Before Hurricane Sandy, Soumitra Eachempati, a trauma doctor at New York Presbyterian Hospital on the city's affluent Upper East Side, spent much of his time dealing with stair falls and Central Park cycling injuries.
Now, Eachempati increasingly finds himself caring for a stream of shooting, stabbing and beating victims from storm-struck lower Manhattan and Brooklyn.
With four hospitals that handle more than 1.5 million patient visits a year still partially closed a month after the storm, the city's medical safety net is straining to hold up. It's a crisis with widespread implications as hospitals across the country struggle to rein in costs even as they must prepare for a myriad unforeseen natural and man-made disasters.
In post-Sandy New York, people are traveling further to get care and waiting hours for treatment. Doctors are working overtime, juggling hundreds of added patients in makeshift rooms. And hospitals are struggling with extra costs at a time when budgets are already strained.
"The health care system was already squeezed pretty tight and by taking these beds out of circulation, it has put a strain on everyone," said Robert E. Kelly, president of New York Presbyterian, in a telephone interview. "We have gotten to the point where there isn't a lot of fat in the system. So when something like this happens, how do you deal with it?"
It's a question more hospital administrators are asking as they reduce capacity to deal with shrinking budgets, including the loss of $155 billion in federal payments under the 2010 health care law. That has left many hospitals regularly operating near full capacity with little extra staff, said Kelly. If there was an added disruption to New York's health system right now, such as a flu epidemic, power failure or terrorist attack, there is a chance patient care could suffer, he said.
"This is something policymakers are going to have to struggle with, how do you tolerate fat in the system for times when you really need it?" Kelly said. "It is one thing when you have a disruption at a manufacturing plant in Tennessee. It is another when you are talking about people's health care." In addition to shrinking revenue, many hospitals have seen their federal funding for emergency preparedness drop 30 percent to $352 million in 2012 compared with 2003 levels, said Roslyne Schulman, director of policy for the American Hospital Association. That funding is used by hospitals to train staff in emergency response, stock up on supplies and drugs and buy backup communications systems.
With less federal funding, hospitals are having to take more money out of their general budgets to prep for a disaster, Schulman said.
Flooding from the storm forced New York University Langone Medical Center to shut its doors and one month later, its emergency room and 705-bed main hospital building are still closed, according to a statement on the medical center's website. The hospital said on Dec. 3 that it plans to have nearly all services running again by the end of January.
Four blocks away, Bellevue Hospital, the city's flagship public hospital and main trauma center for lower Manhattan, was also forced to shut its doors from flooding. Bellevue, which has 828 beds and sees 126,000 emergency room patients a year, now offers limited services and doesn't expect to be fully operational until February.
Many of the patients that would normally seek care at those hospitals are ending up about 2 miles away at New York Presbyterian and Lenox Hill Hospital.
Since the storm, Lenox Hill is running its operating room seven days a week and has performed an extra 256 operations. It has delivered 124 more babies than normal and seen an extra 100 patients a week in the emergency room, according to hospital figures.
Lenox Hill has given permission for 315 NYU doctors and independent practitioners to work at its hospital as well as 700 nurses to meet the demand. Lenox Hill, which is part of the North Shore-LIJ Health System, was able to get extra beds and medical equipment as well as staff from other hospitals in the system. It also opened parts of the hospital that had been closed and used office space to house the extra patients, said Dennis Connors, Lenox Hill's deputy executive director.
"If we were a stand alone, independent facility we wouldn't have been able to accomplish everything we have through the storm," Connors said in a telephone interview.
At New York Presbyterian, doctors are still seeing double the number of trauma patients, volume at the emergency room is up 25 percent and there are no empty beds, Kelly said.
Intensive Care New York Presbyterian and Bellevue are the only trauma centers in Manhattan below 112th Street that are equipped to deal with the most severe patients.
With Bellevue's trauma center closed, patients with major injuries from lower Manhattan and parts of Brooklyn and Queens are being sent to New York Presbyterian. Eachempati said the intensive care unit is full and they have had to be more selective about which patients remain there.
"If we lost all our power, or something, it would really start infringing on people's ability to get care and create really critical delays," Eachempati said. "So far, no one has died on the way to the hospital because we were too far away." Bellevue also has one of the largest psychiatric hospitals in New York with more than 200 beds and a psychiatric emergency room. Many of those patients have ended up at New York Presbyterian, which isn't used to dealing with complex psychiatric cases.
Also closed is the Department of Veterans Affairs hospital in Manhattan, which experienced damage to the electrical system, heating, elevators, water pumping and fire protection systems, according to a Dec. 5 statement. The hospital has been sending patients to other VA facilities in the area and has a mobile medical center setup on site. It plans to reopen its outpatient clinic in March and hasn't set a date yet for when its inpatient facilities will open.
In the Coney Island section of Brooklyn where the streets are still coated in sand and debris, Coney Island Hospital is offering limited services and has no emergency room. In addition, many doctor's offices and clinics in the area are also closed.
As a result, patients are turning to medical vans. On a recent rainy morning, Yolanda Mendez, 39, stood in the parking lot of the Brooklyn Cyclones baseball team, waiting for her mother to emerge from one of five mobile medical vans dispatched to the hardest-hit parts of the city. Her mother was seeking help for throat pain aggravated by weeks of living in a cold apartment and for diabetes medication, which she had run out of two weeks earlier.
For locals like Mendez's family, the van has served as one of few points of care in the neighborhood.
"Thank God these people are here helping -- oh God I don't know what we'd do" without them, said Mendez, flanked by the wheeled cart she uses to transport the donated food and blankets that are helping her family survive Sandy's aftermath.
The mobile "Health Connection" clinic treats an average 25 people per day, most of whom are either patients of a shuttered nearby clinic, the hospital or of private doctors whose offices were trashed by the storm, said Christopher Canale, a surgical intensive care unit nurse at Coney Island Hospital who was one of seven staff members working that day on the van. People most often come seeking treatment for asthma, diabetes or respiratory infections, or because they lost their medicine or prescriptions in the storm, he said.
The care is free, provided by New York City's public hospital system, and ambulances take patients with more serious conditions to the nearest full-service hospital.
Detox Center One of those hospitals is Lutheran Medical Center, which reopened a closed wing and converted its detox center to fit in all the extra patients. It has gone from seeing 175 patients a day in the emergency room to as many as 259 and from discharging 75 patients a day to as many as 116.
The hospital is worried about what the storm will mean for its finances, said Claudia Caine, chief operating officer at Lutheran. Many of the additional patients have Medicaid, the federal-state program for the poor and disabled, which doesn't pay as well as private insurance. It has also seen an increase in patients at the clinics it operates in Manhattan homeless shelters.
At the same time, the hospital has had to pay its staff overtime for working extra shifts and tried to provide some extra amenities, like portable DVD players, for patients put in beds without televisions or mobile phone access.
"We can see the numbers climb every day and we can see where we've gone from, but it is too soon to know if the revenue will outweigh the expense," Caine said. "We can't care about that in a crisis. Everything is about doing what we have to do."