Archives for September 3, 2005

Use of Former (?Shuttered?) Hospitals to Expand Surge Capacity

via MedPundit, the Government (Motto: "We’re Here to Help") has released some guidance for re-opening shuttered hospitals in the even of a disaster, here.

I spent some time looking these guidelines over, and they look pretty good.  This document also points out an incorrect statement I made recently: actually there are empty hospitals waiting for patients.  Nearly every major city has one or two closed hospitals sitting empty, but they’re empty of everything: beds, medicines, but mostly the skilled people who make them run.

The guidance gives several hints for who should staff these places, like DMAT’s, which make sense, especially if it’s a local DMAT and the credentialling is already in place.  The planners state the best way to handle this would be for the ‘surge capacity’ hospital to be considered a satellite of an existing hospital, which makes sense from an organizational standpoint.

Overlawyered: New Orleans Letter and EMTALA

From Overlawyered:

Longtime reader C.G. Moore, a 3L at Tulane Law who lives in St. Tammany
Parish outside New Orleans, writes in to say:

My wife, 4 mo. old son, and I survived [Hurricane Katrina] (we live
in St. Tammany parish, about 10 miles from lake Pontchartrain). I noticed you
had a link to WWL
television’s plea for medical personnel
to assist the victims. I was in a
unique position during the storm and afterward: my wife is an ER doctor, and we
sheltered at the hospital where she works.

The doctors and nurses were
incredible. They worked non-stop, under incredibly stressful conditions. Many
didn’t know where their loved ones were, or whether they had survived, and there
was no way to contact the outside world. Many lost everything to the flood
waters, tornadoes, and fallen trees. And still, they worked 12-hour shifts
(sometimes longer).

But one of the first hurdles they had to contend
with was the effects of EMTALA in a disaster situation. [EMTALA is a federal law under
which hospitals can be sued if they turn away patients needing emergency medical
— ed.] Under EMTALA, ER physicians are cautious to the point of
absurdity. But as the hospital quickly filled to capacity with seriously ill and
injured patients, the ER was able to attend to life-or-death situations only.
Strict triage procedures were needed to separate the "worried well" from the
dying. Medical care really was a limited commodity. Although the magnitude of
the catastrophe was clear to all, some patients and their families couldn’t
understand that minor boo-boos didn’t merit immediate care (much less admission
to the hospital, where it was air-conditioned and they could get a hot meal).

So, my concern is this: once the rubble is cleared and the power
restored, the plaintiffs’ lawyers will ooze back into the scene — that this was
a disaster situation won’t matter one iota — and they’ll use EMTALA to file
lawsuit after lawsuit.

I really hope I’m wrong. But only time will tell.

I wouldn’t bet against it.