Volume 80, Number 44 | March 31 - April 6, 2011
West and East Village, Chelsea, Soho, Noho, Little Italy, Chinatown and Lower East Side, Since 1933

A preliminary design of uses that would be on the center’s first floor.

North Shore-L.I.J. pitches plan for free-standing E.R.

By Albert Amateau and Lincoln Anderson

Executives of the North Shore-Long Island Jewish Health System and the developer Bill Rudin came to this newspaper’s office last week to set the record straight about the new Comprehensive Care Center and free-standing round-the-clock emergency department proposed for the O’Toole Building.

The proposal, which will require a certificate of need from the state Department of Health and approval in April from the U.S. Bankruptcy Court handling the St. Vincent’s Catholic Medical Centers bankruptcy, envisions a gut-rehab of the six-story O’Toole Building, on the west side of Seventh Ave. between 12th and 13th Sts.

The interior reconstruction of the 160,000-square-foot building is expected to cost $110 million, including $100 million from North Shore-L.I.J. and a $10 million contribution by Rudin.

Two of the five programmable floors in the building would be devoted to the 19,000-square-foot emergency department. The department would be larger than the old St. Vincent’s emergency room, which was closed a year ago. According to Michael Dowling, chief executive officer of North Shore-L.I.J., the new emergency department would be able to serve all but the most severe trauma patients. The Comprehensive Care Center and emergency department would be operated as a division of Lenox Hill Hospital, which North Shore-L.I.J. took over in May 2010.

An exterior design rendering of the planned North Shore-L.I.J. Comprehensive Care Center, which would be an adaptive reuse of St. Vincent’s O’Toole Building.

Because O’Toole, built in 1963 for the National Maritime Union, had a two-story-tall hiring hall on the second floor, the third floor of the building is largely structural.

The emergency department would be part of a new community Comprehensive Care Center with imaging equipment, including X-ray, CAT scan, M.R.I. and ultrasound, plus an ambulatory surgery facility providing intervention for sick, elderly and chronically ill patients.

Other space in the building would be devoted to such uses as laboratories, exam rooms and surgical-procedure suites, as well as such things as hazmat, lockers, food services, housekeeping and the like.

Dowling, however, said that the full-service, acute-care hospital and emergency room hoped for by many Villagers to replace St. Vincent’s would be “difficult, if not impossible,” to receive state approval in the current economic climate and in the long-term trend of declining need for acute-care hospital beds.

The latest cost estimate for a full-service hospital is $2 million per bed. Moreover, hospitals with fewer that 400 beds are not cost efficient, Dowling said.

“That means $800 million or $900 million for an acute-care, full-service hospital — and no one has offered to take that on,” he said of calls for bringing back a full-service hospital in Greenwich Village. “Isn’t it better to have a medical center that provides for most of the needs of the community, rather than nothing at all?” he asked.

Four hundred employees
The new center would have a total of 400 employees, including 24-hour access to certified adult or pediatric emergency physicians and a staff of 30 specially trained nurses. There would be a 24-hour observation-and-decision unit, allowing outpatients to be monitored to ensure safe judgments before they are treated and discharged. If the approvals come as planned, construction could begin this fall and the new facility could open by late summer 2013, Dowling said.

North Shore-L.I.J. is working with the Fire Department and private emergency medical services to establish protocols so that patients with severe trauma — such as gunshot wounds and compound fractures (where the bone protrudes through the skin) — and those requiring immediate surgical or cardiac interventions would not be brought to the W. 12th St. emergency department.

“If you went to New York Downtown [on Beekman and Gold Sts.], which doesn’t have a Level 1 trauma center, the same protocols would apply,” said Dr. Andrew Sama, head of emergency services at North Shore-L.I.J.

Nevertheless, Sama said, “If you were a block away and had a gunshot or a stab wound, you could be brought here to be stabilized and then taken to a higher-level hospital.” The new department would have about five beds where emergency patients could be observed for up to 23 hours before being released or transported to higher-level care, Sama said.

Having an emergency department with physicians certified for pediatric emergency medicine would be a great advantage to local schools like P.S. 41 on W. 11th St. at Sixth Ave. and City and Country School on W. 13th St. between Seventh and Sixth Aves., Sama noted.

The O’Toole center would have an ambulance stationed in an inside bay on the ground floor on W. 12th St. to transport patients who need a higher level of care. North Shore-L.I.J. operates the largest inter-hospital ambulance service in the New York metropolitan region, Dowling noted.

