Steve Corwin, CEO of New York-Presbyterian, insists his health system is committed to behavioral health care in northern Manhattan. | Courtesy of New York-Presbyterian NewYork-Presbyterian ignores critics in plan to close behavioral health unit

Medical students, staff and patient advocates are in the midst of a months-long campaign to forestall what many fear is inevitable: the closure of inpatient behavioral health care at the Allen Hospital in northern Manhattan and the decertification of 30 inpatient behavioral health beds.

The hospital is part of the NewYork-Presbyterian Health System and its intent is to expand labor and delivery services and surgery capacity. The $70 million project, which would close the third-floor behavioral health unit, would move labor and delivery to the third floor. That would free up the first floor for an expanded surgical suite with three new operating rooms, according to the application submitted to the state Department of Health, which must approve the plan before it can proceed.


That could leave the poor, mentally frail patients currently in Allen with few places to turn, advocates are telling the health department. It is a particular problem for a community hospital that is right near the Fort Washington Men’s Shelter, a place that can seem like a revolving door for those with mental health needs and substance abuse problems.

Doctors and students, who have taken the lead in protesting the closure, charge that NewYork-Presbyterian is simply seeking to replace the uninsured and underinsured patients with those who have better insurance in pursuit of higher-paying specialty services. And the closures come, critics say, as New York City faces dwindling capacity to administer to behavioral health patients.

Hospital executives refused to answer several specific questions for this story, in line with nonresponses that students and faculty say they have received when lodging their own complaints and questions.

Opponents of the plan do what activists do: The students have sent hundreds of postcards to Ann Sullivan, the commissioner of the Office of Mental Health, asking her to refuse NewYork-Presbyterian’s application.

Staff are writing to their elected representatives at all levels of government.

The Bronx and Manhattan Borough presidents, a state senator, an Assemblywoman and three City Council members have all signed a letter to Sullivan, calling the proposal “deeply worrying.”

State Rep. Adriano Espaillat followed up with his own letter in which he said he was “troubled by the lack of steps taken to ensure that members of the northern Manhattan community will still be able to receive quality psychiatric treatment close to home.”

On February 27, members of Community Board 12 voted 34-0 against the proposal and sent a letter reminding executives at the health system that these beds have been consistently filled for 30 years.

A petition from Dr. Beth Barron, an internist, has received nearly 1,300 signatures .

The New York State Nurses Association is planning a rally on June 13.

But nothing so far has persuaded NewYork-Presbyterian to reconsider, which has left many to wonder what will become of the patients.

“If these beds were not needed, why are they always full?” asked Miriam Callahan, a first-year medical student at Columbia.

Though the Department of Health has made no ruling, NewYork-Presbyterian is moving ahead. Doctors and nurses were told in December to find other jobs within the system. They did. Now, there are only 18 beds open for behavioral health patients, according to Barron.

A spokeswoman for NewYork-Presbyterian would not comment or confirm how many beds are available, nor would she address staffing concerns.

The battle being fought — a lightly organized grassroots campaign versus a multi-billion-dollar, nonprofit hospital — is a familiar one in New York City.

Similar efforts to save St. Vincent’s Hospital, Long Island College Hospital and preserve beds at Beth Israel Medical Center were mostly futile.

And while public rallies forestalled the closures of Interfaith Medical Center and the labor and delivery unit at North Central Bronx, those protesters were up against elected officials, not large health systems.

Steve Corwin, CEO of New York-Presbyterian, insists his health system is committed to behavioral health care in northern Manhattan.

“The popularity of the Allen has surged over the past several years,” he wrote in a form letter sent to anyone who asked about the plan. “More than 2,100 babies are now delivered there each year, and there is also an increasing demand for surgical space and other ancillary services.”

That’s exactly the problem, opponents of the plan say. They contend that NewYork-Presbyterian is simply making room for patients recovering from spine surgery, a particularly lucrative business.

New York-Presbyterian has certainly hyped its spine surgery program. Outside the Allen hospital, a giant red banner is holstered to the fence with white lettering that reads: “Daniel and Jane Och Spine Hospital” in recognition of a $25 million gift the Ochs made late last year.

The spine hospital, which exists inside the Allen Hospital building, has been a point of pride for New York-Presbyterian since it opened in August 2015. That was the year that New York-Presbyterian decertified five in-patient behavioral psych beds at the Allen Hospital, foreshadowing the current fight.

NewYork-Presbyterian renovated space inside the Allen Hospital to make room for its new spine center, which promised to care for some of the rarest, most difficult to treat deformities.

The health system lured three spine surgeons — Drs. Larry Lenke, Daniel Riew and Ronald Lehman — from Barnes-Jewish Hospital and Medical Center in St. Louis. There are five operating rooms and 13 patient beds, though occasionally recovering spine patients need an intensive care unit bed.

Among the concerns that Barron and others have is that removing the behavioral health beds will create a bottleneck that impacts the entire hospital and the surrounding community.

