The system fails New York hospitals

ON THE two-week anniversary of Superstorm Sandy, the media has been virtually silent on the severe and growing crisis facing health care facilities in New York City.

The storm took five major hospitals completely out of commission: Bellevue, NYU Langone, the Manhattan VA, New York Downtown Hospital and Coney Island Hospital. Only one, NY Downtown, has reopened. No date has been set for the other facilities to reopen. Most people think it will be months, not weeks, before they open again--some think six months or more.

Let's take stock of that for a moment. The New York City hospital "system" has been without more than 2,000 hospital beds, including hundreds of Intensive Care Unit beds and two major emergency rooms, for two weeks, and there's no promise that this is going to change anytime soon.

Bellevue is the only Level 1 Trauma center below 57th Street in Manhattan. It's the largest public hospital on the East Coast and the primary facility for most of the inpatient psychiatric care in Manhattan. Also, most of New York City's jails and prisons send their patients to Bellevue. The emergency room sees an average of more than 2,400 patients per week.

So in just one hospital, since the storm, close to 5,000 people have had to be transported or otherwise make it to facilities much farther from where they would have otherwise. No one knows how many times those lost moments have had severe consequences. At best, it's a series of future disasters waiting to happen.

Some people may have heard of the heroism of nurses and other health care workers who evacuated NYU Langone in the middle of night during the storm. The next day, it was Bellevue's turn.

Health care teams had to carry hundreds of patients down multiple flights of stairs, some of them with hand-pumped oxygen, some close to death, and some newly born from the Neonatal Intensive Care units. Because of the brilliance of the staff on the ground, nobody died as a direct result of the evacuations.

By the way, Mayor Michael Bloomberg couldn't find the time to stop by and see how things were going during these two unprecedented health care emergencies. But the morning after the Langone evacuation and several hours before the Bellevue evacuation, he did find a few minutes to swing by the New York Stock Exchange to ring the opening bell. At least we can be clearer about priorities in a time of crisis.

Since the storm, every other hospital in the city has been stretched to the limit, taking on the closed hospital's patients. Doctors and nurses have been working longer hours and conditions in several places are cramped, to say the least. Most hospitals in the city have had to open makeshift hospital units and operating rooms to accommodate the extra patients. My hospital in the north Bronx, relatively far from the crisis, had to open up a formerly closed six-bed per room unit to take transfers from Bellevue.

Reports are pouring in from all around the city about a daily staffing crisis and its consequences. Pediatric nurses are working adult floors, non-critical care nurses are being forced to help out in critical-care areas, and other nurses are working in facilities where they are completely unfamiliar with many policies and procedures which massive increases the likelihood for errors and harm to patients.

But the most worrisome element is how vulnerable hospitals are to any influx of new patients. Let's say there's an influenza outbreak, a mass casualty incident or any health care problem requiring hospitalization or even just a trip to the ER for more than several hundred people. What was bent by Sandy and the aftermath will be broken.

Like the relief effort and the hospital evacuation plans themselves, there is no effort to prepare for this possibility. No teams of nurses and other health care workers were flown in. No backup facilities are being prepared.

What if the city had listened to most of the scientific community and actually planned for the prediction that Manhattan could be flooded with a 10 to 15-feet storm surge? Maybe hospitals would have decided against housing fuel pumps for generators in their basement.

Despite what some hospital administrators have claimed, Sandy turned out to be exactly what weather forecasters were predicting, so while the Manhattan VA and NY Downtown were evacuated before the storm hit, Bellevue, Coney Island and NYU Langone waited until after. We can't say for sure why--but certainly the loss of revenue may have been a factor in that decision. Even public hospitals depend on reimbursements from patient visits to stay financially viable.

This wasn't the only consequence of a for-profit health care system. There was no system in place for where patients would go from the evacuated hospitals. Nurse managers and other hospital administrators had to frantically call and coordinate a plan on the spot for where the patients would end up.

Then there's the health care crisis among the continuing victims of Sandy's aftermath. By that, I mean the thousands without power in New York City housing projects and the devastated areas in the Rockaways, Coney Island and Staten Island--people are unable to stay warm, get adequate food and water, or get new supplies of medicine. Hundreds of people who are chronically ill or elderly have been unable to find the care that they need.

Occupy Sandy, along with the New York State Nurses Association, Doctors Without Borders, Physicians for a National Health Program and, later, the RN Response Network were the only significant forces attempting to assess and treat these groups of people. A makeshift clinic in the Rockaways started by activist Nastaran Mohit has been the key coordinating institution for all medical relief efforts in that area.

These are critical initiatives that have helped many people. But the question remains: Why can't the New York City public hospital system, along with FEMA and the Red Cross, set up dozens if not hundreds of mobile health assessment units? There are well over 1,000 nurses from Bellevue and Coney Island who aren't currently working because of the closures. Couldn't some of them have been organized into teams to help to coordinate care in the most affected areas?

So here we sit. On one side, callous and incompetent administrators, FEMA officials and politicians, unable to put together even the most basic medical relief effort. On the other, thousands of people working at the grassroots to get people out of harm's way, evacuate patients, and volunteer in medical relief efforts.

The solutions to meet people's health care needs in this crisis are very simple and clear. What is lacking is the will, political or economic, of the people that run this city and its hospitals. Nothing has brought this more into stark relief than the past two weeks.