How Is It that, with Years of Warning, Two Major New York City Hospitals Could Not Keep their Emergency Generators Running during Hurricane Sandy? — Denial Explains Complacence in regard to Sea Level Rises and an Increasingly Dynamic Atmosphere

01 November 2012

Complacence’s inviolable rule — why pay for something before its absence bites your behind?

As a former first responder and lawyer, I was perplexed, when we heard that New York’s NYU and Bellevue Hospitals both had to be evacuated, during power failures created by Hurricane Sandy’s swing inland.

These massive hospital evacuations, done under storm conditions, put everyone’s lives at risk. Neither would have been necessary, if management had done its infrastructural job.

In regard to NYU Medical Center:

At times with only flashlights to illuminate the way, NYU Langone Medical Center began evacuating about 260 patients, carrying some of them down 15 flights of stairs to ambulances ready to take them to the safety of other hospitals.

The hospital didn't anticipate such heavy flooding from Sandy, the superstorm that hit Monday, and chose not to evacuate all its patients before the storm, as it did with Hurricane Irene a year ago.

But between 7 and 7:45 p.m. Monday, the hospital's basement, lower floors and elevator shafts filled with 10 to 12 feet of water, and the hospital lost its power, according to Dr. Andrew Brotman, senior vice president and vice dean for clinical affairs and strategy.

"Things went downhill very, very rapidly and very unexpectedly," Brotman said. "The flooding was just unprecedented."

Roof-mounted emergency generators did kick in, but two hours later, about 90% of that power went out, and the hospital decided to evacuate patients.

During Irene, only one building was flooded, and with just 2 to 3 feet of water. On Monday night, seven hospital buildings were flooded with 10 to 12 feet of water each, including the medical school and the Smilow Research Center, which was built about three years ago.

"It had a very sophisticated foundation that was built specifically to withstand a flood, but it flooded anyway," Brotman said. "That's just an example of how stunning and rapid this flooding situation was."

According to Charles Ornstein’s Pro Publica overview (of a report at Modern Healthcare) one of NYU’s power generating units was located on the roof. But the other was in the basement under eight feet of water.

Bellevue’s preparedness turned out to be not much better than NYU’s:

Bellevue Hospital Center, New York City’s flagship public hospital and the premier trauma center in Manhattan, shut down Wednesday after fuel pumps for its backup power generators failed, and it worked into the night to evacuate the 300 patients left in its darkened building. There were 725 patients there when Hurricane Sandy hit.

After pumping out 17 million gallons of water from the basement, the water is still two and a half feet deep in the cavernous basement where the fuel pumps apparently shorted out and became inoperable — unable to feed the 13th-floor backup generators, Mr. [Alan] Aviles [president of the Health and Hospitals Corporation, which runs the hospital] said.

“But Pete, it was a bad storm!” — Yes, but

With the climatic, storm and flooding evidence that we have possessed for quite a few years, it hardly should come as a surprise that these parts of New York are now subject to “unprecedented” amounts of flooding.

Why would Belleview, for example, sit tight with a system that located its generators out of water’s way, but then leave the pumps that fuel them in a foreseeably floodable basement?

This kind of non-preparedness is “slap your face” dumb. Just like Japanese authorities were stupid to leave the seawall at Fukushima Daiichi too low. And then simultaneously located the nuclear facility’s generators where they would be flooded, once the seawall was breached.

These are not difficult engineering problems. Even when we evaluate them prospectively, using the information that authorities had at the time.

So, what is going on?

The most obvious reasons for this stupidity are — expense avoidance and a certain amount of complacent witlessness, as well

From Bloomberg Businessweek:

Blame is being placed on the [NYU] building’s outdated backup power system, which has raised concern that aging infrastructure at U.S. hospitals has created a risk for similar outages that jeopardize patient care.

The board knew the facilities’ generators were outdated and at risk, Gary Cohn, a trustee who is also president of Goldman Sachs Group Inc., said yesterday in an interview on Bloomberg Television.

“The infrastructure at NYU is somewhat old,” Cohn said in a television interview. The backup generators “are not state of the art and not in the most state-of-the-art location.”

“Hospitals are careful to get the latest and greatest medical equipment, but then they don’t spend on the infrastructure,” Michael Orlowicz, a principal at consulting company Lawrence Associates LLC, said in an interview.”

One in 20 hospitals are unprepared for power disruptions, and an incident may result in more than $1 million in lost revenue and other costs, according to Bridgewater, New Jersey- based Lawrence Associates, which focuses on economic justification for technology spending.

