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In late March, when the most serious public health crisis in a century swept across New York, sick people and their caregivers faced a hospital system that was less than the sum of its powerful parts.
At the same time, however, 3,500 beds were free at other New York hospitals, some no more than 20 minutes from Elmhurst, according to state records. The city, which is run by Elmhurst, had a fleet of 26 new ambulances available to transfer patients.
Elmhurst appeared to be caught between the pressures of the moment and the forces of history that valued little cooperation necessary during a pandemic.
For decades, hospital organizations in New York, as in many parts of the country, have existed as independent fiefdoms, rivals that had virtually nothing to do with each other. The state is home to more than 200 private and public hospitals, run by nearly 80 nonprofit corporations and government agencies.
“We really don’t have a ‘public health care system,'” said Governor Andrew M. Cuomo. “We have a hospital system.”
In the week beginning March 16, the number of patients at the Covid-19 hospital increased tenfold.
Hospital networks were on the verge of replicating the fatal confusion of September 11, 2001, when police and fire departments responding to the attacks on the World Trade Center failed to work together or communicate, costing many lives.
Even as hospitals rushed to expand, Elmhurst revealed a gap that city and state officials had not anticipated: there was no single body to unite patients with beds that were already available in dozens of separate systems and hospitals. independent.
Within days, the state created one in the form of an early warning system, a daily live map of conditions at each hospital, regardless of who operated it. When a hospital was filling up, scouts in the field would identify patients who could be transferred. State officials then persuaded or assisted hospital staff to transfer them to less crowded facilities.
The dashboard hacked by Mr. Cuomo’s aides did not create a permanently integrated healthcare system by any measure, but allowed New York, in the worst case, to make the most, or at least, more than it had. the state.
“It wasn’t a problem that all the hospitals were full,” said Gareth Rhodes, an assistant to Cuomo. “It was a problem that a handful of hospitals were close to capacity, while hospitals within a 15-mile to 20-mile radius had a lot of room.”
Why didn’t patients move before Elmhurst, with space available elsewhere?
“It is a fair question that makes sense,” said Matthew Siegler, executive vice president of Health & Hospitals Corporation, the public agency that runs the city’s hospitals.
In the early days, Siegler said, doctors worried that patients were too unstable to move, the disease was too unpredictable. Instead, the agency sent reinforcements to the hospital.
“There is a strong spirit of whatever comes through the door, we can and we will take care of it,” Siegler said.
State authorities said they believed that patient transfers would be handled by public and private networks, through what appeared to be existing transportation operations. Two private hospitals caught in the same flood tide as Elmhurst had eased their burden by moving dozens of people to less crowded places as of March 21, according to records.
“The problem in Elmhurst was not one of capacity,” said Dani Lever, the governor’s communications director, noting that there were thousands of free beds in the city, even within the health network and hospitals. “It was a patient management problem.”
“We dramatically increased the number of transfers,” said Siegler.
A team of doctors and administrators from across the city paved the way. That process became even more important as the number of patients increased, said Mitchell Katz, president of Health & Hospitals.
“For us, making transfers has been a critical part of overcoming the pandemic,” said Dr. Katz.
In late March, the new state system was in place. It may have had its biggest impact for eight consecutive days beginning April 7, when more than 18,000 Covid-19 patients were in state hospitals. One in five needs intensive care.
During those peak days, according to records, the state directly transferred 900 sick people. Others were transferred by the hospital systems themselves: Northwell Health, for example, transferred 800 patients, and the city’s hospitals transferred a total of approximately 850.
The people who managed that logistics, said Nick Caputo, an emergency physician at Lincoln Hospital in the Bronx, “saved countless lives.”
In the past, hospital systems have had spasms of cooperation during hurricanes, power outages, and mass casualty events. They normally operate as independent duchies.
Led by boards of wealthy and influential people, the five largest private systems – NYU-Langone, NewYork-Presbyterian, Northwell, Mount Sinai and Montefiore – invest heavily in their brands. Their most recent tax returns show that they spent a total of $ 149 million on advertising.
On March 20, the heads of all hospitals, public and private, were called to a telephone meeting with Howard Zucker, the state health commissioner, and Larry Schwartz, a lawyer who has been in and out of government for decades now. He often delivers messages from the governor. Cuomo
Dr. Zucker told executives to add space for at least 50 percent more patients, and they did, and ultimately added 35,000 beds. In addition, they were ordered to provide the health department with daily inventories of beds, critical supplies and fans so that the state could ration its own stock out of necessity.
There were some quiet grunts over lengthy polls in the midst of an emergency, but Schwartz reminded executives that state-controlled certificates of need hospitals must look for when they want to buy expensive equipment.
“Basically, the message was that we have to present the increase plan, or nothing will ever be approved,” said an executive at a large network of private hospitals who spoke on condition of anonymity. “It was” Do this or you’re dead. “
Furthermore, Mr. Schwartz said, executives at each hospital had to vouch for the veracity of the daily report, essentially making false statements a potentially criminal matter. Given the urgent circumstances, it was not necessary to twist his arms, said Kenneth Raske, president of the Greater New York Hospital Association, Industry Industry. politically powerful trade association.
“The issue of his power never became a question,” said Raske. “Moral authority replaces everything.”
At regular conference calls, Cuomo and Michael Dowling, the executive director of Northwell, who was appointed by the governor to oversee the transfer of patients to military hospitals at the Javits Convention Center and the US Navy ship. USA Comfort implored hospitals to “decant” their most crowded wards.
Leaders of the five largest private networks have met every other day, “unthinkable” before the pandemic, Raske said, and leading academic laboratories associated with hospitals are sharing strategies on testing and modifying equipment.
Coordination was abnormal, but, Dowling said, “it was necessary for the protection of the community.”
If this appears to be nothing more than common sense, history shows that commodities can be fatally scarce during a crisis.
On the morning of September 11, 2001, police officers, firefighters, and emergency medical workers responded to the catastrophic fires at the World Trade Center, where the hijackers had carried planes in two 110-story towers.
But as was the rival custom, their departments established separate command centers, blocks from each other. As of 9:59 a.m., police helicopter pilots radioed warnings that the second of the two towers in the mall appeared to be on the verge of collapse. “It is inevitable,” reported one pilot.
That alarm, and others, were relayed to police officers inside the tower, most of whom managed to escape.
But the firefighters never heard them. They operated on different radio channels. the Police and fire commanders did not speak to each other. Dozens of firefighters, many of them within striking safety distance, died when the tower fell 29 minutes after police warnings began.
Organizing medical resources was encouraging for Dr. Caputo and his colleagues at Lincoln Hospital.
“You knew you were not alone in the fight and that people were listening,” said Dr. Caputo. “That was great for the soul.”
