In emergency rooms, doctors and nurses seem to be on call 24/7, working odd hours for several patients. But when it comes to emergencies with                the hospital itself, John Muniz, Director of Engineering at Beth Israel, is the one on call.

“My patient is the hospital, the actual infrastructure,” said Muniz, who started at Beth Israel in 2006. “I take great pleasure in the responsibility of my job.”

Muniz handles all things electrical and mechanical, along with the generators, air handlers and plumbing. And his dedication to his patient, Beth Israel, is the reason it withstood the power outages on the east side of Manhattan during Hurricane Sandy.

The Sunday before Sandy hit, he didn’t panic. Instead, he braced for the worse. Muniz made sure there were sandbags in front of the hospital and plywood on the windows. He also got four water pumps in case of flooding. And he scheduled a test for Beth Israel’s 10 generators to make sure they were running properly.

“Thank God we made sure the generators were fine,” he said. “Sure enough that Monday we needed the generators on because we lost all power.”

Muniz said he slept on the floor of his office during Sandy, as he and his staff kept an eye on the generators to make sure they held up. As neighboring hospitals lost power, such as New York University’s Bellevue Medical Center, patients were being sent to Beth Israel.

“Our emergency room was packed, it was just packed,” he said. “It was my commitment to make sure we stayed open and all the generators stayed running and we were getting additional fuel deliveries.”

At one point, one of the generators stopped working. But within an hour and a half, Muniz said he and his team managed to get the generator repaired and running again.

“It was chaotic but I wasn’t alone, it was a team effort with my managers here and workers that stayed through,” Muniz said.

Though Muniz credits his staff constantly, his assistant Tony Renteria had no hesitations when it came to speaking on behalf of Muniz’s leadership, especially during Sandy.

“In emergencies, you need a leader who can think on their feet,” Renteria said.

Renteria has been Muniz’s assistant for two years. However, in the late 90s, Renteria was the Director of Engineering for Cabrini Medical Center and Muniz worked under Renteria. Working together again with the roles reversed, Renteria said he couldn’t be happier.

“I’m proud to work under his leadership,” Renteria said of Muniz. “He’s very humble. He’s got leadership skills that are second to none.”

Muniz has been working in hospitals since 1979. His commitment to his crew and the patients who depend on the infrastructure of Beth Israel to be intact keep Muniz going.

“It’s a very hectic job, very demanding but I love what I do,” he said. “If I get called into the hospital I’m here, I’m always here. If they need me, I’m here.”

Disaster may be fading from other New Yorkers’ minds, but hospitals like Beth Israel have been forced to permanently re-examine their operations.

Before the antiseptic smell even has a chance to reach your nose, the first thing you notice about Beth Israel’s ER is the sheer number of people occupying it. Bodies fill every chair in the cramped waiting room and every bed in sight; bodies linger in corridors. Months after Hurricane Sandy’s New York landfall, one of the few hospitals fully up and running in downtown Manhattan is still bearing the brunt of the storm’s devastation.

Jim Mandler, vice president of public affairs and communications at the hospital, says there’s a method to all this madness.

“That happens over time,” he explained, indicating that however chaotic things may appear, sufficient practice has smoothed out the hospital’s routines.

While Beth Israel never closed during the disaster, it felt the effects of being the only hospital open for a time in the area.

About two weeks after the hurricane that shook Lower Manhattan to its core, Murray Hill resident Brett Shanley was moving into a new apartment when he felt a persistent shooting pain in his back. He knew he’d pinched a nerve. Shanley immediately made his way to NYU Langone Medical Center a few blocks from his apartment. There were sandbags around the hospital; it was still closed. Shanley hopped in a cab to Beth Israel, where a nightmarish scene awaited him.

“I had never seen [an ER] this crowded or this foul. Sneezing and bleeding and shouting, snoring and crying and muttering—it felt like an asylum,” Shanley said.

“People kept streaming in with nowhere to sit … the room maybe held 50 people comfortably and there were 80 to 90 people in it. The ceilings were low and it was poorly lit.”

“The staff seemed hard-working, curt and exhausted,” he added.

After three hours, Shanley was able to see a doctor. “Ultimately I was called back deeper into the depths of the hospital which, in comparison, felt like a high-end resort. The halls were clean, well-lit and uncrowded. People even smiled and joked. It was hard to believe it was the same building.”

Shanley said he spent about six hours in the ER that day.

While Shanley’s visit to Beth Israel did not coincide with the worst of the storm, it reveals the dire circumstances of a facility still facing the fallout of a disaster which shut down every other hospital in the lower third of Manhattan.

