Trauma Continues: For Downtown Hospitals, Hurricane Sandy Never Ended

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."