St. Vincent’s: The Hospital as Mirror

With the capacity of public hospitals eroded and for-profit hospitals increasingly exclusive, nonprofit hospitals weren’t eager to fill the gap in coverage. Both government and private insurance measures to control health care spending—slashing Medicare and Medicaid reimbursement rates, for instance, and ending the practice of Medicare-financed capital improvements—put pressure on already strained hospital finances. Without Medicare to finance the inexhaustible stream of new medical devices, nonprofit hospitals, in order to remain competitive with the private sector, began issuing bonds, suddenly beholden more to Wall Street investment analysts than to God-given mandates.

St. Vincent’s, where the Sisters of Charity had once independently choreographed all finances, stocked its boardroom with experts in the arcana of managed care, fluent in the ever-shifting acronyms of insurance reimbursement. Now a veritable industry, health care was manufactured and consumed, hinged to the fluctuations and demands of the market.

Among the hospital’s competitors for market share was Continuum Health Partners. Former CEO of its St. Luke’s-Roosevelt Hospital Center is State Health Commissioner Richard Daines, regarded by some within St. Vincent’s as the angel of death that hovered over the hospital. Continuum, which also runs Beth Israel Medical Center, is expected to see increased inpatient volume due to St. Vincent’s closing. It is also in the running to manage a prospective urgent-care center in the area.

Meanwhile, as the state threatens to pull up to $370 million from the city’s public hospitals, citywide admissions rates for uninsured patients jumped 14 percent over the last four years. St. Vincent’s closing is expected to translate into an annual 20,000 more ambulance visits to Bellevue.

 

IF HOSPITALS ONCE provided brief sanctuary from a ravenous new breed of industrial capitalism, they’re ever more subsumed into the market ethos. What will become of St. Vincent’s? The National Maritime building was once called the “box the Guggenheim came in.” Maybe it could be a museum. More likely it will be luxury condos after all.

What’s surprising now about the pieces of paper that once covered St. Vincent’s isn’t so much, as newspapers were quick to point out at the time, the wide and divergent multiplicity of their humanity, but that there is a certain hieroglyphics of grief, and for a few days everyone shared it. They speak in codes—”Last seen WTC2 F86″—and litanies of personal details, in smiling, centrally located photos, and above them in bold font, the word “Missing.”

In the end, it wasn’t photographs or inventories of birthmarks city officials asked for. Licked envelopes and tufts of hair displaced images as the required modes of identification. But the wall on West 11th Street remained, filling other functions, becoming as the days went on a kind of continually annotated conduit: construction-paper hearts, stuffed bears, sonograms. In other words, the ways the living talk to the dead.

If there’s a fleeting antidote to the doctrine of commerce all but encoded in the city’s DNA, it’s the feeling quickened by places like hospital waiting rooms, graveyards, shrines of photographs, a sense of proximity to things unknown. Which is maybe why we so seldom memorialize the dead in New York, sending up sky-high glass mausoleums instead.

egeminder@observer.com