Since St. Vincent’s hospital in the West Village closed in 2010, there has been no emergency department that can accept traumas from the Brooklyn Bridge to 17th St. – one of the most densely populated places in the country. When Mount Sinai Beth Israel closes, a process that a judge on Monday said can move forward, patients will have to travel even further when seconds can spell the difference between life and death.
“Time really matters,” said Tracy Feiertag, vice president of Lenox Health Greenwich Village, a surgery center that now occupies the St. Vincent’s building. The next closest hospital will now be Bellevue Hospital in Kips Bay.
Emergency departments downtown have dwindled with the shift among health systems towards more specialty care outposts that cost less to erect and operate than traditional hospitals. Closures like St. Vincent’s have meant a greater demand on the hospitals along the perimeter, stressing safety-net facilities and increasing ambulance times as they drive through a changing health care landscape. Without Beth Israel, there will be no hospital in the four square miles between FiDi-based New York-Presbyterian Lower Manhattan Hospital and Bellevue on 23rd St.
Beth Israel has sat at 16th St. and First Ave. for close to a century, adding hundreds of beds over the years and growing to be one of the largest acute care providers in the city. In 2013, Mount Sinai Health System acquired the hospital through a merger and three years later announced plans to significantly downsize and close. Initially proposing to replace the hospital with a 70-bed facility equipped with an emergency department, Mount Sinai abandoned the idea in favor of investing in a handful of other specialty facilities throughout Lower Manhattan after the pandemic upended local health care provision.
This week, Judge Jeffrey Pearlman tossed a lawsuit brought by a coalition of community activists seeking to block the closure, ending a monthslong temporary restraining order and paving the way for Mount Sinai to permanently shutter Beth Israel, which has been in the offing since the state Health Department gave its approval last July.
When it closes, the volume of patients currently flowing to Beth Israel will have to be rerouted to one of seven hospitals and more than two dozen urgent care centers in downtown Manhattan below 34th St., according to an analysis conducted by the Department of Health as part of the closure process. Not all visitors require emergency care: out of more than 100 daily visits to its emergency department, between 13 and 31% are for non-emergent conditions and could instead go to an urgent care clinic, the report states.
The remaining more than two-thirds of daily emergency department visits – acute cases requiring a higher level of rapid care – will have to go elsewhere. Of those, Bellevue and NYU Langone Hospital, which sits just a few blocks north, are expected to absorb the most patients, between 25 and 26 patients a day, according to the Health Department report, which was included in court filings. The closure has been a slow burn; the two facilities have already reported seeing a higher volume of patients as Beth Israel has diminished from over 800-beds when it was acquired to now roughly 500.
The reduction has strained Bellevue, which is “substantially over” its pre-pandemic census, in part because of Beth Israel’s shrinking, President and CEO Mitchell Katz testified before the City Council last year. A full closure of the hospital would require tens of millions of dollars in renovations at Bellevue to accommodate the expected spillover, he said at the time.
It is not the only stress caused by the shift toward smaller specialty sites. The consolidation and closure of hospitals has also contributed to an increase in ambulance response times, which are currently at their highest in years. Last fiscal year, the average end-to-end turnaround time for ambulances and fire companies was 10 minutes and 3 seconds, more than half a minute longer than two years prior – crucial seconds in a life-or-death emergency. In testimony before the Council in November EMS Chief of Operation Michael Fields said the longer distances ambulances have been forced to drive contributes to the worsening performance.
Other facilities would also see an influx in patients. New York-Presbyterian Lower Manhattan’s emergency department would receive an estimated 10 new patients a day and Lenox Health would see an additional nine, according to the Health Department report. The latter, part of Northwell Health, the state’s largest provider network, has been hardening its emergency care footprint in the neighborhood. Two years ago, Lenox Health became certified to receive stroke patients and it is currently building a $37 million cardiac catheterization lab, which will allow it to receive heart attacks by ambulance when it opens later this year, said Feiertag.
The demise of Beth Israel is part of a plan to change the health system’s downtown footprint, coinciding with a more than $600 million investment in a smattering of downtown sites, including various centers for heart, respiratory and behavioral health care and an urgent care clinic in Union Square, among others, said Loren Riegelhaupt, an independent spokesman for Mount Sinai.
“This is what modern health care requires…and it’s also where the patients want,” he said.
