When the board of St. Vincent’s Hospital voted to close down the 160-year-old institution Tuesday night, the question on most New Yorkers’ minds was where they would find emergency care on the West Side of Manhattan, where soon the nearest hospital will be north of 59th Street. But for many of St. Vincent’s Greenwich Village neighbors, particularly those who opposed its proposed expansion and the preservationists who backed them, the prognosis for St. Vincent’s development remains terminal. While it appears a modernist icon may now be preserved, so too are plans for a large condo project in the low-rise neighborhood.

For more than two years, beginning in the spring of 2007, St. Vincent’s worked with developer Rudin Management to get a new hospital through the Landmarks Preservation Commission. The hospital sought to demolish Albert C. Ledner’s former National Maritime Headquarters, a distinctive modernist landmark owned and operated by St. Vincent’s as the O’Toole Building for many years. Once a new 329-foot hospital by Pei Cobb Freed was completed on the site, the Rudins would demolish a portion of the old hospital campus on the east side of 7th Avenue and replace it with an FXFowle-designed condo complex comprised of new and rehabilitated buildings housing some 500 units.

The commission initially rebuffed the plan in May 2008, determining that Ledner’s building was too important to demolish. This forced St. Vincent’s to file a hardship application, charging that the commission’s decision was impeding its non-profit mission to provide healthcare to the community, an argument the commission narrowly approved in October, followed by the thumbs up for the new hospital, slightly smaller (278-foot-tall) hospital in March 2009 and a revised set of condos that July.

Now that St. Vincent’s is bankrupt, it is unlikely anyone would be able to demolish the O’Toole Building. Even though St. Vincent officials have expressed interest in selling their property to appease creditors, the hardship application only applies to the institution that received it. “The approval for the demolition of O’Toole is not transferable,” commission spokesperson Lisi de Bourbon said. However, because the Rudin proposal was approved separately and on its own merits, that project could still proceed, even under a different developer, once St. Vincent’s sells its land. “There would be no need for review by the commission unless the developer chose to change the plans,” de Bourbon said.

The status of that piece of the project is still unclear. John Gilbert, chief operating officer for Rudin Management, would only say that an elementary school the developer had promised to construct as part of its deal with St. Vincent was still going forward. But in an interview with real estate site Globe St., William Rudin, president of the century-old real estate company, said he still intends to finish the project, including a new medical center of some kind.

“The Rudins are committed to working with all of the stakeholders to come up with a viable alternative plan to create an appropriate healthcare facility and to continue with the development on the east campus,” Rudin said.

This is a situation some of the project’s opponents had feared from the start, including the sole dissenting vote against the Rudin plan, Commissioner Margery Perlmutter. At the time of the project’s approval, she argued that the developer was only being allowed to create an outsized tower because of the special consideration being given to St. Vincent’s needs, which should have been an unrelated issue.

Andrew Berman, executive director of the Greenwich Village Society for Historic Preservation, agreed. “It should have been based 100 percent on whether it was appropriate and nothing to do with the hardship of St. Vincent’s,” Berman said in an interview.

Furthermore, he believes the entire bankruptcy could have been averted had the hospital had a different set of priorities. “This plan was never financially viable,” Berman said. “It was a tragic mistake for St. Vincent’s to pursue when what it should have been doing was finding a partner to make them stable. So instead of a new hospital, we get no hospital.”