New York Times on Emergency Room Crisis

Roni Caryn Rabin at The New York Times wrote an important article today, on the dire loss of emergency rooms and services, primarily to poor, urban populations. The article, which draws heavily on a new study in in the Journal of the American Medical Association, goes into some detail on the situation at the former St. Vincent's. Coalition for a New Village Hospital steering committee member Dr. David L. Kaufman is quoted in the story on the impact these closures have on patient care.

Below are some key points, but the entire article is worth reading at http://www.nytimes.com/2011/05/18/health/18hospital.html

Fewer Emergency Rooms Available as Need Rises

By Roni Caryn Rabin,

May 17, 2011

Hospital emergency rooms, particularly those serving the urban poor, are closing at an alarming rate even as emergency visits are rising, according to a report published on Tuesday.

Urban and suburban areas have lost a quarter of their hospital emergency departments over the last 20 years, according to the study, in The Journal of the American Medical Association. In 1990, there were 2,446 hospitals with emergency departments in nonrural areas. That number dropped to 1,779 in 2009, even as the total number of emergency room visits nationwide increased by roughly 35 percent.

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New York City lost three hospital emergency rooms in 2008, two in 2009 and two more last year, when St. Vincent’s Hospital Manhattan in Greenwich Village closed, followed by North General Hospital in Harlem. St. Vincent’s had handled more than 60,000 emergency visits a year, while North General’s E.R. had recorded 36,000 annual visits.

A 24-hour emergency care and ambulatory surgery center, operated by North Shore-Long Island Jewish Health System, is planned for Greenwich Village. Neighborhood advocates have expressed concern that the free-standing emergency room will not be able to deliver adequate care without the backing of a full-service acute-care hospital.

The new study warns of delays in emergency care that are already playing out in the community, said Dr. David L. Kaufman, a member of the Coalition for a New Village Hospital who worked at St. Vincent’s for more than 30 years. Patients who would have sought care at St. Vincent’s, he said, “take longer to get to nearby hospitals in New York City traffic. They’re waiting many, many hours to be seen and managed, and if they require admission, they have to wait another 12 to 24 hours because there are no beds.”

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So-called safety-net hospitals that serve disproportionate numbers of Medicaid patients and hospitals serving a large share of the poor were 40 percent more likely to close.

Petition To Attorney General Eric T. Schneiderman

Please take a moment and sign this petition calling on our Attorney General to stop this sale and ensure safe and adequate public health for the people of the Lower West Side of Manhattan.

http://www.thepetitionsite.com/1/New-Village-Hospital-Schneiderman/

News broke recently that St. Vincent's Hospital wasted over $25 million paying the people in charge of bankrupting the 160 year old institution instead of simply running a hospital.

In fact, according to a Crain's New York Business, St. Vincent's paid its representatives $8 million to secure a $7 million loan from the state pre-bankruptcy and then almost immediately filed bankruptcy so it didn't have to pay any of it back.

Recently, the Rudin Organization proposed a plan to turn the hospital campus into luxury condominiums. Only a small portion of one of the eight buildings would include a "stand alone" emergency room - a far cry from the hospital our community needs. This scheme violates the obligation to continue St. Vincent's charitable mission. Further, there are serious risks associated with such a facility, which would be the fist of its kind allowed in New York State.

A hospital, properly run, would bring revenues into the state and create thousands of much needed jobs. Yet despite all this, and our community's clear need of a hospital, the same bankruptcy court that allowed the scandalous payouts to St. Vincent's executives and consultants, has given the Rudin's the green light to proceed.

Thankfully there are mechanisms in place for accountability, and many hurdles yet between The Rudin Organization and their condos. The Coalition for a New Village Hospital will be at every one of these steps, demanding a hospital.

In the next step in this process, the Rudin plan must go before our New York State Attorney General Eric T. Schneiderman. Luckily, Eric Schneiderman has made very clear that he supports our community's efforts for a hospital.

But he will not act if we do not ask him to. Please sign the online petition today, post it on Facebook, Tweet it, and forward it around to all you friends and neighbors.

