1999/11/4 – The Healer of Injured and Ailing Hospitals

The New York Times

November 4, 1999

The Healer of Injured and Ailing Hospitals By RANDY KENNEDY

DR. LUIS R. MARCOS loves the little ironies in life.

Like this one: For the last four years, he has overseen the city’s 11 public hospitals, which treated 1.5 million patients last year. But there was a time in his medical career when he didn’t even know what I.C.U. stood for.

He had immigrated from Spain and was working as an intern at a Long Island hospital in the late 60’s. One day, he heard his name echo across the public address system.

»Dr. Marcos! I.C.U! Dr. Marcos! I.C.U!»

He pondered this and decided it was a practical joke. He smiled sheepishly and replied in his thick Seville accent: »I don’t see you! I don’t see you!»

»In Spain, we had no such abbreviations,» he says. »Someone had to explain it to me.»

He keeps another of the little ironies on a shelf by his desk. It is a diploma he received in 1972 after his psychiatric residency at Bellevue Hospital. The diploma is signed by Dr. Joseph T. English, the first president of the newly formed Health and Hospitals Corporation, the agency created to save the city’s foundering public hospitals.

Yesterday, wearing his trademark wire-rimmed glasses and a bright red tie decorated with ducks, Dr. Marcos dashed across the room to get the diploma and show it to a reporter. »See what history does to you?» he said, laughing.

In the 29 years of public hospital history from Dr. English to the present, the procession of leaders through the corporation has been so swift — 11 presidents and 3 acting presidents — that no one has bothered to put up their pictures at the headquarters in Lower Manhattan.

Five presidents lasted just a year. One cleaned out his desk after five months and pointed out that he had been careful not to sell his house in another state when he took the job.

All of which makes Dr. Marcos’s tenure — four years, no big deal at many city agencies — a cause for celebration in itself within the agency. As of last month, he has survived longer than any other hospitals corporation president.

For three of his four years, through a combination of aggressive layoffs, renegotiated contracts and the help of a healthy economy, the corporation has managed to run modest surpluses.

It has conducted its first consumer satisfaction survey, and it has even begun to advertise on city buses and billboards, a move Dr. Marcos said would have been viewed as »almost psychotic» only a few years ago.

»If the president had proposed that,» he said, »he would have been fired, I am sure.»

ALL of this good news is not to say that the agency is completely out of the woods — it still faces an aging infrastructure, mounting numbers of uninsured patients and the advent of cost-cutting managed care for its Medicaid patients. But it has been a while since anyone has called it an »unmitigated disaster» or a »festering bureaucracy,» as it once was.

In a rambling conversation yesterday that touched on everything from pipe smoking (Dr. Marcos, 56, has quit) and endurance running (on Sunday, he will compete in the New York City Marathon for the seventh time) to Francisco Franco (his older brother was jailed and then exiled for making anti-Franco speeches), Dr. Marcos recalled that he came close to turning down Mayor Rudolph W. Giuliani when he asked him to take over the corporation.

Before becoming the city’s Commissioner of Mental Health in 1992, he had been a senior vice president at the hospitals corporation and the head of its office of mental health and substance abuse. From his fourth-floor office, he said: »I could hear the shouting above me in the president’s office on the fifth floor. So I knew.»

»But there’s a part of me that likes adventure,» he explained, sitting in the same spacious office where all that shouting took place. »I think most immigrants are a little like that. I mean, I took a big chance when I came to America, right?»

In fact, he did. When Luis Rojas Marcos, the son of a concrete-factory owner, decided to come to New York after graduating from Seville University Medical School, he knew no one in the city, except his first wife, who immigrated with him.

His father, a Franco supporter and a conservative Roman Catholic, was angrily opposed to his son’s leaving. »He couldn’t understand why anyone would want to leave Spain for anything. God was there and all the answers were there.»

For years, Dr. Marcos said, he believed he had decided to leave Spain solely to become a better psychiatrist. In later years, after many hours of couch time spent in psychoanalytic training, he realized he had also left because Franco’s dictatorship was ripping his family — and him — apart.

»It was hard for me to take sides. My temperament is one of compromise. You can convince me of almost — not everything because that’s going too far. But I’m the type that if you talk to me and express your views on something, chances are I will be able to see your side.» ‘

‘But,» he added, »you pay a price for that sometimes. Your body cannot take it, or even your mind. I used to suffer from terrible stomach pains all the time.»

While that kind of personality always put him in a difficult position back home, it has usually served him well in a tumultuous hospital system and has helped him win compromises from an often uncompromising mayor.

»There are hundreds of ways to undermine the president of this corporation,» he said. »Hundreds. And there’s no way of surviving this place if the people don’t believe in you.»

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