NYU Langone Medical Center and Bellevue represent a tale of two New York City hospitals. Langone is a well-endowed brand-name facility eager to trumpet its state-of-the-art treatments. Bellevue is the country’s oldest public hospital, with a reputation for treating the city’s poor. Last week, though, they were united in disaster. Both offered a single tale of hundreds of patients—fragile newborns in nurses’ arms, the critically ill and the elderly—all transported down the stairs like injured skiers on the slopes of Aspen.
Places of healing were unable to cope with the lashing from Sandy—generators and back-up plans failed as the lights flickered away. The spectacle of patients hauled into waiting ambulances was a blot on the patient safety record of the nation’s hospitals. Why did it happen? NPR reporter Dina Temple-Raston deserves a CJR Laurel for asking a few basic questions, which provided some frightening answers.
It seems that there are disaster standards for hospitals. The Federal Emergency Management Agency (FEMA) has a timeline that calls for hospitals to manage on their own in a disaster for four days—three days for FEMA to arrive and another day to set up operations for assistance. But the New York hospitals weren’t able to hang on that long. At Langone, a back-up generator failed; at Bellevue, floodwaters swamped crucial hospital operations long before day four. By FEMA standards, those hospitals failed the test.
And another test, too: Temple-Raston reported that they failed to meet an accreditation standard from the Joint Commission, a Chicago-based outfit that accredits some 19,000 of the nation’s health care organizations and programs. The Joint Commission inspects hospitals and evaluates such things as patient safety,staffing, and care for certain illnesses and procedures. “All accredited hospitals must be able to manage themselves for 96 hours,” NPR reported. Neither did, and had to evacuate their patients to other hospitals.
Both Langone and Bellevue have received full accreditation from The Joint Commission. And Langone boasts a string of awards and accolades on its website—among them is a 2010 Gold Seal of approval from The Joint Commission reflecting a commitment to high quality care.
But Temple-Raskin presented a different picture when it comes to hospital safety. She spoke to Dr. Arthur Kellermann, who once oversaw the ER department at Atlanta’s Emory University Hospital and is now at RAND Corp. where he studies healthcare preparedness. What he told listeners is sobering:
Most hospitals have not taken seriously enough the need to avoid being a disaster themselves. On any given day [hospitals] are more worried about their immediate operations, their immediate bottom line, and when hospital boards get together and talk about capital spending, a generator is typically not the first thing on their purchasing list.
Indeed, Temple-Raston reported, Langone that trustees knew back-up generators were old and vulnerable to flooding. In a candid interview with Bloomberg Television, Gary Cohn, a hospital trustee and president of Goldman Sachs Group, Inc., conceded that the facility’s back-up generators “are not state-of-the-art, and not in the most state-of-the-art location.” Some admission, huh? But then generators aren’t cool, like robots for prostate surgery, and no hospital would be caught dead advertising disaster preparedness on TV.
All this calls into question not only hospitals’ readiness for the unthinkable, but also the usefulness of the accolades and ratings they’re so eager to tout, as well as our own willingness as journalists to report on the latest and greatest technology while ignoring the basics. Perhaps we have been focusing on the wrong story.
What we need to do for this part of our jobs is to see the inspection reports from The Joint Commission and from the states. The Joint Commission takes a hard line against releasing such reports. It’s afraid that if the public knows about a hospital’s deficiencies, it will make it more difficult for its inspectors to obtain compliance. Hospitals, like most businesses, are loathe to air their dirty linen in the press. As for the states, they are all over the map when it comes to releasing their own inspection data. In New York, for example, some data is available, but for more details, a reporter must file a Freedom of Information Law request.