The health care system seems to have withstood the worst of Hurricane Sandy despite some high-profile breakdowns, including the evacuation of several New York City hospitals. But experts warn that mounting budget cuts could hamper the ability of hospitals and government agencies to respond to future disasters.
Local, state and federal government agencies coordinated with each other and health care facilities to ensure the safety net would hold together during the disaster. In the hardest-hit areas of New York and New Jersey, hospitals remain open despite power outages affecting the region.
"The health care system is pretty robust around the country. We've evidenced that here," said Jerome Hauer, commissioner of the New York state Division of Homeland Security and Emergency Services. Hauer especially praised the federal government's response to Sandy, saying the U.S. Department of Health and Human Services moved 2,100 medical personnel to New York and set up six temporary treatment sites with 1,500 beds in Brooklyn and Long Island.
It's true that the health care system experienced some notable failures during the storm. More than a dozen hospitals and other health care facilities in New York state had to be evacuated, including a handful in New York City that relocated patients during the storm, Hauer said.
New York University Langone Medical Center, Bellevue Hospital Center, Coney Island Hospital and several nursing homes all underook risky and dramatic removals of vulnerable patients in the midst of the storm, power outages and flooding.
"You try to keep as many of these facilities open as possible as long as people are not in jeopardy," Hauer said. "These are always tough decisions."
Neither NYU nor New York City Mayor Michael Bloomberg has offered any explanation for why the NYU hospital in particular wasn't evacuated before the storm hit, as it was last year in advance of Hurricane Irene, or why the backup generators failed. But Jack Herrmann, chief of public health preparedness at the National Association of County and City Officials, cautioned against jumping to the conclusion that authorities made the wrong decision.
"We have to be careful about judging quickly," Herrmann said. The successful evacuation of more than 200 patients, including 20 infants from the neonatal intensive care unit, illustrates that the hospital had a contingency plan in place and carried it out, he said.
The U.S. public health infrastructure is more secure than it was at the time of the Sept. 11, 2001, terrorist assault and the following anthrax attacks, Herrmann said, because the federal government, in concert with lower levels of government, has funneled money into disaster readiness programs. "We are way better off," he said. "We invested billions of dollars in strengthening our ability to protect and respond."
The country is now seeing the "return on investment" from those initiatives to beef up hospitals and improve coordination and communication before and during major emergencies, said Herrmann.
"What you're seeing is a result of a system that has been working hard," he said. "This is why it's important to provide adequate resources."
But austerity budgeting at all levels of government threatens the gains made over the past 11 years, warned Georges Benjamin, executive director of the American Public Health Association. The public health system has been "weakened" since the recession, said Benjamin, who previously ran the health departments in Maryland and the District of Columbia. "I remain worried about the infrastructure," he added.
Last year, 40 states and the District of Columbia cut back on public health programs. Federal funding dropped an inflation-adjusted 38 percent from fiscal year 2005 to fiscal year 2012, according to a report issued in December by Trust for America's Health.
"Hospitals have done a terrific job" responding to Hurricane Sandy, Benjamin said. But that success shouldn't fool people, he added, warning that well-managed major emergencies can create a misleading sense that we are ready for anything.
"People presume that we have greater capacity than we have. When we get the big ones, we throw everything at it," Benjamin explained. "We need to make sure we have that same capacity on the shelf at all times."
Cities and states that reduced spending on public health will find themselves stretched thin when confronted with smaller-scale crises that don't prompt the federal government to get involved, according to Benjamin. "They will find themselves unable to respond to a midsize emergency," he said.
Focusing planning efforts on major disasters also takes dollars away from other important efforts, such as tracking outbreaks of infectious diseases like pertussis and West Nile virus, Benjamin said.
Hauer, the New York commissioner, is more worried about much bigger disasters, such as a major earthquake or a terrorist attack using an improvised nuclear device, that would cause more than 100,000 casualties. Health care facilities in most locales can't handle that many sick and injured people, he said.
"We are not doing very well in our ability to surge to thousands of patients," said Hauer, who previously ran New York City's emergency response agency and joined the U.S. Department of Health and Human Services following Sept. 11. New York City's vast health care system is better prepared than that of most other places, where hospitals only have "surge capacity" for patients in the hundreds, he said.
The recent string of disastrous weather events like Hurricanes Katrina, Rita, Irene and Sandy also suggest the health care system will continue to be tested, Benjamin said.
"We learned an awful lot from Katrina and Rita," he said. But he added, "Having said that, we're seeing more of these extreme storms. We're going to have to do this more often."
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