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Kevin ClarkeJuly 05, 2010

Tom Cunningham, afternoon groceries swaying in his hands, stops to review the notices taped to the wall alongside the closed doors of St. Vincent’s emergency room entrance. The postings, in English, Spanish and Chinese, advise would-be walk-ins where to find help now that the E.R. has closed for good. Just a few feet away, a Fire Department ambulance roars past the E.R. entrance ramp on Seventh Avenue, sirens wailing. It does not turn in to St. Vincent’s but heads downtown, fast.

“I just can’t believe it,” he says. There has been a lot of that going around Greenwich Village these days. Residents were keenly aware of St. Vincent’s precarious health, but many assumed the venerable Village institution would never be allowed to close. “It really hits you now,” he says. “They tell us we can go to Beth Israel or Lenox Hill or five miles north or three miles east or four miles south.” He shakes his head over the impossibility of such a notion. “You know what traffic’s like in Manhattan,” he says.

“I hate to say it, but I wonder what’s going to happen to someone who gets sick or hurt around here tonight,” Cunningham says. “Someone is going to die tomorrow.” Cunningham does not say needlessly, but that is clearly on his mind and has certainly concerned neighborhood groups that in recent weeks loudly resisted the closing of the 161-year-old hospital—to no avail. A six-month-long death spiral and a final whirlwind of last-minute power plays and increasingly frantic negotiations—no fewer than six competing hospital networks at one point or other were in discussion to partner with the faltering St. Vincent’s—ended on April 30. St. Vincent’s Hospital Manhattan, the last Catholic general hospital in New York City and an institution that had a hand in the birthing and the burying of generations of New York Catholics, was closing its doors.

Around the corner from the emergency room, the hospital’s lobby is bustling with activity, but it’s not the human crush of patients, doctors and family members who used to crowd St. Vincent’s. These are departing hospital employees in embraces and kissing goodbyes to friends and fellow workers, clutching plastic bags full of personal belongings salvaged from offices and work stations. One 20-year veteran nurse is leaving arm in arm with another, still incredulous that the doors were closing behind her for the last time.

“It’s heartbreaking,” the R.N. says. St. Vincent’s was not just a place where she worked. “This was home,” she says. “I came here right out of nursing school. We came here to fulfill the mission of St. Vincent’s,” the hospital’s commitment to “compassionate care” that arguably set it apart from other New York hospitals.

This nurse, who asked to remain anonymous, does not blame the Sisters of Charity for the hospital’s downfall, but New York politicians, other hospitals and New York real estate interests are another story. She says the hospital’s closing has less to do with its effectiveness as an institution or the needs of the community than with “politics in the city of New York.”

Who Killed St. Vincent’s?

Conspiracy theories have been circulating madly among staff and neighbors on the Internet since St. Vincent’s closing was announced. The suspicions are not without cause. St. Vincent’s offers a lot for New York real estate vultures to pick over, its campus alone a last-of-its-kind opportunity for developers to get their claws on a sizeable chunk of property within the lucrative confines of Greenwich Village.

Jane Iannucelli, of the Sisters of Charity, a St. Vincent’s board member and director of sponsorship services, is aware of the speculation spinning among St. Vincent’s staff and Village residents. “I think even our employees cannot believe that this happened,” she says. “I think the easiest way to explain why…St. Vincent’s is closing its doors tomorrow,” she says, choosing her words with precision, “is that the State Department of Health said there is no need for an acute care hospital in Greenwich Village. And while St. Vincent’s had many problems, they were on their way to being fixed. But with the Department of Health saying that there’s no need for an acute care hospital here, the board had no choice but accept a vote to close.”

Truth be told, the Health Department may have nailed the coffin closed, but the hospital has had a busy hand in its own grave-digging in recent years.

Just about everything that could go wrong did go wrong as a series of strategic and administrative missteps initially meant to fortify New York’s Catholic hospitals instead accelerated their downfall. In 2000 St. Vincent’s merged with a group of Brooklyn and Staten Island Catholic hospitals with the idea that productivity gains and the elimination of administrative redundancy would allow them all to remain competitive and sustainable into the future. But significant gains never materialized for the newly dubbed St. Vincent’s Catholic Medical Centers. Bad decisions by its board and questionable fiscal practices and consulting expenses certainly hurt the new network, but its fall was hastened by the domino effect of the debt burden brought into the merger by the individual institutions. Ultimately even relatively healthy institutions, like St. Vincent’s, the new system’s flagship hospital, were profoundly wounded by the consolidation. An ever-larger debt accumulated for surviving hospitals as the system staggered through a series of hospital closings and divestitures. That debt burden meant St. Vincent’s was denied reinvestment and modernization capital. It emerged from a 2005 bankruptcy still shouldering a heavy institutional debt load.

Compassionate Care

But no post-mortem of St. Vincent’s would be complete without acknowledging that its mission to the poor itself was a major part of its undoing. Many paying customers opted for Manhattan hospitals with more cachet, but Medicaid patients and the indigent continued to come to St. Vincent’s, adding to a debt burden that by the time of its second and final bankruptcy was over $1 billion.

Even after the hospital closed, the poor still come to St. Vincent’s door. “I believe we had maybe 48 yesterday and in the 60s the day before,” Sister Iannucelli says.

