This has been an interesting few months, so it’s hard to know where to start. Let’s begin with the New York Times article by Anemona Hartocollis that came out on October 9: “New Style of Health Care Emerges to Fill Hospital’s Void.” As I have said before, one can almost imagine this piece being written by the now deceased Dr. Richard Daines, NYS Commissioner of Health, or Stephen Berger or even Mayor Bloomberg. All believed in the mantra, as Sarah Palin would say, of “close baby close” those hospital beds, regardless of location, community needs, or healthcare service access. Ultimately, that was their justification for allowing, some would say forcing, the closure of St. Vincent’s.
During that period, the Times refused to address or investigate any of the issues and concerns that the community repeatedly raised. Then two and a half years after closure, Ms. Hartocollis appears to discover that all is well for the one million residents and visitors of the Lower Westside. She writes that the multitude of new and expensive Urgent Care Centers that have sprung up are a perfectly adequate substitute for the St. Vincent’s Level I Trauma Emergency Department. Besides choosing to ignore virtually everything we discussed in our 30 minute conversation, she appears to have made no real investigative effort.
It might have been educational for her to have spent time, for example, at the Beth Israel Emergency Room. First, she would have seen a street clogged with over 10 ambulances at a time. Then, if she had wandered into the waiting area, she would have discovered a flood of patients. It would have been enlightening for her to ask patients how they feel after waiting 4-6 hours to be seen. Finally, inside the ER, she would have witnessed for herself the overwhelmed staff, and perhaps have had an opportunity to interview the elderly patients often forced to wait 12-24 hours for a bed. If she had really wanted to dig, she could have interviewed the EMTs and Paramedics to find out the truth on transport times (not pick up times), ER patient drop off delays, and life threatening delays for trauma patients.
That would have been real journalism. Instead she wrote an article that tries to show that the “grand experiment” of no emergency and hospital access for one million people is a success.
Twenty days after this article came out, Sandy blew into town. NY Downtown hospital was flooded and closed. One down. Then, at NYU Langone, the emergency generators failed to kick in (how does that happen in a major accredited hospital?) and there was an immediate and orderly evacuation of 215 patients. Two down.
Contrast this with Bellevue Hospital. In two well documented, wrenching articles by Nina Bernstein and Hartocollis, we discover the chaos as the giant hospital was flooded with water filling the elevator shafts and knocking out power. Bellevue, the flagship hospital of our public hospital system, is filled with poor, indigent, often uninsured, often non English speaking patients. It is profoundly disturbing to read how the Bellevue and Health and Hospital leadership chose to dangerously delay evacuating the 725 patients in the hospital. It is a miracle that no patient died as the heroic staff struggled to emergently evacuate these patients. Contrast the Bellevue chaos with the orderly, immediate evacuation of the private well insured patients at NYU. Am I missing something here? Talk about leadership decisions that cry out for an investigation.
Last, but not least, is the article in Crain’s on November 4, “Storm Shows Hospital Excess-Despite Post-Storm Crowding Manhattan Has Enough Beds.” It is difficult to read this article without bursting out in laughter or shedding tears. The author basically makes the argument that since no one died despite the closure of three hospitals (not counting the VA Hospital), it just proves that we have no lack of access or services. Michael Dowling, CEO of North Shore LIJ is even quoted, saying, “ hospitals can handle the surge.” So, we should all be grateful. All is well in Gotham. In fact, Sandy just confirms that we still have too many beds, so let’s close some more hospitals. Thank you, Sandy. Tell that to the staff at the other hospitals left standing where the census is running at 110-120%. Tell that to the patients trying to access care in an overwhelmed system. Tell that to my patients who ask me, with tears in their eyes, “What should I do if I get sick, where should I go?”
So, I have some questions and suggestions to which, of course, no one will listen.
If Sandy shows we have enough beds in Manhattan, why bother trying to reopen NYU and Bellevue? Why not simply build another one or two free standing emergency rooms a.k.a. urgent care centers? – could be a new line of business for North Shore LIJ.
However of course, we all know that will never happen. If the right people want a hospital, want beds, then they will get what they want. NYU has stated that it will take $1 billion simply to reopen. This money will come from the taxpayers – you and I – as the Fed foots the bill. Yet remember, NYU is also building a new tower at a cost of $2 billion. When completed, they will presumably tear down the building they will have just spent $1 billion repairing. Hello. Does this make any sense? The bigger question really is this, how do you justify spending $3 billion to build two hospitals in the exact same flood plain? Even Mayor Bloomberg has acknowledged the growing threat of global warming, rising sea levels, and the increased risk of major storms and flooding. Does anybody at NYU, City Hall, the Department of Health actually think they can hold back the East River with sea walls?
A rational system of planning would at least consider the idea of spending that money on a more centrally located hospital on higher ground. However we have been down that road before. The central high ground needs condos with beds, not hospitals with beds.
Every day, I spend my time on the front lines caring for patients in the office and the hospital. These are the trenches, this is where the action takes place. When is the last time a politician, a Commissioner of Health, a policy planner, or even a hospital CEO, put in real time, not just a stroll, at the front lines?
You couldn’t make these stories up and you would never believe the events of the last three years could happen, but they did. For me, these last few years have been like Alice in Wonderland. I keep falling down the Rabbit Hole.