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Dying woman sues her New Jersey doctors for using a hysterectomy device that the FDA says can spread cancer

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BY ASHLEY LEWIS
NEW YORK DAILY NEWS

Friday, August 14, 2015, 6:08 PM

A 43-year-old New Jersey mother is lying on her death bed, her body racked with cancer a year after she underwent a hysterectomy, and she’s blaming her doctor for using a controversial device in the procedure.

Viviana Ruscitto is suing her oncologist, Dr. Howard Jones, for malpractice, alleging he used a device that she blames for spreading cancer cells in her uterus throughout her internal organs.

“My sister’s prognosis is poor, and I do not know how much longer she can continue fighting this cancer,” Mirian Riviera told a judge last week in a sworn statement.

Ruscitto had a minimally invasive hysterectomy performed in October 2014 to remove a large fibroid in her uterus at The Valley Hospital in Ridgewood, N.J.,The Record reported.

Jones used a controversial surgical tool, a power morcellator, to cut and tear tissue so it could be removed from her body.

The device was approved to remove uterine fibroids in 1991 because the small incisions from morcellation helped patients recover quicker and easier.

The device has come under heavy scrutiny in recent years, however, and in April 2014 the FDA released a safety alert against morcellators, acknowledging that the device can spread undetected cancer cells.

The agency said some of the minced undetected cancerous tissue fragments could be left behind in the abdominal cavity and spread to other parts of the body.

The government discouraged doctors from using the morcellators and encouraged professionals to discuss the risks and benefits with their patients.

The device’s largest manufacturer, Ethicon, a division of Johnson & Johnson, promptly pulled the morcellator off the market.

 

https://www.nydailynews.com/news/national/woman-sues-doctors-controversial-hysterectomy-device-article-1.2326455

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Medicare cuts funds from N.J. hospitals

Valley_Hospital_theridgewoodblog

AUGUST 4, 2015, 11:10 PM    LAST UPDATED: WEDNESDAY, AUGUST 5, 2015, 12:09 PM
BY LINDY WASHBURN
STAFF WRITER |
THE RECORD

Nearly every hospital in New Jersey is being penalized by the federal government because too many Medicare patients had to be readmitted within a month of their discharge — the highest percentage of hospitals penalized in the 50 states.

The cuts — of up to 2.49 percent of a hospital’s Medicare payments — total $23 million for the state, the New Jersey Hospital Association estimated. It is the second year in a row that nearly every hospital was penalized, except for a handful that are exempted.

Only Bergen Regional Medical Center in Paramus received no penalty.

Medicare, the health care program for those over 65, provides more than $3 billion annually to New Jersey hospitals, making it the single largest source of their revenue and a huge influence on hospital policies. This is the fourth year that payments from the government program have been tied to readmissions, in an effort to reward the quality rather than the quantity of hospital care.

Fourteen New Jersey hospitals will see cuts of more than 1 percent to their Medicare reimbursements beginning in October, including three in North Jersey: Palisades Medical Center in North Bergen, St. Joseph’s Regional Medical Center in Paterson and The Valley Hospital in Ridgewood. Their patients returned at higher-than-expected rates after being treated for pneumonia, chronic obstructive pulmonary disease, heart attack, heart failure, and knee or hip replacements, the five conditions measured.

Nationwide, about one in five patients treated for those conditions returned to the hospital within a month.

 

https://www.northjersey.com/news/medicare-cuts-funds-from-n-j-hospitals-1.1386123

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Pascack Valley hospital seeks Approval to Expand ER

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Pascack Valley hospital in Westwood seeks to move ER

JULY 2, 2015    LAST UPDATED: THURSDAY, JULY 2, 2015, 12:30 AM
BY SARAH NOLAN
MANAGING EDITOR |
PASCACK VALLEY COMMUNITY LIFE

Two years after reopening its doors as Hackensack University Medical Center (HUMC) at Pascack Valley, the hospital is before the Westwood Planning Board with an application to relocate its emergency room.

During a June 25 public hearing, hospital chief executive officer (CEO) Emily Holliman said the updates are part of HUMC at Pascack Valley’s “long-range plan to expand,” and will include relocating the emergency department from the rear of the building, to the front, which she said will “provide for a much-enhanced department for patients” with better access.

