By Michael Kitchin

Executive Summary

The NY State Department of Health (DOH) Should Deny the Proposed Lenox Hill Hospital Expansion

The proposed $2.5 billion Lenox Hill Hospital expansion by Northwell would nearly double the square footage of the facility without increasing the number of hospital beds. The proposal has proven contentious, with the local Community Board, City Council Member, and Manhattan Borough President all weighing in. Despite multiple concessions, the proposed Lenox Hill Hospital expansion poses significant healthcare equity concerns. Community advocates should continue to place pressure on the DOH to refuse granting of a Certificate of Need. 

Background 

In March of 2019, Northwell Health unveiled their preliminary plans to expand Lenox Hill Hospital located on the block bordered by Park and Lexington between 76th and 77th St (Krisel, 2019a). The early proposal included a 490-foot market-rate residential tower that would help generate revenue to offset the cost of the proposed 516-foot hospital tower (Londono, 2019). This would make the hospital the tallest in New York City.  Northwell projected costs of $2.5 billion over 10 years of construction, with the expansion nearly doubling the size of the current Lenox Hill facility from 780,000 sq ft to 1.3 million sq ft (Krisel, 2019b). Northwell’s stated goals for the expansion are to revamp Lenox Hill’s emergency department, construct new surgical suites, and launch a new Mother-Baby hospital. Northwell also touts that the expansion would reduce congestion by relocating ambulance from 77th St into the facility and by creating less obstructive loading docks on 76th St. The expansion would not increase the number of beds at the hospital, and would instead allow them to offer individual rooms for all hospital patients (Spivack, 2019).

Stakeholder opposition, explored in Table 1, led to a modified proposal (Figure 1) in October 2020 that removed the luxury residential tower, and shortened the hospital tower from 516 ft to 436 ft to be built over 6 years instead of the original 10 (Garber, 2020b; Raskin & Hicks, 2020). Such a compromise maintains the current limitations of low ceilings, and fails to address ambulance and loading dock congestion (Garber, 2020c). Both proposals would require re-zoning to allow for the increased density, with the early proposal also requiring rezoning for residential purposes (Krisel, 2019d). To accomplish this the proposal must go through the Uniform Land Use Review Procedure (ULURP), a complex review process during which the City Planning Commission, the City Council and Mayor all must approve the plan (ULURP Explained : City LimitsCity Limits, n.d.). The NY State Department of Health must also grant a Certificate of Need predicated on Northwell’s ability to prove the expansion provides for a community healthcare need (Soussloff, 2019). 

Figure 1 Profile Comparison of Lenox Hill Hospital Expansion Proposals (Garber, 2020b)

Table 1: Support & Opposition for Proposed Lenox Hill Hospital Expansion

GroupGroup’s Interest in IssueStrategies Used to Influence OutcomePosition on Issue (+3 most supportive, -3 most opposed)
Northwell Health“The hospital is comprised of ten separate aging buildings that are not configured and equipped to effectively deliver the next generation of care. To maintain our future viability we need to make the necessary investments to meet the needs,” -Jason Strugatz, Northwell’s Vice President for Manhattan Redevelopment (Garber, 2020c)Expansion is also likely motivated by profit, as individual rooms are often a deciding factor for those that can “shop around” for healthcare needs.Presented its early propositions to Community Board 8Adjusted the proposition based on community opposition (Noonan, 2020)After serving 85,000 COVID patients across its health system, Northwell argues that the expansion would help the hospital serve under-resourced communities. “Throughout this process, one thing has become clear: COVID-19 confirms the need for a state-of-the-art hospital.”Indicated that they will submit the revised plan for public review through ULURP (Garber, 2020c)+3
Committee to Protect Our Lenox Hill NeighborhoodGroup organized in response to community outrage about the proposed expansion (SAVE LENOX HILL – Committee to Protect Our Lenox Hill Neighborhood, Inc., n.d.)Believe expansion is “unacceptable” in size and construction will bring air and noise pollution to dense residential area.Remains opposed to the smaller revised proposal, stating “the overall size and bulk of the hospital tower in the revised plan exceeds the original proposal and will have a long-term detrimental effect on the Lenox Hill neighborhood.” (Garber, 2020c)Oppose “health tourism” to their neighborhoodCommunity opposition and a petition of >6000 signatures prompted the revision of the plan to exclude the residential tower. (Petition · New York Elected Officials: OPPOSE NORTHWELL HEALTH’S DEVELOPMENT SCHEME TO EXPAND LENOX HILL HOSPITAL · Change.Org, n.d.)Paused their public opposition to the project in early 2020, recognizing optics of attacking healthcare institutions during COVID-19 response (Garber, 2020a)Use of rhetoric to push the idea that Northwell should instead use resources to construct a hospital in low-income minority neighborhoods to better address equity concerns e.g. Publicly accused the CEO of Northwell Health of putting profit over equity-3
Community Board 8Board members opposed Northwell’s original plan due to the size, construction timeline, and proposed financing of the project through the development of private residences. (Krisel, 2019d)Board’s Zoning Committee unanimously voted to oppose the proposal in September of 2019Board members passed a resolution opposing the original proposal in October of 2019 by a vote of 36 to three. Above resolutions are non-binding-2
Manhattan Borough President Gale Brewer and City Councilmember Keith PowersBoth motivated by a desire for reelection and to represent the interests of both business and residential constituents.Both have voiced their concerns about the plan, but have stopped short of outright opposing it. (Krisel, 2019e)BP Brewer set up a neighborhood taskforce to allow stakeholders to come together and discuss the issue. BP Brewer heads the task force and mediates between the parties.In Feb 2020, Brewer and Powers sent a letter requesting that Northwell reconsider their early proposal and modify it to be accommodated within current zoning. (Krisel, 2019e)0
Metro New York Health Care for All and Commission on the Public’s Health SystemCommunity-based advocacy-groups that support healthcare equity for all New Yorkers. Oppose proposition based on equity concerns. Posits (accurately) that the Upper East Side is well serviced by current hospitals. In response to COVID-19 has advocated for more beds in Lower Manhattan and the outer boroughs.Publicly advocated that Northwell Health focus resources to the outer boroughs, which have been harder hit by COVID-19, instead of expanding in the healthcare saturated Upper East Side. (Garber, 2020c)Publicly added to rhetoric that Northwell is motivated by profit over equity. -3
New York Landmarks Conservancy, Upper East Side Historic Districts, Carnegie Hill Neighbors and CIVITASVarious community organizations that historically oppose large new development projects. Support expansion of the hospital, but request that they downsize or move portions of the expansion elsewhere in the city. (Garber, 2020c)In November 2020, publicly pointed out that the revised proposal would still require rezoning.+1

