By Penny Mintz
It is hard to pry information from Mt. Sinai.
On Wednesday, May 15, 2019, members of the Community Coalition to Save Beth Israel met, for the second consecutive month, in front of the main entrance to Beth Israel Hospital. The CCSBI wants to see the restoration of the hospital services, that were eliminated at Beth Israel after the merger with Mt. Sinai, and an independent, community-needs-based study performed before any further service reductions are made. The group had a table, a chair, and flyers on the history of Mt. Sinai’s broken promises, and a petition urging Governor Cuomo to see that the Department of Health properly regulates the hospital industry in the interests of protecting the needs of the community.
One of the people who spoke with CCSBI that afternoon was Elizabeth Sellman, chief operating officer at Beth Israel. She said that the 70-bed replacement for the 800-bed Beth Israel would be a real hospital, not an urgent care center or an emergency room without doctors, like the Northwell facility that replaced St. Vincent’s. When pressed for more specific information, she took my card, gave me her telephone number, and promised to speak with me. Four calls to her office were unreturned.
Loren Riegelhaupt, who represents Mt. Sinai at SDKnickerbocker, a public relations firm, was similarly unresponsive to calls and emails.
However, some information about the 70-bed facility came out on May 24, 2019, during a public hearing before Judge Shlomo Hagler in the case of Progressive Action of Lower Manhattan et al. v. Howard Zucker, Commissioner, and Mount Sinai Beth Israel Hospital. Jeffrey Braun, attorney for Mt. Sinai, said that the new facility would have a state-of-art emergency room, a full catheter lab, operating rooms, and 70 in-patient beds. No information about the types of surgery, the level of emergency services, or the capacity of the emergency room was available, much less whether Medicaid patients would be served.
Is the 70-bed facility sufficient to serve the needs of the community? It is impossible to know without a needs study, which is one of the reliefs sought in PALM v. Mt. Sinai. The other relief sought is the restoration of the closed hospital units: maternity, neonatal, pediatric intensive care, and cardiac surgery.
Judge Hagler wondered whether the court had the authority to compel the Department of Health to reverse its decisions approving the closure of the four units and compel Mt. Sinai to restore everything that was removed.
Mehir Desai, representing Commissioner Zucker, argued that none of the individual changes at Beth Israel triggered the legal requirement for review. State regulations require oversight when an entire hospital is closed or a new one is proposed, but that was not what the state was asked to review. All that was before the state was eight separate applications asking for the decertification of 150 beds out of an 800-bed hospital.
Judge Hagler pointed out several times that the plan to close Beth Israel and build a new hospital had been widely publicized. The Department of Health had to have “deliberately close its eyes to the big picture” to interpret the applications as not being part of a full closure. The judge pointedly asked whether the agency had responsibility to oversee and protect public health care and whether they had sidestepped that responsibility by allowing the applicants to get around DOH regulations and State Environmental Quality Review Act (SEQRA) laws by segmenting their applications.
The court seemed to be concerned that no one at DOH bothered to look at the ultimate impact of the segmented closures. “As a fiduciary agency, charged with making sure of quality healthcare in New York, aren’t you charged with asking about the ultimate impact?”
Despite the court’s apparent concern, the eventual ruling is hard to predict. The DOH followed the law, according to the state’s attorney. Certificates of need, which trigger review, are not required for reduction in services. As Mt. Sinai’s attorney asserted, the proposal to build the 70-bed replacement for the 800-bed Beth Israel Hospital will trigger public review by the New York City Board of Standards and Appeals and will require SEQRA impact analysis.
The court gave the parties time to provide more case law about its authority to order restoration of the closed units. The ruling should come down sometime in the middle of July.