Beth Israel Hospital. (Violette79/Flickr)

The sign at the entrance to Beth Israel Medical Center on First Avenue at 16th Street screams “EMERGENCY ROOM,” but five hours into her wait to be seen for sharp pain in her ribs, it didn’t feel that way to Yamira Velazquez.

Her regular hospital, Bellevue Hospital Center, shut down after Hurricane Sandy ripped through the northeast. So did both NYU Langone Medical Center and the VA Medical Center next door. Bellevue won’t reopen its emergency room until at least February. NYU and the VA have not yet announced dates.

And so, like thousands of others seeking immediate medical care, she ended up in the emergency room at Beth Israel, the last standing hospital for two and a half miles in any direction.

“I was in pain. It was the worst,” she said.

That was on the Saturday before Thanksgiving. Each day brings its own struggles. For patients in the waiting room, Cyber Monday here felt more like a doorbuster event where the prize was a moment of medical attention.

"Oh come on... F**k," said a woman who'd been waited an hour for a nurse to see her mother as a woman cut ahead.

Another man who had been wheezing in the waiting room and said to a nurse, "Ma'am, I can't breathe," to which the nurse replied, "Well you're talking very well."

Ill patients are lucky to find an open seat while they wait for an emergency room doctor, and once there slump over through the long hours. Others hold back vomit—or let it go into pink buckets. Some moan in pain and others scream in a drunken or deranged state at other patients or their imaginations. Before it closed, psychiatric patients and arrested criminals went to Bellevue. Now, they’re showing up at Beth Israel.

“The waiting area is a little unsecure,” said Melody Rivera, after spending the better part of her afternoon in the waiting room with her sick co-worker. “People were screaming like they’re drunk and belligerent.”

Before the storm, the 871-bed hospital would average about 320 emergency room visits a day. Now, that number is well above 400, and peaked at 470 at one point in the middle of November, according to hospital officials.

The math is unforgiving: people get sick, and they now have nowhere else to go, a problem exacerbated by the shutdown of St. Vincent’s hospital in the West Village. Last year, emergency rooms at the city’s Bellevue Hospital Center and the private NYU Langone Medical Center saw nearly 150,000 patients combined, according to state Department of Health data. And the lion’s share are now being cared for by Beth Israel.

Double the usual number of ambulances churn down 16th Street into the emergency drop-off zone, peaking once in mid-November at 170 deliveries in a day and  ringing a steady chorus of sirens at the edge of Stuyvesant Town.

The backup is part of a chain reaction. Nursing homes, rehab centers and other continuing care facilities where Beth Israel normally sends patients who are well enough to leave but need further care are packed and outpatient services at the nearby hospitals are just starting to open back up. So in the meantime, they stay in the hospital wards. And then the emergency room can’t always find enough beds as new patients come in.

Colette Russen, 42, has been a nurse for the past eight years, and she’s still never seen anything like what has been happening at Beth Israel. With each nurse assigned to at least eight non-critical patients or six high-acuity ones, the little things can fall through the cracks and lead to larger problems, she said.

For instance, she was assigned one man with chest pains, and since he was stable she left to care for other patients. While she was tending to the five others she was responsible for, his symptoms started to flare up.

“He had chest pains and his daughter told me that he didn’t look so good,” said Ms. Russen. “They had to take him for intervention immediately because he had another episode. Thank God his family member was by his side. What if he hadn’t said anything and I didn’t know he had gotten pale and sweaty and quiet?”

“That’s a nurse’s worst nightmare,” she said.

Beth Israel acknowledges the backups and says it’s doing all it can to move patients through and unclog its emergency room.

“With the surge in patients that Beth Israel saw during the storm and in the days and weeks afterwards, we were attempting to safely discharge an unusually high number of patients in an abbreviated time period to try and open up some beds for patients in the ER,” said vice-president of communications Jim Mandler via email.

“There is a process that goes with safe discharge planning. It is not only about finding a bed. It’s about finding an appropriate bed. We had to make sure that home health services would be available for these patients.”

Meanwhile, to make more space in the emergency department—which doubled in 2010 to about 80 beds in response to the shuttering of nearby hospital and long term care facilities—private rooms have been converted into triage and waiting rooms for less acute patients. Staff have converted beds in specialty areas, like short stay detox, to accommodate the influx of more typical patients.

Nursing hours have been extended by 200 per day, said emergency room administrator John Samuels, while physician hours have been increased by a total of 66 hours a day.

