Hospitals may face stricter standards
The chaos, darkness, and death that engulfed some hospitals in New Orleans during and after Hurricane Katrina is likely to lead to tougher standards for emergency preparedness at healthcare facilities nationwide, according to a top disaster-planning official who toured the devastated region this week. The scenes of desperate medical staff carrying patients to the roof for helicopter evacuation, he said, underscore the near-impossibility for any hospital to operate alone without power, water, and other vital services.
Dr. Robert Wise, a disaster planning specialist at the Joint Commission on Accreditation of Healthcare Organizations, said the damage from Katrina is a more extreme version of a pattern he has seen in disasters such as the Northeast blackout of 2003 and back-to-back hurricanes that struck Florida last year. Though hospitals are urged to be ready to survive up to three days with no outside help, Wise said, few have enough generators and other resources to last that long. In New Orleans, Memorial Medical Center staff finally evacuated the building when no help arrived after three days, leaving 45 corpses behind.
''It's very clear that an organization may need to be on its own for a good deal more than 72 hours," said Wise, whose organization sets standards for emergency planning and other activities that hospitals must meet for accreditation. However, Wise said, hospitals can keep running only with extensive help from government and private businesses. ''If you ask the question, 'Is the hospital prepared?' you're asking the wrong question," he said. ''The question is, 'Is the community prepared?' "
Preparing hospitals for a large-scale disaster could be expensive, Wise said. New York City area hospitals estimate they have spent an average of $5.5 million each on emergency upgrades since the terrorist attacks of Sept. 11, 2001. In response, Wise's group published a guide yesterday to help smaller and less affluent communities plan for healthcare disasters in a more cost-effective manner.
Under state law and industry standards, hospitals are expected to keep operating during a disaster. Most are built to withstand severe weather and they usually have backup power, medical equipment, and water to ''stand alone" without outside power or water for some time. A 2003 Joint Commission on Accreditation of Healthcare Organizations report recommends hospitals stockpile enough supplies for up to 72 hours.
In reality, emergency preparedness specialists said, these planning goals are seldom met. For instance, some hospitals in Boston do not have enough diesel oil to run their backup generators for more than a day or two. ''You can't have a lot of fuel storage in downtown Boston. There are significant [US Environmental Protection Agency] hurdles for bulk storage," said Bob Loranger, director of facilities at Tufts-New England Medical Center.
In New Orleans, Memorial Medical Center ran out of fuel for its generators within 24 hours, while Katrina's flood waters were still rising. The flood also knocked out sewer and water service. By the time the last patients were evacuated, food had dwindled to tuna sandwiches and bagels.
While Katrina's damage was the most extensive he has seen, Wise said other recent disasters have left hospitals without power, water, and other resources for extended periods, leaving them barely able to remain open. Charlotte Regional Medical Center in Punta Gorda, Fla., lost drinking water and most power during Hurricane Charley last year, prompting hospital officials to set up a mobile emergency room.
''When you have this kind of devastation, even though the feds can get down there, there's not enough federal resources to go to all the different places," Wise said. ''If the destruction is large enough, [hospitals] are still going to have to be on their own."
Wise said New York City may provide a model for how to get around the limited resources of each hospital. For the past decade, the Greater New York Hospital Association has been building a disaster network among the region's 220 hospitals, allowing them to rapidly divert resources to the areas most affected.
Central to the New York network is a two-way radio system that connects all the hospitals even if phone service is knocked out. During the Northeast's blackout in August 2003, the phone network allowed hospitals that did not have enough emergency power to get mobile generators. No patients died as a result of the two-day blackout. Boston hospitals already have access to an emergency radio system like New York's.
''I cannot underscore enough the importance of having communications systems in place," said Ken Raske, president of the Greater New York Hospital Association.
Dr. Dennis O'Leary, president of the Joint Commission on Accreditation of Healthcare Organizations, said Katrina should prompt hospitals and community leaders nationwide to begin planning for worst-case disasters -- and find ways to keep hospitals operating.
Liz Kowalczyk of the Globe staff contributed to this report. Scott Allen can be reached at allen@globe.com. 
