CONTRA MUNDUM

CONTRA MUNDUM is an occasional Blog committed to the theological reflection on the present situation with a special focus on the religious establishment. CM seeks to summon persons to theological awareness and religious obedience. Raymond J Lawrence Jr. Raymondlawrence@cpsp.org

Wednesday, February 16, 2005

A critical review of New York City’s Health Care Chaplaincy, Inc.

HEALTHCARE CHAPLAINCY’S POTEMKIN VILLAGE

When Prince Gregori Potemkin took Catherine the Great down the river to view his grand construction projects, what Catherine thought impressive was in reality a mere facade. His "villages" did not amount to much, but he did bequeath a vivid metaphor to the common language. The citizens of New York have been similarly taken down the river by the Health Care Chaplaincy, Incorporated (HCCI, a.k.a. HCCI & HCC), which has in the past two decades put on display an impressive array of health care chaplaincy services that are hardly what they purport to be.

HCCI is a not-for-profit corporation that provides contract chaplaincy services to health care institutions in the New York City area. It is one of the few contract chaplaincy services in the country, and the only one in the New York City area.

HCCI has been receiving of late something on the order of $4 million annually from generous benefactors, both individual and corporate, monies that purport to support chaplaincy services to New York area health care institutions. Not one nickel of that $4 million finds its way to direct support of service to patients. The health care institutions that contract with HCCI for chaplaincy services actually pay a premium fee to HCCI for whatever services they are provided.

Furthermore, an active chaplaincy department in a large New York City hospital might typically receive gifts amounting to tens of thousands of dollars annually, without even the benefit of fund-raising activities. Such funds have been commonly used to enhance direct chaplaincy services to patients. In recent years HCCI has so skillfully courted community benefactors that those funds are now largely diverted to HCCI where they provide no direct benefit to patient care in any of the New York area health care institutions.

Several health care institutions have severed their contracts with HCCI recently, and others have had discussions about termination, finding that they could set up their own in-house chaplaincy staff more economically and at the same time provide more professional and proficient structures of accountability.

On balance, the prosperity of HCCI in the last two decades, fueled by its glossy public relations campaigns, has resulted in a significant financial loss to all the health care institutions in the New York City area.

II
So what does HCCI do with the charitable millions that it takes in annually? They go to 1) administrative costs, 2) real estate investment, 3) the HCCI endowment fund, and, 4) various educational projects.

The financial records of HCCI are closely guarded secrets, kept even from high level HCCI staff. But HCCI is a tax exempt not-for-profit, and New York State law requires that its annual IRS report, form 990, be available for public scrutiny. The HCCI 990 reports are far from detailed, but from the aggregates reported, it is clear that monies given to HCCI go entirely to the care and feeding of the central office and its projects, and none to fund patient care services.

The central office expenditures fall into four categories:

1) Administrative costs.
Administrative costs at HCCI are off the chart. Astonishingly, the ratio of central office support staff to working chaplains is very close to one-to-one. Specifically, there are some thirty persons employed in the central office and some forty staff chaplains employed in various health care institutions where the patients are. (Even those working chaplains have certain administrative tasks in addition to their patient care work.) So what do all these central office staff do? They are engaged in administration, fund raising, public relations, and, as well, a minimal amount of educational, resource, and research projects. HCCI needs such a large central office staff because it is primarily in the business of raising money in order to support the work of raising and accumulating money.

2.) Real Estate.
In 1995 HCCI made its first real estate investment, purchasing a five-story office building in Manhattan, at 307 East 60th Street, to house its administrative offices. As the administrative staff has continued to mushroom, HCCI expanded its space recently to occupy as well a large, lavish suite of offices at 315 East 62nd Street. These offices have no beneficial impact on patient care. They are not easily accessible to working chaplains in other parts of Manhattan, and even less so to working chaplains in the suburbs. For most working chaplains, attendance at a meeting at the central office takes the better part of a day out of their work week.


No rationale exists for HCCI’s central offices to occupy some of the most expensive office space in the country, on Manhattan’s tony upper east side. These offices could just as effectively be situated in Flushing or Jersey City, or Harlem with the former President, or many other neighbor-hoods, at significantly lower costs.

An example of HCCI extravagance that adds nothing to the care of the sick is the fact that the central offices contain no less than two well-appointed chapels, one of them being something of a precious semi-private chapel for the CEO himself. Some hospitals, even among those who have contracts with HCCI, have no chapel at all, whereas the doors of the two chapels at the HCCI central office are never darkened by any hospital patient, and rarely even by a working chaplain.

3.) Endowment.
The really unqualified success of HCCI has been the building of its own endowment or net worth, which was on January 1, 2002, pegged at $24 million. HCCI’s net worth has increased in recent years by about three million dollars a year. However, what the endowment will ultimately be committed to has not yet been revealed. It simply keeps growing toward some unknown purpose.

Much of HCCI’s income has come from other endowments, such as the endowment at Trinity Church. So in effect we have a peculiar community phenomenon whereby Trinity Church, along with many other benefactors, has allocated proceeds from its endowment to build the HCCI endowment.

The process does not make sense unless the object is to create more jobs for administrators of endowments. HCCI’s pitch is that its funds will support chaplaincy to patients in area health care institutions. Its pitch would be honest if it asked for public support to build an endowment, the purpose of which has not yet been disclosed.

