Special Mission
Catholic values are constant amid change as St. Vincent's marks 150 years
By BRIAN CAULFIELDThe spirit of St. Vincent's Hospital and Medical Center was seen on a recent windy morning outside the 12th Street entrance in Manhattan's West Village. A group of second-grade students from a nearby school stopped to watch a truck pump liquid oxygen into the medical center's underground receptacle. The children's teacher called on a green-vested security guard to explain the impressive-looking procedure. The guard stepped quickly across the street and gave the children an impromptu lesson on how the oxygen is stored, what it is used for and how patients' lives are saved by it.
"The kids were curious and I wanted to make sure they got the story straight," said the guard, Marcus Rojas. "We all try to do these little things here."
The little things remain important as St. Vincent's celebrates its 150th anniversary and undergoes major changes that will affect the future of Catholic health care in the New York metropolitan area. Sponsored by the Sisters of Charity of St. Vincent de Paul, it is in the midst of a merger with the Sisters of Charity's health care facilities on Staten Island and the four community hospital divisions of the Catholic Medical Centers of Brooklyn and Queens.
The new entity, St. Vincent's Catholic Medical Centers of New York, will have eight acute-care hospitals in four boroughs with 2,600 beds and 61 primary care, behavioral health and ambulatory care sites.
The fact that the citywide conglomerate will retain the St. Vincent's name is indicative of the reputation the hospital has built and the name-brand medical care it has provided over the past century and a half.
Identity of another sort will be carefully watched, however, as the relatively small hospital tucked into 11 unmatched buildings around West 11th and 12th streets branches out. In a highly competitive health care market, in an industry controlled increasingly by reimbursement policies of health management organizations, will St. Vincent's remain focused on the Catholic aspect of its services?
"We are doing this for the survival of Catholic health care in New York," Sister Elizabeth Vermaelen, S.C., president of the Sisters of Charity, said of the merger, which is scheduled to take place early next year after state and federal agencies approve the terms. "We don't have the kind of endowments the large medical centers in New York have. This is one way for us to keep up."
The merger will allow economy of scale. Only one set of administrators will be needed for the whole system, rather than the three that run the separate health care systems now. The same principle holds for heads of medical departments, computer information systems and the purchasing of supplies.
But money is not the sole motivation, Sister Elizabeth said. If it were, the Sisters of Charity would be inclined to get out of health care altogether, given the well-endowed competition and the fact that city and other private hospitals already have enough beds and services to care for the needs of New Yorkers, she pointed out.
The reason for Catholic health care today is not to offer something more but something different, she said. A specific mission to the poor and underserved and a respect for the entire person, from conception to natural death, are the hallmarks of Catholic care, she noted.
With physician-assisted suicide gaining greater acceptance along with a whole range of techniques at the beginning and end of life that violate Catholic medical ethics, specifically Catholic health care is becoming more important.
"I think patients have already made decisions to seek out Catholic hospitals because of these issues," said Dr. Karl P. Adler, president and chief executive officer of St. Vincent's. "On the other hand, some patients have decided not to go to a Catholic hospital because they disagree on these issues."
Dr. Adler added, "We concentrate on the issue of abortion, and rightly so, as something that defines Catholic health care. But we have to consider what will be facing us in terms of very complex end-of-life issues...We in Catholic health care have to be the leaders in this area."
He noted that all physicians working at St. Vincent's must promise to follow the U.S. bishops' directives on health care procedures.
The merger is the first step in what those involved hope will become an affiliation among Catholic medical facilities in seven dioceses in the tristate area, Dr. Adler said.
Commitment to Catholic teachings and practice is shown in the hiring of Dr. Daniel P. Sulmasy, O.F.M., a Franciscan Brother who holds the hospital's Sisters of Charity Chair in Medical Ethics (CNY, Oct. 7). He seeks to maintain the Catholic view in all hospital services and to promote this view in the community at large as the foundation of good medical care, regardless of religious affiliation.
Catholic character is seen in the Department of Community Medicine, founded in 1974, which provides free primary medical care to homeless persons, poor families, the elderly, the homebound and immigrants. Under the direction of Dr. Philip W. Brickner, the department staffs 32 medical programs in shelters, drop-in centers and single-room-occupancy hotels, and runs a large center on Canal Street for Chinatown residents. In addition, more than 160 frail elderly persons are treated at home.