For people who are less digitally inclined, there's a downloadable PDF of the petition below. Please print that out, gather signature, and send it to the Coalition's office at 304 Park Avenue South, Suite 206, New York, NY 10010

CNVH: Petition to New York Attorney General Eric Schneiderman

Consultants, Lawyers, Others Made Big Money out of St. Vincent's Demise

From Crains New York Business.

Bankrupt St. Vincent's pays millions in fees

Law firms, investment banks, accountants, real estate brokers and other advisers in the shuttered hospital system's dissection have been paid about $17 million since last year's bankruptcy filing.

By Barbara Benson

Published: May 10, 2011 - 3:09 pm

The profits that eluded Saint Vincent Catholic Medical Centers when the hospital was alive are being realized after its death—by a small army of law firms, investment banks and advisers. Just over a year after it filed for bankruptcy protection, SVCMC has paid out about $17 million in fees to lawyers, accountants, investment bankers and real estate brokers.

Just last week, the judge overseeing the bankruptcy proceedings signed off on the latest round of fees billed by professionals working on the case. The tab: $5,460,793.

Kramer Levin Naftalis & Frankel took in $2,706,986 for its work as bankruptcy counsel for the final quarter of 2010. The law firm voluntarily discounted its fees by 10% in recognition of St. Vincent's charitable mission. The law firm's write-offs came to more than $350,000 for the three-month period, according to court documents.

Other big earners were investment adviser Cain Brothers & Co., which netted $701,000, and law firm Akin Gump Strauss Hauer & Feld, representing the creditors committee, which was awarded fees of $488,024. Garfunkel Wild, which also discounted its fees by at least 10%, took in $409,398. CBIZ Accounting Tax and Advisory of New York and CBIZ Inc. billed $381,621.

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Full Story at http://www.crainsnewyork.com/article/20110510/FREE/110519987

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Remarks from Dr. David L. Kaufman at the Rally to Demand a Hospital

Remarks from Dr. David L. Kaufman at the Rally to Demand a Hospital

West Village, New York City, April 30, 2011.

Well here we are again, this time to sadly honor this one year anniversary. Luckily it’s a gorgeous day---very reassuring to know that the Bankruptcy Court and the Rudins can’t also control the weather. They can’t “fix” that…

What I want to talk about today will be lots of numbers, numbers that can rule and ruin our lives. And I want to emphasize that every statistic I give comes from the US Census, the NYS DOH or NSLIJ. These facts can tell many stories, and numbers can have great but simple power and speak the clear truth. So stay with me and I’ll try not to go too fast. Oh, and there will be a quiz on the numbers at the end.

365 days ago Greenwich Village and the entire Lower Westside was plunged into a health crisis. For 52 weeks we have had no easily accessible emergency services, trauma services, hospital beds, none of the broad range of medical, surgical, psychiatric, and ambulatory services that St. Vincent’s provided to all in need. Over the last 12 months, the 61,394 people previously cared for in the St. Vincent’s Emergency Room have had to travel through traffic one to five miles in trips lasting twenty to sixty minutes to get emergency services where they have been forced to wait on average over five hours before being seen and then, if admitted, often wait another 12-24 hours for a bed to become available. How many people never made it to an ER? How many suffered in pain while waiting for care? How many had more damage to their hearts or brains because of delays in transport, triage, and management? How many died?

Last year, 70% of the patients admitted to St. Vincent’s Hospital came from the Emergency Department. Let me crystal clear here: that means in 2009, an incredible 13,572 people were so sick, so acutely ill that they required IMMEDIATE admission for treatment of their heart attacks, strokes, pneumonias, perforated organs, injuries, etc. What has happened to those 13,572 patients over the last 52 weeks? Does anyone really know?

In 2009, St. Vincent’s hospital admitted a total of 19,388 patients. In 2009, St. Vincent’s Hospital had an average daily census of 340 patients. That means 340 people from our community were sick enough to be hospitalized every single day of the year. Where have all those patients gone? How far have they had to travel, how badly has their care been delayed and disrupted?

