Pamela Brier and her husband, Peter Ashkenasy, were coveting a few relaxing days at their second home in upstate New York before submerging themselves into their respective careers when, "in the twinkling of an eye," Brier says, "this happened."
It was 1 or 2 in the morning on July 3, 2003, and they were on a back road only five minutes from their destination when Ashkenasy fell asleep at the wheel and crashed the car into a tree. Charlie, the couple's Chesapeake Bay retriever, was riding in the back seat and escaped unscathed, but between them Brier and Ashkenasy broke too many bones to count.
Paramedics arrived quickly, extracted them from the car using the Jaws of Life-"such an interesting term," Brier says-and airlifted them by helicopter to Albany Medical Center. Brier credits the car's air bags and the hospital's trauma center for saving her husband's life. The doctors say they never saw anyone injured as badly as he was because most people injured that severely do not survive such accidents, she says.
That one fleeting moment, which Brier cannot remember, cascaded into a medical odyssey that continues to this day, some nine months later. Thanks to Brier's career as a hospital administrator, Ashkenasy, 61, and Brier, 58, both benefited from the best healthcare that expertise could buy. It hasn't been so much an eye-opening experience as one that validates everything Brier already knew intellectually, she says.
"You cannot plan for a catastrophe like this," Brier says. She should know because if anyone could have planned for it, she would have.
The night of the accident was supposed to be the calm before the storm of a busy summer for Brier and Ashkenasy, who have been happily married since 1997. As the owner of Central Park's Sheep Meadow Cafe and Concert Foods, a concessionaire for park activities, Ashkenasy was readying himself for his busy season.
Meanwhile, Brier had just been appointed to succeed Stanley Brezenoff as president and chief executive officer of 639-bed Maimonides Medical Center in New York where she had been executive vice president and chief operating officer under Brezenoff since 1995. The two have worked together off and on for more than 20 years, many of those at the New York City Health and Hospitals Corp., the city's public health system.
"She's a hands-on, analytically based manager, but with a great ability to work with and motivate people and with a terrific service orientation," says Brezenoff, who left Maimonides in May 2003 to become president and CEO of four-hospital Continuum Health Partners in New York.
At Maimonides, Brier heads an eclectic community hospital ensconced in the Orthodox Jewish enclave of Borough Park, Brooklyn, but surrounded by a United Nations of ethnic communities, necessitating a patient bill of rights in 10 languages. Despite its community-oriented approach to healthcare, the hospital also strives to compete with the nation's best academic medical centers, and after investing a considerable amount in information technology-half of a $20 million yearly capital budget for several years in the mid-1990s-it has been recognized as one of the country's most-wired hospitals.
Brier is an executive who thrives on the controlled chaos of hospitals. One of her "great joys" as a senior manager is the opportunity it affords her to meet people, she says. She says she loves to walk around the floors and talk to patients and staff. Occasionally on the way home from a night out, her husband would suggest they cap off the evening with a visit to the Maimonides emergency room.
"You don't manage (the hospital) by walking around, but you sure pick up good information and see a lot and talk to staff, patients and the families of patients," Brier says. "You can't be an effective CEO and stay in the office-and it's such an enjoyable thing to do. There's a million stories."
Still, Brier has a sober-eyed view of hospitals. She says the first day she walked into her first hospital as a CEO-Jacobi Medical Center in the Bronx in 1989-she was humbled by the overwhelming responsibility; "the sense that you as CEO are responsible for overseeing the care of all these people 24 hours a day, seven days a week." But she says it didn't take long for her to realize that the work got done not because of her but because of the hundreds of employees who knew what they were doing.
Brier was no stranger to hospital care as a patient either. After suffering years of chronic back pain and buying and selling three cars because she thought there was something wrong with the seats, in 1997 she was diagnosed with congenital scoliosis and underwent 10 hours of spine surgery at Maimonides. She admittedly was in a "good position to marshal resources," in addition to being reasonably young and healthy, with "a great husband who was an energetic caregiver," but still, she was frightened, she recalls.
"I think the most frightening thing for a patient is going home from the hospital and having all the things you need without access to the system," Brier says. "The health system is not so good at nonmedical things. Reimbursement for these services is time-limited." Brier focused on the caregiver issue after her spine surgery and saw to it that a program was started at Maimonides that helped give support to the friends and family members who are so crucial to the well-being of patients.
Lanky and energetic, Brier is in many ways the consummate New Yorker, though she was born and raised in Los Angeles. She is forceful and direct, giving the impression of a taskmaster with heart. Clearly, her walking-and-talking style of doing things was seriously cramped by the Fourth of July weekend accident.