"We're making the difference in their lives because we are going where medical needs may not otherwise be attended to," Dr. Brickner said.
Last year, the hospital provided some $25 million in uncompensated care to indigent and needy elderly patients.
Celebrations of the 150th anniversary will conclude with a dinner at the Waldorf-Astoria on Monday, Nov. 1, and a Mass in St. Patrick's Cathedral Saturday, Nov. 13, at 2 p.m.
St. Vincent's was founded in 1849 on East 13th Street, the first Catholic hospital in New York City, by four Sisters of Charity who enlisted the aid of five volunteer doctors. The first administrator was Mother Mary Angela Hughes, S.C., sister of Archbishop John J. Hughes. She established the hospital's mission as care of the sick poor, though persons of all economic means and of every religious persuasion were treated. A cholera epidemic three years later forced them to rent another building on the same block. By 1868 the hospital had purchased a former Catholic orphanage on West 11th Street to begin its long record of service in Greenwich Village.
Funding has been a perpetual problem. Catholic women responded early on with two large fund-raising fairs, one at the Crystal Palace and the other at the Palace Gardens. The events put the hospital in the black and set the pattern for the St. Vincent's Auxiliaries, originally founded as a ladies' group in 1897, which raised $1.3 million in recent years for hospital projects.
A branch of St. Vincent's was opened in Harrison in 1879 for the treatment of mental illness, and in 1892 a school for nurses began. The last class graduated this past spring, and nurses now are trained in a bachelor's degree program at the College of Mount St. Vincent in the Bronx, run by the Sisters of Charity.
An automotive ambulance was introduced by the hospital in 1899 and discontinued shortly afterward because the city's streets proved too bumpy for patient safety.
The church-size chapel was dedicated in 1899 on 11th Street, with the name Our Lady of Good Counsel, and rededicated in honor of St. Elizabeth Ann Seton by Cardinal O'Connor in 1990.
Over the years, St. Vincent's has responded to major catastrophes, from treating survivors of the Titanic in 1912 to providing emergency care in the 1993 terrorist bombing of the World Trade Center. The city has designated the hospital as the primary emergency care site for a large portion of the West Side.
Expansion continued most recently with the opening of St. Vincent's Comprehensive Cancer Center earlier this month on the first floor of a former warehouse on West 15th Street (CNY, Oct. 7). Cardinal O'Connor, undergoing radiation treatments after having a brain tumor removed, dedicated the $33 million facility, which offers outpatient care on a 24-hour basis.
St. Vincent's today is an 813-bed facility with 17 medical departments, 900 attending physicians, 330 interns and affiliation with New York Medical College in Valhalla.
Last March, the archdiocese ended formal affiliation with the hospital after serving as co-sponsor for about 20 years. The dire financial straits of the 1970s that necessitated the archdiocese's help have been overcome, Sister Elizabeth explained.
The planned merger also will affect the level of care provided. Although emergency and primary care will continue, the Manhattan hospital will become more of a high-tech, third-level (tertiary) facility where patients will be sent for specialty and surgical procedures not available at the community hospitals and treatment centers that will become part of St. Vincent's citywide system. The movement in health care is toward treating patients in neighborhood ambulatory centers with hospitals providing intensive care.
"Basically, there will be one hospital with multiple sites. The buildings on 12th Street may well service certain specialized areas," Dr. Adler said.
Cardiovascular, cancer and psychiatric care are areas the hospital is noted for, he pointed out.
"We may take other services and locate them in other parts of our new hospital, which now will have several locations," he said.
The community hospitals, in turn, will serve as referral centers for advanced care at the Manhattan facility.
St. Vincent's commitment to this new direction was one factor that brought Dr. John A. Ambrose from Mount Sinai Medical Center in upper Manhattan to head the Comprehensive Cardiovascular Center, in the hospital's Spellman Pavilion.
"We're building the department up from the ground. We have an increased number of labs and have hired a number of top-flight cardiologists," Dr. Ambrose said. "I'm here for the opportunity to develop something. To me, it is a great honor that I could make a contribution of this kind."