The plans also call for dedicated, separate entrances for emergency medical vehicles and walk-in patients or visitors, a security vestibule and bereavement room, as well as a drop-off area for patients or visitors, and continued valet parking, a service the hospital currently offers.

The new location will essentially double the square footage of the emergency department to 22,000 square feet, Holliman said, and provide 25 private patient rooms, including five pediatric treatment rooms, which the hospital does not currently have.

It will allow for direct access to several other departments, from the emergency department, improving the flow of the department.

Holliman said that while the hospital currently sees six or seven inbound ambulances per 24 hours, she anticipates with the new department it will be able to handle 14 a day, and double annual Emergency Room visits from 18,000 a year to 37,000. The new emergency department will be located in an area of the hospital that is not currently being utilized – the old obstetrics unit, Holliman said.

“This new department will allow us to grow and expand in the future and continue to provide high quality, efficient service,” she said.

https://www.northjersey.com/news/hospital-seeks-to-move-er-1.1366722

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Reader says Valley has become more of a Liability to this town than an asset

Valleywood_theridgewoodblog

I really hope the mediator that has been appointed in the Valley lawsuit concludes that Valley, through their own doing over the years, has become much more of a liability to this town and it’s residents than an asset. Nice to have it, but in no way really needed, especially when you factor in their ridiculous expansion plans, as well as their attitude towards the financial obligations they should have operating in a town that has helped make them extremely profitable. Make a ton of money and don’t pay taxes on a good portion of your assets. What a gig.

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Valley lawsuit is troubling

Valleywood_theridgewoodblog

JULY 31, 2015    LAST UPDATED: FRIDAY, JULY 31, 2015, 12:31 AM
THE RIDGEWOOD NEWS

Wealth shouldn’t determine future of community

To the Editor:

The litigation with Valley Hospital over its $780 million expansion plan is in the news again. I’m having a lot of trouble trying to reconcile Valley’s position with my understanding of what democracy is all about. I thought the people in the village, through elected officials, determine the nature of the village. We have established a master plan that presumably gives guidelines of a general nature about the village, such as defining ourselves as a residential community as opposed to, say, a home for heavy industry like the oil refineries that we see from the NJ Turnpike. We also have zoning specifying the maximum height of buildings, etc. All these plans and regulations were established by officials elected by the citizens of Ridgewood.

Now along comes Valley who seems to be saying: “Your master plan and zoning regulations are restricting our expansionary vision. Change your regulations!” Valley has been here for a long time, and it certainly knew our regulations when it decided to build and operate in Ridgewood, but now it has decided it wants to change the regulations established by the citizens of Ridgewood. Hmm. I know a number of people who have settled in Ridgewood because they like the community as it is, its ambiance, its schools, its zoning and other regulations. If we now give in to Valley, have we not abandoned an implicit trust?

The Valley litigation says to me democracy is not about the majority of citizens deciding on our regulations. No, instead it says to me it’s about wealth deciding the fate of the community. Valley, with its $780 million allocated for expansion (where did a non-profit, suburban hospital get $780 million anyway?), can out-litigate the Village of Ridgewood simply because the village doesn’t have Valley’s budget of discretionary funds. This is democracy?

Martin Cohen

Ridgewood

https://www.northjersey.com/opinion/opinion-letters-to-the-editor/letter-to-the-editor-valley-lawsuit-is-troubling-1.1384024

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US News and World Report Rates Valley Hospital Number 15 in New Jersey

valley_hospital_theridgewoodblog

Ridgewood NJ, U.S. News and World Report sifted through data for nearly 5,000 hospitals and results from surveys of more than 140,000 physicians to rank the best centers in 16 adult specialties from cancer to urology, according to the publication

Death rates, patient safety and hospital reputation were a few of factors considered. Only 137 hospitals were nationally ranked in a specialty.

