Not long after posting a recent column which, admittedly, was somewhat critical of healthcare providers in and around New York City following Super Storm Sandy, I decided to get a clearer picture from someone intimately connected to the disaster – my own brother.
A few months ago, Ira Nash, MD, was appointed Medical Director for Physician and Ambulatory Network Services at North Shore Long Island Jewish Health System (NSHS), a 15- hospital system with approximately 380 ambulatory practice sites distributed throughout the now-devastated southern shore and barrier islands – a 75 mile stretch from Brooklyn to Suffolk County.
A conversation with him yielded a compelling story of how a complex collection of independent moving parts – towns, municipalities, hospitals, nursing homes, and hospitals, each with its own geography and disaster plans – grappled with the storm and its aftermath.
For NSHS, the highest priority was to make certain that its hospitals could continue to function, and administrators spent the night of the storm in the hospital’s command center addressing concerns related to potential flooding, loss of power, and patient safety (e.g., some high-risk patients were relocated to facilities at less risk for flooding).
The water level reached the door of one facility, and multiple transformers exploded around another, but most of the hospitals dodged a bullet. Although the backup generators worked during peak power outages and serious flooding was avoided, some hospitals remained shuttered in mid-December.
NSHS’s healthcare providers didn’t “arrive on the scene”; rather, the scene played out in their backyards. From the chief operating officer to staff nurses to maintenance workers, hospital staff and their families were touched directly.
Once the storm passed and manpower and other resources were reallocated among the hospitals, a huge effort was undertaken to assess the ambulatory care practices – a vast majority of which were up and running by the end of the first week.
Although the sites were open, patients had difficulty accessing them because of flooded cars, gas shortages, and impassable streets.
It was at this point that NSHS decided to expand its services by undertaking a humanitarian effort in consultation with New York State’s health department.
Specifically, a refitted Winnebago-type van equipped with medical supplies and staffed by volunteer physicians, nurses, and administrative personnel was dispatched to hard-hit sites with the goal of providing accessible, free care (no insurance information was requested and no one was billed).
Ira described his first impression of the coastal communities as, “Surreal … like the set of a post-apocalypse movie. Because the buildings are still standing, things seem normal … then you notice water lines at 5 to 6 feet, recovery crews going about their sad business, hundreds of cars strewn about, and snow plows removing huge quantities of sand from streets.”
While parked near public buildings that served as shelters, the mobile unit provided primary and urgent care to more than 313 people with an age range of 7 months to 82 years, treating flu (39%), upper respiratory illnesses (13%), and chronic conditions (>9%) as well as administering tetanus boosters (19%) and refilling prescriptions for patients who brought valid prescription bottles.
Given his first-hand experience with the type of extreme weather event that is likely to become the norm, I asked Ira what changes he could foresee in disaster planning for the future.
The health policy “gene” must run in our family — he said that, while the long-term implications are still unclear, response to this event must go far beyond traditional disaster planning to address the real need for change at the policy level: “In the coming weeks and months, it would be wise to view the aftermath with questions in mind: What are the new needs? Where are the needs most acute?”
For example, this means looking closely at communities and clusters of nursing homes in some of the most flood-prone areas (e.g., the Rockaways) and asking whether they should be rebuilt in the same places or the same ways.
This means looking at community hospitals – some of which are still shuttered without causing an appreciable increase in the censuses of those that remain open – and asking whether it really makes sense to re-open hospitals in coastal communities.
Although the logical answers to these and other questions will surely prompt emotional outcries and political posturing, they are vital to the health and survival of our communities.
David B. Nash is Founding Dean of the Jefferson School of Population Health at Thomas Jefferson University and blogs at Nash on Health Policy.
