An advisory board tasked with designing the future of SUNY Downstate’s University Hospital recommended that the cash-strapped medical center cut nearly half of its beds and build an ambulatory surgery center to help buoy its finances.
The Downstate Community Advisory Board, a nine-member panel appointed by elected officials last year, has spent seven months deliberating how to spend up to $1 billion in state funding to renovate the East Flatbush medical center, which SUNY says has faced financial deficits due to low volume and a deteriorating physical infrastructure. The board’s final recommendation, which was due June 1 and is subject to approval by state officials, proposes that Downstate renovate its existing facility at 445 Lenox Road and build a four-story ambulatory surgery center across the street – a disappointment to community advocates and labor leaders who lobbied the state to build a new full-service hospital.
A draft of the board’s proposal, dated May 29 and reviewed by Crain’s, estimates that the projected cost will be $928 million. It suggests that SUNY upgrade the hospital’s mechanical systems, electric and plumbing, as well as convert all existing patient rooms to private rooms. The hospital renovation would preserve the same amount of clinical space but slash the bed count from 342 to 192, according to the document.
The panel also urged SUNY Downstate to build a four-story ambulatory surgery center for specialty services, including oncology and cardiology, positioning it to capitalize on growing outpatient volume nationwide, according to the report. The proposed center, which would be located on the site of an existing parking garage across the street, would include five operating rooms, 18 beds for patients before and after surgery, a cardiac catheterization lab and an oncology suite, the board recommended.
The plan for Downstate is not set in stone as negotiations continue. The final plan for the hospital is expected to bring the total bed count to 225 after converting all rooms to single beds, with the goal of increasing the daily patient census, according to a source with knowledge of the negotiations. The source said that the plan will preserve all inpatient services, including maternity and kidney transplant care.
“We are continuing to work with the Downstate Community Advisory Board on a final report that reflects the community’s priorities and implements Gov. Hochul’s historic investment in health care in central Brooklyn,” said Holly Liapis, a spokeswoman for SUNY.
The recommendations, mandated by a state law passed last year, offer a peek into what could be in store for SUNY Downstate after more than a year of uncertainty. Gov. Kathy Hochul put forth a plan in January 2024 to shutter all inpatient services and replace the hospital with an outpatient care hub because of Downstate’s financial challenges, but the state delayed the implementation of that proposal after fierce community opposition, instead appointing an advisory board to make recommendations for the hospital. The state allocated $750 million in its recently enacted budget for the project, as well as an additional $250 million from SUNY’s capital budget, according to the board’s report.
The board’s proposal is aligned with Hochul’s previous plan to boost outpatient services at Downstate, but also answers calls from community members to preserve some level of hospital services. The recommendations are a far cry from what the state deemed the most ambitious proposal put forth by community-led opposition group Brooklyn for Downstate, which lobbied to build a new hospital and an ambulatory surgery center. The state estimated that that plan, backed by unions including United University Professionals and Public Employees Federation, would cost more than $3.7 billion.
SUNY Downstate has operated at a reduced inpatient capacity, which the board says justifies its decision to cut beds. Though state health regulators have certified the hospital to operate 342 beds, it only staffs 286 of them, and on an average day, only 165 patients occupy those beds, the report said. The hospital expects that the upgrades, including both private rooms and the modernized facility, will attract more patients and boost its daily census, the source familiar with negotiations said.
Though the board’s proposal cuts inpatient capacity, it bolsters Downstate’s emergency room. Downstate’s emergency room is at times overcrowded and the neighboring ED at Kings County Hospital has wait times that exceed four hours on average, according to the report, prompting the board to suggest that Downstate boost its emergency room capacity by 10% by adding four treatment bays and three observation beds.
The board recommended changes that extend beyond physical building upgrades. It suggested Downstate obtain a new electronic health record system to improve billing, scheduling and communication with patients, as well as develop a fundraising strategy to offset potential federal funding losses.
June 2, 2025: This story has been updated to include a statement from SUNY and provide more details about ongoing negotiations related to the board’s proposal.
