“I would not go back to St. Luke’s, except in the case of dire emergency,” said Zach Kaplan CC ’12 of his experience at St. Luke’s Hospital for an emergency appendectomy last year.
Kaplan’s skepticism reinforces a belief frequently voiced by Columbia students that the health care across the street is inferior to that offered elsewhere in the city. While Columbia and Barnard Health Services often refer students who need more advanced medical attention to St. Luke’s because of its proximity on the corner of Amsterdam Ave. and 113th Street, a number of large hospitals and smaller clinics serve the health care needs of residents of Morningside Heights, Harlem, and the Upper West Side.
Community health care
The Ryan Center—a branch of the William F. Ryan Community Healthcare Network, located on 97th Street between Amsterdam and Columbus Avenues—offers a full range of services, including pediatrics, adult medicine, mental health, women’s health, prenatal care, neurology, ophthalmology, and dental, plus a number of health outreach programs.
Built on former U.S. Representative William Ryan’s (D-N.Y.) belief that “healthcare is a right, not a privilege,” the Ryan Center serves primarily low-income communities, accepting Medicaid and Medicare, Child Health Plus, Family Health Plus, and numerous other insurance plans. For uninsured people, payment is based on a sliding scale relative to income and family size. Eligible low-income patients can get their prescription drugs for only $10 each.
The Charles B. Rangel Community Health Care Center on 135th Street between Broadway and Amsterdam Ave.—one of 12 primary care practices in the New York-Presbyterian Hospital’s Ambulatory Care Network clinics—specializes in internal medicine, pediatrics, pharmacy assistance, and social services, and offers a sliding scale to uninsured patients and assistance with applications for government-sponsored health plans. Medicare patients can get affordable pharmaceuticals through the Pharmacy Assistance Program, and pregnant women who do not qualify for Medicaid can get prenatal care at the Prenatal Care Assistance Program.
Local hospital scene
But while community-based clinics like the Ryan Center and Rangel Center are low-cost options for routine medical visits and non-emergencies, larger hospitals have the benefits of emphasizing emergency room service and teaching components.
The Harlem Hospital Center on Lenox Avenue at West 135th Street—founded in 1887 and affiliated with Columbia’s College of Physicians and Surgeons since 1962—is a Level 1 Trauma Center, meaning it has a full spectrum of emergency medical services, from respiratory intensive care units to cardiac care. The hospital is also a teaching institution with a large residency program and is known for its sickle cell, tuberculosis, asthma, and burn units. One of only a few hospitals with a specialty in plastic and reconstructive surgery to treat scarring in African Americans, Harlem Hospital also launched its “Asthma Prevention Project” to serve the nearly 20 percent of Harlem residents with asthma—compared to a 4 percent national asthma rate.
The much larger St. Luke’s Hospital is also an academic affiliate of the College of Physicians and Surgeons, and is frequented by Columbia students who need treatment beyond what Health Services can provide. Its emergency room boasts 40 physicians with 24-hour stroke and heart attack teams and specialized services for victims of sexual assault, and it offers a comprehensive list of clinical services, from HIV to urology. St. Luke’s is part of a five-hospital network, and partners with Roosevelt Hospital on 10th Avenue and 59th Street.
A little farther away is the hub of New York-Presbyterian Hospital, which serves not only its immediate Washington Heights community but also residents of all five New York City boroughs and beyond. Its constituent hospitals and facilities are affiliates of either Columbia’s College of Physicians and Surgeons or Weill Cornell Medical College. The Columbia University Medical Center and Morgan Stanley Children’s Hospital—both located near West 168th Street—and its Allen Hospital at Broadway and West 220th Street, serve as both medical and research centers.
Patients at New York-Presbyterian are responsible for all fees left over after insurance payments. But New York state residents may qualify for “charity care” for medically necessary procedures, and patients with incomes less than four times the federal poverty level may qualify for discounted rates depending on income and family size.
Disparities in service
But as Kaplan’s discontent with St. Luke’s demonstrated, disparities between these hospitals and clinics—both real and perceived—persist.
