Interfaith Medical Center. Brookdale Hospital. Wyckoff Hospital. St. Mary's Hospital. Kingsbrook Jewish Hospital. What do they all have in common? They're failing – fast. And as they rapidly continue on a path to complete non-performance and financial chaos, the Brooklyn community – especially the African and Caribbean-American communities – are suffering. With very few exceptions, Brooklyn's stock is akin to useless junk bonds, and while the health crisis continues unabated, our elected leadership fiddles like Nero while the "Medical Rome" burns.

With the disintegration of those institutions that help promote good health, the health outcomes for the community are bleak and getting bleaker. For instance, the New York City Department of Health and Mental Health reported in 2006 that in Flatbush “one in four adults persons were obese and more than 50 percent of the community reported that they did no physical exercise whatsoever.”

The upshot is that Flatbush and East Flatbush have some of the highest rates of diseases associated with obesity – diabetes, high blood pressure, heart disease and cancer of every sort. Kings County Hospital Center, one of the few performing hospitals in all of Brooklyn, is literally overwhelmed. Triage time is over three hours and the emergency room, used as a clinic by uninsured Brooklynites, especially immigrants, is strained to near breaking point. Sick patients routinely spend up to 15 hours a day at Kings County Hospital, because of the heavy case load that the hospital carries each and every day.

On October 4, 2005 St. Mary’s Hospital, which served a largely African-American community, closed its emergency room that, like Kings County, took care of poor Blacks who had no health insurance. This left a community of over 110,000 to find alternative medical help – especially in emergency situations. In 2004, St. Mary’s emergency room received 35,000 visits, 90 days later the entire hospital was closed.

St. Mary’s was the eighth Hospital in New York City to close since 2003. It is unclear how many more of the 73 remaining hospitals in the city – 11 of them publicly owned – are in danger of failure, but there is a general agreement that New York’s hospitals are facing financial crisis. And on both sides of the issue are to be found advocates for closing failing hospitals and those who argue to keep them open.

True, these large hospitals are victims of what I call a hospital cultural problem: keeping up with modern technology, while remaining alienated from the patient base that the institution is supposed to serve. A permanent hospital bureaucracy does not understand the community nor make informed changes – technological or otherwise – based on empirical community evidence, changing demographics and other socio-economic considerations and indicators. The end result is that when a crisis hits, this bureaucracy is at its wits ends to come up with Band-Aid solutions that only delay the next crisis.

That, of course, has a direct bearing on the quality of health care delivered. Because of these constant crises, these hospitals are not able to recruit the brightest and the best medical professionals available.

This greatly undermines the quality of care and its delivery, opening up a Pandora’s Box of problems, ranging from increased malpractice suits due to incompetence, inexperience and suspect medical practices. All this undermines the society’s confidence in the institution.

But part of the solution is simple. There is no Borough oversight authority that monitors these hospitals and how they spend public money, provide care to the consumer and look for indicators of possible trouble long before the situation becomes a crisis and is almost irreversible. Here is where I slight the political establishment, there have been recommendations on how to handle this problem, but I guess it’s not the sort of thing that makes the 6 o’clock news as a sexy crisis does.

So they wait for the next crisis to posture, talk, promise and ultimately do nothing – until the next crisis.

At any rate, there is a clear and unmistakable lack of political will to make this happen. And the sad thing is that the cost is minimal when compared with the rewards.

The upshot is that these large hospitals have all lost market share to a new phenomenon in the health care industry.

For example, loss of occupancy that creates excess bed-space is the direct result of dynamic changes in the health industry, most noticeably the growth and development of walk-in clinics that, with modern technology, are now providing services once the exclusive domain of hospitals. This has helped drain revenue away from hospitals and siphoned off its patient base, thus occasioning a loss of revenue.

The problem for hospitals is that excess bed space has to be paid for no matter that nobody occupies it. Hospitals are not clinics and must operate 24-7, bringing into question higher insurance costs, labor and wage issues, employee compensation, medical malpractice suits and a host of other variables and compliance issues that walk-in clinics do not have to bother with. So that excess bed space means loss of revenue for hospitals.

No large hospital in Brooklyn is now operating above 70 percent capacity – I believe that the average is about 60 percent, for every 100 beds only 60 are occupied at any given time.

The end result is that across New York State, hospitals have been bleeding financially since 2003, but the problem was there looming and creeping up long before that. In 2004, the City’s Health and Hospitals Corporation racked up a budget deficit of more than $200 million – five times the $39 million they lost the year before.

Today, in 2008, over 60 percent of all private hospitals in the city are operating in the red.

Long-term trends in health care have also taken a financial toll on New York City hospitals. Since the 19th century, when philanthropist, religious groups, and the city itself began enthusiastically building hospitals, a large proportion of medical care has been given through hospitals. Today, New York City has more hospital beds per capita than any other American city.

But over the past few decades, health care has shifted away from hospitals. Improvements in medical care have allowed patients undergoing procedures that would have kept them in the hospital for long periods to go home earlier. Advances in drug treatments for AIDS, for instance, have allowed patients who have in the past have been hospitalized to live reasonably normal lives.

Having clinics provide services that once required hospital admission has improved the lives of patients. But New York’s hospitals have found themselves under strain as they look for ways to adjust.

Many hospitals are following Brooklyn’s lead as the market becomes more and more competitive and health care for the undocumented, uninsured and underinsured becomes a daily struggle and challenge.