Conflict Resolution

Elected officials, including Community Board 8, Councilmember Powers, and BP Brewer have all taken active roles in responding to the concerns of a neighborhood of wealthy constituents (Pushback on Lenox Hill’s Revised Expansion Plans, n.d.). The most vocal opposition has been seen from civic groups, most notably the Committee to Protect Our Lenox Hill Neighborhood (Garber, 2020c). These officials and this group have all been a part of the task force created by BP Brewer, which also includes representation from Northwell Health. This task force met every few months since its establishment in late 2019 through at least the end of 2020  and is directly responsible for the revision of the plan to exclude the residential building (Noonan, 2020). 

Despite this cooperation, several issues remain unresolved. The adjusted proposal still fails to meet the requests from Powers and Brewer to adhere to use-by-right zoning, and civic organizations still question the size of the expansion (Pushback on Lenox Hill’s Revised Expansion Plans, n.d.). Northwell has indicated it intends to move the plan forward with the Uniform Land Use Review Procedure (ULURP) (Renewing Lenox FAQ, n.d.), at which time the community board and borough president will submit their non-binding recommendations to the City Planning Commission, who will then vote on the proposal and pass it off to the Mayor and City Council. 

Policy Proposal

There are significant equity concerns that come with the approval of any hospital expansion in Manhattan. At the outset of the COVID-19 pandemic There were 6.4 hospital beds per 1000 people in Manhattan, compared with 1.5 beds in Queens, 2.2 in Brooklyn, 2.5 on Staten Island and 2.7 in the Bronx ($1B Project to Rebuild Lenox Hill Hospital on Upper East Side Would Ruin ‘Character of the Community,’ Opponents Say – New York Daily News, n.d.). Northwell maintains a presence in Queens, Staten Island, and Brooklyn, and should strongly consider diverting the $2.5 billion dollars towards revitalization or expansion of their outer borough hospitals. 

The New York State Department of Health has yet to issue a Certificate of Need for the expansion, and community advocates should continue to apply pressure on the DOH to consider the following:

  • The proposed expansion of Northwell’s Lenox Hill site adds no additional beds in its current form, thereby doing little to change what needs the current hospital addresses. 
  • The proposed expansion is driven primarily by the desire to offer luxury amenities to patients in order to compete in a saturated healthcare market. 
  • Construction of a luxury housing tower incorporated into the hospital will increase the foot traffic in the area, and potentially lead to increased COVID-19 exposure to both building residents and healthcare workers.
  • To compete for market share, other local hospitals, such as New York Presbyterian/Weill Cornell Medical Center, may be incentivized to expand in Manhattan further contributing to healthcare access inequity in New York City. 

Michael Kitchin is an MD/MPA student applying into psychiatry residency programs. His main policy interests are health insurance reimbursement reform, early childhood development, and mental health literacy. His clinical interests include child & adolescent psychiatry, addiction, and the intersection between the two. 