Here is the list for New Jersey:

1. Hackensack University Medical Center, Hackensack

Bed Count: 685

Type: General medical and surgical

Doctors: 1,169

Nationally ranked in 5 specialties

2. Morristown Medical Center, Morristown

Bed Count: 656

Type: General medical and surgical

Doctors: 1,009

Nationally ranked hospital n 4 specialties

3. Robert Wood Johnson University Hospital, New Brunswick

Bed Count: 610

Type: General medical and surgical

Doctors: 1,259

4. AtlantiCare Regional Medical Center, Atlantic City

Bed Count: 534

Type: General medical and surgical

Doctors: 508

5. Jersey Shore University Medical Center, Neptune

Bed Count: 546

Type: General medical and surgical

Doctors: 727

6. (Tie) St. Peter’s University Hospital, New Brunswick

Bed Count: 374

Type: General medical and surgical

Doctors: 887

6. (Tie) University Medical Center of Princeton at Plainsboro, Plainsboro

Bed Count: 338

Type: General medical and surgical

Doctors: 23

8. Overlook Medical Center, Summit

Bed Count: 428

Type: General medical and surgical

Doctors: 1,047

9. (Tie) Holy Name Medical Center, Teaneck

Bed Count: 318

Type: General medical and surgical

Doctors: 670

9. (Tie) Riverview Medical Center, Red Bank

Bed Count: 270

Type: General medical and surgical

Doctors: 1,065

9. (Tie) South Jersey Healthcare Regional Medical Center, Vineland

Bed Count: 331

Type: General medical and surgical

12. Valley Hospital, Ridgewood

Bed Count: 446

Type: General medical and surgical

Doctors: 953

13. (Tie) Capital Health Regional Medical Center, Trenton

Bed Count: 271

Type: General medical and surgical

Doctors: 684

13. (Tie) University Hospital, Newark

Bed Count: 281

Type: General medical and surgical

Doctors: 53

https://health.usnews.com/best-hospitals/area/nj

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Mediator assigned to resolve Valley Hospital lawsuit against Ridgewood

valley_hospital_theridgewoodblog

JULY 16, 2015, 9:39 PM    LAST UPDATED: THURSDAY, JULY 16, 2015, 9:46 PM
BY CHRIS HARRIS
STAFF WRITER |
THE RECORD

RIDGEWOOD — A mediator has been assigned to attempt to resolve a lawsuit that was filed last fall against the village by The Valley Hospital.

Last month, a state judge denied Ridgewood’s request to be dismissed from The Valley Hospital’s suit, which suggests the village’s Planning Board acted improperly when it rejected the hospital’s expansion plans nearly a year ago.

It was the second defeat for The Valley Hospital in four years. The suit seeks a state judge’s intervention to end the pricey and protracted stalemate.

Ridgewood’s council signed off on a mediation agreement at its meeting Wednesday night that formally retains former New Jersey Supreme Court Judge Virginia Long.

The village will pay $7,500 for Long’s assistance.

Long will earn a total of $15,000 for her services as a mediator in the case, with The Valley Hospital agreeing to pay the remainder of her fee.( we would have done it for $10,000)

https://www.northjersey.com/news/mediator-assigned-to-resolve-valley-hospital-lawsuit-against-ridgewood-1.1375796

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Help Needed Identifying a living John Doe , Please Share

john_doe_headshot_theridgewoodblog

UPDATE: Ridgewood Police Department : The person the Ridgewood Police was trying to identify earlier this evening has been positively identified through social media Thank you

Help Needed Identifying a living John Doe , Please Share

ON THE EVENING OF JULY, 8 2015 A MAN WALKED INTO THE EMERGENCY DEPARTMENT AT THE VALLEY HOSPITAL IN RIDGEWOOD, NJ. HE HAS NO RECOLLECTION OF ANY EVENTS PREVIOUS TO WALKING INTO THE HOSPITAL AND DOES NOT KNOW HIS IDENTITY. PHYSICIAN’S REPORT THAT THE PARTY MAY BE SUFFERING FROM “GLOBAL TRANSIENT AMNESIA”.

PHYSICAL DESCRIPTION: WHITE MALE, 40S TO 50S, NO TATTOOS, TWO SURGICAL SCARS ON HIS LOWER BACK, APPROXIMATELY 4CM IN LENGTH FROM A SPINAL FUSION OF L5 AND S1. MUSTACHE AND SCRUFFY BEARD UPON ENTRY TO THE HOSPITAL

CLOTHING DESCRIPTION: WEARING OFF-WHITE HAT, GREY HANES BRAND LONG SLEEVE SHIRT, DARK GREY SWEAT PANTS, SIZE 9 ½ WHITE REEBOK CLASSIC SNEAKERS.

john doe theridgewoodblog.net

ANY ASSISTANCE IN IDENTIFYING THE PARTY WOULD BE APPRECIATED.

