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NYC, Doctors Without Borders struggle to serve patients amid hospital closures

Officials say it could be weeks before closed hospitals reopen

Topics: Access to Care, Quality, Performance Improvement, Service, Patient Experience, Trauma, Service Lines

November 09, 2012

New York City health providers are scrambling to meet patient needs amid the continued closure of several large hospitals, prompting Doctors Without Borders to open its first-ever U.S. clinic.

Hospitals struggle to keep up with patient needs

"This is not a tenable situation," says Lewis Goldfrank, who oversees emergency medicine at NYU Langone Medical Center and Bellevue Hospital Center. Both hospitals remain closed 10 days after they lost emergency power during and after Superstorm Sandy, which caused major power outages and flooding throughout downtown Manhattan.  

Manhattan Veterans Affairs Medical Center and Coney Island Hospital in Brooklyn also have not reopened. "There [are] just too many people," Goldfrank says, adding, "You can't dump this level of patients out on the open market."

Expressing similar concerns, UPMC biosecurity expert Amesh Adalja notes that the hospital closings have left "a whole blank spot in the lower part of Manhattan."

Bellevue—the city's flagship public hosptial—was the only Level One trauma center in the downtown area. Its ED treats more than 100,000 patients per year, often serving victims of stabbings, gunshots, terrorist attacks, and patients in police custody. Now, downtown patients with Level One trauma needs must travel to New York Presbyterian/Weill Cornell Medical Center on the Upper East Side or St. Luke's/Roosevelt Hospital on the Upper West Side.

"All systems can work at above capacity for some time without significant detriment," says Ronald Simon, Bellevue's director of trauma. But "with time, people will tire, over-worked systems will fail, and patients will suffer," Simon warns, adding that "the current status of care in Manhattan is not sustainable for any length of time."

At Beth Israel Medical Center, ambulance traffic has increased by 70% since Sandy, according to Gregg Husk, the hospital's chairman of emergency medicine. "For us, this is Guinness Book of Records territory," Husk says.

Beth Israel currently receives about 135 patients per day by ambulance, up from an average of 84 patients per day before the storm. Bellevue's staff has been working at Beth Israel, as well as other New York hospitals, to help deal with increased volumes.

Although hospitals are struggling to keep up, city officials say that patient needs are being met. "Response times for life-threatening emergencies in Manhattan are meeting FDNY Bureau of EMS goals," says New York State Department of Health's Bill Schwarz. "Turnaround times at EDs at Manhattan hospitals have remained steady, with no noticeable increases as a result of the storm impact."

New York City Health and Hospitals Corporation (HHC) spokesperson Ian Michaels says the agency does not know when hospitals will reopen. "The assessment is ongoing... we'll know more soon," Michaels says. Reopening is imperative because currently there are only nine public acute-care hospitals in New York City, and all are "operating very near capacity. There are very few beds available within the HHC system right now," Michaels says.

Doctors Without Borders opens first U.S. clinic

To help meet patient needs in the area, Doctors Without Borders has opened medical clinics in the Rockaways, a remote part of Queens that faces the Atlantic Ocean. It is the organization's first clinic inside the United States.

"A lot of us have said it feels a lot like being in the field in a foreign country," says Manhattan physician Lucy Doyle, who has worked with the organization in the Democratic Republic of Congo and Kenya. "I don't think any of us expected to see this level of lacking access to health care," she adds.

In the Rockaways, "pharmacies are closed," says Beth Israel Medical Group physician Danya Reich, adding, "Their doctors' offices are closed. They need a way to get refills of the medicines they take all the time" (Ornstein/LaFleur, ProPublica, 11/8; Honan, Reuters, 11/8).

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