State probes emergency care at Mount Sinai Beth Israel as planned closure nears

NEW YORK — The state is investigating Mount Sinai Beth Israel to determine whether it has violated a law requiring hospitals to treat anyone who comes to the emergency room, according to two emergency department staffers with direct knowledge of the matter and an internal memo.

State Health Department inspectors were at the downtown Manhattan hospital for seven days at the end of January, during which they interviewed health care workers about staffing levels and emergency department procedures, the two people said. The hospital’s president later described the surprise visit in a memo to staff, which was seen by POLITICO.

The probe, which has not been previously reported, comes amid state scrutiny of the Mount Sinai Health System’s plan to close the financially distressed hospital by this summer pending state approval. In December, the health department determined Beth Israel was unlawfully closing beds and services and issued a rare cease-and-desist order.

The closures have continued anyway, in line with the hospital’s original proposed timeline for phasing down operations, according to those two people and two additional emergency department workers. The 16-bed intensive care unit — already a fraction of the hospital’s total 44-bed ICU capacity — now has just a handful of beds in use, and non-emergency surgeries have been curtailed, the four people said. State guidelines prohibit any discontinuation or limitation of services related to a proposed hospital closure prior to receiving approval.

While Mount Sinai is denying that it is reducing its capacity since the cease-and-desist order, the employees said the health system seems to be quietly trying to force the Health Department’s hand and ensure Beth Israel closes. Loren Riegelhaupt, an outside spokesperson representing Mount Sinai, did not directly address the claim that non-emergency surgeries have been curtailed.

The four health care workers interviewed by POLITICO were granted anonymity because they were not authorized to speak to the media, but their accounts were corroborated by internal hospital memos, emails, text messages and screenshots of the hospital’s dashboard that tracks bed capacity in real time.

As a result of the continued downsizing, patients are increasingly requiring transfers to receive the medical care they need, the workers said. All the while the emergency department has been crowded with patients who need to be admitted to the hospital but are waiting days for a bed, they added.

“You go into work every day scared that someone's going to die on your watch,” one of the four health care workers said in an interview.

A state Health Department spokesperson declined to comment, citing an open investigation.

In response to a detailed list of questions, Riegelhaupt said no new beds have been closed since the state issued the cease-and-desist order and noted the state has so far issued no citations or imposed any fines.

“It is important to us and to everyone that we have clear plans in place as we move through this process, which is why we are continuing to work with [the state Health Department] to ensure a seamless transition for our patients and community,” Riegelhaupt said in a statement.

At times there can be staffing challenges, he acknowledged, but they have resulted only in short, minor delays and were addressed as quickly as possible. He did not address the Health Department’s visit.

“We understand and appreciate the community's concerns and questions and remain committed to continuing our ongoing dialogue throughout this process,” Riegelhaupt said in a statement. “Our goal is to ensure that all Mount Sinai Beth Israel patients are cared for and treated in the most appropriate manner possible, whether at another Mount Sinai location or elsewhere.”

Beth Israel’s closure has been on the table since at least 2016, when executives proposed replacing the hospital with a smaller facility to address mounting financial losses. If the current plan is approved, it will add to a yearslong pattern of hospital closures that disproportionately affect low-income patients from communities that are already medically underserved. SUNY Downstate Medical Center in Brooklyn is next in line for potential closure.

That pattern, which is exacerbated by years of flat Medicaid rates that lag far behind hospitals’ skyrocketing costs, has a ripple effect on the city’s broader health care system — especially as patients shift to the next-closest hospitals.

An NYU Langone employee, who was granted anonymity because they were not authorized to speak to the media, said patient volume at its hospital in Kips Bay is already “off the charts” as Beth Israel scales down. So far this year, the emergency department has already seen three of its highest-volume days on record, the person said.

Riegelhaupt said any recent uptick in emergency department volume at other hospitals cannot be attributed to Beth Israel because it has not closed.

In contrast to employee portrayals of the situation at Beth Israel, executives there have struck an optimistic tone. Hospital President Elizabeth Sellman told her staff the Health Department conducted two surprise surveys related to the Emergency Medical Treatment and Labor Act, also known as EMTALA, and a state law that sets hospital operating requirements. She said patients’ responses to the surveyors were “very positive and complimentary,” according to the memo obtained by POLITICO.

The state usually conducts EMTALA surveys after receiving a complaint, given that all alleged violations of that law must be investigated, but it is unclear what exactly spurred the department’s probe.

“As the surveyors moved through the hospital, evidence of our exceptional performance shined through,” Sellman wrote in the memo, which was sent last Thursday to staff. “We demonstrated how we provide safe, quality care each and every day. Prior to their departure, the surveyors shared that they were impressed with the way we provided ‘care with dignity’ and so appreciated everyone’s cooperation and professionalism.”

The health care workers who spoke to POLITICO said the Health Department may have gotten a rosier picture of the hospital’s operations than they experience on a daily basis.

Once the Health Department showed up, the hospital offered emergency department nurses hundreds of dollars in “crisis pay” on top of overtime pay for each additional shift worked that night or the following day, said two of the employees, who have direct knowledge of the offer. One of the employees said Beth Israel typically offers crisis pay in times of severe understaffing, such as during the height of Covid.

Riegelhaupt said that was factually inaccurate because there was a job fair at the same time that pulled some staff, so a few bonuses were offered to maintain baseline staffing levels. But POLITICO obtained internal emails showing the job fair, which was for emergency department nurses to secure a new placement elsewhere in the Mount Sinai network, was ultimately postponed.

While investigators were on site, the four employees said they found it easier to secure beds for patients who came in through the emergency department and needed to be hospitalized, shortening wait times. Before the Health Department showed up, the emergency department was routinely overwhelmed with admitted patients waiting days for a bed, the four people said. During the visit there were only a handful, and waits were significantly shorter, the employees said.

After the department left, two new beds in the ICU were marked “blocked: administrative decision,” whittling capacity to just eight beds, according to screenshots of the hospital’s internal dashboard reviewed by POLITICO.

Riegelhaupt said the hospital has not closed any new ICU beds since the cease-and-desist order but said sometimes beds become blocked due to infectious patients or plumbing leaks; that has nothing to do with the proposed closure, he added.

However, one of the emergency department employees said beds blocked for those reasons are typically marked “isolation” or “engineering,” which POLITICO corroborated with internal dashboard screenshots of other units.

The four employees said patients who are seriously ill and require close monitoring, such as people with sepsis, are increasingly being transferred to other hospitals due to the limited ICU capacity. While they await transfer, the hospital’s strained emergency department staff are left caring for them.

“There’s been days where I’ve gone home and I’ve upped my malpractice insurance,” one of the employees said.

The ICU is slated to close completely in March, according to an updated closure timeline circulated by hospital executives late last year.

Other patients are being transferred because the hospital has curtailed non-emergency surgeries, another employee said. For example, Beth Israel has long served diabetic patients in need of vascular surgery to restore blood flow, but they are no longer being admitted, that employee said. Endoscopy and urology services are also slated for relocation to other Mount Sinai locations this month, according to the hospital’s internal timeline.

New signs of the imminent closure keep appearing, even though the state review of Beth Israel’s closure plan is still pending. Recently the emergency department’s patient volume has begun to thin, because Beth Israel no longer has dedicated ambulances bringing patients in, two workers said. The hospital allowed its ambulance contract with SeniorCare Emergency Medical Services to expire Feb. 1.

And executives are already leaving frontline health care workers with a memento: A shiny gold pin engraved with a picture of the hospital’s rounded facade. It reads, “1889-2024.”