CASE CONTACT INFORMATION:

DETECTIVE JEFFREY CASSON
PHONE: 201-251-4537
EMAIL: JCASSON@RIDGEWOODNJ.NET

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The Valley Hospital Named 2015 Most Wired

Internet1

July 10, 2015

Ridgewood NJ,  For the 15th consecutive year The Valley Hospital has been recognized as one of the nation’s Most Wired Hospitals, according to the 17th annual HealthCare’s Most Wired™ Survey, released by the American Hospital Association’s Health Forum and the College of Healthcare Information Management Executives (CHIME).

The Most Wired distinction recognizes hospitals for successful health IT planning and implementation.  The survey examined how organizations are leveraging IT to improve performance for value-based healthcare in the areas of infrastructure, business and administrative management, quality and safety, and clinical integration.

“The Valley Hospital is proud to have once again made the Most Wired list,” said Eric Carey, Vice President of Information Systems and Chief Information Officer for The Valley Hospital. “Valley is committed to providing excellent clinical care and service, and we continue to invest in technology that helps us improve the quality and delivery of patient care,” he said.

HealthCare’s Most Wired™ Survey, conducted between Jan. 15 and March 15, 2015, is published annually by Health & Hospitals Network. Respondents completed 741 surveys, representing more than 39 percent of all U.S. hospitals. Last October, the AHA/Health Forum and CHIME announced the formation of a Most Wired partnership to enhance collaboration between the two organizations in the development and sustainability of the survey, and to collectively help meet the growing demand for useful data on health IT integration.

Detailed results of the survey and study can be found in the July issue of Health & Hospitals Network. For a full list of winners visit www.hhnmag.com.

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Reader says the Morristown case is a clear precedent for Valley, USE IT

valley_hospital_theridgewoodblog

Reader says the Morristown case is a clear precedent for Valley, USE IT

Why the Council hasn’t been protecting Village taxpayers is just stunning in the failure to uphold their fiduciary responsibility. Now they have a court ruling that establishes CLEAR precedent to go after Valley’s not-for-profit tax status and force them to pay the +$4.3 million they should be paying annually based on assessed value of their properties in Ridgewood, and yet they’d rather argue about an HR hiring and a parking garage that should be paid for in a public private partnership with the business owners in the CBD. Wake up and go after Valley, and stop pandering to biz owners. Taxpayers deserve your immediate attention to these issues, which can bring in millions in new revenue. Otherwise they’re not doing their job to protect the interests of tax paying Villagers.

Morristown just put in the effort for us, all you need to do is cut & paste and change the name of the defendant from “Morristown” to “Valley”. The Morristown ruling establishes clear precedent, it’s a lay-up tailor made for Ridgewood vs. Valley. They pay their supposedly “not-for-profit” CEO $2 mm a year but pay no Village taxes. But our Council has a bunch of people trying to start knife fights while our house is on fire. Very, very damning of the current five.

It would be great to see Ms. Hauck use her relationships and actually stand up against Valley Hospital and ask them to 1) drop their lawsuit; and 2) pay for the municipal services they consume like police, fire and snow removal. Or suggest that we use the Morristown Medical Center court ruling that it should pay property taxes on virtually all of its property in town, and go after Valley to pay property taxes in Ridgewood on ALL of their property. How can they argue they are a NOT-for-profit when they are paying their CEO $2 million a year and expanding in an arms race to become a “hospital system” with other regional hospitals? I would have a much stronger view of Ms. Hauck’s independence if she supported either of the above ideas without any form of quid pro quo on Valley’s expansion plans in Ridgewood .

If anything, Ms. Hauck is probably advising them on how to make sure it doesn’t happen. With no background or interest in public service except raising money for Valley, and no knowledge of how it works or most of the issues, she agreed (not decided–agreed–was invited–I know this) to run for council solely to help Valley–I would be a lot on that–in exchange for being the third vote for anything Aronsohn wanted. And she had to agree not to attend the social functions she had enjoyed for many years. This is conjecture, not inside information. It just makes sense.

When 2 of the 3 Council majority members are publicly pro-Valley? Where the 3 council bosom buddies always vote in a block (hmm, how do they do that without meeting illegally?)? When the Council majority doesn’t even allow discussion on an issue if they already have the votes to get their way?

