Standing on Gold Street in lower Manhattan, Susan Brown Roschen looked up, dumbstruck at the sight of the "sick hospital" she had just been elected to lead as board chairwoman.
It was April 1990. A power shortage lasting several days sent the feeble healthcare facility into multisystem failure. It limped along on an emergency generator until power sputtered out 11 hours later. Then, Consolidated Edison came to the rescue.
Tubes carrying electricity from the street snaked up the side of New York Infirmary-Beekman Downtown Hospital like "octopus hands," Roschen says. Inside, intensive-care nurses pumped patients' oxygen bags by hand while staff scurried up stairwells with trays of food and medicine.
Although Roschen had been active at the hospital since John F. Kennedy was president, she had "absolutely no idea" what she was getting into when she agreed to take the helm of the board. That moment of crisis helped crystallize the enormous task before her.
Today the "patient" is breathing easier. The newly renamed NYU Downtown Hospital has mended its deteriorating infrastructure, cemented relationships with Wall Street and the local Chinese community, secured a committed partner in New York University Medical Center and stabilized the bottom line.
For nursing the hospital back to health when others were ready to write do-not-resuscitate orders, Roschen is MODERN HEALTHCARE's Trustee of the Year for hospitals and health systems with more than 200 beds or annual revenues of more than $25 million. Roschen stepped down as chairwoman of the 30-member board in 1995 but remains active as a trustee and co-chair of its development committee.
"When I came on (as chairwoman in 1990), the hospital was just about in bankruptcy," recalls the 62-year-old mother of six. From 1981 to 1991, 140-bed New York Downtown piled up losses topping $60 million for the decade. Under Roschen's guidance, management pared the loss to $478,000 on revenues of $104.3 million in 1996. That's down from an intolerable $8.3 million in 1991, when the determined chairwoman began revamping the hospital's management and governance.
Bringing up baby. "This is my seventh child," she says now with pride.
How this former nurse's aide put her most difficult child back on track still impresses those who witnessed the turnaround.
"This is a woman who's truly a lady," says Bruce Logan, M.D., senior vice president of ambulatory services and the hospital's chief of medicine. At the same time, one of her greatest assets, he says, is her disarming manner. "People don't realize that she's got a backbone of steel."
In late 1993, for instance, Roschen successfully opposed a "sponsorship" arrangement offered by New York Hospital-Cornell Medical Center, its former academic affiliate. The deal consisted of a $10 million loan and certain support services. But it would have dismantled the board, remade under Roschen's reign to represent key community leaders. If the hospital had accepted the deal, the board felt it would be cutting off its ties to the Chinese community, she says.
The steadfast chairwoman held out for a better offer. And she got it, from NYU: $18 million and a commitment to maintain the hospital's community focus.
Ronald H. Menaker, who took over as chairman in 1995, says Roschen recognized what needed to be done and made it her mission to see that the hospital survived.
For many years, Wall Streeters thought "we were simply throwing good money after bad," says the managing director and head of corporate services at J.P. Morgan. Roschen's focus on providing and publicizing community services, like maternity and cardiac care, has helped change that perception, he says.
NYU Downtown Hospital began life in 1853 as the New York Infirmary for Poor Women and Children, which was founded by Elizabeth Blackwell, the nation's first licensed female physician. The hospital has changed monikers several times in recent years since merging with Beekman Hospital in 1979.
Long service. Roschen's involvement at the hospital began in 1961 when she was a volunteer nurse's aide for the Red Cross. Clad in white stockings and a hat, she trained at the old New York Infirmary, where she became acquainted with the head of the auxiliary, who drew Roschen into the hospital's inner circle of women ambassadors. In 1978 she became a trustee.
Stewardship practices had changed little since the 1940s, when women donned white hats and gloves and sipped tea at board meetings, according to Roschen. "Problems were never discussed, to be truthful, in those days," she says.
By 1989, the year she was asked to lead the board, the hospital's future existence seemed doubtful. Eleven chief executive officers had come and gone in 14 years. Meanwhile, the board was stifled by a lack of new blood.
Roschen's first task was to bring in some fresh faces. Cleaning house could have been a bloody undertaking, but it wasn't. "It was the same group that ran the hospital in the '40s," she notes, saying most of the board's elder statesmen passed away during her tenure. "The hardest thing was to get new recruits in," especially for a woman lacking high-profile visibility in the community, she acknowledges.
To instill efficient management practices, she turned to the Hunter Group, a St. Petersburg, Fla.-based hospital management company, for assistance. CEO David Buchmiller stabilized operations and helped hospital staff become sensitive to community needs. He was succeeded in 1991 by Alan Channing, who stepped down in July 1997. Leonard Aubrey is acting CEO. A search is under way for a permanent replacement.
Not crazy. Roschen also recruited a number of new medical service chiefs and won over cynics on the medical staff. When she told them the hospital would be getting a new intensive-care unit, they laughed. "They thought I was absolutely crazy," Roschen says.
But eventually she won their respect. For the first time, physicians gained representation on the hospital's board. And the hospital secured a $55 million state-backed bond to make needed repairs and modernize the timeworn infrastructure. "They trust her," says Logan, chief of medicine since 1991. "I think that they trust that she's really trying to do the right thing for the hospital."
NYU Downtown serves a diverse population of commuters and residents. The hospital sits just blocks from City Hall, the World Trade Center and Chinatown.
In an emergency, NYU Downtown is the sole hospital serving lower Manhattan. Five years ago, its cafeteria doubled as a triage room for patients who survived the World Trade Center bombing, which killed six people and injured more than 1,000.
In recent years, NYU Downtown has made strides in embracing the Chinatown community, hiring bilingual staff, developing alliances with community organizations and revamping its maternity ward. It also has catered to the financial community by building a chest pain unit actively used by stressed-out Wall Streeters.
During Roschen's tenure as chairwoman, outpatient visits have soared, reaching 27,600 last year from 14,855 in 1993, pediatrics has expanded, and a team model of patient care has been implemented.
"These are all innovations that Mrs. Roschen was involved in," Logan says.
Passing the baton. To her credit, Roschen recognizes that the hospital now needs a new kind of leader. Having J.P. Morgan's Menaker at the helm will raise the hospital's profile in the financial community, part of its core service area.
"She knew when to pass the baton, and she picked the right person to pass the baton to," Logan says. "When you're raising money, you need the old-boy network on Wall Street."
Roschen's legacy to the community is a healthy hospital, a figment of its former, frail self. "The future is for us to just get better and better at what we're doing," she says.