“This used to be a private room, but we’ve turned it into a kind of triage and waiting area,” he said, pointing out a dimly lit room with five people waiting for further care. One read a newspaper, another stared blankly at the salmon-colored wall.

He said nursing staff had been bolstered by an additional eight, with two more undergoing training and orientation. The hospital has also put out feelers to find more.

They may be needed. A mountain of research has found that increasing the number of patients that a nurse has to care for leads to worse outcomes. One widely accepted study found that the for every extra patient a nurse is assigned, the risk of 30 day mortality after surgery increases by 7 percent. The national average is about one nurse to five patients, according to University of Pennsylvania professor of nursing and director of the school’s center for health outcomes and policy research, Linda Aiken. And some departments at Beth Israel hospital are now at the one to eight range.

“Those would be on the high side,” said Ms. Aiken. Departments like general medicine and surgery maintained their pre-storm ratios, but those were already above the national averages. “So for a hospital that already has staffing on the high side to absorb a lot of additional patients over a long time, on the basis of research, would be concerning.”

The biggest concern of all for the doctors and nurses is the newly arrived flu season. So far, it has been relatively light in New York City. Emergency department visits for flu like symptoms only account for 1.3 percent of total visits in the city, about half the regional and national baselines and nowhere near the 8 percent level reached during the 2009-2010 pandemic. But if that number were to spike, “that would be scary,” warns Nurse Russen.

“A flu epidemic,” said New York Presbyterian President Dr. Robert Kelly, when asked to name the scenario that troubles him. “We get crunches some times during the winter where everyone gets sick… it starts putting strain on the system.” The Cornell/Weill campus of his network, up bedpan alley on 68th Street, is the closest trauma center to the now-closed Bellevue. It, too, has been swamped by dislocated patients, with surges of up to 150 percent of their usual numbers.

Meanwhile, Beth Israel officials are doing their best to keep up.

Joseph Santora rushed by taxicab from his home on 28th street, a literal stone’s throw away from the closed Bellevue and two blocks from NYU Lagnone Medical Center, to Beth Israel.

“I was scared,” the 68-year-old said, sitting on the steps leading out of the waiting lobby at Beth Israel Medical Center’s emergency room, where some 50 patients with injuries both serious and minor, crowded together in hopes their name would be called next. He had pneumonia and couldn’t breathe, he said. “When you can’t get oxygen, you really feel like you’re going to die.”

Because of his urgent condition, doctors zipped him passed the waiting room and into the emergency room for treatment. They stabilized him quickly. And then, like so many others, he got stuck in lower Manhattan’s healthcare gridlock. He had to wait half the day to be transferred from the emergency room to the geriatric department on the 7th floor, because, he was told, no bed was available. And like almost every patient here, he was nonetheless thankful for the care he was able to get.

“They’re doing the best they can,” he said, stubbornly smoking a cigarette despite his condition. “And you have to applaud them for that.”

Charlie Murphy.

The Commercial Observer: National construction spending increased by 1.5 percent in December, the most since August. Has that uptick been felt inside Turner Construction?
Mr. Murphy: It has. For instance, one of the trends going on right now is residential again. There’s a market out there, more on the rental side, I think. We’re working with a developer for a site in Greenwich Village, and this developer was able to, without a lot of trouble, get his financing together. For a large project. This is a half-billion dollar project. So I think the money’s out there; they just want to invest in the right projects with the right developers.

Is the money available to all, or only New York City’s most recognizable developers?
It’s probably like anything else: How much do you want to pay for your money? But what else is interesting is, in the Greenwich Village case, it was a consortium of lenders. It wasn’t just one bank participating. You could see that the banks are splitting up their risk. There were a number of banks involved in this particular project, and, of course, they’re making the developers put more of their own money into the project.

Turner has expanded its work with its institutional and government clients over the past several years. What’s the strategy behind that move, and when the economy recovers will Turner recalibrate its focus on commercial clients?
Here in New York we’ve always worked for the [School Construction Authority]—and when I say “always” I mean the past 15 or 20 years—as well as the Economic Development Corporation and the Port Authority. So through good times and bad times, we’ve always made a conscious effort to meet that part of our portfolio so when you have a downturn, and there’s less private money available for things, we’ve established a reputation with those public clients that we continue to work for. They become a repeat customer for us.

Since 2008, has that particular sector been more active?
It had until the past year or two. They seem to have cut back work. With less revenues coming into the municipal government, they had less for capital, so we’ve witnessed that.

