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Hospital workers evacuate patient Deborah Dadlani from NYU Langone Medical Center during Hurricane Sandy Monday evening.. More than 200 patients were evacuated from the hospital after backup generators failed due to flooding following a power outage.
It is a hospital's nightmare: The power goes out and backup generators don't kick in, leaving critically ill patients without the mechanical help they need to breathe.
It happened in New Orleans after Hurricane Katrina, when hospital staff were on their own when electricity and water cut out. Some died.
It happened last year in San Diego, when generators at two hospitals failed during a blackout.
And it happened last year in Connecticut, when a hospital had to be evacuated during Hurricane Irene when its generator failed.
As Hurricane Sandy headed toward the East Coast, New York City Mayor Mike Bloomberg said Sunday, he was assured that hospitals were ready. "The teams from the City Health Department are at these facilities making sure that the emergency generators are working and that they have back-up fuel supplies," he said at a news conference before the storm.
In spite of this confidence, the generators at some hospitals did not work as expected. In the most high-profile case, New York University Langone Medical Center had to evacuate all 215 of its patients when its power went out and both of its backup systems didn't work. Staff had to hand pump oxygen to critically ill patients until patients could be taken by ambulance to another hospital.
In New Jersey, patients at Palisades Medical Center had to likewise be evacuated in recent days after two generators failed. A hospital spokesman said today that officials were working to bring the "plant up to speed" and could not immediately answer questions about the generators.
And this afternoon, Bellevue Hospital in New York City said it is evacuating hundreds of patients because of failing power and deteriorating conditions. "It's Katrina-esque in there," one nurse told ABC News.
Experts say such failures are troubling but not entirely surprising. Dr. Arthur Kellermann founded the emergency department at Emory University and headed it from 1999 to 2007. Now, he's Paul O'Neill-Alcoa Chair in Policy Analysis at RAND Corporation think tank.
The other night, as the NYU evacuation was unfolding, he tweeted, "Hospital preparedness and well-functioning backup systems are a costly distraction from daily business, until they are needed. Like now."
In an email interview with ProPublica, Kellermann elaborated: "I have no doubt when the hospital assured the Mayor that their backup systems were ready, they believed they were. They were wrong. What I find most remarkable about this story is that [more than seven] years after Hurricane Katrina, major hospitals still have critical backup systems like generators in basements that are prone to flooding."
Bruce Altevogt, a senior program officer at the Institute of Medicine who has studied crisis standards of care, lauded NYU for safely evacuating patients. But he said the incident should prompt a new discussion about where hospitals place generators and how to ensure they work when they're needed.
Newly constructed hospitals are supposed to place their generators and fuel in adjacent locations above flood level. But the location requirements do not apply to already-built hospitals.
"These older facilities, it's just an economic issue," Altevogt said. "They don't have the resources, or they haven't devoted the resources to moving the equipment to locations that would be less prone to disasters or flooding in these cases."
An NYU spokeswoman told Modern Healthcare magazine Tuesday that "part of the generator is on the roof and part in the basement, which she said took on 8 feet of water. The reason for the failure, she said, is being investigated."
New York hospitals have had experiences with generator failures before and have seen the consequences firsthand.
In 1987, a 22-minute power failure led to the death of a 40-day-old infant at New York Hospital. "The prematurely born infant, whom officials declined to identify, died after his electric respirator stopped and efforts to help him breathe with a manual air pump failed," the New York Times reported at the time.
A decade before that Bellevue Hospital lost all power during the massive New York City blackout in 1977. The Times reported at the time: Doctors and nurses squeezed bags of air with their hands to resuscitate patients when respirators stopped, and emergency generators were brought in."
During another New York City-wide blackout in 2003, an official report later said, "Despite prior testing according to applicable State and accreditation standards, [some] generators malfunctioned, experiencing, for example, problems with switches and overheating. ...In a few cases hospitals reported that fuel supplies for generators fell to dangerously low levels, in part because of transportation difficulties encountered by fuel delivery trucks."
Back at NYU, a hospital trustee, Gary Cohn, said that the board knew the facilities' generators were outdated and at risk, according to Bloomberg Businessweek.
