Kevin Cahill. (Photo by Dan Barton)

When HealthAlliance of the Hudson Valley first announced that it is considering closing one of Kingston’s two hospitals, Assemblyman Kevin Cahill was upset. Cahill, who served as a midwife of sorts in the merger between Kingston and Benedictine hospitals back in 2009, called that possibility “a disaster” and demanded complete accounting of the $47 million in state money he had helped get to make the merger happen.

He’s now tempering that reaction, saying the state invested money in the hospitals’ survival, and that the closing of one hospital may well be the next logical step. His priority now, he said this week, is making sure the community has a voice in whatever decision is made.

“This isn’t going to happen overnight,” said Cahill. “There are so many steps between here and there, not the least of which is [state] Department of Health approval. The terms and conditions are not necessarily strictly in the hands of the people who are saying we need to make decisions.”

Cahill concedes that Kingston is not a large city, which may make supporting two hospitals a challenge in an era when hospitals are becoming less dominant as providers of health care. But, he said, HealthAlliance draws patients from a very large geographical area, which convinces him that two large health-care institutions, if not actually two standalone hospitals, can attract sufficient business to survive.

“Can they be two full-service hospitals? Probably not,” he said. “Nor would that make sense in the 21st century, given the whole transformation of health care. At the end of the day, what we may see is one of the facilities turned into a place where you go and you stay after surgery or to recover from an illness, while the other becomes a place where you go to have a procedure and you leave. Those comprehensive outpatient centers are something we’re really lacking across New York State.”

Continue to repurpose

It’s a tightrope walk — providing health care services as more and more hospitals in New York State find themselves unable to meet their financial obligations. For some, the answer is turning off the lights and locking the doors. That’s what has happened in the past couple of years at several New York City hospitals.

The Cuomo administration is knee-deep in restructuring health care, not only in reducing the number of hospital beds but also in encouraging alliances among insurers, employers, groups of doctors and hospitals. The challenge of creating a new model for health care is not a new problem. It’s why the Berger Commission originally looked at the state’s hospitals and decided back in 2006 that nine should be closed and 48 restructured.

Cahill believes that radical creative solutions must be considered inKingston. “One of the challenges that HealthAlliance mentioned is that doctors are doing more procedures in their offices,” he said. “That’s because they’ve determined that the return is worth the risk. If a center could reduce that risk and maintain that return for the doctors, perhaps that’s the place they would go. We should encourage them to do procedures in a central place that has a lot of the other services they need. All the secondary support — follow-up, even administrative services — can be done far more efficiently on a larger campus rather than five or six or seven individual doctors’ offices.”