Of course, the NYS Dept Of Health, the NSLIJ hospital system, the Rudin Organization, our elected politicians—Cuomo, Bloomberg, Duane, Gottfried, Quinn and the rest—our elected leaders supposedly responsible for our community’s health and welfare---of course THEY don’t have any of those answers. Suddenly their statistics machine is broken, their multimillion dollar PR operations are eerily silent. No answers. Nothing. What has happened to the concept of holding officials, be they appointed, elected, corporate or non-profit, responsible and accountable?

Instead of answers, our community has been supremely insulted. These people are offering us an urgent care center, a doc in the box on steroids, a turbocharged clinic. They further insult us by calling it an Emergency Room. And then, talking to us like we are ill mannered children, they insist we are lucky to even get this, that it’s better than nothing. I will not, again, go through all the reasons they are wrong, all the ways they are deceiving us and all the life threatening risks of their generous offer. Read the flyers, read Westview, and then think about this: can their Comprehensive Care Center, their free standing emergency room treat 61,394 people a year, can it house 19,388 patients sick enough to require inpatient care, can it deliver the life saving, critical care that 13,572 poor souls required in the emergency room in 2009. These are not rhetorical questions, these are not melodramatic questions-no, no, these are life and death questions and the lack of answers, the utter disregard of these facts puts my life and yours in danger every day.

OK, time to move on to a different set of numbers. Are you ready? OK, here we go. According to the data collected by NSLIJ, the Lower Westside and the so called primary service area of St. Vincent’s hospital has a population of 385, 000 and the hospital had about 380 operational beds. 385,000—I want you to remember that number and also keep in mind that it does not even include the estimated 500,000 additional commuters and tourists that come to the Lower Westside every day. 385,000.

Now, we going to take five mile trip to the Upper East Side and East Harlem, an area geographically defined by the Harlem River to the North, the East River, south to 59^th street and west to 5^th Ave. The population of those two communities totals 325,286 people, 60,000 people less than ours. What do all those people do for healthcare—what are the hospital and Emergency Room resources in their community? Hold onto your hats and try not to faint as I read you these statistics:

· NY Presbyterian Cornell Weill Hospital –867 beds and full service emergency room

· Mt. Sinai Hospital—1171 beds and a full service emergency room

· Memorial Sloan Kettering Cancer Center—437 beds and a full service emergency room

· Metropolitan Hospital—341 beds and –you guessed it—a full service emergency room

· Hospital for Special Surgery –172 beds and limited emergency services

· And finally, last but certainly not least, we have Lenox Hill Hospital, NSLIJ’s latest acquisition with 652 beds and another full service emergency room

Can anyone guess how many beds that adds up to? Are you ready? 3,940. Yup, that’s 3,940 beds for 325,286 people or one bed per 82 persons. Oh, and I almost forgot, FIVE full service emergency rooms with all the bells and whistles, all the medical and surgical backup required to do the job right.

What do we have? NOTHING. We have zero beds for 385,000 people or close to a million if you include the commuters and tourists. I want to make sure you all got that: it’s zero bed per 385,000 as compared to one bed per 82. In some circles, that would be called criminal policy and planning. I suspect most third world countries have better bed ratios than zero per 385,000.

So what can be done? We are up against a government mindset that insists New York State has too many hospital beds, that the only way to solve our financial healthcare problems is to close beds and hospitals. Let’s just assume that the DOH and the so called healthcare experts are correct. How do they implement this decision, how do they get rid of beds? It’s a fair question and one would think that experts like these would approach the challenge rationally and carefully. But, the utterly astonishing fact is, they do not. They give no thought to the distribution of beds—all they care about is shutting them down. Community needs, bed per person ratios, socio-economic issues are all irrelevant. How else explain the behavior of a our city and state officials, of that guardian of your health and mine, the DOH, -- how else explain their decision to leave all 385,000 of us with NO hospital, NO Emergency Room, No critical services, while five miles north of here there are 4000 beds for 60,000 less people? Incredible and shameful.