Leaning against Brier's desk in her office is a metal cane, and there is also a stepper and a small cycling wheel that helps her exercise her legs while sitting in a chair. The office is relatively unencumbered now, she says. When she first returned to Maimonides, there was a wheelchair and a walker at the ready. Ashkenasy has been home-at least in the new home they moved into that doesn't have stairs and is close to Maimonides-only since January. He's using a walker and making wonderful progress, she says, but he and Brier both are looking at more surgery and more physical therapy.
Brier spent one week in the intensive-care unit at Albany with little memory of it. Brezenoff also has a home upstate only 30 miles away from Brier and Ashkenasy. He visited them at the hospital the day after the accident.
"She was heavily sedated," Brezenoff recalls. "First, it was truly miraculous that they were alive and as grateful as we all were for their survival out of that awful event, they were both looking at a long, painful and difficult immediate future." Brier's expertise offered no guarantees. "I suspect there are pluses and minuses" involved in being so intimately familiar with hospitals, he says. "You can know too much and be shifting a lot of information and evaluating all of the possibilities."
Coming up with a plan
Almost immediately, the chairs of surgery, orthopedics, plastic surgery and others from Maimonides drove up to Albany and brainstormed with doctors there on a recovery plan for Ashkenasy, Brier says. They helped the couple decide on New York University.
Three weeks after the accident they both transferred to NYU Medical Center, where expert plastic surgeons could help put Ashkenasy back on his feet again. Ashkenasy, who spent two months in intensive care, was airlifted back to New York. Brier was taken by ambulance to NYU's famed Rusk Institute of Rehabilitation Medicine.
No surprise to Brier, being a caregiver to her husband was more emotionally wrenching than being a patient. She spent about four weeks at Rusk and then moved to an apartment across the street from NYU so she could be close to her husband. Even while she was a patient at Rusk, she says, she would visit him three times a day, getting someone to help her wheel over there after her own grueling physical therapy sessions. At the same time, she was "checking in" at Maimonides, working on the telephone and summoning managers to Rusk, and later her apartment, for meetings. Her recovery was challenged by "a few knee infections," which she describes as "very annoying-just to show you that hospitals can be dangerous places."
Brier was back at Maimonides a couple of days a week by early September, though she was still undergoing therapy-as an outpatient at Maimonides-and still working full time as Ashkenasy's caregiver. The hospital never skipped a beat, a testament to the staff that works under her, she says.
"Coming back to work and taking up the authority to function as the CEO after the accident and still trying to be a responsible caregiver was the hardest thing I have ever done in my life," she says unequivocally.
Success was "really due to my unbelievable friends and family and the people who work (at Maimonides). Not a day goes by that I'm not grateful for what I have and the staff here. But back to the point-it's just not one person who runs a hospital. It's just not."
Ashkenasy spent two months at Rusk, and was later a patient at Maimonides. In the meantime, Brier moved yet again to an apartment just blocks from Maimonides. They have a full-time home health aide and do not want for help, yet "the life of a caregiver is a tough life," she says. The costs are largely paid by insurance but she has developed an appreciation for coverage limits. To her surprise she realized the hard way that Maimonides negotiated a contract-which she as CEO tacitly approved-with Oxford Health Plans that sets a two-month maximum for inpatient rehabilitation. There is also a 90-visit lifetime cap on outpatient visits. "Now who thinks about that?" she asks rhetorically. "But listen, I am very fortunate-more fortunate than most people because of my position."
The truth is the experience only reinforced what Brier had observed during her many years as a senior executive. Always an enthusiastic proponent of having the best nurse-to-patient ratios that a hospital can afford, now she says she really understands what it feels like when patients have to wait for medications or a change of dressing. "Not that I didn't appreciate it before, but I really get it," she says.
In general, "the health system is everything we know it is," she says. "It is not rational. There are gaps in coverage and services. That's always been true." No senior manager will be surprised to hear that the categorical nature of healthcare-the levels and levels of specialists often caring for the same patient-presents a monumental challenge to coordinate care. "It's a Herculean effort to get care organized," Brier says. "For all of the great, great care we received, it's been an issue."
On the mend, Brier is finally getting her life back, although she says she cannot say she is pain-free or that it doesn't hurt to walk. "That's not a big deal," she says. "I'm only looking forward to starting to walk around the hospital again."
Birthplace: Los Angeles
Family status: Husband, Peter Ashkenasy; daughter, Jennifer, 32; stepson, Paul, 35
Education: Bachelor's degree in history, University of California, Berkeley, 1967; master's of public health, health administration, University of California, Los Angeles, 1971
Previous jobs: Health plan analyst, Kaiser Foundation Health Plan, 1973-1975; associate management analyst, New York City Department of Health, 1976-1977; various senior management positions with the New York City Health and Hospitals Corp., including vice president of finance, executive vice president and chief executive officer of Jacobi Medical Center, CEO of Bellevue Hospital Center, and senior vice president of Southern Manhattan/Northern Brooklyn Network, 1977-1995; executive vice president and chief operating officer, Maimonides Medical Center, 1995-2003.