35,000 visits a year
St. Vincent’s emergency room saw about 20,000 treat-and-release patients a year, said Dowling.

“We’ll get 30,000 to 35,000 visits a year,” he said, adding that the new emergency department would be able to treat and release 95 percent of patients arriving at the unit. After five years of operation, Dowling projected that the O’Toole center would be treating more than 80,000 patients annually. “We will provide emergency medical care that is efficient, readily accessible and linked to a continuum of care to anyone, regardless of insurance coverage and irrespective of income,” he said.

St. Vincent’s H.I.V. and AIDS services, which operated out of the O’Toole Building, were taken over by Mt. Sinai and Beth Israel — but their leases at O’Toole expire in June. Dowling said Mt. Sinai and Beth Israel are working to relocate these clinics in the surrounding neighborhood.

In addition, representatives from Rudin Management visited doctors who have offices at the O’Toole Building last week to help them relocate. The O’Toole center will not have an H.I.V. center. Neither will it have childbirth services.

Dowling said he intended to hire the best possible staff for the Comprehensive Care Center.

“We work very closely with 1199 [the Service Employees International Union local that represents hospital workers],” he said. He noted that North Shore-L.I.J. has hired about 100 former St. Vincent’s staffers to work at Lenox Hill.

“This will not be an urgent-care center or a walk-in clinic,” Dowling stressed. “It is a full-service, free standing emergency department with procedure rooms for ambulatory surgery — able to handle anything that can be done in one day.”

While the O’Toole center will be the first free-standing emergency department in the metropolitan area, there are more than 200 such departments across the country.

“We think we will serve as a model for many others in the region,” Dowling said.

Rudin said he was excited to be involved in the partnership with North Shore-L.I.J. The adaptive reuse of the landmarked O’Toole Building would be an added preservation benefit of the project, he said. Rudin will also convert part of the triangular open space across W. 12th St. from O’Toole into a public park. He promised to involve neighborhood groups in the design of the triangle park. However, the part of the triangle now occupied by a storage facility for oxygen tanks would remain as it is and would not be converted to public space.

Rudin also said the project, which would provide employment for about 1,000 workers during construction, in addition to the permanent staff of 400, should be welcomed by merchants in the St. Vincent’s area who have had a tough time surviving since the hospital closed.

Rudin residential plan
As for the former St. Vincent’s Hospital main campus on the east side of Seventh Ave., Rudin said the plan is the same as was approved by the city’s Landmarks Preservation Commission in 2009. The project would save four of the existing complex of eight cobbled-together buildings, and include 250 to 300 residential apartments. It would have a 203-foot-tall apartment tower on Seventh Ave., plus townhouses on W. 11th St. The project would still have to go through the city’s uniform land-use review procedure, or ULURP — including a public review by Community Board 2 — during which the design’s bulk and height could be challenged.

Rudin would pay something less than $300 million for the property. The developer said the deal has been approved by St. Vincent’s board of directors and the hospital’s creditors. St. Vincent’s closed last April with $1 billion in debt.

Die-hard hospital activists contend that one of the former St. Vincent’s buildings on the main campus — the Coleman Building — could be converted into a full-service mini-hospital. Asked when Coleman would be demolished under the plan, Rudin said it would be sometime next year. If all goes according to plan, the residential project would be completed by 2015.

Asked if they intend to decrease the residential project’s height, John Gilbert, Rudin Management’s chief operating officer, said they already did this twice previously, for a total height decrease of 24 percent from the original plan. The design is set, he said.

“The Landmarks Preservation Commission gave us a certificate of appropriateness,” he noted, adding, “I think that’s a pretty good stamp of approval.”

Rudin also pointed out that a community benefit of this latest scenario is that there would no longer be a 300-foot-tall hospital tower built on the O’Toole site. Under the original plan, Rudin’s purchase of St. Vincent’s main campus would have partially financed this new state-of-the-art hospital on the west side of Seventh Ave. Neighbors and preservationists had vehemently fought the new hospital and residential developments, with some yelling that St. Vincent’s should “Get out of the Village!” But St. Vincent’s bankruptcy dashed the scheme for the hospital tower.

“We tried,” Rudin told this newspaper. “Nobody worked harder than my family to have a Level 1 trauma center here. We got caught in a very difficult storm.”

Added North Shore-L.I.J.’s Dowling of the free-standing emergency department scheme, “On a macro level, this is a very forward-thinking and innovative model. The alternative is — nothing,” as in no emergency care or comprehensive care to help fill the vacuum left by St. Vincent’s closure.

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