A barebones Beth Israel continues sending ER patients elsewhere

NEW YORK — More and more patients who show up at Mount Sinai Beth Israel’s emergency room are leaving in an ambulance as the hospital prepares to close.

The Manhattan medical center is increasingly transferring seriously ill patients suffering potentially life-threatening emergencies to other hospitals in the city because they need procedures that are no longer being made available at Beth Israel, nine health care workers told POLITICO.

In one recent instance, the hospital transferred a patient with a ruptured appendix who was developing sepsis because the person required “specialty care” that Beth Israel did not provide, according to a health care worker with direct knowledge of the case. Internal anonymized records reviewed by POLITICO corroborated the worker’s series of events.

Both conditions can quickly become life-threatening, so time is of the essence. But instead of receiving surgery at Beth Israel, the patient was forced to wait for more than an hour until an ambulance could bring them to another hospital, the health care worker said.

Other recent transfers from the emergency department included a patient with gastrointestinal bleeding, another with gangrene and someone with a bowel obstruction, according to two health care workers familiar with the three cases. A patient with an abscess eating into their muscle, which emergency department staff had deemed potentially life-threatening, waited two hours for an ambulance to take them elsewhere for surgery, one of the workers said. In such cases, health care workers have cited a lack of operating-room capabilities as the reason for transfer, internal records show.

The health care workers were granted anonymity because they were not authorized to speak with the press. They did not disclose the patients’ identities.

Loren Riegelhaupt, an outside communications consultant representing Mount Sinai, which runs Beth Israel, told POLITICO, “We vigorously disagree with the faulty and misguided premise of your story.” He did not directly address a detailed list of POLITICO’s findings or answer a series of specific questions.

The revelations come as Mount Sinai is already being accused in a pending lawsuit of unilaterally dismantling crucial services at Beth Israel in an effort to force the closure of the financially ailing hospital, which technically requires state approval. By transferring patients elsewhere for necessary and potentially life-saving procedures, several health care workers said they also worry that Beth Israel may not be meeting its legal obligation to care for anyone who comes to the emergency room.

“We should not be able to transfer patients for services we’re supposed to provide,” one of the workers told POLITICO. “Then any hospital unilaterally could decide to do that.”

The emergency department transfers became increasingly common at the end of January, when Beth Israel curbed most — if not all — surgical services, according to the four workers and an internal email reviewed by POLITICO. In some instances, the workers said, patients have been transferred to other Mount Sinai-run emergency rooms because those hospitals did not yet have an available bed for them — joining scores of patients already waiting there for beds.

It is unclear whether the hospital received state approval to curtail surgeries because the Health Department and Mount Sinai have declined to directly address that question.

“We had a functioning hospital and then suddenly it was like we don’t,” the same worker said. “We were transferring people constantly.”

Under the federal Emergency Medical Treatment and Labor Act, hospitals cannot refuse to examine or treat patients with an emergency medical condition. At minimum, these patients must be stabilized before being transferred to another hospital that can treat them.

Health Department investigators recently spent seven days probing Beth Israel’s compliance with that law, POLITICO previously reported, but the department has declined to release the results of their survey. Spokesperson Erin Clary said the department cannot comment on open investigations.

Riegelhaupt did not answer POLITICO’s inquiry asking how Beth Israel’s pattern of transfers was not in conflict with the hospital’s obligations under the Emergency Medical Treatment and Labor Act.

“Mount Sinai Beth Israel and its emergency department remain open with a dedicated team of doctors and medical professionals ready to serve the community,” Riegelhaupt said in a statement. “As we have always done and will continue to do, every patient that enters our doors is treated in the best possible manner for their individual needs.”

Riegelhaupt declined to comment further given an ongoing legal dispute over the hospital’s closure plan and wind-down of services.

Mount Sinai announced in September that it planned to close Beth Israel, citing “continued and growing losses” that posed “a real existential threat to the viability and future of the entire Mount Sinai Health System,” according to a closure application submitted the following month to the Health Department. Administrators laid out a timeline for winding down services leading up to a July 2024 closure date.

Then, in December, the Health Department slapped the hospital with a cease-and-desist order after finding that it was unlawfully ending services and closing beds.

In February, a coalition of downtown Manhattan residents and Beth Israel employees sued the hospital and the state Health Department, accusing Mount Sinai of “intentionally creating ongoing, dangerous conditions” at Beth Israel with “unapproved service alterations and reductions” even after the state’s cease-and-desist order. Their complaint also called on the Health Department to reject the closure.

After a judge in that case barred the hospital from implementing further closures of beds or services, Beth Israel reopened some inpatient beds that had been marked as “blocked” for administrative reasons, according to images of the hospital’s internal capacity dashboard reviewed by POLITICO.

But the health care workers who spoke to POLITICO said administrators have turned Beth Israel into such a shell of its former self that the closure seems inevitable.

Emergency-room doctors were given six months’ notice late last year that their employment would conclude in May, according to one such letter obtained by POLITICO. Nurses and other frontline health care workers have been assigned new job placements at other Mount Sinai locations. The hospital allowed a private ambulance contract to expire Feb. 1, which has thinned the flow of patients coming through its doors. A prestigious stroke accreditation lapsed and is not being renewed. Staff handed out Beth Israel pins that read, “1889-2024.”

“The prevailing feeling is they’ve done so much damage there’s no way to recover from it,” said a staffer in the hospital’s intensive care unit, one of the nine interviewed for this story.

“Basically, we are all now resigned that it’s happening,” an emergency department staffer said of the closure. “The fight in everyone is gone. Now everyone just feels demoralized and disempowered.”

Local lawmakers and health care advocacy organizations are already bracing for the closure’s ripple effect, particularly on wait times and access to care.

New York has one of the longest ER wait times of any state, at about 3 hours and 20 minutes, according to federal data released in January. The average wait time is even longer in New York City hospitals, reaching about 3 hours and 40 minutes, a POLITICO analysis of that data found. Critics of Beth Israel’s closure say it risks pushing wait times even higher, because patients who would have otherwise gone there will have to go elsewhere for emergency medical attention.

Beth Israel executives have argued its emergency department volume fell by 42 percent over the last decade to just over 70,000 visits in 2022, as care shifts to outpatient health facilities.

But those figures are skewed by Superstorm Sandy in 2012, which caused a surge in patients at Beth Israel after other lower Manhattan hospitals lost power. As a result, emergency department volume spiked by 20 percent, researchers later found, and reached a record high of 122,000 visits by the end of the year.

The previous year, in 2011, the hospital’s emergency department logged just over 87,000 discharges, according to data provided by the state Health Department.

Recent history indicates emergency department volume will rise to some extent at other nearby hospitals if Beth Israel closes. After the April 2010 closure of St. Vincent’s Hospital in the West Village — which handled more than half of ER visits by local residents that did not require hospitalization — patients largely shifted to Beth Israel and to city-run Bellevue Hospital for emergency care, a data analysis later found.

A repeat could come at great cost to Bellevue: The hospital is already seeing many more patients than before Covid, likely due in part to service reductions at Beth Israel, Dr. Mitch Katz, president and CEO of NYC Health + Hospitals, told the City Council earlier this month during a public hearing.

If Beth Israel closes, the city will likely have to expand Bellevue to accommodate any influx of patients, Katz said. Just one new unit could cost as much as $50 million given the age and condition of Bellevue’s building, he added.

Patients could become collateral damage. When a hospital closes, research shows, an untold number of patients forgo care completely — whatever the consequence.