Will health care facilities be better prepared next time?

From the NY Times:

Amid the worst hurricane to hit New York City in nearly 80 years, the home, the Promenade Rehabilitation and Health Care Center, failed to provide the most basic care to its patients, according to interviews with five employees, federal, city and hospital officials, and shelter directors.

Although nursing home officials say they cannot be blamed for what happened, the State Health Department has opened an investigation into Promenade’s actions.

Cold, thirst, fear: The situation grew so dire that the next evening, as the vestiges of the storm blew across the peninsula, ambulances arrived, evacuated the nearly 200 patients over several hours and deposited them in emergency shelters in the city.

In most cases, no Promenade staff member accompanied the patients, and many patients traveled without their medical records. Both are violations of state regulations.

Some family members are still desperately searching for their loved ones, with no help from Promenade, at 140 Beach 114th Street. These patients now live in various emergency shelters or have landed in cots and beds in hospitals and nursing homes across the region.

From The Huffington Post:

New York City hospital and nursing home patients and their loved ones might reasonably have believed they were safe as Hurricane Sandy approached. Mayor Michael Bloomberg had exempted hospitals and nursing homes in low-lying "Zone A" areas of the city from his pre-storm evacuation order. Much thought and planning had gone into the decision to "shelter in place."

But anyone following the recent history of how hospitals and nursing homes have fared in American disasters had ample reason for concern.

In many New Orleans hospitals after Hurricane Katrina in 2005, floodwaters knocked out vulnerable backup power systems. A day later, still awaiting rescue in intense summer heat, doctors at Memorial Medical Center were so desperate, they intentionally hastened the deaths of some patients by injecting them with morphine and sedatives, and ultimately 45 bodies were found at the hospital.

Over the past five years, I've reported on the impact of disasters on hospitals and medical systems, from Hurricanes Katrina, Gustav and Isaac in New Orleans to Hurricane Irene in New York. I'm also writing a book about this subject. So when Hurricane Sandy approached, I interviewed city and state health and emergency commissioners about their plans and the reasons for their decision this time not to mandate hospital and nursing home evacuations in the city's most vulnerable areas.

I pressed them on this even though there was every indication they and their staffs had diligently prepared for the storm. Last year, these commissioners decided that many of the same hospitals and nursing homes should be evacuated before Hurricane Irene, many of them shutting their doors for the first time in history in part due to the lessons of Katrina.

In interviews, they told me that the decision to evacuate last year was based on fears that an eight-foot storm surge could knock out backup power. Even after Irene proved less damaging than expected in New York City, they stood by their decision to shift thousands of patients to safer locations. It was much better, they said, to move patients in a controlled, calm environment with full power than it would be to empty hospitals in the midst of an emergency.

This time around, the commissioners decided not to order as many evacuations, an approach that puzzled me since the weather service was predicting as early as Sunday morning that the storm surge could reach 11 feet in lower Manhattan and, as early as Saturday morning, up to eight feet from Ocean City, Md., to the Connecticut-Rhode Island border.

What had changed in the intervening year? Were the hospitals and nursing homes better prepared to handle a hurricane? Were the lessons from other recent disasters being applied to a storm being described as the worst in a century?

I rented a car and drove to the Long Island command center in hope of finding out. The answers I came away with after reporting from crippled hospitals in Manhattan and Coney Island and darkened, sand-swept nursing homes by the ocean in the Rockaways highlight the complexities of that decision and raise some serious questions.