The only thing gloomier than the weather today was the members of the Landmarks Preservation Commission, sitting out this morning’s thunderstorm as they decided the fate of Albert C. Ledner’s iconic O’Toole Building, which St. Vincent’s Hospital hopes to demolish and replace with a new 300-foot-tall hospital.

“This is the most distressing challenge to the landmarks law that I have witnessed since the Grand Central case in the 1970s,” commissioner Roberta Brandeis-Gratz said. Fred Bland, the commission’s newest member, said he awoke at 3:30 this morning, unable to sleep, and stood out in the rain at dawn for one last look at O’Toole. He had hoped it would help his “highly frustrating” decision between preserving a one-of-a-kind building and expanding the increasingly limited medical facilities downtown.

"In a perfect world, no individual landmark or contributing building would ever be demolished,” Bland declared. “But we live in New York, a place very much grounded in reality.” And with that, he cast his vote, the final deciding vote, in favor of the hospital. By a tally of 6-4, St. Vincent’s was victorious.

“We’re pleased with process and we’re pleased with the landmark commission’s decision,” Henry Amoroso, the hospital’s president and CEO, told AN afterwards. “But we are also sorry it had to come to this. It’s certainly not an occassion to celebrate.”And the trial is not over. St. Vincent’s still has to get approval from the commission for its new hospital designs before they can build on the O’Toole site.

Back in May, the commission turned down a similar proposal from the hospital and its development partner, the Rudin family, which is paying $310 million for the right to build condos on a group of buildings across 7th Avenue that St. Vincent’s will vacate when it moves into the new hospital. At the time, the commission said the plans did not meet the standard of historical appropriateness to warrant demolition.

On second try, the hospital submitted a hardship application, arguing it could not continue its charitable mission of providing equitable healthcare in its current facilities. It was on these grounds, and not those of preservation, that today’s decision was to be made, following a number of hearings in recent months on the matter.

Each of the ten commissioners gave a halting, deliberative explanation before casting their vote, all expressing the difficulty and trepidation it brought them. Some questioned whether sufficient alternative sites had been vetted, whether a mid-block or off-site proposal belatedly offered by the hospital might not be more sufficient than administrators said. Others recalled the tragedy of 9/11 and how it reinforced for them the importance of ample and accessible medical facilities in the city. Many worried about what sort of precedent their decision could set.

No one was happy making this decision, but perhaps commissioner Joan Gerner best encapsulated this damning ambivalence. “I think this is a matter of life and death,” she said. “Which is why I’m voting to demolish the O’Toole Building with great regret.”