"The infrastructure at NYU is somewhat old," Cohn said in a television interview. The backup generators "are not state-of-the-art and not in the most state-of-the-art location."
A hospital spokeswoman defended its systems to the Huffington Post.
"Our generators are fully compliant with all state and federal regulations and, using good prudence, we test them all the time as we have to do anyway," Lisa Greiner said.
Emails to NYU staff by ProPublica were not returned prior to publication.
Another expert in disaster planning, Dr. Dan Hanfling, said in an email that the failure of the back-up power at NYU Langone "is certainly unexpected."
Hospitals, he said, are required by the Joint Commission, a hospital accreditor, to have back-up power capabilities. They are required to "load test" those systems a few times each year. (Update 10/31: The Joint Commission says it requires tests 12 times a year for 30 minutes and once every three years for four hours.)
"Evidently, the catastrophic failure must be explained by something else," wrote Hanfling, a special adviser for emergency preparedness and response for Inova Health System in Virginia.
In his email to ProPublica, Kellermann wrote that the irony of the NYU generator failure is that New York City's hospitals and health department "have taken preparedness more seriously than nearly everyone else in the country, particularly since 9/11/01." RAND tested a novel, no-notice disaster drill at a different city hospital a few months ago and it performed very well.
The situation at NYU should be a lesson for all.
"Preparedness is not simply a hoop to jump through to satisfy the Joint Commission, or to keep the Fire Marshall off your back," Kellermann wrote. "It is a fundamental duty to the community, state and country. Assuming nothing will ever happen, or counting on your staff to 'rise to the occasion' is not a plan, and it is not preparedness."
Hanfling went a step further. "Lesson to learn: hospitals must be prepared to evacuate patients. This may be the 'new normal' for hospital preparedness efforts," he wrote.
This story was originally published Oct. 31 by ProPublica.
Related stories on Vitals:
- New York's Bellevue Hospital evacuates patient as power stays off
- Hundreds evacuated after generator fails at NY hospital
- Confusion in the storm: Alzheimer's patient refused to evacuate
Leave a Comment:
As a way of cutting expenses, they failed to maintain emergency systems. Bank on it.
Many back up systems are gasoline or diesel fuel which cannot be stored for long periods of time because it gets gummy. However with propane its not a problem, this article dosen't say what systems are in use. Small 20kw standby units are relatively cheap and use up little space, they could have several in strategic locations. The cost is less that what they charge for one hour in the operating room.
Crisis in NYC as it crumbles, meanwhile the Mayor is out playing politics. The Governor of NY needs to take over if the catastrophe is to be halted.
Makes me wonder if Nuclear Power Plant back-up systems would work for a prolonged period - the financial incentive for underfunding such systems is part of pure Capitalism's soft underbelly.
There should be absolutely no excuse by the maintenance staff; City Codes departments and the State of New York. Yes, commercial back-up generating systems are expensive, and their automatic monitoring systems; Load Transfer systems and all of the maintenance thereof is absolutely critical.
The secondary, electrical back-up systems for large hospitals need to be state of the art and maintained with the same importance as the patients they serve. ALL back-up generating systems 'self-test' themselves through programed 'starts' with load transfers on a regular basis. Usually once a week. I would bet that that isn't happening. Fuel supplies MUST be Natural Gas, not should be Natural Gas. These systems should also be either roof mounted (reduce chances of flooding out) or mounted high enough to preclude most flooding events of any nature. I think it's about time the hospital administrators, City government, State government and the people DEMAND fail safe, critically important generators. This should be an embarrassment to them all.
Natural gas is not approved for life safety use unless it is stored onsite. The best for short duration outages (hours not days) is diesel, however most older hospitals have most of their electrical distribution in the basements so even if the generators are placed higher some electrical components remain below unless tons of money is spent. Putting them in the middle of the building is very expensive on a retrofit but the best solution.
I work in the pork industry. Once a week, (Wednesday) the generators run for an hour. Also, during peak times in the summer, the generators run the barn. I believe that they get a break from the electric company. I know this because I'm an IT person and need to make sure every computer has 2 surge protectors because the generators kicking in and out really mess up the computers.
I would think hospitals would test at least as well as the pig industry. Once a month doesn't seem like much of a test.
