Oversight Hearing: Emergency Planning and Management Emergency Preparedness and Response at Healthcare Facilities During and After the Storm
Committee on Health and Committee on Mental Health, Developmental Disabilities, Alcoholism, Drug Abuse, and Disability Services
Alan D. Aviles, President
New York City Health and Hospitals Corporation
Jan 24, 2013
Good morning Chairpersons Arroyo, Lappin, Koppell and members of the Committee on Aging, Committee on Health and the Committee on Mental Health, Developmental Disabilities, Alcoholism, Drug Abuse and Disability Services. I am Alan D. Aviles, President of the New York City Health and Hospitals Corporation (HHC). I appreciate being given the opportunity to discuss HHC’s emergency preparedness and planning before, during and after Sandy.
I would like to begin by thanking the City Council and Mayor Bloomberg for appropriating $300 million for restoration expenses in the wake of the storm. Having the commitment of these funds enabled us to immediately start making extensive repairs to our storm damaged facilities. We, at HHC appreciate the swift action taken by the Council to assist HHC merely days after the storm.
And I want to express my great appreciation and that of the HHC leadership team, for the diligent planning, hard work, bravery and selfless dedication of thousands of HHC staff who protected our patients from harm and helped to relieve their discomfort and anxiety during the storm and in its immediate aftermath. Many staff, often despite their own concerns for family and home, worked tirelessly over multiple shifts with a determined focus on ensuring the wellbeing of our patients.
The services that HHC provides during and after an emergency such as Hurricane Sandy are among the critical components in the City’s overall response. We work closely with colleagues in the health care community, the New York State Department of Health, the New York City Department of Health and Mental Hygiene and the New York City Office of Emergency Management. HHC invests a considerable amount of time and resources into emergency preparedness planning. This planning occurs at a facility level, as well as on a system-wide basis. We have emergency management teams that plan for, drill for and refine our responses to different disaster scenarios, including hurricanes.
Days before Hurricane Sandy made landfall, HHC Corporate emergency management staff and facility leadership activated Emergency Response Plans. Emergency generators were tested and fully fueled. Extra medical supplies and food were secured. Disaster staffing patterns were set in motion and preparations were made for staff to sleep over at their facilities. Our hospitals and nursing homes staffed up to ensure continuous and adequate coverage. Hospitals discharged those patients who could safely be sent home. All scheduled outpatient services and non-emergency procedures were cancelled. Additionally, eight Special Medical Needs Shelters were opened, and staffed around the clock with the help of HHC personnel who worked extended shifts caring for some of the City’s most fragile residents displaced by the storm.
As you know, Bellevue and Coney Island Hospitals experienced severe flooding and damage caused by the extraordinary storm surge and both had to be evacuated. I was in the emergency command center at Coney Island Hospital on the night of the storm and witnessed the exemplary performance of the hospital staff who reassured and protected patients as the rising waters flooded the basement and eventually washed through the first floor of the hospital.
As you know, hospital evacuations present a significant risk to patients, even when performed under the most optimal conditions and this is why a decision to evacuate before a forecasted storm is not made lightly. It is a testament to the skill and commitment of our staff at both Bellevue and Coney Island that nearly 1,000 patients, including many critically ill patients, were ultimately evacuated safely. All of these patients were transferred to HHC hospitals and to some nearby voluntary hospitals. Essential clinical information was sent with each patient and information regarding where these patients were transferred was made available to families as quickly as was possible.
Extensive clean up, repair and restoration work is under way at these two hospitals. Coney Island Hospital re-opened a portion of its primary care services just two days after the storm and has restored outpatient primary care and specialty services since then. The emergency room and other inpatient services have received approval to reopen by the New York State Department of Health and we began phasing in those inpatient services last week.
Bellevue Hospital Center has also resumed providing primary care and specialty ambulatory care services, as well as emergency services for non-ambulance transported patients. We expect that Bellevue will reopen its inpatient units by the second week of February and will resume full emergency and trauma services at that time.