The walking wounded making their way to the dying hospital’s doors are part of the reason Sister Iannucelli remains skeptical about the city’s stopgap plan for urgent care materializing during St. Vincent’s wake. A spokesman for North Shore-Long Island Jewish, the corporate parent of Lenox Hill, said the “urgi-center” would be able to treat about 25,000 patients a year, but at a lower level of care than St. Vincent’s emergency department, which provided top-level treatment to 60,000 people a year. Sister Iannucelli notes the increasing number of families moving into the St. Vincent’s service area, the large residential projects being developed in adjoining communities and Greenwich Village’s large aging population already in place. Replacing a fully equipped hospital with a limited capacity urgent care unit “could be sufficient” over a short term, she says. “But I think the long view says we need an acute care hospital in the Village.” She means a full-service general hospital, though smaller, which she says St. Vincent’s was on its way to becoming when the Health Department pulled the plug.

Sister Iannucelli worries that the loss of St. Vincent’s will deal more than just a practical blow to New York. The Sisters of Charity and St. Vincent’s grew up with the city. St. Vincent’s opened in 1849 in a small brick house with 30 beds on West 13th Street to treat victims of a cholera outbreak. When the immigrant gangs of New York finished their skirmishes on the streets of the infamous Five Points, they brought the survivors to St. Vincent’s. Its doors have opened to virtually every catastrophe and community emergency New York City has known. It has treated survivors of the Triangle Shirtwaist Factory fire and the sinking of the Titanic, victims of the first World Trade Center attack in 1993 and the more than 800 injured during a day in September 2001 that will not be forgotten. St. Vincent’s treated victims of the Spanish flu epidemic and was at the frontlines during the city’s H.I.V./AIDS crisis, when its beds were full of the sick and the dying. “Almost every health care crisis that has existed in our city,” Sister Iannucelli says, “St. Vincent’s has responded to…. I say St. Vincent’s not being here is a big loss to our city.”

St. Vincent’s doctors and nurses have already begun scattering to other hospitals around the city. They will be bringing St. Vincent’s with them, Sister Iannucelli says. “The values of the sisters that have been inculcated in St. Vincent’s really are in the marrow of everybody’s bones in this place…. So when our employees, our doctors, our nurses go someplace else, they’re carrying this all with them,” she says. “They can’t kill the spirit of this place just because the doors close.

“Maybe the name of St. Vincent’s will fall into the background in another generation or so,” says Sister Iannucelli, “but for the men and women who were in this place, what seeds were sown in them and what they take into the future, you can’t take that away.”

A New York Legacy

For her personally and for the Sisters of Charity, Sister Iannucelli can’t say what comes next. “I think this is a big end of a cycle, of an era for the Sisters of Charity,” corresponding with the closing this June of St. Patrick’s Old Cathedral School, the city’s first parochial school, which the Sisters of Charity opened in 1822. “When you think of what we did in education, starting out in Old St. Patrick’s, then you think about the…number of orphanages we founded, the New York Foundling and St. Vincent’s. You know that’s an unbelievable legacy and an unbelievable part of building the city of New York. So Old St. Patrick’s closes. St. Vincent’s closes. For us, it really is the end of a cycle of what we have contributed to New York. What comes next? I don’t know.

“We’re not as many as we used to be,” Sister Iannucelli says, and the sisters are not getting any younger. “We’re in the process of saying, ‘What are we being invited into; where are the unmet needs; what is going to be our focus? We acknowledge that God has been good to us through our works, but now we have to let go of them and ask: What are we being called into in the future?”

“Heartbreaking” is how Carol Keehan, D.C., president and chief executive officer of the Catholic Health Association, describes the closing of St. Vincent’s, “a haven for so many, especially the vulnerable.” Despite the downfall of the St. Vincent network, she still believes that institutional consolidation “from a position of strength” is not a bad strategy for Catholic hospitals. Because of the peculiarities of the New York market, she is not sure St. Vincent’s offers much of a cautionary tale for institutions elsewhere. “We all know how challenging it is to care for very sick and very poorly insured populations,” says Sister Keehan. “It is one of the reasons we needed health reform.”

Sister Iannucelli, for her part, is convinced there are lessons in St. Vincent’s demise for other Catholic hospital administrators. At the very least, she says, they could learn from some of the missteps of St. Vincent’s administration and board of directors. “I can’t live in a blame mentality,” she says. “I can only say I know I did my best, and I think that I can honestly say that most of the people I worked with did their best.” Still, she says there is much that she would have done differently if she could have in the hospital’s final years.

To be successful in the contemporary medical environment, “I think you have to be politically savvy,” Sister Iannucelli says. “I think you need to be assertive and aggressive for the things that you believe in. I think you have to stay on top of your game; your fiscal structures have to be very, very sharp. You have to be willing to realign yourself and change with the economy and what’s happening with respect to, say, health care reform or budgeting in your state.

“Health care today is a very, very complicated ministry. So quality leadership, good strategic planning and a great values system [are important] because it’s so easy to get lost in the complexity of the game and the work.”

Out on Seventh Avenue, Thomas Cunningham worries that he and his neighbors are the ones who got lost in the St. Vincent’s endgame. Mr. Cunningham has taken the ride himself into the emergency room bay at St. Vincent’s, and he is grateful for the care he received then. He says the residents of the Village have always known they could count on St. Vincent’s when they needed it. “I had friends who were cared for here; I had friends who died here. You never had to worry what kind of treatment they would receive.”

“It’s a very sad day,” he says, taking a final look before walking away down Seventh Avenue. “I just can’t believe something couldn’t have been done to keep it open.”

View a slideshow history of St. Vincent's Hospital.


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