On Sunday, October 28, while the second worst storm in modern history was barreling toward the most populated region on the continent, I was contacting family and friends in other states who were anxiously watching the Weather Channel to assure them that I didn’t live in Zone A. I was in Zone B. So, they shouldn’t worry. Back in my Westbeth apartment after a two week evacuation, the irony is only now beginning to dawn on me. I have spent the past few days searching the internet for information that will help me get a grip on reality only to discover that I am hardly alone in my confusion over this worst-case scenario over which we’re still reeling. Nowhere is that more clear than reading about what transpired at the five remaining general hospitals in Lower Manhattan. Especially disturbing are the conflicting accounts of events on “hospital row,” the cluster of medical centers along First Avenue – Manhattan VA, NYU, and Belleview – all of them on the East River in Zone A.
With the acknowledgement that these hospitals are still in crisis mode and many questions remain unanswered, here is what I have been able to glean from a variety of websites and publications, mostly outside the city, among them Pro Publica: Journalism in the Public Interest, the Huffington Post, and the New England Journal of Medicine.
New York Downtown Hospital
This teaching hospital for New York Presbyterian and Weill Cornell is at 170 William Street, not far from Battery Park City, and since the closing of St. Vincent’s, it is the only hospital south of 14th Street. Although it is in Zone C, 20 ft. above sea level, hospital officials pre-evacuated 125 patients. According to their website, the decision was made because of concern not of flooding but loss of electricity. Their back-up generators ran for 42 hours, but “the possibility of not getting more fuel was a risk the hospital couldn’t take.”
The VA was the only hospital on First Avenue that evacuated before the hurricane struck, and it did so because of their Irene experience, when they pre-evacuated out of fear that the predicted eight ft. storm surge would knock out their back-up generators. According to their website, the decision to pre-evacuate before Sandy was “one of geography. The hospital is in a flood zone close to the East River. When an 11 ft. storm surge was predicted early Sunday we began evacuating patients to the Brooklyn VA.”
NYU Medical Center
It is when decisions were made not to pre-evacuate these East River hospitals that the story gets murky, with many discrepancies in the official accounts. The City had not included these hospitals in its pre-Sandy evacuation order, opting instead for what is called “shelter in place.” The officials also factored in their Irene experience, when hundreds of patients had been evacuated from six hospitals, a process that proved to be unnecessary and always involves risks to their well-being. In addition, low-lying hospitals were told to test their back-up power to make sure they met new requirements. NYU had installed two above-ground generators, one on the roof, which according to hospital administrators had been “tested several times.”
Nevertheless, at 9:30 Monday night, the New York Emergency Command Center at Long Island North Shore Hospital got a call from NYU. “They want to evacuate,” a worker reported. “I don’t know how to help them right now. They’re in a panic mode.” NYU asked North Shore to send ambulances from Lenox Hill Hospital, which they did. That night, however, EMTs spent hours in ambulances that extended around the block, waiting for an evacuation order that never came. One hospital official told a reporter, “I don’t know what they’re there for.” The confusion has yet to be explained. Meanwhile, both fuel pumps on the hospitals’ back-up generators failed and the concept of shelter-in-place turned into a nightmare. One woman who had just given birth walked down 13 flights of wet stairs in the dark, lit by her husband’s iPad, a nurse cradling the newborn, another holding an oxygen tank. According to the Huffington Post, Mayor Bloomberg, “clearly angry,” blamed the hospital for assuring the city their back-up power worked, but hospital officials insist they were “fully compliant with the new regulations.”
Perhaps the most inexplicable comment about the situation at NYU Langone came from Kenneth Langone, the founder of Home Depot, who happened to be a patient at the hospital center that bore his name, “Do you think they would have kept me there if they thought I was going to be unsafe?” He was among the 200 patients evacuated to mostly uptown hospitals.
On Monday night, at the country’s oldest public hospital on First Avenue and 25th Street, doctors heard water pouring through the elevators “like Niagara Falls” and began pleading with the administration to start evacuating. The hospital had also installed a back-up generator on a high floor. When its fuel pump failed, the staff formed a bucket brigade up 13 flights of stairs to keep the generator running while others coped with an evacuation of 725 patients, assisted by the National Guard, that lasted three days.
According to the New York Times, “The fact that many health care facilities are in low-lying areas proved to be something of an Achilles heel.” That’s putting it mildly.
Beth Israel on 16th Street is in Zone C, as it is farther from the East River than the other hospitals on First Avenue and is now the only major medical facility that is open in Lower Manhattan. Having already absorbed the overflow of patients from St. Vincent’s after its closing, their current situation post-Sandy is described in an alarming article in the New England Journal of Medicine, “The ER is double normal volume, 100 ambulances each day, through gridlocked streets, coming in with lack of medical records, dialysis patients arriving every three minutes to the only provider in all of Lower Manhattan. For us, this is Guinness Book of Records territory. The closing of Bellevue and NYU leaves a whole blank spot in Lower Manhattan.”
“An Untenable Situation”
Last year, 100,000 patients were treated in the emergency room at Bellevue Hospital. It will have limited ER service by mid-December, but due to the wreckage of its infrastructure, it will not be fully operating until mid-February. Until then, the nearest Level 1 Trauma Center is on 58th Street. This all sounds to me like a catastrophe waiting to happen, but don’t take my word for it. Read the comments of medical personnel as they describe the cascading effects of these hospital closings that will continue for months.
New York Presbyterian: “The hospital can barely keep pace with the number of people coming into the ER.” Mount Sinai: “This is a moment-by-moment planning phase. I would have thought FEMA or the NYC Office of Emergency Management would go straight in…grid out the patients…look at potential services. If that’s happening it isn’t visible.” Bellevue: “This is not a tenable situation. You can’t dump this level of patients on the open market.” Health Department official: “No question in my mind that the current status of care in Manhattan is not sustainable for any length of time. Overworked systems will fail and patients will suffer.” City Health Commissioner: “We have to rethink the vulnerability of our health care facilities.”
Suddenly the loss of St. Vincent’s Hospital takes on a new and even more ominous urgency. Every time I walk past West 12th Street I think of all the doctors and nurses standing outside the hospital on 9/11, waiting for the ambulances that never came, and I wonder, where are they now? Have they been hired to relieve the work load at these other hospitals? I hope so. Then I look up at the demolishment of the hospital that played such an essential role in the disaster response capabilities for Lower Manhattan to the emergence of yet another luxury high-rise, and the sight makes my blood boil. Yes, Mr. Commissioner, it is most definitely time, long overdue but better late than never, and now more than ever, to “rethink the vulnerability of our health care facilities.”