The Coler campus of the Coler-Goldwater Specialty Hospital and Nursing Facility, our largest long-term care facilities which serve some of the City’s most physically fragile and chronically disabled individuals, lost power and heat after the storm. This made it necessary to transfer 104 medically fragile residents to the Goldwater campus. More than 500 residents remained at Coler, diligently cared for by Coler’s dedicated employees. Power and heat were restored to Coler in the days after the storm. However, we are still operating on temporary generators and we need to transition back to Con Ed power. Significant work must be done to permanently repair and re-position to a higher elevation damaged electrical systems at this essential long-term care facility. Repairs and abatement have been made to the steam tunnels that were impacted by the flood; and we have been able to move from use of temporary boilers to restoration of normal heating systems. The damage from the storm was not limited to Bellevue Hospital, Coney Island Hospital or the Coler campus. The widespread loss of power required seven HHC facilities in three boroughs to switch to emergency generator power after the storm. Several other HHC facilities including: Harlem Hospital, Metropolitan Hospital, Queens Hospital, Jacobi Medical Center and Gouverneur Healthcare Services experienced storm-related damage.
In addition, more than 1,200 staff members who provide important functions such as our Finance Department, our Home Care Agency, our Information Technology Department, and our MetroPlusHealth Health Plan were displaced from their work places at Water Street. Despite being relocated to several sites across the City, these resilient and dedicated employees have kept these core functions operational.
There were so many stories of the heroic actions taken by HHC’s staff during the storm it would take me the entire day to talk about all of them, so I will highlight just one example.
Bellevue Hospital safely evacuated approximately 500 patients in just under two days, each carried from one of the hospital’s 21 floors since the elevators were not working. Several days later, after diligent effort, one elevator was brought back into service enabling the safe transport of the last two remaining patients who could not be safely evacuated down the stairs, including a young man in his late thirties with a serious heart condition. Before the storm, Bellevue cardiologists had inserted a temporary device in this patient’s chest to correct a life-threatening blockage to his heart. This device had to be removed and his chest closed before he could be safely transferred. A large team of doctors, nurses and operating room staff set to work creating a pristine operating theater for Bellevue’s skilled surgeons to operate on this patient. The operation was not only a success, but the expert post-operative care facilitated a seamless transfer of the patient to Columbia-Presbyterian for ongoing care. The patient’s family was on-site throughout the operation and transfer.
As I mentioned at the beginning, $300 million was appropriated to help our public hospitals to repair the extensive storm-related damage to our facilities. These city-appropriated funds have gone toward structural restorations, new boilers, new mechanical and electrical systems, roof repairs, flood remediation and more. This only covers a fraction of our costs though. At the moment, we estimate that the impact of Hurricane Sandy on the New York City public hospital system will exceed $900 million to cover response, temporary repairs, revenue loss and the permanent reconstruction and mitigation work needed to prevent flood damage in the future. The estimate breaks down into four categories:
- Storm preparation and response costs: up to $20 million
- Estimated patient revenue losses: $183 million
- Emergency protective measures: $137.5 million
- Estimated permanent reconstruction and hazard mitigation costs: $632.5 million.
- Estimated Total: $973 million
I am pleased to report that our $137.5 million claim submitted to FEMA in December was approved on January 17th. Once these funds are obligated, HHC will receive 75%, or $103 million as FEMA’s share. I want to specifically point out that none of these funds (or other FEMA funds) will cover lost patient revenue that we estimate may approach $183 million. This loss of revenue makes a bad situation worse as we are projecting a $691 million gap in our Financial Plan for FY 14.
HHC has faced adversity before, and we have come out of it stronger. The physical damage to some of our facilities is significant, and the storm has exacerbated our already serious fiscal challenges. As a result, it will be more challenging to implement the strategic initiatives we have planned for the coming year. However, I have full confidence in our ability to rebuild and move forward primarily because of HHC’s incredible staff who work tirelessly to ensure that we sustain our mission serving all of the New Yorkers who rely on us for their health care.
Thank you for the opportunity to testify this morning. I can now answer any questions that you have.