Closing Six Hospitals To Be Sought in the City

The commission created by Governor Pataki and lawmakers to overhaul health care in the state will recommend the closing of at least six New York City hospitals, including three hospitals in Manhattan, according to a member of the commission who has viewed what is believed to be its final report.

At least one hospital in each of three other boroughs, Queens, Brooklyn, and the Bronx, is slated for closing. The commission member, who spoke to The New York Sun under the condition of anonymity because the person isn't authorized to disclose the group's recommendations, said the total number of New York City hospitals designated for closure is fewer than 10.

All the members of the New York City Health and Hospitals Corporation, the public hospital system in the city, appeared to have avoided the chopping block, at least for now.

The six hospitals slated for closure are, in Manhattan, St. Vincent's Midtown Hospital, Cabrini Medical Center, and Manhattan Eye, Ear & Throat Hospital; Victory Memorial Hospital in Brooklyn; New YorkWestchester Square Medical Center in the Bronx, and the Parkway Hospital in Queens, a member of the commission told the Sun.

In effect, the commission is recommending at least a 10% reduction in the number of hospitals in the city. There are a total of 59 hospitals in the city, according to a 2006 report prepared by the Greater New York Hospital Association.

The member said all of the hospitals targeted were fighting for their financial survival and were not deemed by the commission to be a vital presence in their communities because of the lack of occupancy and their proximity to other hospitals serving similar functions.

Cabrini Medical Center, a 328-bed hospital on E. 19th Street, is located in an area known in the medical community as "bedpan alley," with Beth Israel Medical Center, New York University Medical Center, NYU Hospital for Joint Diseases, and Bellevue Hospital Center nearby. Cabrini's surgical occupancy rate has fallen to 23% from 70% between 1994 and 2004.

Victory Memorial Hospital in Brooklyn, which has 243 beds, has accumulated about twice as much debt as its assets, according to one health-care expert. Its volume has drained away as more patients have driven to Staten Island University Hospital for care.

New York Westchester Square Medical Center, with 205 beds, has been facing stiff competition from Montefiore Medical Center on East 210th Street in the Bronx, whose Jack D. Weiler Hospital is in walking distance of Westchester Square.

Parkway has lost market share to more successful hospitals in Queens. It's expected that patients at Manhattan Eye, Ear & Throat Hospital, a 30-bed hospital located on E.64th Street, would be folded into Lenox Hill Hospital on 77th Street. The commission source said the hospital could be allowed to continue ambulatory service. Patients at St. Vincent's Midtown would conceivably receive care at the flagship Saint Vincent hospital on West 12th Street.

Other hospitals in the city are perhaps in even greater dire straits but serve a more crucial function. The commission is advising that some of them merge with other hospitals or restructure their services.

The commission is also advising that the state close an unknown number of hospitals outside of the city.

State and city officials are gearing up for an explosion of anger from the targeted hospitals and their surrounding communities. Hospitals are expected to fight back with lawsuits and intense lobbying efforts, while community groups are likely to stage protests.

The final report represents the culmination of a massive undertaking by the state to come up with a plan to restructure an outmoded and costly hospital and nursing home system that is bloated with inefficiency, saddled with debt, and reluctant to adapt to a competitive environment and new technologies that have changed how people seek health care.

Gaining the approval of the two major hospital associations and the health care workers union, SEIU 1199, Mr. Pataki and lawmakers last year created the Commission on Health Care Facilities in the 21st Century and put Stephen Berger, a former executive director of the Port Authority of New York and New Jersey, in charge.

The commission convened more than 19 hearings, pored through reams of statewide data, and devised a complex formula for grading hospitals and nursing homes, using metrics that took into account profitability, racial makeup and economic status of patients, volume of visits, quality of care, and how the loss of an institution might affect the surrounding communities.

Mr. Pataki can either accept or reject the report in its entirety. If he accepts it, the recommendations become law as long as the Legislature does not act to block it before the end of the year. Governor-elect Spitzer, a Democrat, has said he won't be bound by the report but said his administration would close some hospitals as it part of its health care plan. If the recommendations become law, the health department would have 18 months to implement them.

Due to the highly sensitive nature of its work, commission leaders have taken extraordinary measures to guard the secrecy of the report, which will be released to the public on Tuesday. Mr. Pataki, Mr. Spitzer, and Mayor Bloomberg are expected to receive a briefing on it as late as Monday.

Only select members have been given a copy of the report, while others who worked on the report have been given permission only to look at it, then return it.

Officials reached at the hospitals designated for closure would not acknowledge that they were doomed. A spokesman for Parkway, a 251-bed hospital located in Forest Hills, vowed that institution would not "be impacted at all," saying that there was "too much need in this borough for hospital beds."

The spokesman, Fred Stewart, said the hospital would battle any attempt to shut it down. "We certainly wouldn't accept it lying down," he said. The source said the commission is not recommending shutting down any of the government-owned Health and Hospital Corporation's 11 acute care hospitals, six diagnostic treatment centers, and four long-term care facilities, despite the fact that many members in the system, including Metropolitan Hospital Center, are struggling for volume and running major deficits.

For the commission, targeting the public hospital system may not have been politically tenable. Mr. Bloomberg is a champion of the system, which is largely controlled by the city with state oversight and is considered to be the safety net of the city's poorest and uninsured.

Behind the scenes, however, the commission is putting pressure on the HHC, which uses a major chunk of the state's Medicaid money, to be more efficient, sources say. The public hospitals will likely have to come up with survival plans that could include a reduction in acute care services.