Welcome to my blog, a place to explore and learn about the experience of running a psychiatric practice. I post about things that I find useful to know or think about. So, enjoy, and let me know what you think.

Wednesday, June 1, 2016

A Tale of Two Hospitals

This is the story of two New York city hospitals, Mount Sinai, and Beth Israel.

According to Wikipedia. Mount Sinai was founded in 1852 as the Jews' Hospital, in response to discrimination against Jews by other hospitals, which would not treat or hire them. It is one of the oldest teaching hospitals in the US.

Also according to Wikipedia:

Beth Israel was incorporated in 1890 by a group of 40 Orthodox Jews on theLower East Side each of whom paid 25 cents to set up a hospital serving New York's Jewish immigrants, particularly newcomers. At the time New York's hospitals would not treat patients who had been in the city less than a year. It initially opened a dispensary on the Lower East Side. In 1891 it opened a 20-bed hospital and in 1892 expanded again and moved into a 115-bed hospital in 1902.[2] In 1929 it moved into a 13-story, 500-bed building at its current location at the corner of Stuyvesant Square. It purchased its neighbor the Manhattan General Hospital in 1964 and renamed the complex Beth Israel Medical Center, located at First Avenue and 16th Street in Manhattan.

According to other verbal sources I've encountered, Beth Israel Hospital was founded in response to discrimination by Mount Sinai against poor Jewish immigrants on the lower east side. Mount Sinai would not treat them, but restricted its Jewish patients to middle- and higher-class Jewish immigrants from Germany.

I like to believe that this is the reason for the inscription on the entrance to the original Stuyvesant Square building:

It's a little hard to see, and it's in Hebrew, but roughly translated (by me) it reads:

Welcome! Welcome! From far and near. So says the Lord and his Healers. (Isaiah 57:19)

Hospitals in NYC are like 7th graders. They merge, split up, merge again with a different hospital, move around. For a while, Beth Israel belonged to a group of hospitals known as "Continuum," which included Albert Einstein Hospital, from which Beth Israel got its medical school affiliation. A few years back, Columbia Presbyterian joined up with New York Hospital Cornell, and became New York Presbyterian. These two hospitals are in very different parts of Manhattan, so the merger gave them access to a huge group of patients from diverse neighborhoods. My guess is that this was done for financial reasons. Then Mount Sinai decided to be even bigger, and subsumed Beth Israel, as well as St. Luke's/ Roosevelt (these two had merged years previously, and were formerly affiliated with Columbia).

For a little orientation, this is a map:

This gives you an idea of the current relationship statuses, which I've color coded. Mt. Sinai is the white star. Beth Israel, now called Mt. Sinai Beth Israel, is all the way downtown in red. It is the southern-most hospital in Manhattan.

Well, in case you didn't read it in the NY Times, Mt. Sinai Beth Israel Hospital in Manhattan Will Close to Rebuild Smaller.

The 825-bed Beth Israel will be closed over the next four years, to be replaced by a 70-bed hospital somewhere nearby, with an ER a few blocks away. Residents will be dispersed to other Mt. Sinai hospitals, union employees will be found new jobs. And according to an email I got from Mt. Sinai, where I'm affiliated, everyone else will be assisted in finding new employment. I suspect that's not precisely what will happen.

Ken Davis, President and CEO of the Mt. Sinai Health System (and former chair of psychiatry) explained that health care is too expensive, that Beth Israel lost $115 million last year and stood to lose $2 billion in the next 10 years, that hospitals are no longer the most efficient vehicles for delivering care, etc.

They plan to have 16 outpatient practice locations and 35 stand alone operating and procedure rooms.

Interestingly, from what I can tell, they plan to keep the psychiatry building, and expand its services. I assume the department actually makes some money, although I thought that was because of the rapid turnover on the Dual Diagnosis unit.

I worry about the impact on the community. There used to be 3 hospitals in Beth Israel's area, Beth Israel, itself, Cabrini, and St. Vincent's. Cabrini closed in 2008. St. Vincent's, much larger, and beloved by the community, closed in 2010. It's been replaced by some pretty fancy condos. Beth Israel is also situated in an extremely desirable neighborhood.

Going from 825 beds to 70? It may look like, what's the big deal, there are dozens of hospitals throughout NYC. But there are 8.5 million people living in NYC, plus people come in for treatment regularly from neighboring New Jersey and Connecticut.

Dr. Davis may be correct in stating that hospitals are not the future of medicine. But I don't believe 70 inpatient beds are adequate to the needs of all of lower Manhattan. We seem to have come full circle since 1890.

The word I translated above as "Welcome!" is Shalom, and the Hebrew word has multiple meanings. It can mean welcome, peace, and hello. It can also mean, "Goodbye."