NEW YORK - Kim Bondy was in New Orleans seven years ago when Hurricane Katrina devastated the city, and scores of patients died in flooded hospitals cut off from power. She never thought that she might face that danger herself.
But on Monday night, as superstorm Sandy submerged parts of New York City, Bondy was one of 215 patients evacuated from New York University's Langone Medical Centre after basement flooding from the East River cut off its electricity.
"Knowing everything that happened in New Orleans hospitals, I'm thinking, 'I am not going to be that story,'" said Bondy, 46, a New Orleans resident who was hospitalized in New York over the weekend with a blocked intestine. "Did you not pay attention to what we learned from Katrina?"
The equipment failures at NYU and nearby Bellevue Hospital, the nation's oldest and one of its busiest, brought to the fore what emergency experts have warned for years. Despite bitter lessons from the recent past, US hospitals are far from ready to protect patients when disaster strikes their facilities.
"I've been asking hospitals to look at their own survivability" after a natural or manmade disaster, "and I just can't get it on their radar screens," said Dr. Art Kellerman, an expert in emergency preparedness in healthcare at the RAND Corp.
"If you asked me the one city in America that has its act together, I would have said New York. That tells you how much trouble we're in Dayton and Detroit and Sacramento."
For most hospitals, "emergency preparedness" means being ready to treat a surge of patients from an earthquake or terror attack - disasters outside their walls.
Even the federal programme that coordinates hospitals' preparedness at the Department of Health and Human Services has this mindset: it focuses on planning for mass fatalities and quickly reporting their number of available beds, not having redundant electrical systems.
When the next Katrina or Sandy strikes, "we're going to have the same problems," warned a scientist who has led studies on hospital preparedness at a leading research institution. He asked not to be named so as not to antagonize hospital officials and others he works with.
For hospital administrators trying to keep their institutions in the black, disaster-resistant infrastructure is expensive and lacks the sex appeal of robotic surgery suites and proton-beam cancer therapy to attract patients.
"People don't pick hospitals based on which one has the best generator," Kellerman said.
Unwilling to invest
Unwilling to invest
A recent survey by the Joint Commission, a non-profit group that accredits more than 19,000 hospitals and other healthcare facilities, found that only one-third planned to upgrade their infrastructure, said head engineer George Mills.
"Two-thirds said they were going to keep going with what they had and hope it was enough," he said. "Unfortunately, many of our hospital buildings are 50 or 60 years old."
No national assessment has determined whether hospitals can survive a disaster, said a high-ranking HHS official.
Storm-hardened infrastructure is not cheap. Continuum Health, which operates St Luke's Hospital in New York where Bondy was sent, spent about US$10 million (S$14.7 million) over the last decade on generators and other emergency measures.
Mount Sinai Medical Centre, next to Manhattan's Central Park, is replacing four basement generators with four on higher floors for US$12 million.
And many hospitals do not factor in all of the potential threats. As Sandy barrelled toward New York City last weekend, hospitals tested their generators and assured city officials that they had enough fuel to run them for several days, according to all the hospitals interviewed.
NYU's "emergency power system was designed and built according to all safety codes," spokeswoman Allison Clair said. "We were confident we could withstand a (storm) surge of approximately 12 feet," but it was at least a foot higher.
By Monday night, the NYU basement that houses one of its generators and fuel tanks for the seven on higher floors was under eight feet of water. Sensors shut down the fuel pumps, and the generators fell silent.
"There was no electricity and all the IV machines were going haywire," said Bondy. "I heard one nurse yell to someone, don't use that water, it's brown. I couldn't believe how fast things were failing."
By all accounts, it could have been much worse had other preparations not been in place.
The staff used flashlights to carry out the evacuation. Police officers fanned out through the building and on stair landings as staff members carried patients to safety, including critically ill infants.
Waiting ambulances - organised days ahead by the Federal Emergency Management Agency - had come from hundreds of miles away. Bondy's driver was from Ohio, and needed to ask directions to the hospital that was due to receive her.
At St. Luke's, staffers meeting evacuees had her checked in and settled in a room within 10 minutes. "Cupcake, don't worry about it; we've got you," a nurse told her.
Hand carrying fuel
Hand carrying fuel
The response at nearby Bellevue was less coordinated. On Monday night, the power grid failed in its neighbourhood and then its backup power stumbled as basement pumps meant to deliver fuel to the main generators on upper floors were flooded.
Staffers hand-carried fuel for hours, but by Tuesday the situation was desperate. Bellevue began what became a full evacuation of some 725 patients.
Other city hospitals went into overdrive to receive Bellevue and NYU evacuees, and no patient deaths were reported. Around midnight on Monday, Zahava Cohen, nurse manager of the neonatal intensive care unit at Montefiore Medical Centre, was roused by a knock on her office door.
"They're calling from NYU," a colleague told her. "They want to know how many babies we can take," Cohen recalled.
Hospitals that remained functional were either lucky or better prepared. They didn't lose power. But many were prepared if they had.
Montefiore built a 5-megawatt co-generation plant for heat and electricity in 1995, said Ed Pfleging, vice-president of engineering and facilities, and doubled its capacity a few years later. The plants now supply 90 per cent of the power at its main campus, allowing the hospital to run for days if the electrical grid fails.
"During the 2003 blackout, we were the only New York hospital with fuel power," he said.
Mount Sinai took in 64 NYU patients and some two dozen from Bellevue. It did not lose utility power this week, but was prepared with 13 back-up generators and several separate power systems if it had. Instead, communications were an Achilles heel.
Mount Sinai's chief medical officer, Dr. Erin Dupree, was on the phone with her NYU counterpart on Monday night to discuss the evacuation, But they were repeatedly cut off as landlines and mobile phones failed throughout the city.
"We literally had no communications with these people," she said. "They were in the dark, and we didn't know who was coming here."
Emergency drills light on detail
That also could have been predicted. Loss of communication contributed to the scope of the September 11, 2001, attacks in New York, when emergency responders were unable to receive instructions and information in the minutes before the collapse of the World Trade Centre towers.
"We all lost telecommunications on 9/11," said Gail Donovan, chief operating officer of Continuum. "After Sandy we had limited cellphone capabilities at Beth Israel," one of Continuum's Manhattan hospitals, "so we used walkie-talkies."
Emergency drills light on detail
What hospitals must do to harden themselves against disaster is determined by a patchwork of federal, state and local regulations. The Joint Commission mandates a long list of preparedness steps, including running disaster drills.
But many hospitals just go through the motions, said Dr. Dan Hanfling, special advisor on emergency preparedness at Inova Health System: "Until events of Sandy's magnitude come along, emergency preparedness is just a box that has to be checked."
Virtually no emergency drills simulate a disaster inside a hospital. "I can't remember the last time a hospital ran a disaster drill where the hospital itself was the site of the disaster," Kellerman said.
The Commission also requires hospitals to maintain back-up power equipment and test it 12 times a year for half an hour and for four hours once every three years. There is no requirement for war-gaming a situation that knocks out that equipment.
Only with "new construction or renovation projects" are hospitals supposed to place such equipment above flood level, explained the Commission's Mills, and even in those cases it is something that "should" be considered but is not required. That means the stricken New York hospitals are not unusual.
"We are definitely making progress in preparedness, but many hospitals are still trying to figure this out," said Inova's Hanfling. "They would fare about the same" should another storm like Sandy roar ashore.