The media spotlight on the impressive evacuation efforts of NYU Langone Medical Center during the storm has overlooked the pressure put on other facilities due to overcrowding, say hospital administrators. This pressure has been enormous, particularly at Beth Israel.

“We’re getting a different population than we’re used to,” explained Mary Walsh, the chief nursing officer for Beth Israel. “Psychiatry has probably been the major difference.”

In addition to added psychiatry services, the hospital has had to take on more emergency patients, provide extensive obstetrical (OB) services and even house some of Bellevue’s prison population.

“[Admitting] four to five patients under arrest at one time is unusual,” said Walsh, compared to standard procedure.

Throughout the storm and its aftermath, Beth Israel was forced to meet many very specific and unusual needs. The hospital served not only as an emergency room, but a pharmacy, a dialysis center, a methadone clinic, a place to sleep and a place to charge cellphones. Displaced people throughout the city made their way to Beth Israel, often simply wandering in off the street, said John Samuels, the administrative director for emergency services. He pointed out that it became a real security issue.

“People would come in and say, ‘Can you go pick this person up in the street?’ People couldn’t call 911,” Samuels said.

Anything for which someone might ordinarily call their doctor, they turned to the only open hospital—and one of the few open establishments at all—downtown.

“We weren’t just meeting medical needs, we were meeting social needs too,” Mandler said. The hospital became a sort of community center; no one was turned away.

Perhaps counterintuitively, though, the real spike in patients—and in the severity of their cases—came after the storm had receded. At that point, the social needs had been met, many could return home, and those who were seriously sick or injured came to the hospital for the first time.

“That’s when people woke up and realized, ‘I need to get to the hospital,’” Samuels said.

Prior to the storm, Beth Israel saw approximately 320 patients a day; during the storm, the hospital was seeing highs in the mid-400s. Ambulance volume doubled as well. According to Samuels, an ambulance is more ominous—indicative of a sicker patient.

The current patient load remains substantially higher than usual, with between 75 and 100 extra patients per day.

Beth Israel brought on other doctors—many from NYU—and purchased more resources, including beds and linens, to meet increased need. The hospital also opened up additional units and fed its employees around the clock while they were holed up inside. Samuels said it was hard to place a price tag on the added costs.

Alan D. Aviles, president of the Health and Hospitals Corp. (HHC), said the cost to repair New York City public hospitals and ensure against future damage would likely exceed $800 million.

The exhausted staff Shanley encountered had been sleeping side by side on the floor of the hospital, often in four-hour shifts, throughout the worst of the storm.

“The nurses did a yeoman job,” said David Bernhard, the senior vice president of medical affairs. “Employees were sleeping in the hospital who might have gone home … it was really a remarkable effort.”

Beth Israel also took in about 140 evacuees from sister hospitals, but running on a generator still didn’t mean everything functioned properly. Walsh explained Sandy was different than other disasters because not only was the environment affected, but so were the hospital’s usual techniques.

New York City Council members have introduced a bill in the aftermath of Sandy which aims to strengthen flood-proofing requirements for health-care facilities in the city. Hearings have been under way to address these issues.

Administrators agreed emergency planning, including the hospital’s emergency management committee, was helpful, but everything could be better the next time around.

Hospital administrators realized, for instance, post-Sandy, the ER demanded certain necessary modifications. For one, they needed to re-examine their fast track system, which aims to move patients with less serious ailments in and out quickly. They transformed one of their three treatment pods into the fast-track area during the storm, a change that has remained in place. The hospital also opened up a private VIP room into a space where several patients could be treated side by side.

“We will still need to reassess the fast track,” explained Lisa Dyer, Beth Israel’s nursing director, adding with the new changes, non-urgent patients are already not waiting as long as before. She described it as a work in progress.

Despite its severity, Hurricane Sandy wasn’t the first event in recent years to spur much-needed change at Beth Israel.

Mandler described a recent decision by the hospital he called fortuitous. After Cabrini Medical Center closed in 2008, Beth Israel expanded their space, allowing them to take in many more patients. After the 2010 closing of St. Vincent’s hospital, the added space was a major help, as Beth Israel patient numbers saw an immediate surge. However, Hurricane Sandy has taught administrators at Beth Israel they still need to address surge capacity issues.

Lisa Cannistraci, who is something of a West Village staple as the owner of Henrietta Hudson bar and a member of Community Board 2, recently had to confront these issues firsthand.

Cannistraci broke her thumb in a freak accident two weeks ago and went to Beth Israel around 11 p.m.

