At Bellevue, a Desperate Fight to Ensure the Patients’ Safety
Published: November 1, 2012
From the moment the water lapped above street level in Lower Manhattan, the doctors and nurses of Bellevue Hospital Center began a desperate struggle to keep patients safe. By 9 p.m. Monday, the hospital was on backup power, and an hour later, the basement was flooded.
Outside Bellevue Hospital Center, a line of ambulances lined up to evacuate patients on Wednesday after fuel pumps for the hospital’s backup generators failed.
Officials rushed to move the most critically ill patients closer to an emergency generator. After midnight, doctors heard shouts in the hallway. The basement fuel pumps had stopped working, and medical residents, nurses and administrators formed a bucket brigade to ferry fuel up 13 flights to the main backup generators.
By Tuesday, the elevator shafts at Bellevue, the country’s oldest public hospital, had flooded, so all 32 elevators stopped working. There was limited compressed air to run ventilators, so oxygen tanks were placed next to the beds of patients who needed them. Water faucets went dry, food ran low, and buckets of water had to be carried up to flush toilets.
Some doctors began urging evacuations, and on Tuesday, at least two dozen ambulances lined up around the block to pick up many of the 725 patients housed there. People carried babies down flights of stairs. The National Guard was called in to help. On Thursday afternoon, the last two patients were waiting to be taken out.
The evacuation went quickly only because Bellevue had planned for such a possibility before Hurricane Irene hit last year, several doctors said. But the city, which had evacuated two nearby hospitals before that storm, decided not to clear out Bellevue. In the wake of Hurricane Sandy, the consequences of bad calls, bad luck and equipment failures cascaded through the region’s health care system, as sleep-deprived health care workers and patients were confronted by a new kind of disarray.
A patient recovering from a triple bypass operation at Bellevue walked down 10 flights of stairs to a waiting ambulance, one of the dozens provided through the Federal Emergency Management Agency to speed patients across the metropolitan region.
Mount Sinai Medical Center, already dealing with the 2 a.m. arrival of a dozen psychiatric patients who spoke only Chinese, was struggling to identify the relatives of brain-injured traffic victims from Bellevue who arrived three hours later with only rudimentary medical records.
Maimonides Medical Center in Brooklyn was straining to meet a rising need for emergency dialysis for hundreds of people shut out of storm-crippled private dialysis centers. Patients who would normally get three hours of dialysis were getting only two, to ensure the maximum number of people received at least a minimal amount of care.
“The catastrophe is growing by the minute,” said Eileen Tynion, a Maimonides spokeswoman. “Here we thought we’d reached a quiet point after the storm.”
Every hospital maintains an elaborate disaster plan, but after Hurricane Sandy, the fact that many health care facilities are in low-lying areas proved to be something of an Achilles’ heel. Bellevue became the third hospital in the city to evacuate after the storm’s landfall, after NYU Langone Medical Center, just north of Bellevue, and Coney Island Hospital, another public hospital.
New York Downtown Hospital, the only hospital south of 14th Street in Manhattan, and the Veterans Affairs Hospital, just below Bellevue, had evacuated before the storm.
Hospital executives were reluctant to criticize their colleagues or city officials. But the sequence of events left them with many questions.
“All hospitals are required to do disaster planning and disaster drills,” Pamela Brier, the chief executive of Maimonides, noted. “All hospitals are required as a condition of being accredited, to have generators, backup generators.”
City health department and emergency officials have been particularly fervent about citywide disaster drills, she added, but “as prepared as we think we are we’ve never had a mock disaster drill where we carried patients downstairs. I’m shocked that we didn’t do that. Now we’re going to.”
The city’s health commissioner, Dr. Thomas Farley, defended the decision not to require evacuations of Bellevue, Coney Island and NYU Langone hospitals before the storm, which he said had been made in consultation with the state health commissioner, Dr. Nirav Shah.
Dr. Farley said they based the decision on their experience with Hurricane Irene, when they ordered the evacuation of hundreds of patients from six hospitals, including NYU Langone, and a psychiatric center, as well as of thousands of residents of nursing and adult homes.
“We saw there was definitely risks to patients from evacuations,” Dr. Farley said.
He added that, “As the storm got worse on Sunday, we did recognize that there would be some risk to health care facilities, so we took some steps to make sure that they were aware of that.”
But he said he considered the decision to wait a success overall: “There was no loss of life as a result of those evacuations.”
He said the city was still assessing what to do differently next time. “We certainly are seeing many more severe weather events in this city than we’ve seen in the past, that does mean we have to rethink the vulnerability of our health care facilities,” Dr. Farley said.
A major concern for hospitals is that traditionally, generators, fuel tanks and fuel pumps have been located in their basements. Both NYU Langone and Bellevue had actually shored up their defenses after Hurricane Irene, according to executives of both hospitals. Among other changes, both built flood-resistant housings for their fuel pumps.
But some circuitry, as well as tanks and pumps, remain on low floors, making backup systems vulnerable. The equipment is enormously heavy, so putting them on higher floors would require a great deal of reconstruction and possibly changes in building codes, said Dr. Steven J. Corwin, the chief executive officer of NewYork-Presbyterian Hospital, which has been taking on extra patients and bringing in extra staff.
Another serious issue is how long a hospital should expect to rely on a generator if the power fails.
“Heretofore, it was felt that generator power would be for a self-limited time, not more than a day — two, three at the outside,” Dr. Corwin said. “Now we’re looking at events where it could be a week.”
Alan Aviles, president of the Health and Hospitals Corporation, which runs the city’s public hospitals, said that all signs pointed against a storm emergency. “Up until an hour before the storm made landfall, the National Hurricane Center was saying that there was only a 5 percent probability of a storm surge over 11 feet in the area that would impact Coney Island, and they weren’t even showing a 5 percent probability on the East River,” Mr. Aviles said.
When the main power went off about 9 p.m. Monday, doctors and nurses were initially told not to worry, because the backup generators were working fine, people there at the time said. But by about 10 p.m., the basement was completely flooded, the pumps were flooded, and doctors were warned that they could lose backup power very shortly.
Critical-care doctors and nurses immediately began moving their patients to the area served by a lower-floor generator. Everyone moved quickly to disconnect patients from respiratory machines and then reconnect them.
A Bellevue doctor said midlevel administrators began begging their bosses to evacuate the hospital Monday night, when water could be heard pouring through the elevators, “like Niagara running through the hospital.”
“The phones didn’t work,” he said, speaking on the condition of anonymity for fear of being fired. “We lost all communication between floors. We were in the dark all night. No water to wash hands — I mean, we’re doctors!”
When the evacuation began, patients were bundled into red and orange sleds and dragged down as many as 13 or 15 flights of stairs. “If they were ventilated, someone was dragging them with a bag” of hand-pumped oxygen, one doctor said. “It was a herculean effort.”
Despite the power problems, Bellevue was able to print out some medical records or get summaries from doctors to send with patients. But landlines and cellphones were affected, and doctors and nurses said they wished some other form of communication, like walkie-talkies, had been available.
It was not until Wednesday, Mr. Aviles said, that everyone realized the situation was beyond repair and the final decision to evacuate everyone was made. “It was at that point that it was clear that it was just not tenable to keep patients for a longer term in the hospital,” he said. “We know that all these patients were successfully transferred to safety and are doing well, and I think that’s what’s important.”