Endnote References

$1B project to rebuild Lenox Hill Hospital on Upper East Side would ruin ‘character of the community,’ opponents say – New York Daily News. (n.d.). Retrieved May 11, 2022, from https://www.nydailynews.com/news/politics/new-york-elections-government/ny-lenox-hill-hospital-project-upper-east-side-20210125-sdkxpmkmsngybis4a5cjiipymm-story.html

Garber, N. (2020a, October 12). Lenox Hill Hospital Expansion Battle Resumes After Pandemic Pause | Upper East Side, NY Patch. https://patch.com/new-york/upper-east-side-nyc/lenox-hill-hospital-battle-resumes-after-pandemic-pause

Garber, N. (2020b, October 15). Controversial Tower Nixed In New Lenox Hill Expansion Plan | Upper East Side, NY Patch. Patch. https://patch.com/new-york/upper-east-side-nyc/controversial-tower-nixed-new-lenox-hill-expansion-plan

Garber, N. (2020c, November 12). Lenox Hill Expansion Opponents Unmoved By Hospital’s Concessions | Upper East Side, NY Patch. https://patch.com/new-york/upper-east-side-nyc/lenox-hill-expansion-opponents-unmoved-hospitals-concessions

Krisel, B. (2019a, April 3). Lenox Hill Plans UES Apartment Complex To Fund Expansion: Report | Upper East Side, NY Patch. https://patch.com/new-york/upper-east-side-nyc/lenox-hill-plans-ues-apartment-complex-fund-expansion-report

Krisel, B. (2019b, October 2). Neighbors Fear Lenox Hill Hospital Expansion | Upper East Side, NY Patch. https://patch.com/new-york/upper-east-side-nyc/neighbor-group-fears-lenox-hill-hospital-expansion

Krisel, B. (2019c, October 24). Community Board Opposes “Unbelievable” Lenox Hill Hospital Plan | Upper East Side, NY Patch. https://patch.com/new-york/upper-east-side-nyc/community-board-opposes-unbelievable-lenox-hill-hospital-plan

Krisel, B. (2019d, November 21). Thousands Sign Petition Against Lenox Hill Hospital Expansion | Upper East Side, NY Patch. https://patch.com/new-york/upper-east-side-nyc/thousands-sign-petition-against-lenox-hill-hospital-expansion

Krisel, B. (2019e, December 20). BP Hopes Lenox Hill, Neighbors Reach Consensus On Expansion | Upper East Side, NY Patch. https://patch.com/new-york/upper-east-side-nyc/bp-hopes-lenox-hill-neighbors-reach-consensus-expansion

Londono, V. (2019, June 10). Renderings for Lenox Hill Hospital’s Show Two Towers on the Upper East Side – New York YIMBY. https://newyorkyimby.com/2019/06/renderings-revealed-for-lenox-hill-hospitals-two-new-towers-on-the-upper-east-side.html

Noonan, D. (2020, February 17). New Lenox Hill Task Force Gets Results. http://www.westsidespirit.com/news/new-lenox-hill-task-force-gets-results-BY908715

Petition · New York Elected Officials: OPPOSE NORTHWELL HEALTH’S DEVELOPMENT SCHEME TO EXPAND LENOX HILL HOSPITAL · Change.org. (n.d.). Retrieved December 2, 2020, from https://www.change.org/p/new-york-elected-officials-oppose-northwell-health-s-development-scheme-to-expand-lenox-hill-hospital?recruiter=1018075462&utm_source=share_petition&utm_medium=copylink&utm_campaign=share_petition&utm_term=share_petition&use_react=false

Pushback on Lenox Hill’s Revised Expansion Plans. (n.d.). Retrieved December 2, 2020, from http://www.ourtownny.com/news/pushback-on-lenox-hill-s-revised-expansion-plans-GY1405392

Raskin, S., & Hicks, N. (2020, February 10). Lenox Hill may ditch apartment tower meant to pay for hospital overhaul. https://nypost.com/2020/02/10/lenox-hill-may-ditch-apartment-tower-meant-to-pay-for-hospital-overhaul/

Renewing Lenox FAQ. (n.d.). Retrieved May 11, 2022, from https://www.renewinglenox.org/faq

SAVE LENOX HILL – Committee to Protect Our Lenox Hill Neighborhood, Inc. (n.d.). Retrieved December 2, 2020, from http://www.savelenoxhill.org/

Soussloff, A. (2019, October 21). State Health Department Must Reject Unneeded, Burdensome Luxury Hospital Expansion. https://www.gothamgazette.com/opinion/8863-health-department-must-reject-luxury-lenox-hill-hospital-expansion

Spivack, C. (2019, October 24). Lenox Hill Hospital expansion blasted by Upper East Siders – Curbed NY. https://ny.curbed.com/2019/10/24/20930089/lenox-hill-hospital-expansion-blasted-upper-east-sideULURP Explained : City LimitsCity Limits. (n.d.). Retrieved December 2, 2020, from https://citylimits.org/zonein/ulurp-explained/

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