Ever since the closing of St. Vincent's Midtown hospital, St. Luke's-Roosevelt Hospital Center has been feeling the crunch associated with more patients.

The volume of traffic at St. Luke's emergency room has increased almost twofold, according to Dr. Dan Weiner, chairman of Emergency Medicine at the hospital. Because of this influx, a recent $15 million allocation devoted to the expansion of the hospital emergency room at the Roosevelt campus was, according to Weiner, both necessary and inevitable.

New York City emergency rooms have long faced criticisms of overcrowding, a frantic atmosphere, and a lack of organization. Forced to operate on tight budgets with limited resources and understaffed facilities, emergency departments across the city have battled for financial lifelines from state and municipal authorities.

And the financial pressures have only been increasing. Governor Eliot Spitzer recently proposed a state budget cut that will chiefly target Medicaid reimbursements to hospitals, further limiting their funds. Yet, any signs of support are out of sight, and while some hospitals like St. Luke's have decided to take matters into their own hands by sponsoring development programs of existing and new emergency rooms to combat common problems, the prospects for others remain dim.

"The effect of that is that you constrain the budget of a hospital like St. Luke's, a nonprofit hospital with a certain number of self-pay and Medicaid patients, that really works on the financial edge," Wiener said. "A fluctuation in a few million dollars can really have a significant effect."

Since 2006, five hospitals in the city have been closed by the state, forcing the remaining hospitals to accept the spillover of patients.

"If the state had not closed some of the hospitals in Manhattan, we would not be currently feeling the effect of this crash," said Dr. John Cahill, an attending physician at St. Luke's emergency room.

The irregularities have led to an influx of patients in emergency rooms. "In any given week the question is whether we'll be overcrowded one to two days, or every day. Lately, it's been every day," said Dr. David Newman, director of clinical research at St. Luke's-Roosevelt Hospital Center.

Medical experts agree that overcrowding delays patient care and significantly increases the turnaround time for patient stay.

"The greater volume of patients delays lab tests and X-ray results, so it becomes very hard to move around and uncomfortable for staff and patients just because of everybody's close proximity," Wiener said.

Newman cited the negative effect that overcrowding has on patient care. "The doctor-patient relationship is definitely harmed," he said.

An overarching issue that has troubled to emergency rooms across the city, including St. Luke's, is patient privacy. Rooms that are designed to hold one person are often occupied by two or more.

"We just don't have enough space to hold everybody in a private room, but we're trying to do the best with screens and curtains and things like that," said Mary Sweet, a charge nurse at St. Luke's emergency room.

Rising rates of hospital closings and increased demand for patient care across New York City, along with limited funding, foreshadow a challenging future for city emergency departments.

"Ten percent of emergency departments have disappeared in the last 10 years, primarily because of hospital closings due to financial collapse, while visits have gone up by 18 percent," Newman said. "That's a formula for disaster, and we're living it."

roland.zemla@columbiaspectator.com.