St. Vinnie's Hospital Compromise Clears Key Hurdle
Plan by North Shore-LIJ and Lenox Hill Hospital for a $125 million emergency department on site of bankrupt medical center gets thumbs up from a state committee.
Crain's New York
By: Gale Scott

A controversial proposal to build a freestanding emergency department on the campus of the former St. Vincent's Hospital in Greenwich Village was approved Thursday morning by a key state planning committee. The application, from North Shore-LIJ Health System's Lenox Hill Hospital division, must now be approved by the state health commissioner. The Department of Health has already signaled it favors the plan.

The facility will be known as the Lenox Hill Hospital Comprehensive Care Center.

Even as community members at the meeting shouted "people will die" and other doomsday warnings, the New York State Public Health and Health Planning Council gave its blessing to the proposal. For months, activists and some health care advocates have pushed politicians to try to defeat the plan and instead hold out for a proposal that could result in a new full-service hospital on the bankrupt St. Vincent's medical complex. Some critics have called the proposed facility "an urgi-care center on steroids," saying it will offer no more care than one of the extended-hours walk-in medical officers that have popped up throughout the city since St. Vincent's closed its doors.

The freestanding emergency department is a "hybrid model of care" according to the applicant. The facility would be located in the O'Toole building on Seventh Avenue, a former maritime union hall. Construction would involve partially gutting the building and reducing its 160,000 square feet to 140,000 square feet. Most of the money would come from Lenox Hill, with the Rudin Group real estate firm contributing $10,000. Pending the commissioner's approval, construction would begin in December 2011 and the facility would be operational in the 2nd quarter of 2014.

Technically, the $125 million center will be classified as a two-bed hospital and will operate under Lenox Hill Hospital's operating certificate. The facility will have paramedic-staffed ambulances standing by around the clock, and board-certified emergency physicians on duty. It will be able to treat and release an estimated 90% of patients and stabilize others so they can be transferred to other hospitals.
Before the vote, the committee heard testimony from NorthShore-LIJ representatives that addressed several concerns raised at the group's last meeting.

The concerns included questions regarding assertions that, while the concept of a freestanding emergency room is new to New York, it is a successful model in other states. Lenox Hill's emergency medicine chairman, Dr. Carl Ramsay, cited a study of Florida facilities and another of patients in Washington state. “There were no complaints of adverse events in Florida,” he said, and no indication that transferring the most seriously ill patients from the Washington facilities resulted in higher overall death rates.

Charles Abel, who sits on the committee in his role as acting director of the DOH's Division of Health Facility Planning, responded that the department's own researchers came to the conclusion that there is no convincing evidence one way or the other on the question of whether such centers' patients do better or worse than they would in a hospital's emergency room.

A secondary issue—whether the city's 911 emergency system, run by the New York Fire Department—will use the right criteria in deciding which patients should go to the new facility and which should go straight to other hospitals in the area, appears to have been resolved.

The committee said it was satisfied that existing FDNY protocols for triaging patients—such as taking burn victims to burn centers and apparent stroke victims to stroke centers—are already adequate. The NorthShore-LIJ representatives also said they will have a psychiatrist on call and social worker on staff at the St. Vincent's site to care for walk-in patients who have mental health or substance abuse problems. But those picked up by ambulance crews are not to be taken to the facility.

The approval requires NorthShore-LIJ to conduct future studies to gather data on how patients at the new facility fare. But the committee rejected a proposal to make its approval a short-term one, in which case the committee would have been able to assess those results and possibly refuse to renew the approval in future years.

"This certificate of need will be permanent," said Richard Cook, deputy commissioner of the Office of Health Systems Management and a member of the committee. "You can't ask someone to invest $125 million in a facility and give it a limited life."