By Gerald Beallor, Co-Chair, Health Care Policy and Practice Network
(September 1995)

Despite the outpouring of support on many levels for NASW's position on Governor Pataki's proposals to eliminate hospital social work departments, the battle is not yet won.

The change in New York State's political climate and the anti-regulatory stance of the health care industry combine to place large obstacles in the way of a satisfactory resolution. The Hospital Review and Planning Council, which makes recommendations to the Commissioner of Health, has acted to postpone voting on the proposals by "unbundling" the various parts which requires publication in the New York State Register and a further public comment period.

The Council action is in response to the wishes of its members who want to have the opportunity of voting on various parts of the original proposal. The unbundling approach to the hospital portion of the deregulation proposals was initiated at the Council's Codes Committee meeting held in Albany, July 20. At that meeting representatives of all the social work organizations in the coalition presented testimony on the impact of proposed regulatory changes on the quality of patient care and on the ability of social workers to carry out their mission in the hospitals.

Presentations were also made by others including the senior vice president of the New York Academy of Medicine, Dr. Alan Fleishman. The testimony was impressive and was topped off by Ted Alter of Staten Island who presented the chairman with one thousand letters from patients, clients and other citizens of the borough. Members of the Code Committee commented on the volume of mail they had received; more than on any issue they could remember. They were upset, however, by the prospect of having to vote a number of proposals up or down as a package and therefore resolved to have the issues unbundled for their next meeting. This action was approved by the Hospital Review and Planning Council and was supposed to have been published in the State Register at the end of August.

Prior to the Codes Committee meeting, hearings were held in Albany and New York City by Assemblymen Richard Gottfried and Roberto Ramirez who chair the Health Committee and Government Operations and Regulations Committee respectively. Important testimony was provided by social workers and others on all the Governor's proposed deregulations of Health Department regulations. Health Commissioner Barbara DeBuono brought suggested changes in the social work regulations to the hearing, indicating her interest in finding an appropriate compromise. The suggested changes made by the Commissioner and her Executive Associate Commissioner, Karen Schimke, were designed to protect patient care as well as ensure standards of social work services in hospitals. However, as the members of the Coalition to Save New York Social Work (made up of the New York City and State Chapters of NASW and 1199, The National Health and Human Services Employees Union) were considering whether to support the new language which was to be published in the New York State Register by the end of August, new objections surfaced from health care industry sources.

Action postponed

As of the end of August, Executive Deputy Commissioner Schimke and her staff are working to produce yet another version which would be acceptable to the Health Department, the social work community, the health care industry and the Governor. Publication in the Register is not expected before the end of September and action by the Hospital Review and Planning Council is therefore postponed to December at the earliest.

The changes in the proposals which were questioned would have assured services which meet social work standards, under the direction of a social worker with full credentials, including a masters degree from an accredited school of social work. That person would be responsible for the management of the social service staff, the

provision of a stated list of services and for quality assurance; all to ensure access, patient satisfaction and appropriate coordination. The coalition leadership was informed that the objections of the governor's office included these provisions which are designed to protect patient care. If the Governor's objections are sustained, the proposal would be totally unacceptable to the social work coalition. Also, whatever the language in this portion of the regulations, the provision requiring a social work department would be eliminated as originally proposed.

Seeking compromise

The Health Department Commissioner's office is seeking a compromise acceptable to the social work profession and the hospital associations. Next steps will depend on the specifics of the Health Department's revised proposal. The leadership of the Coalition, including Dr. Barbara Brenner, President of the New York City Chapter of NASW, will meet to develop further strategy during the month of September. The members of NASW and of other organizations in the coalition will receive an update and suggestions for further action late in September. The leadership will have to take into account both the changes that will take place in the membership of the Hospital Review and Planning Council and the role of the Governor in seeking deregulation in Executive branch agencies. The members of the Hospital Review and Planning Council are appointed by the Governor with the confirmation of the State Senate. Most of the members of the Council are sitting with expired terms until the Governor makes new appointments. These are expected in the very near future. Once the new appointments are completed, the Council will reflect the State's current political divisions.

Leaders of the Assembly who helped in the original effort are concerned about the Governor's use of regulatory power. However, they recognize that legislative and regulatory matters cannot go forward without cooperation of the Governor. The Coalition leaders recognize the need to reach the Governor with the concerns of the profession regarding the need to maintain quality care. They also understand that pressure is coming from the hospital associations. Hospital managements are working to consolidate departments and functions to minimize costs. However, in re-engineering hospitals, care must be exercised not to harm patient care as a result of lack of understanding of the professional role of social workers. Such concerns will occupy this profession and others for some time to come. Bottom line thinking and an anti-government, anti-regulatory atmosphere threaten to destroy many of the services social workers have initiated and supported for many years. Those services are basic to safeguarding consumer services and safety.