1995/09/03 – Savvy Troubleshooter

The New York Times

September 3, 1995

Savvy Troubleshooter By KIMBERLY J. MCLARIN

When asked last week if he expected to be the last president of New York City’s Health and Hospitals Corporation, Dr. Luis Rojas Marcos smiled wryly and spoke about the tendency of human beings to try to predict the future.

Speculation, Dr. Marcos seemed to suggest, is often fruitless. He would not be drawn into a discussion about what might be. «I don’t have a crystal ball,» Dr. Marcos said. «I wish I did, but I don’t. I’m not going to guess right now.»

In choosing the 52-year-old Dr. Marcos to succeed Dr. Bruce Siegel, who resigned on Tuesday amid allegations of sexual harassment, Mayor Rudolph W. Giuliani tapped a respected psychiatrist and researcher who is no stranger to the Health and Hospitals Corporation: before becoming the city’s Commissioner of Mental Health in 1992, he was senior vice president at the corporation and head of its office of mental health and substance abuse.

As mental health commissioner, Dr. Marcos has already presided over one city department at a time of drastic cuts. And as one of a handful of commissioners to survive the transition from the Dinkins administration to the Giuliani administration, he is a survivor who knows how to say the right thing. Such was his comment last week that «this is certainly a time of change, but that’s positive.»

Stepping calmly into the maelstrom left by Dr. Siegel, Dr. Marcos declared himself ready and eager to begin. Arriving for a meeting of the corporation’s board of directors, on which he has been a member, Dr. Marcos shook hands all around and smiled patiently for the photographers jostling in front of him.

«I’m very excited and very happy,» Dr. Marcos said after the board approved his appointment. «Having worked here over a decade before, it’s like coming home.»

He was named interim president to fill out at least the remainder of Dr. Siegel’s contract, which expires on February.

In August, a panel appointed by Mayor Giuliani proposed selling or closing the city’s 11 public hospitals, effectively dismantling the system. At a news conference on Thursday, Dr. Siegel described his deep concerns about the plans.

But Dr. Marcos would not speak directly on privatization, saying only that he would support decisions made by the board of directors.

«I’ve always felt that where there are challenges, there are opportunities,» he said.

Friends attributed his ability to bridge the last two mayoral administrations to a professional stature that transcends partisan politics.

«I think both Mayors recognized that Luis Marcos is a real professional,» said Pam Brier, a former vice president of the hospitals corporation who serves on the mental health department’s community service board. «He is not a political person.»

But Dr. Marcos is clearly savvy enough to know that taking over the hospitals corporation at a time of turbulent change will require a delicate touch. And he is political enough to avoid antagonizing a powerful mayor.

Dr. Marcos is a leading researcher in mental illness among the homeless. He was the main architect of Project HELP, a program that sends social workers out to identify and treat homeless mentally ill. In the 1970’s, he also did seminal studies on the influence of language barriers and cultural differences on psychiatric examinations.

As an administrator, Dr. Marcos is open and responsive, colleagues said. «He’s not some bureaucrat who sits in his office and administrates,» Ms. Brier said. «He has met with agencies all over the city, and he meets with clients and staff.»

But some advocates for the mentally ill have raised concerns about Dr. Marcos’s stewardship of the mental health department, particularly in regard to his handling of the 1993 Community Reinvestment Act. That landmark state legislation was intended to revolutionize care for the mentally ill and reduce the number of sick, disoriented people living on the streets.

Some advocates say the department has been unable to handle the changes brought about by the law, which required the state to begin closing its expensive psychiatric hospitals and to use the savings on community mental health programs. For that they blame Dr. Marcos.

«What we have today in the system is not enough, and Marcos has a share in the responsibility for that,» said Avia Rice, a member of the Alliance of the Mentally Ill/Friends and Advocates of the Mentally Ill. «The programs are not there.»

Vera Hassner-Sharav, an advocate for the mentally ill, said: «I think he has been almost like an absentee administrator. Where are the additional housing programs for the homeless mentally ill? We know that the services are not available and that people are without care.»

Complaints like those led the Public Advocate, Mark Green, to question, among other things, the department’s decision to award $4.7 million in contracts for mental health services without competitive bidding.

Dr. Marcos responded that neither state law nor city rules required competitive bidding in this case. Joe DePlasco, a spokesman for Mr. Green, said that Dr. Marcos appeared to be correct on that issue.

But Dr. Marcos received high marks among mental health advocates for his willingness to listen to family members of the mentally ill.

«His door is always open,» Ms. Rice said.

Peter Saperia, executive director of the Coalition of Voluntary Mental Health Agencies, said he was so impressed with Dr. Marcos that he hated to see him leave the mental health department. «These are extremely unpredictable times we’re moving into, financially and programatically,» he said. «We’re looking for experienced and solid leadership at the helm, and to the extent that he can speak on behalf of the mental health community, I think the mental health community will benefit.»

Dr. Marcos was born in Seville, Spain, on Aug. 27, 1943. He graduated from Seville University Medical School in 1967 and moved to New York shortly afterward. He did his residency in psychiatry at Bellevue Hospital Center. He is a professor of psychiatry at New York University School of Medicine. He lives in Greenwich Village and is married with four children.

Although he would not detail his thoughts about reducing or eliminating the hospitals corporation, Dr. Marcos seemed to hint that he was not opposed to restructuring. The health care picture has changed dramatically in recent years, he said. Private hospitals that would have resisted caring for Medicaid patients five years ago now compete aggressively for them.

«Of course, that’s only Medicaid, he said. «There are poor without insurance. But I’m sure we can find a way of making this corporation fiscally sound and of insuring care for the poor.»

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