constituents in my ward would be very willing to give a temporary easement,” Feiszli said. “That’s their priority, widening those waterways so they won’t have to deal with flooding every year.”
Increasing the flow capacity along the creek would require significant financial and time commitments, Tytler said, and would likely require that work be done over a number of years, as funding becomes available.
“None of this can be solved overnight; the problems didn’t happen overnight,” Tytler said.
The more immediate potential fix to flooding problems, according to Wickman and DeTota, is setting up detention ponds to help manage flow during high water events.


Homer school board OKs  $16.5M   project

Staff Reporter

HOMER — The school board voted unanimously Tuesday to approve a $16.5 million project to renovate all of its school buildings.
The project would improve security at the schools, make the buildings more handicapped accessible and make the facilities more modern and useful, board members say.
The project will not raise taxes, said Michael Delair, business director, as money in the district’s reserves and state aid will cover the cost.
The district will cover about 10 percent of the cost, which includes money in its reserves and about $700,000 in projected state building aid. The state will pay the rest.
Of the $16.5 million, about $5.5 million would go to Homer Elementary School, $2.7 million would go to the intermediate/junior high school, $1.7 million would go to the high school, $600,000 would go to Hartnett Elementary School and $300,000 would go to the bus garage/music building.
The remaining approximately $6 million would be allotted to design contingency, construction contingency, inflation and incidental costs.
Security would improve at all the buildings, with upgrades to the buildings’ fire alarms, video surveillance and public announcement systems. Doors would be renovated so they can be locked from the inside.
Board President Forrest Earl said recent school shootings and other incidents have prompted schools to improve their security.
“I think we’re not the only district,” he said. “I think schools across the country are looking at the security of their buildings.”
The high school’s cafeteria would expand to cater to more students while Homer Elementary School’s cafeteria would move from the front of the school on the basement level to the back of the school on the first level, he said.
Other improvements would include better playground equipment at Hartnett Elementary School, a new building facade at Homer Elementary School, six new classrooms in Homer Elementary School, handicapped accessible bathrooms in the high school’s lobby and paved parking lots throughout the district.
A public referendum on the project will likely take place in February, Earl said this morning. Several public meetings will take place prior to the vote, he said. If approved by voters, the project would take about three years.



Dryden takes steps toward school project

Staff Reporter

DRYDEN — The Board of Education took the first step Tuesday to begin using $578,430 in state aid to help pay for a $3 million project to repair and improve its buildings.
Expanding Our Children’s Education and Learning aid would cover the local taxpayers’ portion of a capital project.
The state included $14 billion in this year’s budget in response to a court order for more equitable distribution of education funds.
At Tuesday’s meeting, officials of architectural firm Highland Associates, of Clarks Summit, Pa., and Christa Construction, based in Victor, gave a presentation on Dryden’s district needs.
Tracy Wescott, an architect for Highland, said the five school buildings are in satisfactory condition, but Dryden High School and Middle School could use a project worth as much as $11 million.
“The majority of it is for the middle school,” she said.
Some of the things Wescott said needed upgrading were roofs on the A and C wings, windows and door replacements, wheelchair access work in bathrooms, and heating, ventilation and air condition work.
Board President Anderson Young said the board welcomes public input on how to spend the $3 million.
A facilities committee will meet at 4:30 p.m. Dec. 6 in the district office conference room to discuss options. The public is invited.
“This will be the first in a series of meetings with board members, faculty and staff, to meet, review and advise the board on the basic options for the EXCEL money,” Young said.
Stewart Gray, who has a child in the district, said he did not have any concerns over the planned project. “I am very much in favor,” he said. “It is a great opportunity for the district to get a capital project for no cost or for very little cost.”
Wescott put forth two scenarios of how the $3 million could be best utilized. Both included renovating two boilers that have exceeded their “life expectancy.”
One option would cost $3 million and the other $3.3 million.
The district also wants to use $500,000 remaining from recent renovations at elementary schools to pay for more work at those buildings.
At Dryden Elementary, the district wants to do an acoustical treatment in the small gym. For all three elementary schools — Cassavant, Freeville and Dryden — the district wants to do roof repairs or replacement, replace the intercom systems, upgrade the phone systems, replace a master clock system and install security systems with card access and cameras at certain entrances.
According to Wescott’s timetable, if voters approve the project, work would begin in summer 2008.