In the lobby of the Service Employees International Union Local 32BJ’s lower Manhattan headquarters on Feb. 10, senior citizens with oxygen masks who might lose their closest hospital gathered with paramedics, nurses and doctors who might lose their jobs. They came to hear the city’s highest elected officials -- everyone with the notable exception of Mayor Michael Bloomberg -- express their outrage over the imminent closing of St. Vincent’s Hospital in Greenwich Village, their shouting often competing with the voices of parents of various ethnicities trying to sooth their coughing children with winter colds.

New Yorkers are used to hearing doomsday calls and cries that the closing of this or that institution will cause irreparable harm to the city, and the cynical newsreader often walks away unimpressed, sure that at the end of the day it will be no big deal. But community activists, health care experts and many local officials said, to put it bluntly, that the closing of the St. Vincent’s Hospital is a big deal, and a sign of an intensifying contraction of the already overburdened health-care apparatus in the five boroughs. This, they fear, will lead to chaos, a spike in avoidable fatalities and an inadequate response to a future disaster, natural or otherwise.

Start with the immediate impact. Assuming St Vincent's does close, if you live, work, or spend significant time in the West Village, Chelsea or Soho and you have a heart attack or any other kind of serious medical emergency, an ambulance would have to take you across town to Bellevue, a public hospital, or Beth Israel. Alternatively, the emergency medical technicians could head south to New York Downtown, which is also a long trip. Medical responders note that all of these facilities are already overburdened with patients, meaning that, if they have to take on more, ambulance response capability and quality of emergency care in the entirety of lower Manhattan could plummet.

Residents of the East Side are worried, said Jo Hamilton, chair of Community Board 2, which represents Greenwich Village, noting that her constituents have the support of Community Board 6, which represents part of the East Side. "They're very, very concerned about what the impact of this closing is going to have on their hospitals, which already filled to the brim," she said. "So where are those 60,000 emergency visits that St. Vincent's has every year, who's going to absorb those?"

Stopping short of invoking 9/11, Hamilton noted that St. Vincent's is a Level 1 trauma center, meaning it is equipped to handle the highest level of care to trauma patients, who often require a number of different types of treatments. "God forbid any kind of a disaster be it natural, or another -- I don’t even want to say it. If anything major happens, this is the place that is actually equipped to service those kinds of emergencies," she said.

Manhattan Borough President Scott Stringer, speaking at the 32BJ event, said, "This is the hospital that was ready to roll during the terrorist attack, and every day is ready to help if you have a heart attack."

How Did We Get Here?

St. Vincent's is a Catholic institution that turns away no one. The hospital incurs the cost of treating uninsured patients every day, resulting in a massive financial loss that has reached a breaking point.

In short, St. Vincent's is a victim of the bigger problem of the American privatized health-care system. Two hospitals in Queens -- St. John's and Mary Immaculate -- closed a year ago after falling into bankruptcy. According to Patrick Bahnken, who as president of District Council 37 Local 2507, which represents Fire Department paramedics, this has put a strain on both the 911 system and the other medical centers in the borough. Specific numbers are unavailable, but the Mayor's Management Report released last week found that citywide "ambulance response time to life-threatening medical emergencies increased three seconds to six minutes 39 seconds, while fire unit response to these emergencies remained the same at four minutes 14 seconds."

St. Vincent’s, like the two Queens hospitals, cannot reconcile the goal of serving the public good with staying in the black, and its closing would cause similar problems beyond its immediate surroundings. The lack of long-term thinking on how to keep the hospital alive only highlights just how broken the entire health-care system is. Gov. David Paterson has established bridge loans to the hospital, which, if we're lucky, will have kept the place running as you read this article. In the meantime, he's meeting with unions, creditors and other stakeholders.

On Friday, the hospital began laying off some 300 employees, including managers, unionized workers and medical residents. The hospital has also instituted a temporary 20 to 25 percent pay cut for non-union workers, and it proposed a temporary 15-percent pay cut for 1199/SEIU members, which the union is considering if it can stave off closure.

The hospital could switch hands, meaning that it would no longer be a Catholic hospital, but could still provide care to the surrounding community. One group has already pulled away from doing this, but even if that deal had gone through the hospital would have been converted to an outpatient facility, resulting in the same strain on the emergency response grid.

Real Estate to the Rescue?

The hospital, in conjunction with Rudin Management Co., proposed leveling the hospital's signature O'Toole building to build a new medical center and condominium. The deal could provide the hospital with much-needed revenue, and Hamilton expects to hear about the approval in the spring. But in the meantime, it has become irrelevant. "This is completely on the back burner,” she said. “It’s more important at this point to save the hospital."

The plan was controversial. "From the beginning, critics have assailed the mass and height of the proposed towers and their impact on the historic neighborhood, while the hospital’s supporters underscored the need to upgrade St. Vincent’s," the New York Times observed.

After much controversy and some modifications, the Landmark's Preservation Commission endorsed the plan, but it still needs approval from the City Council.

No Easy Answers

Bloomberg's absence from the discussions involving St. Vincent's future has disappointed community groups and unions (3,500 workers would lose their jobs). Stringer, along with Comptroller John Liu and Public Advocate Bill de Blasio -- all of whom are seen as likely mayoral candidates in 2013 -- won applause at the 32BJ meeting by pointing the finger at City Hall, accusing it of inaction.

"I'm tired of people telling me every time there's a recession or a budget cut that the most vulnerable will have to pay this price," Stringer shouted.

De Blasio said the city and state should "help us put together the building blocks to save this hospital. Because if you don’t, we’ll look back for decades and say, 'How did this happen on our watch?'"

With the crowd on their side, the officials pleaded for the city to do something.

What? No one knows, and if three mayoral hopefuls cannot offer an alternative to the mayor’s silence, Bloomberg probably cannot do much either. He has already proposed cuts in city services, so a city bailout at this point seems unlikely at best. The reality is that the closing of two hospitals in Queens and the fate of St. Vincent's are not isolated incidents but part of a system failure. All the city’s private hospitals could be threatened by the American notion that health care must generate revenue. That is something a Community Board chair or even a mayor who has made public health one of his top priorities cannot change.