For decades, Nassau University Medical Center has been prominent for both its possibilities and its failures.

As one of the few public mission hospitals in the state, NUMC has served as a safety net for Nassau County's vulnerable residents by providing care regardless of an individual's ability to pay. But the hospital also has been plagued with financial mismanagement and poor governance, compounded by endless political patronage that favors vendors, executives and board members who support the party currently in power.

All of this evolved against a backdrop of extensive, tumultuous changes to the delivery of health care as top medical providers merge and expand their reach in an ever more competitive landscape, while insurance reimbursements are reduced and medical coverage costs more.

Now, however, a struggling NUMC is finally at the cusp of a turnaround.

There's an enormous amount of work to do.

The hospital's future now rests with Gov. Kathy Hochul and other state leaders, who appropriately have taken on the extraordinary challenge and remarkable opportunity to change the hospital's trajectory.

In the short term, that means making sweeping changes to NUMC's governance and management, establishing communication and cooperation between NUMC and the state Health Department, analyzing in detail the severity of NUMC's troubled finances, and defining the hospital's role.

That starts with remaking the board of directors of NUMC's public health corporation, Nassau Health Care Corp., and replacing much of the hospital's executive team. The budget legislation lets Hochul fill four of 11 board seats and appoint the chair. Two additional seats will come from the leaders of the State Legislature. Importantly, those changes give the state control over the board majority and take effect June 1.

That doesn't give state officials much time. Hochul told the editorial board last week she is seeking "competence" and pledged that the hospital will no longer be a "political patronage pit." That's critical. It means anyone chosen must not come with political connections like those who preceded them, such as former NUMC chairman Matthew Bruderman, who donated $200,000 to the Nassau County Republican Committee in October 2021, the month before Bruce Blakeman was elected Nassau County executive. 

Instead, Hochul must select dedicated professionals who understand the demands of quality health care, the difficulty of changing institutional culture, the tricky details of government and private financing, and the principles of solid management. State Senate Majority Leader Andrea Stewart-Cousins and Assembly Speaker Carl Heastie must do the same, with input from their Long Island members. Blakeman should rethink some of his board picks, too, emphasizing competence over political fealty.

The new board must immediately reform NUMC's management team from the top down. NUMC chief executive and general counsel Megan Ryan has proved she is not up to the task. She and her team must go. A fresh start is needed.

Once a new board and new management are in place, the hard part begins. State officials must be willing to consider all scenarios regarding the scope of services offered by NUMC in the competitive health care market on Long Island. At the core, it must stay true to its mission of helping those on the lower end of the socioeconomic scale who rely on NUMC, especially those at the A. Holly Patterson nursing home, which takes patients turned away by most other facilities.

Near the top of the to-do list is addressing the hospital's $400 million debt to the New York State Health Insurance Program, which continues to grow and threatens the hospital's financial stability and the health insurance for current workers and retirees. Also important is tackling NUMC's severe operating losses and its dwindling cash position, which has fallen from a reported $77 million in December to as low as $31 million last week — and that's before the hospital made its latest payroll. Capital improvements must be made, using $50 million for building repairs provided in the new state budget.

The spending plan also requires NUMC to outline by December 2026 the hospital's longer-term strategies. That will help guide next steps.

Hochul told the editorial board she hasn't yet determined what NUMC's future will look like, saying a "forensic audit" is required. That's wise. NUMC must prepare to address the changing needs of Long Islanders, especially those with financial and medical challenges, while finding a tenable path forward that provides financial stability and upgraded medical care. That might mean changing the hospital system's size, scope and areas of focus. The new team should work with other hospital systems in the region to share best practices and establish partnerships. Conversations must be had about how to best utilize NUMC's vast real estate — including development opportunities on available parcels.

Hochul has tasked Karen Persichilli Keogh, secretary to the governor and a native Long Islander, to take the lead on NUMC. Nassau Interim Finance Authority chief Richard Kessel also has assumed a key role. Keogh and Kessel can't do this alone; a team of capable state officials including Hochul should oversee the many steps to come.

Undoing years of neglect and mismanagement will take time, expertise and perseverance. But with the right people and the right tools — and a willingness to do what's hard — NUMC can be nursed back to health.

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