Valley is not only going to continue to get a free pass from this Council – wait until they cut a deal on the Valley lawsuit that lets them double in size and still pay no taxes. We are going to be paying for the damage these 3 Council members have done for a generation.

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Reader says given the recent court rulings on non profit hospitals maybe its time to visit a PILOT program for Valley Hospital

valley_hospital_theridgewoodblog

A PILOT program has been discussed and quickly pushed under the table several times. Perhaps a lawsuit directed at Valley would do the trick?
I am not anti-Valley (I prefer a modified, reasonable expansion, including locations on Rte 17NS). I believe Valley is an important part of our community. But I have never quite understood how they can be classified as a non-profit. To be fair, I think to expect them to pay +$4mio in taxes is aggressive. But clearly they are a consumer of Village services? Clearly “we” subsidize their activities through our own taxes. So there must be a compromise somewhere, i.e. the PILOT program.

I don’t like the idea of another lawsuit. It’s not productive. But the fact that Valley is suing the Village absolutely dips into our pockets, as the VOR has to pay legal fees. So where does it end? Regardless of where you stand on the Valley Expansion, I think it is reasonable to expect Valley to pay its fair share for the use of Village services.
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Hospital’s tax ruling could have ripple effect

valley_hospital_theridgewoodblog

JULY 1, 2015, 11:47 PM    LAST UPDATED: WEDNESDAY, JULY 1, 2015, 11:48 PM
BY LINDY WASHBURN
STAFF WRITER |
THE RECORD

A ruling in state tax court that has taken away the property-tax exemption of a major medical center because it operates more like a for-profit business than a charitable institution could have implications for other non-profit hospitals around the state if the municipalities that host them seek to collect property taxes.

Judge Vito Bianco declared in a closely watched opinion that Morristown Medical Center failed “to qualify for property tax exemption” for three years beginning in 2006. The case has been in the court system for the better part of a decade. It is unclear how the ruling applies to later years.

Non-profit hospitals have changed a lot since their origins as “charitable alms houses providing free basic medical treatment to the infirm poor,” he said, likening Morristown’s business model to that of its “new for-profit competitors.” Eight hospitals statewide currently are owned by for-profit companies, with two more due to be acquired at the end of this month. These investor-owned facilities pay taxes, unless they negotiate tax abatements with local authorities.

Like the for-profits, “today’s non-profit hospitals have evolved into labyrinthine corporate structures, intertwined with both non-profit and for-profit subsidiaries and unaffiliated corporate entities,” Bianco wrote. They “generate significant revenue and pay their professionals salaries that are competitive even by for-profit standards.”

https://www.northjersey.com/news/hospital-s-tax-ruling-could-have-ripple-effect-1.1366632

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Valley Hospital : A Step Closer to a Blood Test for Lung Cancer

valley_hospital_theridgewoodblog

Valley Hospital Researchers Leverage Their Success in Discovering a Pancreatic Cancer Biomarker to Identify a Better Way to Screen for Lung Cancer
June 30th 2015

Ridgewood NJ, The Valley Hospital in Ridgewood, NJ, is pleased to announce that two of its oncologists and a research scientist are helping pave the way to an easier, more accurate, less invasive way to screen for the most common form of lung cancer. Lung cancer is the most common cancer in men worldwide and the number one cancer killer in the United States.

Ganepola A. P. Ganepola, M.D., FACS, medical director of research for Valley’s Okonite Research Center and director of Valley’s Center for Cancer Research and Genomic Medicine; Robert J. Korst, M.D., FACS, FCCP, medical director of Valley’s Blumenthal Cancer Center; and David H. Chang, Ph.D., research scientist at the Center for Cancer Research and Genomic Medicine in Paramus, NJ, collaborated with the Wistar Institute in Philadelphia on the study, led by their scientist Qihong Huang, M.D., Ph.D., associate professor in the Tumor Microenvironment and Metastasis Program. The findings were published online by the journal Oncotarget.

The team discovered a protein that circulates in the blood that appears to be more accurate than the current method of low-dose CT scans for detecting non-small cell lung cancer. The research built on the success of a study Dr. Ganepola led previously that discovered a biomarker for pancreatic cancer. Valley began biomarker research approximately six years ago “before the word biomarker was common,” he said. “Our research on pancreatic cancer made a significant contribution to medical research and with Wistar’s support, we used the exact same approach for the lung cancer study.”

