How Do We Get a Full Service Hospital?

By Brian J Pape, AIA, LEED-AP

About a decade ago, NYC saw major shake-ups in the medical care field. Of course, that’s when we saw St. Vincent’s Hospital close suddenly, after years of planning for expansions. Ever since Saint Vincent’s closed in 2010, it left the lower west side of Manhattan without any hospital at all, so the need for a full-service hospital is as great as ever, especially as shown by the COVID-19 pandemic.

In a short time, New York-Presbyterian acquired New York Downtown Hospital; Mount Sinai acquired St. Luke’s-Roosevelt, Beth Israel Medical Center, and New York Eye and Ear Infirmary. Shortly after that, in 2016, NYU Langone Health acquired Lutheran Medical Center in Brooklyn; Montefiore Health System acquired Mount Vernon and New Rochelle hospitals.

Kenneth E. Raske, president of the Greater New York Hospital Association, wrote a letter to Crain’s (March 14 New York issue), responding to an earlier Crain’s article “After the hospital leaves town.” In it, he claims that hospital mergers and consolidations are actually good for under-served communities, including communities of color. For example, he notes that when Columbia-Presbyterian Medical Center merged with New York Hospital in mid-town, it “ensured that the new health system would care for vast numbers of low-income New Yorkers of color.”

Regarding St. Vincent’s closing, he writes “Outpatient ambulatory services have filled this void. The full-service emergency department and medical complex at Lenox Health Greenwich Village, which Northwell Health established….provides critical health care services while transferring the small number of patients who require inpatient services.” Likewise, other communities have benefited from the new outpatient facilities, he says; ”One Brooklyn Health, created through the merger of three safety-net hospitals, is converting the Kingsbrook Jewish Medical Center campus to a medical village with ambulatory services. Simply, the closure of inpatient services at New York City hospitals in the past decade has not eliminated health care services at those sites.” Furthermore, “St. Vincent Catholic Medical Centers….. collapsed in massive debt, mostly from the weight of acquiring five financially struggling Catholic hospitals serving large indigent communities across Brooklyn and Queens.”

Meanwhile, the Upper East Side Lenox Hill Hospital, at their original location since 1857, has a 10-year, $2.5 billion expansion master plan. Lenox Hill Hospital merged into the Northwell Health system in 2010. Northwell has established nearly 80 outpatient facilities in Manhattan since 2010.

Michael Dowling, president and chief executive officer of Northwell Health, his staff, Ennead Architects (formerly James Polshek Partners), and EwingCole, a firm with extensive hospital design expertise, worked on plans for larger service departments, only single-bedded patient rooms and more beds than before (475), state-of-the-art equipment and technology, and more operating rooms. They will establish a dedicated “mother-baby” hospital wing to accommodate mothers and family members in an elegant, private setting with its own separate entrance on Park Avenue. Plans include shared, programmable community spaces. In total it will be 1.3 million square feet, up from 780,000 square feet, including a 30-story tower. All that space and equipment amounts to $5,263,000 for each of the 475 beds, or $1923 per square foot.

Pei Cobb Freed and Partners, and Ballenger, in the architects’ report to the LPC in 2008, said their St. Vincent’s Hospital design would consolidate all of the hospital’s operations into one building and features an egg shaped terra-cotta clad tower on a five-story podium, 19 stories and 286 feet tall, with 366 acute care beds and 614,000 ft.² of floor area. It included 30 beds per floor, with floors dedicated to ICU, OB/NICU, OR, RAD/ONC, clinical support, diagnostic, mechanical, and emergency departments. The emergency department was designed for more than 60,000 patients a year. The cost was approximated at $830 million, averaging $1352 per square foot, or $2,267,760 per bed.

The process to plan and construct a new hospital takes years. Every planning decision mentioned here is highly regulated by government agencies, including having to justify any change, based on community needs. That makes any plan a long-term plan.

For a new Greenwich Village hospital, it should be a full service trauma center, with emergency department, and other service departments such as 200 single-bedded patient rooms, state-of-the-art equipment and technology while providing flexibility for future technology advancements, dedicated “mother-baby” hospital area, and full operating rooms. We anticipate that such a full-service hospital would cost $1.5 to $2.2 million per bed to construct, and encompass about 400,000 gross square feet of floor area. A patient and medical office tower of 12 or more stories may be needed, depending on the site. Combining it with the existing Lenox Health Greenwich Village facility would be smart.

Mr. Raske concludes, “A key driver of hospital closures is Medicaid woefully underpaying NY hospitals. New York’s Medicaid program covers less than 65% of hospital costs.” He concludes with “advocating for more Medicaid funding in the state budget and for additional funding from the federal government.”

Brian J. Pape is a citizen architect in private practice, serving on the Manhattan District 2 Community Board Landmarks Committee and Quality of Life Committee (but speaking solely in a personal, and not an official capacity), Co-chair of the American Institute of Architects NY Design for Aging Committee, is a member of AIANY Historic Buildings and Housing Committees, is LEED-AP “Green” certified, and is a journalist specializing in architecture subjects.