The hospital system’s reputation has also become more high-profile. Since 1963, when it began serving as the teaching hospital for Albert Einstein College of Medicine, it has become a renowned academic medical center. In 2018, Montefiore was ranked eighth of the 167 hospitals in the city’s metropolitan area by U.S. News & World Report.
Nicknamed “Monte,” the hospital is also a primary care provider and lifeline for Bronx residents who need emergency treatment. The Montefiore Children’s Hospital and Moses campus developed expertise in asthma and diabetes, illnesses which disproportionately affect the borough. Arthur Hopkins, a doctor specializing in internal medicine at the Montefiore Yonkers campus, said that when he worked at the Moses location, he found that the patients were sicker because “the Bronx is tough.”
“80 percent of our patients are on government programs,” he said, “You can’t just sit down and negotiate with Medicare for a better rate. The thing that has really kind of saved us is that we’ve gotten good at managing care appropriately … efficiency is something we’re very good at.”
Steven Safyer, Montefiore’s president and CEO since 2008, wields great influence over health care in the Bronx. He is chair of the League of Voluntary Hospitals and Homes and a past chairman of the Board of Governors for the Greater New York Hospital Association, an influential industry group.
In 2016, Montefiore reported employing just under 23,000 people (it is the largest employer in the Bronx) and bringing in $3.6 billion in revenue. Montefiore spent $10 million of its budget on advertising that year, even financing a feature film called “Corazón” that premiered at last year’s Tribeca Film Festival.
As Montefiore has grown, it has also snapped up other hospitals as part of its expansion strategy. In 2015 it acquired St. Luke’s Cornwall Hospital in Hudson Valley and Nyack Hospital in Rockland County, and last year, it merged with Crystal Run Healthcare, a private health system based in Orange County.
There have been other signs of trouble at Montefiore. Earlier last year, a dispute with the nurses’ union over staffing levels and Montefiore’s tendency to hold patients in hallways broke into the open, resulting in protests and calls for the city to investigate the practice. Government inspectors had previously found that from November 2016 to May 2017, between 15 and 49 emergency room patients were placed in temporary locations (day rooms, treatment rooms, and hallways) every day except for one.
The first story involving Montefiore and suicide dates to 2009, but involves a death that did not occur at the hospital. Vladimir Makarov, a 30-year-old Bronx resident who suffered from both depression and paranoia, checked into the psychiatric ward of the Moses campus on October 29, 2009. He had previously attempted suicide and was hospitalized at a different health care facility in Westchester. His Montefiore doctors failed to complete the paperwork required to keep him in the hospital, according to a lawsuit filed by the family in July 2011. When Makarov returned home in December 2009, he jumped to his death from his grandmother’s 24-story apartment building in Co-op City. “He was very depressed and needed help,” his sister, Anna Satalkina, told the Daily News in 2011. “He absolutely shouldn’t have been released.” It is unclear how the lawsuit was resolved. Court updates stop in 2014 when several doctors were dropped from the suit.
The first of the four suicides to take place on hospital grounds in recent years occurred on June 23, 2012, when an inpatient walked off a Montefiore patient care unit in the middle of the night and was later found dead on the facility’s premises. He broke a window using a fire extinguisher and jumped from the ninth floor, onto a rooftop of a different hospital section. The incident was noted in a 2012 federal report.
A national problem
Successful patient suicides have occurred in other hospitals in New York City, but Montefiore is the only hospital with more than one since 2011, according to CMS reports released to the Association of Health Care Journalists (and available on its website hospitalinspections.org.)
For example, in August of 2017, a patient at Coney Island Hospital, a public hospital in Brooklyn, was admitted to the psychiatric emergency department with suicidal thoughts. He hung himself in his room. Inspectors found that he was not monitored appropriately.
At New York-Presbyterian Hospital, a nonprofit hospital in Manhattan, a patient was admitted to the psychiatric ward for suicidal ideation in September 2016. Though his doctor’s plan called for checks every 15 minutes, records show that a few days later, he was found hanging in the bathroom.
According to The Joint Commission, an accreditor of health care organizations, suicide is considered a “never event,” or an adverse, unambiguous, and serious event that is usually preventable. Last year, it found that suicide was the fourth most-common cause of unexpected death or injury in hospitals, with 89 reported to the organization that year.
Aiming to address to lack of reliable data on hospital inpatient suicides, last September the group released a new study that it says provides the first data-driven estimate of suicides in U.S. hospitals. It found that approximately 49 to 65 hospital inpatient suicides occur each year, and among those, 75 to 80 percent are among psychiatric inpatients. Some experts believe the actual number is far higher.