Yes, and lets not forget Joplin. They had their generators outside and guess what was the first thing sucked up by the tornado?
I do medical facility inspections and most facilities have national companies that do the maintenance and testing. They are normally very thorough. As stated. Joint Commission requires the generator be run once a month for 30 minutes and for 4 hours every few years. The battery systems are inspected and documented monthly. Not sure what else you can do.
Problem is what disaster do you prepare for? Someone mentioned Natural gas. Well, if you have an earthquake, the gas lines get damaged. On site fuel is still the best solution.
Backup power vary in capacity depending upon the load they are designed to handle. A hospital should have a pretty substantial system. The issue is that these were not designed with a hurricane surge or flooding in mind. In the city, these can be on a roof, but not to high of a roof so they can be removed by a craine as needed.
There was a STUPID law in the 70's that required businesses to have backup fuel source using propane. They are not very practical and the tanks are an explosion hazzard.
Diesel is by far the best to use. As long as Biofuels are not used, diesel can last quite sometime when stored and since by law auxiliary power plant are fired up once a week fresh diesel is added periodically.
The 10th street Bellsouth / AT&T telephone office has a megawatt of generating capacity with phase synchronization capacity to connect to the grid. The one aspect that never gets tested is picking up the entire load from an unpowered state. Hospitals have the same problem in that they are not going to interrupt all power and then pick it up with the emergency system. This leaves a big window for failures that are not part of the test. At El Paso Electric company, the test was initiated by cutting off the main power switch, making most of the lights go out (which would come back on in seconds when the generator started). A large Uninterruptable Power Supply that ran continuously from batteries handled critical load. Quite expensive but well worth it. This UPS was not like the ones used with computers that switch, it ran all the time, which caused a loss of efficiency and generated a lot of heat. Hospitals could take a lesson from the power companies. Cost should be secondary to safety.
My whole-home stand-by generator "exercises" itself once a week. Last winter, it didn't start on its scheduled exercise schedule, although it had the previous week. The reason was because the battery went dead. In a week. And these hospitals only have to test once a month? No wonder the equipment failed.
J Reid.. You are so right.. When Preventive Maint. goes out the door it will always bite you in the a$$.
Hospitals are run by administrators who economize everything.. Apparently there was no plan B..
The reason for Homeland Security and the job of FEMA is to respond quickly and efficiently to any emergency. The latter has had many opportunities to show how they would react to a emergency situation, without success. State and Federal resources are more than adequate to handle supplying what is needed in first responder command centers. HOSPITALS! After the owners can be sent a bill for not being prepared, by paying costs of state or federal agency. .
What do people expect? You have a mayor who announced today that he is endorsing a President just because he favors abortions and same sex marriage. Bloomberg is a joke. Instead of finding time to endorse he needs to concentrate on the more important things, like helping the suffering citizens of NYC.
Ah, but there are additives for gasoline that will keep it usable for years, one of which is Stabil and can be bought at WalMart. We use that in the gas for our generator! Diesel has a FAR longer shelf life than gasoline. It needs to be kept airtight and at reasonably low temperatures. It does tend to collect water, hence the airtight recommendation and needs to have the water drained off annually (preferably by a drain in the bottom as water is heavier than diesel).
There's no excuse for these hospitals not to have their generators in good working order.
Johnathan,
that is almost a certainty. We see the same greedy ignorant behavior everywhere. Cut corners in safety to save a buck. We really need to reform our greed-based economy because it is going to end up killing us before too long.
We test our home generator weekly. When I worked, I was responsible for facilities. We had a generator, diesel powered via a huge buried tank. The generator was on a raised platform. We had a huge UPS to protect systems that we did not want interrupted during the turnover. Did it cost money? Of course, but it is a better choice to prevent disruption to business and services.
Smurf, the other problem with diesel is cold temperatures - it'll start to gel. But a little AV-gas will keep it flowing.
