St. Vincent’s plight has been portrayed by public officials and the media as a story of local misfortune—a community losing a vital piece of its infrastructure and a centerpiece of its identity to a combination of mismanagement, the recession, and bad luck. The truth, though, is considerably more alarming. St. Vincent’s collapse is only the most visible symptom of an ongoing financial emergency facing the city’s five dozen remaining hospitals and threatening those they serve. In a sense, St. Vincent’s is the Lehman Brothers of the local hospital industry: an institution whose dramatic disappearance, once unthinkable, raises dire questions about the viability of the entire system.