So here is my proposal. Let’s get rational, let’s act responsibly, let’s plan intelligently, and let’s all work together—our community, the Rudins, NSLIJ, our elected and appointed officials—let’s solve this absurd situation so that everyone wins. NSLIJ has taken over Lenox Hill Hospital in a community that, as I have just described, is practically drowning in beds. The DOH would be absolutely correct in stating that the Upper East Side is way overbedded, that the situation is not financially sensible or sustainable. And Lenox Hill, even with the marketing might and deep pockets of NSLIJ, will be hard pressed to compete with the likes of Sinai, Sloan, Hospital for Special Surgery, and NY Hospital. But, hey look around you—behind me is a huge empty hospital campus, across the street is another 160,000 sq ft of empty space, and all around me are 385,000 patients—customers—with no hospital, no services, and we are desperate for help.

So-I say to NSLIJ, come on down.

Move the entire Lenox Hill Hospital downtown. Bring the doctors, bring the nurses, the support staff, the beds, the fancy equipment, bring it all, and we will fill your beds. We’ll even be getting a lot of our great St. Vincent’s docs back since Lenox Hill recruited so many of them. And in exchange, let the Rudins move uptown to build their condos. Talk about prime real estate---we’re talking 76^th and Park Ave, doesn’t get much better than that. And if NSLIJ doesn’t need the entire St. Vincent’s campus, well, they can throw the Rudins a building or two to develop down here. Just think about it---at a minimum it’s bed neutral but they could probably do it with 400 beds, so we actually close another 250 beds—hooray. I’m not a banker or a mogul, but I suspect the dollars work to everyone’s benefit. And nobody loses their job, businesses would reopen in this ghost town, and we, the people, get our healthcare crisis resolved with the opening of new world class, full service hospital and emergency room. Think of the good will generated, think of the fund raising opportunities, imagine the restoration of healthcare for 385,000 people. Everybody wins, nobody loses.

Let’s all work together to create the new World Trade Center Memorial Hospital.

The Westside Healthcare Coalition is a Lie

Lower West Side residents have been receiving some interesting astroturf in their mailboxes lately. It's from a group called The "Westside Healthcare Coalition". Trouble is, they don't exist. They're just a front for the real estate developers that want to build luxury condos where we need a hospital.

Don't fall for it.

West Side Healthcare Coalition is a Lie

Statement on Today's Court Decision

Statement from the
Coalition for a New Village Hospital's attorney Yetta Kurland

We were disappointed, but not surprised by today's Court decision. While we disagree with the Court's determination, this is just the first of a number of hurdles that the Rudins will have to overcome to purchase and develop the St. Vincent's campus.The Coalition for a New Village Hospital stays principled in our stand and unwavering in our position that this community requires nothing less than a full service hospital. We will continue to unite the community toward that objective. Our April 30th rally will be a testament to the community's desire for a hospital. At the same time, we are prepared to work wiith Rudin Management and North Shore-LIJ to achieve that goal.

Delay Approval of the Rudin, North Shore LIJ Condo Deal

For: The Coalition For A New Village Hospital

Media Contact: Steven Greene

For Immediate Release

Delay Approval of the Rudin, North Shore LIJ Condo Deal

New York, NY – April 7, 2011 – The Coalition for A New Village Hospital called on the U.S. Bankruptcy Court today to delay approval of the proposed sale of former St. Vincent’s Catholic Medical Center site to RSV LLC, an affiliate of Rudin Management.

Said Yetta Kurland of the 7,000 member Coalition, “While recent court decisions prevent us from filing objections to the proposed sale of the St. Vincent’s property to the Rudin Management Company, we stand firm in our conviction that this community is in urgent need of a full-service emergency room and in-patient hospital. The current plan offered by Rudin Management and North Shore-LIJ falls far short of that goal. “

On April 6, The Southern District Court reaffirmed the Bankruptcy Court’s decision to bar attorneys for the Coalition from “taking any actions and otherwise proceeding in furtherance of or in connection with” related to the allegations in their earlier state court action.

Said Dr. David Kaufman, “We are fully prepared to work with Rudin Management and North Shore-LIJ Group or any other qualified buyer toward the realization of a hospital. If necessary, it would be in the best interests of the community and the creditors to re-open bidding to additional qualified buyers committed to a new hospital.”

On March 10, the Rudin Management firm announced they had partnered with North Shore-LIJ to with plans to build a walk-in emergency facility and hundreds of luxury apartments in place of the full service in-patient hospital. Community members have protested the plans citing a number of health concerns and efforts by other jurisdictions that already offer free standing emergency rooms to introduce legislation banning them because of these concerns as well as exorbitant costs associated such facilities.