This had nothing to do with cold temperatures and gelled diesel fuel.. Most large generators are diesel fuel which has a longer shelf life.. The lack of maint. here is the culprit. They got caught with their pants down.. I totally agree about Bloomberg. He is a total a$$.
let me tell u something. at the price a hospital charges every patient just to walk in there is no excuse what so ever that these places dont have newer up to date generators on there roofs or were ever is safe from floods or other major weather problems. NO EXCUSE AT ALL!!!.MAYBE NOW THE ONES THAT SCREWED UP BY NOT CHECKING AND DOUBLE CHECKING BEFORE A MAJOR STORM SHOULD HAVE LOTS OF LAW SUITS AGAINST THEM for haveing to transport sick people who depended on them and were put in danger unnesisarilly. just like the law suits hospitals throw at the people unable to pay there bills to them when the hospitals want them. hospitals must make an enourmose amount of money judgeing by what they have charged me in the past. for insteance 18 dollars for a tylenol pill, and 150 dollars to check in. whats up with that??
You're paying $18 for a Tylenol pill because hospitals are required to provide emergency treatment to people who can't pay them, and there are tens of millions of Americans who don't have health insurance. So the hospitals have to charge huge amounts to the people who do have insurance or at least have the finances to pay to offset the many who can't.
Ask your safety and maintenance people how much cooperation they get from senior management in enforcing testing of back-up power systems. Ask them how high up on the capital improvement budget priority list these items are compared to new high-tech surgical equipment or attractive furnishings for the board conference room.
Often the attention given to these systems is the bare minimum needed to comply with regulatory and accreditation standards because these are not considered "revenue generating" expenditures. Really hope that's not the case in these facilities.
Considering the amounts the hospital charges for care whether it is being paid by individuals or the insurance companies, one would think they would have at least one no-fail back up system. This is unacceptable.
If everyone receiving care at the hospital was indeed paying, then this might not be an issue. Having to provide service free to the indigent cuts into a hospital's ability to upgrade.
Insurance companies pay THE Hospitals between 12-20% OF THE BILL THEY TELL YOU THEY ARE PAYING 80%. Ask for a copy of any bill and look at what the Insurance company actually paid.
Intimately familiar with emergency power systems, their operation and maintenance. Properly maintained and serviced these systems do not fail. Look to the maintenance companies that have been contracted not the medical facilities.
At every hospital I've ever worked at over the last 20 years, there has been a failure of the backup generators during an emergency and patients had to be transferred out. This was about 4 times total, so about every 5 years on the average. To have a failure like that is extremely expensive, irresponsible and harmful to patients. While I'm sure the hospital quoted was following all the laws, obviously those laws are not very concerned with patient safety.
Patient safety is something the administrators of hospitals always act as if that were their top priority...unless it costs money. At one hospital a patient fell and was seriously injured. But when I suggested we put in reasonably costing state of the art electronics to detect patients when they got up, the rest of the committee looked at me like I had grown a second head or something. After months of discussion, they finally decided they would just make the nurses patrol the halls more to watch for patients trying to get out of bed and still use the tag alarms the patients could just remove and get up. That's what often happens in hospitals: the administrators make an edict but the nurses having to take up the slack and actually do the work.
So, it doesn't surprise me that in this example, the pumps for the fuel were in the basement and when it flooded (duh, like we're having a storm here...), they no longer worked. This was predictable by anyone who really was concerned about patient safety and not just "following the letter of the law." It's really disgusting now that administrators have taken over hospitals, they are willing to take on potentially heavy law suits rather than cut into the bottom line during their time at the wheel. However, once those hospitals get their butts sued into the next millinium, perhaps the remaining hospitals will fix the problem.
Without gasoline and diesel available, it's not going to make much difference if the generator works or doesn't because none will. You sound like someone who got fired from a hospital. Why bother to take your family to one, just you and your holier than thou attitude keep them alive at home. You think medical care is owed to you, do you?
If the public expects hospitals to provide medical assistance to indigents (as it does) and if the public also expects hospitals to provide working generators when needed, then why does the public refuse to pay for a national health insurance, payable by EVERYONE, deducted at source. If the public expects all holders of driving licences who own a car to pay for driving insurance, why is health insurance such a problem?
Just wondering.
But... but... the private sector is supposed to make *everything* better!
Clark - that's a cheap shot. You sound like the kind of senior management Rural Washington describes as wanting to give the appearance of safety and quality as a priority as long as it doesn't cost much. The points he/she makes are true more often than people want to believe.