4) Educational Programs
The educational programs conducted in HCCI’s central office are arguably a beneficial public service. But they are for the most part redundant with programs conducted in several health care institutions throughout the city and region, even institutions that have contracts with HCCI. Thus the central office space set aside for educational events is largely duplicate space. All the educational events scheduled at HCCI could just as appropriately take place in one of several health care institutions, where the patients are. Furthermore, these educational programs are not a significant cost item. Hospitals that have such programs generally receive in service to patients a value that exceeds the cost of the program.

III

Successful at accumulating money, HCCI has at the same time become a morally troubled institution, troubled not only because its benefactions are used only to engorge itself, but because it has become an institution marked internally by secrecy, intimidation, cynicism, and is bereft of any process of self-criticism.

The critique of HCCI provided by current and former staff persons goes much beyond the typical complaints about leadership that one commonly hears in most any institution. The consensus gathered from our interviews is that the HCCI current leadership is bereft of a moral rudder and has failed to win the basic trust of the staff.

Secrecy in HCCI reaches peculiar extremes, particularly around budget and financial matters. HCCI staff persons are directed not to disclose their salaries to each other. Persons who are assigned the title "director of pastoral care" in any of HCCI’s specific contract hospitals are given the title with few of the tools of the office. The directors, for example, are kept uninformed of the salaries of those they "direct," some of whom receive higher salaries than the directors themselves. The directors have no authority to hire and fire their own staff, nor are they permitted to participate in policy and contract discussions between HCCI and hospital administrators. The directors, in short, do not really direct anything, but merely carry a job title with little of the management authority that one would presume attends to such an office. All forty working chaplains answer directly to the central office. No one outside the central office is entrusted with any significant level of authority. Important decisions are made behind closed doors at the central office in a system seemingly designed to keep all staff on tenterhooks.

The cynicism of HCCI manifests itself most clearly in its pandering posture toward centers of money and power. Annually, HCCI bestows a so-called "wholeness of life award" on a CEO of some major corporation, in a transparent gesture to bring in financial support. HCCI’s glossy literature has through the years hyped annually the likes of Philip Morris CEO, Geoffrey Bible, in full-page glossy as one of the promoters of "wholeness of life." We will be the first to say that money from the tobacco industry is just as good as money from Trinity Church, and any gift deserves a word of thanks. However, such effusive approbation for those who promote the unhealthy interests of the likes of big tobacco is at very least unbecoming to the health care community. Such is the moral tone set at HCCI by its current leaders. There is seemingly nothing they won’t do for money. Catering to money interests throughout the whole institution is debilitating to authentic religious work of any sort. Authentic pastoral care is poisoned when religious leaders pander to bearers of great wealth.


HCCI’s leadership employs a mix of suave self-promotion and aggressive intimidation in dealings both with hospital administrators and the chaplaincy staff. It is a work of genius in the manipulation of power and money.

IV

The original idea of HCCI was a noble one. The organization was created in 1961 with the clumsy appellation, the "East Midtown Protestant Chaplaincy." Its purpose was to support chaplaincy services for Protestants in the area designated. Four congregations created the organization: Christ Methodist, Brick Presbyterian, Epiphany, and St. James Episcopal. In the 1970s the organization appropriately became multi-faith, as did most pastoral services in public health care institutions, changed its name, and expanded its geographic reach to the entire New York area. During its first decades of existence HCCI actually used its funds to support direct chaplaincy services in health care institutions.

What began as a generous, caring innovation, undertaken by a handful of religious people from four congregations on Manhattan’s east side, has now evolved into a self-aggrandizing imperial monopoly furthering unsavory relationships that must make its founders restless in their graves.

HCCI might yet become again the blessing to the New York community that it promised to be at its beginning. Five matters must be addressed and corrected if HCCI is to be redeemed as an institution of financial and religious integrity:

1) HCCI must cure its far too top-heavy central office staff. Its financial resources and staffing must be shifted to the health care institutions where the patients are. Health care institutions are currently under severe financial constraints, and they need trained chaplains on-site, at the bedside, not ensconced in luxury offices far from any patient.

2) The moral tone of the leadership must be elevated. The chichi ambience and gaudy luxury of the central offices are unbecoming to those who serve the sick and dying. Catering to the rich is unseemly. Bullying by the HCCI administration is demoralizing. Research objectives must be independent from fund raising objectives. An end should be put to secrecy and obfuscation in financial and administrative matters. A candid self-critical process of reflecting on its own institutional values and relationships must be instituted.

3) The chaplaincy personnel in the various hospitals must be given the authority to administer their own programs and authority over their own staff. Forty chaplains answerable to one administrator in a distant office is an invitation to fecklessness.

4) HCCI should cease the process of enlarging its endowment and disclose the designated purpose of its existing endowment, and that purpose should be directly related to patient care. That is what donors generally have thought all along that their contributions supported.

5) HCCI should sell its building and resort to leased space, and much less of it, and in a lower rent district.

The generosity of New York’s benefactors has created the large expansion of HCCI over the past two decades, the results of which are a very impressive facade and a $24 million endowment. No one can rejoice at this enormous misappropriation of so much generosity. Little wonder that public cynicism about religious leadership abounds, when a public posture of serving the needy is in reality a covert way of serving self-interest. The HCCI story should grieve anyone who longs for a more humane city and more compassionate and effective services for those in need.

Prince Grigori Potemkin, however, would undoubtedly gaze on HCCI with admiration and awe.