“Without the samples provided by Valley Hospital, this study would have been impossible to complete,” said Dr. Huang. “They are excellent collaborators and we’re looking forward to continuing this partnership in our next trial, which we hope will confirm the important findings we made in this initial pilot study.”

The U.S. Preventive Services Task Force recommends an annual screening for patients 55 to 80 years old with a history of smoking and who are at high risk for developing lung cancer. Confirming the accuracy of the protein, AKAP4, in a broader, more robust study could result in developing a simple blood test for annual screenings, rather than the less accurate, more expensive CT scan, which exposes patients to radiation.

“Cancer is a dreadful disease which kills more than half of patients,” said Dr. Ganepola. “The other half survives for only one reason – if the disease is detected early enough to be eradicated completely. This is only possible if you have a test that can detect cancer non-invasively early enough so patients can benefit from early, rather than late-stage treatment. If the tumors are detected early enough, the survival rate can dramatically improve from less than 5 percent to over 55 percent in lung and pancreatic cancers.”

The achievements in cancer studies stem from Valley’s superior research facilities and the caliber of its staff, the practicing oncology surgeon said. “Our advanced capabilities can meet the high demand cancer research required to care for cancer patients at all levels. Our early research on metastatic colon cancer is considered among the best in the world and we maintain that lead today.”

Dr. Ganepola is excited about the future of genetic research and protein analysis. “Cancer is basically a genetic disease, but not usually inherited from birth. Ninety percent of cancers are acquired as mutations of the genome, consisting of DNA and RNA molecules. If you look at DNA-RNA-protein, the axis of all biological growth, protein is very important and will lead as a cancer biomarker in the next five to 10 years as technology advances.”

The Valley Hospital and The Wistar Institute team plan to validate their lung cancer research results in a larger study involving more than 800 blood samples from various hospitals. “Our partnership with Wistar is a good example of collaborative research in which two institutions work together for the good of patients,” Dr. Ganepola said.

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Readers say Morristown Memorial Hospital Decision suggest Valley should be paying taxes in Ridgewood

valley_hospital_theridgewoodblog

Morristown Medical Center should pay property taxes on virtually all of its 40-acre property in town, a tax court judge ruled Friday in a decision closely watched by other hospitals across New Jersey. https://www.nj.com/morris/index.ssf/2015/06/morristown_medical_center_loses_tax_case_raising_f.html#incart_river

Based on the recent ruling by a tax judge regarding Morristown Memorial Hospital and paying taxes on the property they own in that town, why should Valley continue not paying taxes in Ridgewood ? How is Valley not paying taxes on all of their properties “serving Ridgewood?”

This is just what Valley did not want to hear…and what we’ve been clamoring about for years based on Valley’s behavior. Ridgewood should use this ruling as leverage to convince Valley to drop it’s current lawsuit and adjust it’s growth plans to something reasonable based on its footprint in a heavily residential area.

Can you imagine how much this town would have benefited from Valley paying even a quarter of what they could have over the years ? Instead, they’ve decided to bite the hand that has fed them and file suit.Two words: greed and arrogance.

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Morristown hospital loses property tax court case; judge says facility does not meet non-profit status

valley_hospital_theridgewoodblog

By Tim Darragh | NJ Advance Media for NJ.com
Email the author | Follow on Twitter
on June 26, 2015 at 7:50 PM

Morristown Medical Center should pay property taxes on virtually all of its 40-acre property in town, a tax court judge ruled Friday in a decision closely watched by other hospitals across New Jersey.

Tax Court Judge Vito Bianco ruled that the hospital failed to meet the legal test that it operated as a non-profit, charitable organization for the tax years 2006 through 2008. Only the auditorium, fitness center and the visitors’ garage should not be assessed for property taxes, he said.

The decision, the hospital’s attorneys have said previously, could cost it $2.5 million to $3 million a year. The ruling applies only to the medical center’s property taxes, not to its federal tax status as a non-profit.

Other non-profits in New Jersey, especially hospitals and universities, have been concerned about the case, fearing that a ruling for the town – which also is in court for property taxes from the hospital for 2009 through 2015 — could encourage host municipalities to challenge their property tax exemptions as well.

https://www.nj.com/morris/index.ssf/2015/06/morristown_medical_center_loses_tax_case_raising_f.html#incart_river