Short term gains versus long term risk. Don't maintain your car with new oil, general maintenance and even driving and you will see what happens to equipment not maintained properly. All emergency equipment must be tested on a regular (quarterly) basis or you risk your victims' lives.
I'm wondering how the other hospitals are absorbing so many critically ill patients and infants. Does anyone know how to volunteer to help or if they need the help? I'm sure the staff from the flooded hospitals are helping out if not just taking assignments of their own patients but they are having troubles in their own lives...childcare, ect.
QA and maintenance check may need to be upgrade and take it seriously.
I guarantee you that the mandatory testing they do doesn't included filling the basement with 8 ft of water or even putting any stress on the generator other than a load. As for the hand pumping, I'm surprised that they do not battery backup units for the infant respirators as a redundant backup to the generators. It would have been a shame if one of those infants had died because of the hand respirators. However big kudos to the teams that got those infants to the backup locations without losing anyone!
Their Chief Engineers need to be fired immediately!
Generators for hospitals should be TESTED & VERIFIED weekly if not daily!!
This is a dismal reminder that at the dawn of the early-21st century nobody cares about anything anymore, and the concepts of ethics, accountability, and responsibility left the building along with Elvis and are unlikely to return anytime soon, really . . .
Really! :-o
I think Elvis is more likely to return.
hospital staff resent the testing of the generators and do everything they can to stop the tests they also resent the money spent on the equipment claiming it should go to staff salaries i should know i am a retired generator mechanic
In Florida, fire stations usually have emergency generators fueled by stored propane that start automatically every monday and run for about an hour. Orlando hospitals also have large generators; hell, I think even Dizzy World has generators. WARNING! Using a portable generator (or cooking w/ charcoal) inside your house will kill you. It is local government who needs to inspect all emergency equipment. Hey, NYC, NJ...did you read this?? You failed.
This was only a single storm - and yet the upper east coast is essentially paralyzed.
It's only a precursor of what to expect when the dollar fails - and there's no way to pay for the fuel or the food.
A word to the wise is sufficient, (but a sermon to the simple falls on deaf ears...)
Several countries have had their currencies collapse since WWII and the results were painful, but nothing like what you're talking about. You're exaggerating the danger in this case.
I seen the label where it was made ..Made in China enough said..
But look at how much money they saved vs. the cost of a generator from a reliable company!
As I discussed in another post; strategically located gas stations in 'evacuation zones,esp' should be required to have emergency back up generators. Learn by my horrible hurricanes in Florida in 2004. Jeb Bush enforced it. A very good 'Bush'.
It was a natural disaster...if a comet hit they would still complain. Shows the people can not survive without this way of live people are used to. People have forgotten how to take care of themselfs.
I smell a law suit. A big one. And justifiably so. The behavior of these hospitals shows a callous disregard for human life. The feeble condition that these emergency back-up systems are in underscores just how broken our health care system really is. These hospitals are cashing in, while hawking all the drugs for big pharma, and they can't spend a few bucks on emergency back-up systems that actually work?
I missed something here; Emergency generators in basements? (w/ propane gas). I wouldn't have one in a basement of my house and I wouldn't have a bomb there either. Geez, did I miss something in the article? Did anyone see the natural gas fires burning in NY in the open? (perhaps there WAS a house there before).
Excuses,excuses excuses, come on do we need to send people the boy scout manual about being prepared! I learned this as a young girl hiding under my desk during drills during school. My daughter is a nurse and was astonished that they did not have all their t's crossed and i's dotted!
And the bad thing about this also was the fact all the nurses busted their butts to keep everybody alive while the head honchos of the hospital are the reason of the neglect and failure! Thank God for nurses!
Generators Fail Again. Why oh Why can't people and our Government learn from past experiences? This government of ours is so Damned concerned about foreign countries and THEIR welfare that we are left to flounder in an Emergency. This should be Another lesson to Hospitals all over the country to start doing some Maintenance on their Backup Generators. It's Crazy. Oh, has anybody Heard of all the offers of help from around the world?? Neither have I.
