More crowded ER’s, slower ambulance turnaround,
 less primary care among likely consequences

Comptroller William C. Thompson, Jr. holds news conference on December 21, 2006 to release his report on the impact of the proposed closures of five New York City hospitals on nearby emergency rooms.

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A study issued today by Comptroller William C. Thompson, Jr. concludes that the recently proposed closures of five New York City hospitals could lead to large, potentially disruptive influxes of emergency room patients at neighboring hospitals, cause reductions in ambulance availability, and require some New Yorkers to travel farther to reach an emergency room – extra minutes that could prove especially critical for people needing the most urgent care.  

With these closures, recently recommended by the Commission on Health Care Facilities in the 21st Century, the number of New York City emergency rooms will have decreased 21 percent since 2002, according to the study, Emergency Room Care: Will It Be There? Assessing the Impact of Closing Emergency Rooms on New Yorkers.

The study found that several emergency rooms recommended for closure are heavily used by uninsured patients, and when uninsured patients switch to nearby hospitals, including New York City municipal hospitals, the receiving facilities would have to absorb extra costs.

Additionally, several emergency rooms slated to be closed are heavily used by Medicaid enrollees for primary care and are located in areas experiencing a “serious shortage” of primary care physicians who accept Medicaid.

Thompson’s report also noted that several of the hospitals nearest to those recommended for closure have high inpatient staffed bed occupancy rates, raising concerns about their capacity to handle inpatients that would have been treated at the closed facilities.

“The hospitals proposed to be closed provide significant amounts of under- and unreimbursed care and essential emergency care as well as substantial amounts of primary care to vulnerable populations,” Thompson said.

The Commission recommended that New York Westchester Square Medical Center in the Bronx, Victory Memorial Hospital in Brooklyn, Cabrini Medical Center and St. Vincent’s Midtown Hospital in Manhattan, and Parkway Hospital in Queens close.

The study focuses primarily on the impact of the Commission’s recommendations on emergency services, an issue given relatively scant attention in the Commission’s report. The Commission focused mainly on low hospital inpatient occupancy rates to justify proposed closures, when in fact the overwhelming majority of patient contacts with the hospitals recommended for closure were as outpatients and emergency room visitors.

“This is a historic moment for health care reform in New York, and it should not be carried out in a hasty manner,” Thompson said. “Community members, local government officials, providers and other stakeholders need adequate time to examine all of the Commission’s recommendations and consider both their strengths and weaknesses.  This critical work should not be rushed.”

Among the key findings of the report:

Emergency services:

• At least three of the recommended closures - St.  Vincent’s Midtown, Westchester Square and Parkway hospitals - could lead to significant influxes of emergency patients at the nearest remaining hospitals.  For example, if instead of going to Westchester Square Medical Center emergency patients went to Montefiore/Weiler, Weiler’s emergency room volume would increase by 50%.

• Ambulance turnaround times could suffer as patients who would have gone to one of the closed hospitals instead go to another emergency room.  The result could be fewer ambulances available to take calls.  Nearly all New York City emergency rooms currently experience delays due to overcrowding and therefore exceed the Emergency Medical Service-performance goal of a 25-minute turnaround time. 

• Closure of five emergency rooms would require some New Yorkers to travel farther for emergency treatment.  

• Emergency rooms of several hospitals proposed for closure are heavily utilized by uninsured (“self pay”) patients who would go to another hospital, including New York City Health and Hospitals Corporation (HHC) facilities, with financial implications for these hospitals.

• Medicaid patients who currently receive primary care at several of the emergency rooms proposed for closure could have even more difficulty finding alternative primary care in their community, inasmuch as these hospitals are located in areas with serious shortages of primary care physicians who accept Medicaid.

Inpatient and outpatient services:

• Hospitals adjacent to several of the hospitals recommended for closure currently have high inpatient occupancy rates, raising concerns about capacity to absorb more patients.  For example, St. Luke’s-Roosevelt’s Intensive Care Unit is at 120% occupancy (combined rate) and Roosevelt Hospital would treat patients who would have gone to St. Vincent’s Midtown Hospital. 

Among Comptroller Thompson’s recommendations are:

• New York City EMS should analyze the impact on affected communities of the five recommended emergency room closures, including additional travel time for emergency patients and the ability of remaining hospitals to absorb additional emergency patients.  The findings should be publicly released.  In addition, New York State should require local EMS agencies to prepare a written report evaluating the potential impact on the community of downgrading or closing emergency room services, as required in California.

• The New York State Department of Health should closely monitor emergency room utilization in communities affected by emergency room closures and be ready to grant emergency approval to increase capacity.

• The impact of the recommended emergency room closures on HHC facilities should be fully assessed to ensure that HHC does not absorb a disproportionate share of the medically displaced uninsured and under-insured.

• There is a need to redirect a substantial portion of any savings from closures and mergers to community health and primary care programs.

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