“There was no seating, it was packed to the gills,” said Cannistraci. “They alluded to the fact that I’d be there all night … I did the intake and then after I sat down I said to myself, ‘I gotta go.’”

Cannistraci had a friend drive her to a hospital in New Jersey where she was in and out in under two hours.

“The ambiance was very dismal among people waiting [at Beth Israel],” said Cannistraci. “There had to be 120 people there.”

Cannistraci noted the staff at Beth Israel was “fantastic” despite the overcrowding.

“St. Vincent’s closing was a tragedy to everybody,” she added.

With regard to long-term plans for the hospital, including additional facility construction, Mandler said Sandy will definitely influence the outcome.

Beth Israel’s president, Harris Nagler, agreed with this assessment. For all Beth Israel’s response efforts, “Sandy really tested the system,” he said. “We need to ask if we’re currently at the tipping point of responding.”

While most New Yorkers may have moved on from the hurricane, Beth Israel and other downtown hospitals do not share that luxury. Bellevue, which closed for the first time in 275 years according to Aviles, has resumed many of its services but is still not taking ambulances. The VA hospital is closed with plans to reopen in mid-February.

Even so, Walsh believes Beth Israel’s patient load is likely to be higher for good. “When Bellevue opens again some patients will still come back,” she said. “Because of our care.”

The impact of Sandy on the hospital will not be forgotten by Beth Israel staff members anytime soon.

“Here,” said Bernhard, Hurricane Sandy “is still on everybody’s mind every day.”

Barbara Warren heads LGBT health division at Beth Israel

Barbara Warren, the director of LGBT health services for Beth Israel, is a humble woman who, according to Vice President for Public Affairs Jim Mandler, “has spent her entire career advocating for individuals in the LGBT community.”

Before arriving at Beth Israel 11 months ago, Warren spent ten years as a policy advocate, doing research and policy work. The position at Beth Israel was “an opportunity to actually implement this work in a real-world setting,” she explained. “That’s what’s gratifying.”

Since joining the hospital, she has overseen training in LGBT cultural competency to over a thousand employees. The hospital will also be piloting data collection for clinical management of gender identity this spring, under Warren’s supervision.

She noted in the past year there has also been increased community wellness programming.
Warren explained that the Services and Advocacy for GLBT Elders group (SAGE) opened the first LGBT senior center in the world.

“We got a small grant from a donor to do a wellness series called ‘Ask the Docs’ at the SAGE senior center starting this winter,” Warren said. “We’re doing similar stuff with the LGBT center and Gay Men’s Health Crisis.”

Despite these successes, Warren’s time at Beth Israel has not been without its difficulties.
“It’s a huge challenge to take good intentions and policies and translate them into sustainable practice in an institution where over 8,000 employees across a variety of disciplines have a lot of other things they’re working on,” Warren said.

“There’s a lot of competing demands on time and interest,” she added.

One of the biggest challenges facing Warren is balancing the delicate art of meeting patient needs, while also protecting their safety and confidentiality.

She explained it’s a sensitive process, addressing these many factors. “It’s not just training,” she said. “It’s new systems, outreach in the community, grappling with issues in order to do quality assurance and document both emerging needs and best practices.”

These new systems include the implementation of electronic health records.

Warren explained that for health reasons it can be important to identify people who are lesbian, gay and transgender in these records, but there are confidentiality concerns, as it’s not simply “the same as saying your age or ethnicity.”

“We still don’t live in a world where people feel totally safe about being out and having their sexual orientation in an electronic health record,” Warren explained. “Even in a city like New York, where there’s equal protection under law.”

“I hear people say: ‘I don’t mind telling my provider, but if it’s on my electronic health record, what if I’m in the emergency room, unconscious, in Oklahoma, and it’s on my record that I’m a lesbian,’” Warren said. “That’s a challenge.”

Warren plans to continue addressing these issues as aggressively as possible, saying the challenges will not stop her or her colleagues.

“We’ll never have to worry again with this [electronic database] system about people being treated inappropriately in any setting … but there are related issues, particularly when you’re talking about sexual orientation.”

She continued: “There isn’t equal protection all the way across the board. Experience says it’s better to be out, [but] it’s still anxiety-provoking.”

“We’re still at the cutting edge in the real-world setting,” she added.

Nonetheless, Warren believes there’s broad support across the institution for improving services to LGBT patients.

“This institution is 100 percent behind working through the problems,” Warren said. “It’s really motivated by doing the right thing. A lot of people are motivated by getting patients, but [Beth Israel and its partners] are motivated by quality of care.”

While grappling with these tough issues on a regular basis, Warren even devotes some of her free time to providing medical care to others, including taking care of her elderly mother.