Patients who need urgent psychiatric care will most likely be transferred to a waiting area known as CPEP, or Comprehensive Psychiatric Emergency Program, at NYP/Columbia University Medical Center on 168th Street.

That has 18 emergency beds and six observation beds. When those are filled, patients sit and wait in the emergency room, meaning patients with medical needs will face a more crowded, uncomfortable emergency room and longer wait times, and patients with behavioral health needs will be in an emergency room where they do not belong.

Already, patients wait an average of more than six hours to be admitted through that emergency department, according to the state Department of Health.

“That’s an unintended consequence no one is addressing right now,” Barron said.

Staff must see every person in the CPEP, every day. Typically, the first few hours are dedicated to follow-ups and then new patients are seen. The more people waiting in the CPEP, the longer it will take for new patients to be seen. New patients with a psychiatric problem could be waiting hours to see a psychiatrist.

A spokeswoman for NewYork-Presbyterian declined to discuss the potential bottleneck or spine patients in the ICU.

Another consequence: If NewYork-Presbyterian prevails, it will be the latest in a string of private health systems to reduce inpatient behavioral health beds in New York City.

Since 2012, more than 150 psychiatric beds have been closed by six private hospitals, according to the state Department of Health.

As a result, NYC Health + Hospitals, the city’s financially beleaguered municipal system, is picking up the slack.

The number of mental health admissions at public hospitals has skyrocketed over the past decade. Of the 2,840 hospital beds for psychiatric patients across the 37 hospitals in New York City, roughly half are in the 11 public hospitals. And just three hospitals — Bellevue, Kings County and Elmhurst — account for roughly 25 percent of all psychiatric beds in the city, according to a 2017 report from the Independent Budget Office.

There’s no mystery as to why this is occurring. Hospitals that care for behavioral health patients, particularly those with substance abuse problems and other medical issues, are poorly reimbursed by Medicaid. Those patients are, in short, money losers.

“We are the leading provider of behavioral health services,“ Mitchell Katz, CEO of NYC Health + Hospitals, said Tuesday at a Crain’s breakfast, speaking on an unrelated topic. “No one is even close. Why? Because if you were the most efficient health system in the world, you’d never break even on behavioral health. It’s impossible.”

New York-Presbyterian executives insist that the behavioral health patients will find beds in other parts of Presbyterian’s expansive system, but that seems impractical, according to Espaillat.

“This proposal to close 30 beds at Allen Hospital would reduce New York-Presbyterian’s total number of psychiatric beds by roughly 8 percent, and of the beds remaining approximately 78 percent of them are located at Presbyterian’s Westchester campus, not easily accessible to those who rely upon public transportation,” he wrote Corwin. “Under the current proposal, it appears as if too many northern Manhattan residents would be hard-pressed to find psychiatric care in their community, feasibly leading to disastrous repercussions.“

Corwin’s letter boasted of 500 psychiatric beds and extensive outpatient services throughout the health system, but a spokeswoman for New York Presbyterian declined to say how many of those beds are in Manhattan.

At least some of the patients at Allen will have much farther to travel — no small task for the mentally ill.

There is also the question of the type of beds being offered and the type of patients NewYork-Presbyterian will serve. The psych beds at Allen Hospital are for mentally ill and chemically addicted patients, many of whom come through the emergency room.

A spokeswoman for NewYork-Presbyterian would not say how many beds for the mentally ill or addicted — known as MICA beds — are available throughout the health system.

Milstein 9 Garden North, a 24-bed psychiatric inpatient teaching unit on 168th Street about two miles south of the Allen Hospital, does not take drug-addicted patients. And rarely, if ever, does that hospital treat patients with Medicaid or without insurance.

In an email seen by POLITICO, NewYork-Presbyterian administrators said 9 Garden North will not change in size or the patient population it serves, which appeared to underscore that patients from Allen will not be moving there.

A spokeswoman for New York Presbyterian would not address where patients from the Allen Hospital were expected to receive care or whether other facilities such as 9 Garden North or Weill Cornell would accept a greater percentage of underinsured or uninsured patients.

Corwin’s letter suggested that closing the Allen’s beds would not be a problem because “less than half of the current behavioral health patients at the Allen are from the surrounding neighborhood.”

But a spokeswoman for NewYork-Presbyterian would not say if that took into consideration the nearby men’s shelter. People in the shelter may not technically be from the area, but it is where they reside, and the homeless are a population who are typically ill-suited to outpatient psychiatric care.

Corwin, in his form letter, said New York-Presbyterian will build additional outpatient space, which is great, advocates say, but not the same thing.

Inpatient beds are for those who are a danger to themselves or others. These are patients who often need to be stabilized. Dosage for their medications isn’t always precise and it can take days or weeks for psychiatrists to strike the right balance.

"The [state] Department of Health and the Office of Mental Health are evaluating both New York Presbyterian’s request and public comments on the proposal,” said Erin Silk, a department spokeswoman. “Ensuring appropriate access to psychiatric services is our primary goal.”

Corwin, through his spokeswoman, declined to speak for this article.