Comments

1. Jason 02/09/2010 - 7:52 am

   The article does a pretty good job summarizing the situation.

   Charity has failed, and justice, in a Christian sense, can’t gain a foothold in a country where Libertarianism has saturated the consciousness of the people.

2. Barbara 02/09/2010 - 11:05 am

   Well, in defense of stating the larger picture. First, New York has a A LOT of hospital beds, throughout the entire state and especially in the city. It is what is called overbedded — and closing beds has been, to varying degrees, a priority for both the federal and state governments. If St. Vincent were one of two hospitals, its provision of charity care would not be an economic catastrophe — but being one of 10 or more makes it hard to sustain an economically viable institution that provides the lion’s share of charity care (which I am not sure that it does, but that appears to be what the article suggests).

   Second, the article touches on although it couldn’t possibly resolve what appear to be real questions about the competence of the hospital’s board and management, and the effect of wasted opportunities. How much effect did this have? Who knows — but for anyone who has worked with hospitals, it fits a frequent pattern, of non-profit hospitals unable to understand when they have stopped playing in an amateur league and failing to run themselves more professionally.

   Third, the hospital was stymied by the community that it purports to serve, when it was unable to build upgraded facilities. As the article notes, many people felt perfectly free to oppose a newer hospital because they were already using other facilities — even as they probably now oppose the shutdown of the existing facility.

3. Margaret O’Brien Steinfels 02/09/2010 - 11:22 am  subscriber  contributor

   Barbara’s points are probably very much–well to the point! I suspect Saint Vincent’s has a complex relationship with its neighborhood. There are still many low-income people in an otherwise wealthy neighborhood. So poor people probably do use it, especially its emergency room. The anti-new building’s crowd may have been among the rising elite–although their defense of a pretty ugly building–the former headquarters of the National Maritime Union–seemed pretty ridiculous.

   Still and all, I always like to visit friends hospitalized there just because it was such a very nice place, say as compared to Memorial Sloan Kettering or NYU hospital, which are institutional and cold, and not necessarily any more germ-free.

   There is probably a lot of political posturing going on, especially from the governor’s office, but it sounds like some gizzilionaire would have to step up to save it. It is also the only hospital on the West Side south of 59th Street. In New York that’s far! although I realize there are people who have to drive many miles to get to any hospital at all.

4. Barbara 02/09/2010 - 12:05 pm

   One of the pressures of “overbedded” regions is that people’s perception of accessibility is influenced by existing patterns. For instance, the closest hospital to my IL’s is 15 minutes drive, seven miles away — and they are close, compared to many others in their region.

   In addition, people’s perception of the value of proximity to a hospital has not changed with technology. In terms of true emergencies, it is probably far more important to have a well-trained and equipped and responsive EMS team than a hospital emergency room which, however close, is probably never going to be less than 10 or 15 minutes away. Not that the hospital ER isn’t important, it’s just that it’s simply not going to be the first responder for the vast majority of true emergencies it handles.

   Finally, once you get past the ER, a hospital’s ability to manage on-call staffing of non-ER personnel is the most important factor in your ability to obtain urgent surgical care. This is a huge problem for ERs outside of teaching facilities, where staff are there 24/7 and are often employees of the hospital.

   I don’t know anything about how St. Vincent fares when it comes to “true” emergencies, but I would venture that its emergency department sees “opportunistic” emergencies far more than “true” emergencies. I would bet that “true” emergencies are already being routed to facilities that can handle post-stabilization services — e.g., gunshot wounds, car accidents. That’s certainly how it works in DC — if you get shot, you are probably going to GWU, even if there is a closer hospital ER.

   St. Vincent’s could probably survive if health care reform does. This is what gets lost in the debate: it isn’t solely about people — it’s also about the ability of institutions to survive and carry out a local mission of providing services. One less ER, or doctors refusing to accept call because they don’t want to deal with non-paying patients has an impact not just on those non-paying patients, but on those who can and would pay.