A 2006 New York Magazine ranking of city hospitals named New York-Presbyterian the No. 1 overall hospital in the city: No. 1 for pediatrics, psychiatry, cardiac care, OB-GYN, and neurology/neurosurgery, and No. 2 for emergency care, cancer, and digestive disorders. The hospital ranked No. 6 on U.S. News & World Report’s 2009 Honor Roll of hospitals nationwide.
The Roosevelt Division of St. Luke’s made No. 10 on the list for neurology and neurosurgery, but paled in comparison to New York-Presbyterian’s rankings.
Local clinics like the Ryan Center are less apt comparisons, since they are health centers rather than hospitals and provide outpatient primary care rather than emergency, surgical, or inpatient treatment. They also cater to communities that might otherwise be unable to afford basic health care.
Daniel Baxter, the chief medical director at the Ryan Center, said that the center has seen the number of uninsured patients double over the past year, largely due to its low, sliding-scale fee.
“The increasing burden of uninsured patients—that is really killing us,” Baxter said.
Other clinics, like the Rangel Center, are components of larger health care systems—in this case, New York-Presbyterian—which are widely perceived as top-notch providers. All tend to deal not only with primary care, but also with issues that cross into the social services realm, such as HIV, depression, and substance abuse. As such, they are not centers for medical teaching, research, or specialty fields for which large hospitals are recognized, such as oncology or neurosurgery.
Quality and closeness
The teaching component of larger hospitals can be a decisive factor in which provide the best care. While St. Luke’s is affiliated with the Columbia University Medical School, New York-Presbyterian “is not only a teaching hospital, but also an academic medical center,” said Helen Morik, vice president for government and community affairs at New York-Presbyterian.
As the result of a merger between what had been New York Hospital on the east side of New York City and Presbyterian Hospital in Washington Heights, as well as the affiliation between
Columbia’s and Cornell’s respective medical schools, New York-Presbyterian is now one of the largest hospitals in the country. Its teaching and research components attract top doctors, and Morik said the system trains close to 20 percent of physicians in the country. She added that New York-Presbyterian’s unique specializations, such as its transplant center—ranked No.
1 in the country—and top cardiology unit, draw patients internationally, nationally, and from the immediate community.
“The quality of our health care is very high because we are a teaching hospital and academic center,” Morik said.
The allegedly lower quality of care at St. Luke’s could be a function of its smaller teaching component and the fact that the many of the best doctors and medical academics in the city flock to New York-Presbyterian. Though St. Luke’s boasts more beds and patients than Harlem Hospital Center, the latter offers more specialty medicine and research in asthma, sickle-cell disease, and other areas.
But the quality of basic services may be lacking. Kaplan cited a long wait in the emergency room for his infected appendix, having chosen St. Luke’s after waking up in the middle of the night in pain and finding the Columbia Health Center unavailable. St. Luke’s officials declined to comment for this story.
It may be proximity rather than quality that drives the high volume of Columbia students to St. Luke’s during the academic year.
When a student needs specialty care, “There is a general requirement obtained through one of the primary care providers,” and “the specialty care is largely covered by the insurance plan,” said Samuel Seward, assistant vice president of Columbia Health Services. These referrals are often to St. Luke’s, and in the case of an emergency—in which no referral is required to guarantee student insurance coverage—the fastest option is arguably the best.
And not all students have been dissatisfied with the closest hospital to campus.
“It isn’t the nicest-looking hospital, but in terms of patient care, I think it’s the best in the city,” said Liza Kostreva, BC ’12. She didn’t have high expectations for her ER visit earlier this fall, but “the nurses and doctors were wonderful. I didn’t have to wait, there was a good level of privacy, and after being treated I was released quickly.”
When in doubt, the choice of health care might be easier, at least for students under 21.
“Stay in pediatrics,” advised Kaplan, who spent his weekend of recovery in the children’s wing of St. Luke’s. “The care is better, and it’s more fun.”