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WARNING! The North Shore-LIJ “Emergency Department” Plan May Be Hazardous To Your Health

For: The Coalition For A New Village Hospital

Media Contact: Steven Greene

For Immediate Release

WARNING! The North Shore-LIJ “Emergency Department” Plan May Be Hazardous To Your Health

10 Ways North Shore-LIJ Gets It Wrong

1. The North Shore-LIJ “Emergency Department”may be dangerous to your health. The trip you take to an urgent care center can cost you vital minutes that make the difference between life and death. The chances of surviving a cardiac arrest declines by approximately 10% for each minute without defibrillation. At the new North Shore-LIJ urgent care center, it may be hours before examinations, blood tests and electrocardiograms reveal an acute heart attack. Whether the ambulance trip that follows is to Beth Israel Hospital or more than 4 miles to Lenox Hill, it would be too late for the emergency intervention available at a hospital. At the end of the day, their proposed “Emergency Department” is a lot like a “doc-in-the-box” urgent care center.

2. Free Standing “Emergency Departments” like the one planned by North Shore-LIJ can actually drive up medical costs. While they claim freestanding emergency rooms are less expensive to operate, there is growing evidence that they actually increase costs as the quality of healthcare declines. In states like Washington the legislature is considering putting a moratorium on using these facilities after seeing costs skyrocket.

3. You can’t take an ambulance there. How can it be a true Emergency Room if it doesn’t have ambulance services? Without large changes in laws and regulations, these types of facilities will not have ambulance service to bring in a patient. The reason: The managers of the 911 emergency system does not believe these independent ambulances are equipped to treat emergencies. To make the changes North Shore-LIJ is requesting will mean a ”freelance” ambulance system that operates separate and apart from the life-saving 911 system.

4. Emergency medical technicians will be forced to make decisions about what type of treatment you will receive before you see a doctor. If a patient calls 911, medics are going to have to make critical life decisions without the guidance of a medical doctor. If these medics are rushing patients to an “emergency room” unprepared for life-threatening emergencies, patients’ lives will be at risk.

5. It is an unregulated facility where patients without coverage can be turned away. Unlike hospital emergency departments that are obliged to accept all patients regardless of their ability to pay, private centers like the one planned by North Shore-LIJ, are legally allowed to turn away patients who have trouble paying for treatment. What’s more, they are not even required to hire union employees.

6. It will be in their interests to transfer you miles away to Lenox Hill. An emergency room helps cover its costs by admitting patients to the hospital. ERs are the major source of new admissions. It is widely understood that a “stand alone ER” like this one acts as a “feeder” to get patients. That would mean that assuming you did actually need care you wouldn’t receive it in your neighbourhood, but would be transferred by ambulance to North Shore-LIJ’s one and only NYC medical center, Lenox Hill Hospital, which is crosstown, and 4.09 miles away.

7. The emergency care they can’t provide is the care that matters most. NSLIJ claim this new “Emergency Department” will provide 95% of the care available at St. Vincent’s former ER. Importantly, that figure does not include the most important reasons patients rush to an emergency room -- acute stroke, heart attack, trauma, septic shock, respiratory failure, and other emergency events including those suffered by first responders from the World Trade Center.

8. This new Emergency Department” will treat 40% fewer patients annually in a community that’s doubled in size. Despite a doubling in the size of the community, the new center will treat only 35,000 patients per year versus 60,000 treated annually at the former St. Vincent’s.

9. Contrary to claims, St. Vincent’s was used by the majority of the community until the day it closed. In fact, St. Vincent's treated 55% of the local community in 2009, its last full year of operation, according to New York State data. This was true even while rumors were growing that the hospital would soon close.

10. A new hospital can be built at a fraction of the cost While NSLIJ claims building a new hospital could cost $2 million/bed, a global firm of engineers has estimated the cost of reinstating a hospital in the current Colman building at a fraction of the cost, and close to the cost as the\is proposed freestanding urgent care center.

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Winners and Losers

Winners and Losers in the Battle for Healthcare on the Lower West Side