NYC Public Health System Not Fully Prepared

Not terribly surprising:

New York City's health care system is not prepared for a major disaster such as a large-scale attack, hurricane or pandemic, health care and disaster planning experts said.

The city, struck in the September 11 attacks and a world financial center, is vulnerable due to underfunding and a lack of understanding of the possible complexities of a crisis, officials from city hospitals and emergency services said this week at a conference on disaster preparedness.

"We have no idea what a prepared New York is. What we're doing now is random acts of preparedness that all together don't really amount to an appropriate safety net," said Irwin Redlener, director of the National Center for Disaster Preparedness at Columbia University's Mailman School of Public Health.

"We're in a very, very bad place."

There's a problem - long known - with a lack of excess capability. NYC, despite its high-profile status, is not immune to the problem:

Brian O'Neill, who heads emergency services for the North Shore - Long Island Jewish Health System, said the city's emergency services have the potential to move large numbers of people injured in a catastrophe, but not necessarily the hospital capacity to deal with them.

"We don't have 20,000 open beds ... for hospitals to absorb that," O'Neill said. "We would have to rely, at that point in time, for long-term solutions from the federal government."

Columbia's Redlener said hospitals would be immediately overwhelmed in such a situation and the number of deaths would balloon.

Like I said, all of this is not terribly surprising. Given the threat of pandemic flu, there has been a lot of study of our public health system. The basic problem is that we've given up excess capability for the sake of efficiency. (Which makes perfect sense for most businesses but is debatable in the healthcare field, where you need to be able to accommodate surges in demand.)

The Trust for America's Health reported late last year that we don't have enough beds for a flu pandemic. (Also see my post.)

Half of states would run out of hospital beds within two weeks of a moderately severe pandemic flu outbreak.

Last December, the Trust for America's Health, in it's "Ready or Not?" report, found that:

Forty states and D.C. have a shortage of registered nurses.

Six states cut their public health budgets between FY 2004-05 and FY 2005-06. As of FY 2005-06, the median state funding for public health is only $31 per person per year.

And that the public health system is hampered by:

• Lack of clear roles for the various state, local, and federal agencies.
• Limited coordination among the levels of government, including determination of how federal assets would be deployed to states and localities, and across jurisdictions, such as sharing assets and resources among states.
• No minimum standards, guidelines, or recommendations for capacity levels or services required of state and local health departments. This results in major differences in services and competencies across state and local agencies.

Public health officials in NYC are seeing the effects of this lack of clarity:

Bruce Logan, Chief of New York Downtown Hospital's Department of Medicine, said he was unable to get federal funding for an expansion of the hospital's emergency room, despite being four blocks away from Ground Zero where the World Trade Center's twin towers were destroyed on September 11 and the first hospital to respond to the attacks.

"We're in the financial capital of the world ... I see that emergency room as an element of our national defense," Logan said. "Unfortunately, I can't get our government officials -- especially the state and federal ones -- to see it the same way."

Public health is like anything else: You pays your money, you takes your chances. And we are taking our chances, that's for sure.

(Note: Late in 2007, we're supposed to get an updated report on the status of public health preparedness from the CDC.)