5. Paul Moses 02/09/2010 - 10:58 pm  subscriber  contributor

   There were other Catholic hospitals in New York City that closed in the past couple of years with scarcely a whisper – hospitals that were located in poor neighborhoods, such as Mary Immaculate in Jamaica, Queens, and which provided a significant amount of service to the medically indigent. These hospitals in the Diocese of Brooklyn all failed after they were combined with St. Vincent’s in Manhattan – a merger that may have worked against the hospitals in the Brooklyn diocese.

   Because of its location in Manhattan and in the Village, St. Vincent’s is getting a lot more media and political attention than the now-deceased Catholic hospitals in Brooklyn and Queens did when they faced financial problems.

   I think New York state politics is the underlying issue in the whole mess. I haven’t made a study of this, but I suspect that the large, influential, Manhattan-based “non-profit” teaching hospitals get an inordinate amount of New York state’s generous spending on health, and that the hospitals that take seriously their non-profit mission of serving the medically indigent are the ones being squeezed out as a result of the way health money is disbursed.

   One other reaction to the Times article. It’s especially sad that a community so famously liberal has shown so little regard for St. Vincent’s mission to serve the medically underserved. Susan Sarandon becomes an emblem for that in the article.

6. Barbara 02/10/2010 - 9:07 am

   Paul, I doubt if those other hospitals escape their share of indigent care. If St. V’s ER closes, you can be sure that the dislocated patients will patronize the ERs of these other facilities, however much further away.

   Regarding state funding, I don’t know the answer, however, as to federal funding, the teaching hospitals probably get more IME funding (indirect or overhead medical education), but St. Vincent’s almost certainly qualifies as a “DSH” or “disproportionate share hospital” eligible for additional funding because of its indigent care load. Parenthetically, most funding is federal, even in relatively generous states like New York: Medicare is 100% federal and Medicaid is almost never less than 50% federal.

   But the reality is that all institutions in urban environments, whether it’s St. Vincent’s or Weill Cornell Medical Center, shift the burden of indigent care to paying patients. If there are too few paying patients, the load is unsustainable.

7. Margaret Steinfels 02/10/2010 - 9:27 am  subscriber

   Slightly off topic but related and grotesquish: “Long-Term Care Hospitals Face Little Scrutiny” about how for-profit, long-term care hospitals game the system. But who says reform is necessary?
   http://www.nytimes.com/2010/02/10/health/policy/10care.html?ref=us

8. Jim Pauwels 02/10/2010 - 12:08 pm  subscriber

   I see this closure as symptomatic of a larger issue: the church’s decades-long struggle to maintain a physical presence among the poor despite economic unviability. In that sense St. Vincent’s closing isn’t that much different than a parish or school closing after the demographics have changed in a poor neighborhood.

   The Sisters of Charity could probably run an economically viable institution in a more upscale suburb but that is not their mission. They need to figure out how to make their mission economically sustainable.

   Religious orders that serve the poor need the largesse of the very wealthy, and/or government contracts – otherwise they can’t afford to sustain the services they are trying to provide.

   A Catholic Church that serves only those who can give enough money to keep its plants open and its employees salaried isn’t fulfilling its mission. I don’t think the Catholic Church in the US has solved this problem yet.

9. Cathleen Kaveny 02/10/2010 - 10:17 pm  contributor

   I think these institutions are important. They embody –however imperfectly–the corporal and spiritual works of mercy. Without them, the church’s broader presence in the public square is essentially limited to being a lobbying group.

10. Barbara 02/11/2010 - 5:54 pm

    Whether the institutions survive or not, whether their mission is unique or important — the reality is that, when most of them were founded, more than 100 years ago, the amount of meaningful care that could be provided to a sick person was only slightly more than nil. Having that care provided by someone who would meet the needs of your soul and your conscience while, more often than not, easing you into death was perhaps advantageous.

    It’s not that I fail to see a spiritual dimension to the provision of health care, but in reality, most health care is a technical exercise and most health care providers are technicians. People will always need charity, but it’s less than clear that the intersection of charity and health care makes a lot of sense as modern health care has evolved.

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