By Penny Mintz
Mount Sinai is in the final stages of its application to the State Department of Heath for authorization to replace Beth Israel with a 70-bed facility, and move the vast majority of the medical treatments and tests that were once available downtown to “centers of excellence” far uptown.
On Thursday, January 23, the Establishment and Project Review Committee, which is part of the Public Health and Health Planning Council (PHHPC), conducted the state’s preliminary hearing on the Mount Sinai application. The Department of Health will eventually make its decision based on the conclusions of PHHPC. The decision of the committee was something of a surprise because all indications beforehand had been that PHHPC and the DOH had no interest in hearing, much less acting upon, the concerns of the public.
First, PHHPC had originally scheduled all their Mount Sinai-related hearings in Albany, where local people would be unlikely to participate. Fortunately, Lois Uttley, of Community Catalyst, successfully pressured PHHPC into conducting the hearings in New York City.
Second, the hearing date is released only one week before the hearing, thus limiting the time to contact local people who would want to come and speak.
Third, PHHPC has a very tight schedule for accepting written comments. The cutoff is 72 hours before the start of the hearing. In this case, that meant that no written comments would be accepted after 10 am on Monday, January 20, which was Martin Luther King Day. With a great deal of pressure from Lois Uttley and from State Assembly members Harvey Epstein and Richard Gottfried, the cutoff was moved to 4 pm on January 21.
The overall impression of disinterest in the concerns of the public was compounded with the statements of the initial speaker, committee member and DOH representative Tracy Raleigh. The DOH accepted wholesale every element of Mount Sinai’s analysis and predictions.
After Raleigh, Jeremy Boal, Executive Vice President and Chief Medical Officer of the Mount Sinai Health System, was joined at the speakers’ table by three other Mount Sinai colleagues. They spoke about the “centers of excellence” that they were creating and the declining hospital census. Hospitals, in their view, are apparently dinosaurs.
After Mount Sinai, members of the public were given three minutes each to speak. In attendance were about 20 concerned citizens and members of an ad hoc coalition of groups focusing on Mount Sinai’s plans for Beth Israel and for Rivington House. Most wore white ribbons, so that they would be clearly visible to the committee. Nearly all of them spoke, including George Capsis, publisher of this newspaper.
George Capsis dramatically shared the traumatizing experience of his wife’s final illness, which occurred when they could still walk from their home in Greenwich Village to Saint Vincent’s Hospital—now gone. Mount Sinai, Capsis pointed out, is now eliminating another full-service local hospital. This will leave large swaths of lower Manhattan underserved.
The concerns of the rest of the public with regard to Beth Israel fell primarily into two categories: the impact of the loss of maternity services, and the difficulty of accessing all of the myriad medical services that were until recently provided locally. Now they are available only in the Mount Sinai “centers of excellence” at 102nd Street and Fifth Avenue, 59th Street and Ninth Avenue, or 91st Street and Columbus Avenue. These facilities are extremely difficult to access from downtown, especially for the frail and elderly.
Dr. Boal claimed that the trip from Beth Israel or Union Square is “a straight shot uptown.” But that is not exactly true. Even in a car, which he apparently believes that everyone in medical distress can afford, it’s a time-consuming trip. Once you get to 102nd and First Avenue, there is still the crosstown jag all the way to Fifth Avenue. If you have to rely on public transportation, you need a train and bus and still have several blocks of walking from the bus to the excellence facilities.
The committee voted after the public comments concluded. Four members, including Ann Monroe, the newly appointed member representing public consumers, had serious concerns and opposed the application. Without the necessary quorum, the committee was unable to approve the application.
The committee chair was concerned that, without PHHPC approval, Mount Sinai’s promised $1 billion investment would disappear, and we would end up repeating the St. Vincent debacle. So the committee attached two contingencies to the plan.
First, Mount Sinai is required to provide evidence of investigating studies and developing concrete plans for the addition of a birthing center at the new 13th Street facility. Dr. Boal said that they are very committed to that, but only if the service can be provided safely. That gives Mount Sinai a lot of wiggle room.
Second, Mount Sinai must come to the next PHHPC hearing with a comprehensive plan to assist lower Manhattan consumers in navigating the changed system of health care access and solve problems of traveling uptown to the other Mount Sinai facilities where the services are being consolidated. That would be an improvement, but not as good as continuing to provide medical services locally.
The next PHHPC hearing on Mount Sinai’s Certificate of Need application will take place on February 6, 2020, at 90 Church Street, 4th Floor. The large outpouring of public concern changed the outcome last month. Continued public presence is needed to make sure that the contingencies squeezed out Mount Sinai come to fruition before they will be permitted to build the new facility and sell the existing Beth Israel real estate to the highest bidder.