Gasoline cannot be stored for a long period, however generators of this size are mostly Diesel, which can be stored considerably longer. There may be a few generators that are natural gas or propane. The story does not explain what the failures were caused by. Mechanical failure cannot always be predicted, fuel being contaminated by water (due to the storm), or even an electrical component within the generator can cause this issue. A second generator with separate fuel storage would help the situation. If the first unit quits, at least the second can be used while the first unit is being worked on. I work in the third world and I always consult that we install 2 generators for these situations.
Also, if a generator is on natural gas and the natural gas supply is cutoff, the generator fails. On site diesel is a more sure source. However, this brings environmental issues for storage and this gets expensive. Short term solutions for long term problems always bites us in the butt. But no one wants to pay for long term solutions and then we get angry at the officials instead of ourselves for allowing these decisions in the first place. Are we willing to pay for proper long term solutions? Really?
Could have something to do with having main electrical distribution panels in the flooded basement too.
My only comment at this time is that as long as large populations of human beings continue to live with the oceans as their next door neighbor stuff will happen. This article highlights backup generator stuff. Whatever. We are no match for mother nature and daring her by living a few feet above sea level and a few feet from shore is just plain stupid.
Fed Up,
We have these things called ports and railroads that are necessary to move goods. You can't have a port twenty miles inland. People who work in these places need to live within driving distance.
As for not living near the shoreline. There are millions of people and thousands of businesses clustered near these ports. How do you propose moving them? How do you propose telling people and business owners that they must walk away from their property? Are you going to promise that they will be made whole if the agree with you? Or do you just propose they should abandon their homes and businesses without financial compensation? If the latter is the case, you haven't got a prayer. If the former is the case, most of them still won't go. What do you propose?
It's all well and good to make these sweeping pronouncements. But you need to think through the logical consequences of such a move, the costs of such a move, and the liklihood of such a move. It may be expensive to build sea walls and dikes and dams, but it's cheaper than moving cities and populations of millions. Consider the realities of what you recommend.
Actually, you can have a port 20 miles inland. But I agree that moving NYC is not going to happen. They do need to build and upgrade sea walls. That said, practically the entire borough of Manhattan is built on steel stilts below the water table. If the pumps ever turn off, the subways and basements will flood over days to months and the whole city will slowly collapse. Cities are artificial constructs wherever you find them, and require constant upkeep. Sea levels over the next hundred years are going up a few feet I think, so these upgrade will happen. Irene last year missed flooding NYC by inches. In ten years, those inches will be gone.
I thought that Obama's brief photo op in Jersey would have fixed all this. Maybe he was in a bit of a hurry to get back to Vegas and campaign all down and funky instead. The weather is good there, and there are lots of golf courses. Haven't had an Ambassador murdered in days. SWEET! Just another day in the life of our POS in Chief!
Blamo,
You really need to do something about your anger issues. Using that kind of epithet to describe your President does not sway people to your point of view. It alienates them and serves little purpose. If you cannot be respectful of the man, then be respectful of the office. There is more than enough anger and animosity in the world. It doesn't help to add to it.
He debases the office. I am not angry. Just call them as I see them. I don't live life with blinders on. It is amazing when one embraces reality. Try it. I guarantee that you will like it.
Blamo: Why bother to find fault with the President's actions in visiting the scene of the greatest storm damage. If he hadn't gone there but continued to campaign for the past 3 days you would have found fault with that. if he stayed longer, you would say he should get out of the way and let the local experts get to work. Save your phony arguments and just say it right out: You hate Obama and whatever he does is wrong.
Very few basement electrical system work well under water. I'm not a huge fan of rooftop systems as hurricane winds can severely damage rooftop installations. The best placement would be midpoint.
Would it be costly to relocate back up systems and electrical grids? Of course. But in the event of a disaster that precludes transferring patients and lasts longer than a few hours, what is the real alternative? Do we just accept that a certain number of people are going to die?
The alternative is the so called terror attack response team(Homeland Security) to do their job. Save lives, assist local and state agency with federal resources. If anything it would train them in techniques required in a major attack. Unless of course there aren't going to be any attacks. In Florida we have gone without power for weeks. Water is number 1 item. To bathe, flush, and drink.