Are the commercial clients coming back?
There still isn’t a lot. We’re doing just a few commercial office buildings. We’re doing Boston Properties’ 250 West 55th Street, which is exciting because it was a stalled project that’s now come back to life after they secured an anchor tenant. We’re also building Canon’s Americas headquarters out on Long Island. That was another project that got postponed a year due to the 2008 financial collapse.

So, if the institutional clients are less active, and new construction is still not what it used to be, where’s the work coming from?
We’re seeing more work on the interiors side of that commercial market. We’ve done work for JPMorgan Chase, American Express, Brookfield Properties, Time Warner, and we just landed a very large project for Nomura Bank at World Financial Center. They retained us to do their tenant fit out, and that came at the very end of last year.

Health care and education are growth sectors. Has that translated to new construction?
I’m in my 34th year with Turner. We’ve been doing health care projects since as long as I’ve been here, so it’s really one of our core competencies. But we’re seeing even more now, and very large. NYU Langone Medical Center, which we’re doing the preconstruction for, actually has two large projects on its campus: it’s the Energy Building and Kimmel Hospital. Though there’s a lot of preparation work—buildings are getting demolished on the site and you have to move people out in their move to other buildings in the area—we should start in earnest in the spring of 2013 with the Kimmel Center.
New York Presbyterian is looking at a large program. We’re working up at Sloan-Kettering. And North Shore Hospital has a really robust facility upgrade happening.

Turner Construction is building 2 World Trade Center, but Tishman Construction won bids for the other buildings on the site. Did you guys make a play for those jobs?
Historically, Tishman was Silverstein’s builder, and we got an opportunity … There was just so much going on there, and we had built the Norman Foster-designed Hearst headquarters, and to Silverstein’s credit, he said, ‘Who makes sense to go do another Norman Foster building: Turner Construction.’

Put yourself in the owner’s shoes: Does it become more complicated juggling construction companies for what, in many ways, is one project?
I don’t think it adds to the complexity. I think what it lets him do as an owner is he can draw on a larger talent pool of builders. As much as you like to think that all 800 of our employees are A pluses, there are some who are better than others. So to be able to draw on a larger pool I think is advantageous to a client like Silverstein, especially when you have that much work going on at one site.

Do you work well with your counterparts at Tishman, which I imagine is among Turner’s biggest competitors?
We have a great deal of respect for Tishman. In fact, we’re joint venture partners because we’re doing the transportation center together. So there’s a collaboration really from the top down that we like. We have a common client in Silverstein, and from my vantage point and theirs, we want to do the best for the customer. So even though we’re on the same campus we’re going to work together for the best results for the client.

jsederstrom@observer.com

Nonprofit Leasing by Submarket.

Deals like NYU Langone Medical Center’s combined 420,000-square-foot lease at 1 Park Avenue in May, and Open Society Foundations’ lease for 152,000 square feet at 224 West 57th Street in April, were among the biggest deals of the year and accounted for a large chunk of all nonprofit leasing activity, according to Cassidy Turley’s "Not-for-Profit & Public Sector Leasing Activity in 2011" report.

The number of leases that exceeded 50,000 square feet comprised 1.29 million total square feet this year, as opposed to 477,000 square feet the year before.

The burgeoning and expanding health care industry, which added 1,300 healthcare jobs in 2011, also contributed to the size of these deals. Three of the five largest leases were by health care firms, according to the report.

One of the hottest buildings for public sector tenants was 100 Church Street, which absorbed a 58,000-square-foot expansion by Healthfirst and a 90,000-square-foot expansion by the State of New York’s Office of Temporary and Disability Assistance, according to the report. Add that to the 280,000 square foot lease renewal that the NYC Law Department is finalizing for renewal and it’s little surprise the SL Green-owned building has seen a shrinking occupancy rate.

Other buildings, like 120 Wall Street, The Empire State Building and 77 Water Street (which added The William J. Clinton Foundation as a tenant), also performed well in 2011.

“You see a concentration of leasing activity all the way downtown,” said Robair Reichenstein, a managing director at Cassidy Turley and one of the authors of the report.

The fact that these nonprofits have big backers, especially with the George Soros-backed Open Society Foundations, have helped fuel this leasing activity.

“All that grouping of the top five [leases] are all organizations with healthy balance sheets,” said Mr. Reichenstein. “These are all organizations that are as solid as solid can be, so I think it makes sense that these are the large organization that can make the large floor commitments,” he added.

Drosen@Observer.com