© 2012 Stephanie Armour, Shannon Pettypiece and Michelle Fay Cortez, Hospital Evacuation in N.Y. Exposes Outdated Power Backup, Bloomberg Businessweek (31 October 2012) (italics added) (paragraphs split and re-ordered)

Even leaving climate change aside, these hospitals had years of warning from other hospitals’ experiences with blackouts.

Charles Ornstein pointed out that hospitals’ emergency power failures are not isolated. New York had at least three previous incidents (1977, 1987 and 2003) of emergency generator failure. The 1977 occurrence involved Bellevue. (Apparently its institutional memory is no better than its current management’s personal memories.)

The 1987 incident, at another hospital, is especially stark. According to the New York Times, a 40-day old boy on a respirator died, when a planned power outage went awry (while an electrical switching panel was being modernized):

During the work, electricity was supposed to be supplied by four emergency generators, but they failed after their coolant pumps broke down, according to Cosmo LaCosta, the hospital's executive associate director in charge of operations.

The blackout plunged wards in five hospital buildings into darkness: the neo-natal intensive-care unit, where the infant died; the coronary-care unit; the cardio-thoracic intensive care unit; the surgical, trauma-surgery intensive-care unit; the pediatric intensive care unit, and part of the medical intensive care unit.

According to Mr. Ornstein, three pertinent infrastructural warnings also came from other states. In my words:

Memorial Medical Center, New Orleans, went dark during Hurricane Katrina in 2006, leading to a horrific aftermath.

Scripps Mercy and Sharp Memorial Hospitals’ generators failed during a blackout in the San Diego area in 2011.

And Johnson Memorial’s generators failed during Hurricane Irene in Connecticut, also in 2011.

What explains the inferred pattern? In my words:

Phrased diplomatically, lack of financial resources.

Stated somewhat less tactfully, a failure of sensible prioritization.

And said most directly, greed-based complacence.

Mr. Ornstein quotes two experts:

Dr. Arthur Kellermann founded the emergency department at Emory University and headed it from 1999 to 2007. Now, he's Paul O'Neill-Alcoa Chair in Policy Analysis at RAND Corporation think tank.

The other night, as the NYU evacuation was unfolding, he tweeted, "Hospital preparedness and well-functioning backup systems are a costly distraction from daily business, until they are needed. Like now."

Bruce Altevogt, a senior program officer at the Institute of Medicine who has studied crisis standards of care, lauded NYU for safely evacuating patients. But he said the incident should prompt a new discussion about where hospitals place generators and how to ensure they work when they're needed.

Newly constructed hospitals are supposed to place their generators and fuel in adjacent locations above flood level. But the location requirements do not apply to already-built hospitals.

"These older facilities, it's just an economic issue," Altevogt said.

"They don't have the resources, or they haven't devoted the resources to moving the equipment to locations that would be less prone to disasters or flooding in these cases."

Economic shortsightedness — the price of complacence is not just lost revenue — liability costs loom, as well

Given how many patients had to be moved through dangerous conditions, patient and staff harms probably occurred. There will likely be lawsuits aimed at compensating these people for their injuries.

Will the climate change debate wind up in court over this?

If tort litigation does ensue:

Will the equivalent of an “act of God” defense serve to avoid liability?

How effective will “knew or should have known” arguments be?

The legal key is that abstract climate change is not the issue. Instead, instances of previous infrastructural failure, combined with statistical inferences that one might make from storm activity in recent years, are.

More broadly — what about hospital management’s ethical obligations to its staff?

Do emergency medical conditions include those that hospital management creates, when it fails to prepare for foreseeable occurrences?

If management drops the preparedness ball, should nurses and hospital staff be expected to keep critically ill people alive, while moving them through dangerous environmental conditions?

The moral? — For an appropriate preparedness perspective, ask the most basic questions

Would “you” prepare for conditions that are likely to lead to power outages by:

(a) depending on unreliable equipment and wiring

or by

(b) locating generators and fuel pumps in the only places where large amounts of water could foreseeably get to them?

Stupidity and unwarranted greed are sometimes so prevalent that we don’t see them. Until we phrase pertinent questions in their most obvious forms.

PeteFree.com

How Is It that, with Years of Warning, Two Major New York City Hospitals Could Not Keep their Emergency Generators Running during Hurricane Sandy? — Denial Explains Complacence in regard to Sea Level Rises and an Increasingly Dynamic Atmosphere