A plume of black smoke rising from a skyscraper on 50th street was causing mild panic even before a meeting on disaster prepardedness in New York had begun Tuesday.
It was an apt prelude to the annual ‘State of the City’s Healthcare Market’ briefing which was convened at Capriani’s Hotel on 49th Street.
The debate between academics and professionals working in the New York healthcare sector highlighted the need for greater federal government spending and a large-scale review of how the healthcare system would deal with a large-scale disaster.
The panel was composed of Bruce Logan, the President of NY Downtown Hospital; Brendan O’Neill, a physician; Scott A. Graham, from the Red Cross in New York; and Irwin Redlender, a professor at Columbia University.
“We have no idea what a prepared New York is,” said Redlender. “I don’t personally think we’ve made much progress since 9/11. There is a huge disconnect between need and funding, it’s laughable.”
Redlender blamed a combination of the federal government underfunding and disjointed operating for the ‘bad shape’ the city was in.
Scott A. Graham was more sanguine. “We have the best disaster response in the world,” he claimed. He also took the pressure off the government and put the onus on grassroots organisation. “We’ve got to develop preparedness from the family to faith groups.”
Bruce Logan said he ‘was amazed that only 3,000 people died on 9/11’. ‘That should have been a wake-up call,’ he added. ‘The was terrible communication problems and we need additional resources from state and federal level.”
O’Neill called the goal of disaster preparedness a “journey, not a race”. He added: “Comprehensive planning needs to be the focused. The margins are small, but there are areas of great innovation.”
There was discussion of the infrastructure problems in getting a coherent and cohesive system of disaster preparedness. “We don’t know who is responsible for what,” said Redlender. “80% of infrastructure is private – do they pay? Or is it the responsibility of the government and taxpayer?” he asked. “We are in a very, very place,” he added.
Brendan O’Neill said he had ‘grave concerns’ over the current set-up. “Some things work on a small-scale, but when you get to big disasters I don’t think it’s plausible.” He continued: “We need to stop the complacency.”
Logan contrasted the response on 9/11 to the debacle in New Orleans after Hurrican Katrina. “Things went better in New York,” he said. “But it all depends on the specific disaster. 9/11 happened to be in the morning and it was a contained disaster. We had terrible trouble in the hospitals at the start but the flow of victims stopped in the afternoon, that didn’t happen in New Orleans.”
Redlender lashed out at the Bush administration. “The root of this problem of unpreparedness is at the top,” he said. “We’ve never had the Oval Office take an interest in this. “The federal government must understand what it will cost to deal with a big disaster – at the moment they don’t. We also need American people to think about but at the moment we are missing national leadership.”
After the debate was a lecture by Adam Scowcroft of the PriceWaterhouseCooper. He talked at length about the health problems currently facing New York. He said 14% of people in the state are uninsured. He also said physicians are calling for hospital restructuring and more power being given to physicians. He noted that Governor Pataki had overseen a $1.5 billion shortfall on medical expenses and that a federal audit had recommended the closure of five hospitals and the merging of 11 others.
He argued that the resulting composition was “stronger and leaner, but not meaner.” There was a problem, he said, that ‘the federal government are using hospitals to square their own fiscal problems.”
He talked at length about the advent of smart cards that are now being used widely across the city. He said physicians were ‘taking it on the chin’ and were now seeking collective bargaining and several health plan contract reforms.
The event finished with a question and answer session with the assembled health professionals and the panel. One woman expressed her dismay at the lack of information available about how to prepare for large-scale disasters. Scott detailed how the Red Cross produce packs exactly for this purpose. A physician in New York City worried about the logistics of actually getting patients to the hospital in the event of a disaster. “That is a big worry, still to this day” said Redlender.
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