Steve Enderley, an emergency medical technician at St. Vincent’s Midtown Hospital on West 51st Street in Manhattan, thinks he knows where ambulances would take patients if his hospital weren’t available: to St. Luke’s-Roosevelt Hospital Center or William F. Ryan Community Health Center, both on Tenth Avenue.

But St. Vincent’s Midtown, which has consistently shown up on recent lists of New York City hospitals that may be recommended for closure Nov. 28 when a state commission issues a report on the “right-sizing” of state medical facilities, is needed in the area, Enderley says.

“It’s in Midtown, we’re near the theater district, it’s a good hospital, there are a lot of good doctors. We’ve actually increased [the number of] people going to the E.R.,” he said Sunday afternoon as a bank of ambulances lined the street outside the emergency room.

The question of what hospitals city patients will use if their present facilities are eventually closed has remained wide open as the statewide Commission on Health Care Facilities in the 21st Century has deliberated over the past year. Hospital closings are often controversial wherever they occur, and here in New York activists critical of the Commission’s “closed-door” process are worried that closures could perpetuate what they identify as chronic under-serving of lower-income residents.

According to the state Department of Health, there are 241 hospitals statewide, 71 of which are in New York City. Across the state on an average day, one-third of hospital beds are empty, says the commission. Broadly, its goal is to better allocate resources and make the system more cost-effective. Even the federal government considers the state’s hospital industry so troubled that it recently agreed to pay the state $1.5 billion over five years in return for the state cutting costs, including federally-funded Medicaid expenditures.

“I’m not aware of any plan” for redirecting hospital users, said Juan Alduey, a leader of the Save Our Safety Net campaign that’s been critical of the commission and has tried to influence its process. “If such a plan has been made, it will probably be released along with the list of hospitals,” Alduey said.

For decades, most hospitals that are closed are in federally-designated “medically underserved” areas, he says. Save Our Safety Net is composed of dozens of health, community and political organizations that want a “community needs assessment” to be performed before any hospital can be shuttered. “This whole process has taken place behind closed doors,” Alduey said, so his group doesn’t know what factors are being taken into consideration. “It is almost impossible to influence and have a public voice.”

Although David Sandman, the commission’s executive director, would not outline last week exactly what kind of planning for patient triage is taking place, he said that since the whole project’s purpose is to stabilize the state’s health care system, the capacity of hospitals near those recommended for closure is “absolutely” a key consideration. Involved hospitals “will be notified,” he said.

The commission’s report does not seal hospitals’ fates, however; that’s up to the state legislature. Unless the legislature rejects the entire plan by the end of the year, it will become law – and then it could take up to 18 months to implement, Sandman said.

“An orderly transition is certainly required,” he said. In addition to defending the commission’s workings as “extremely open and fair,” he noted the benefit hospital closings can have for other facilities.

“Driving volume to other institutions allows them to emerge much stronger. It also allows them to improve quality of care,” Sandman said. According to the state Department of Health, planning for the possible redirection of patients is primarily the commission’s responsibility, not DOH’s, spokesman Marc Carey said.

New York Westchester Square Medical Center in the east Bronx was one of six hospitals slated for closure in a list, provided by an unnamed member of the commission, published by the New York Sun newspaper last week. The east campus of Montefiore Medical Center is one of the closest hospitals to Westchester Square, and Montefiore spokesman Steven Osborne says his hospital is ready to accommodate more patients, if it comes to that.

“We’re planning for any eventuality. All those patients will be served,” Osborne said. Montefiore is one of the biggest Medicaid providers in the city, he said, and provided $90 million in charity care last year to patients without Medicaid. “We don’t turn anyone away from our area, which is the Bronx and south Westchester,” he said.

But for Judy Wessler, director of the Commission on the Public’s Health System and a leader of the Save Our Safety Net campaign, examples of poor coverage after hospital closures come all too readily to mind. Clinics and programs were promised to remain after two recent facility closures in Brooklyn, she said – but they didn’t.

The campaign won’t be over when the state commission issues its report this week. “We do hope to continue to influence the process,” Wessler said.

-Karen Loew