Hospitals In Cities Most At Risk Of Terrorist Attack Do Not Have Capacity To Treat Injured, Report Finds

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Article Date: 07 May 2008 - 12:00 PDT

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Emergency departments in seven U.S. cities would be "overwhelmed" if a terrorist attack occurred, and their ability to handle such an event would be further affected if proposed Medicaid changes are implemented, according to a report presented Monday by Democrats on the House Committee on Oversight and Government Reform, the Washington Post reports (Hsu/Sheridan, Washington Post, 5/6).

The report, as well as testimony from hospital officials, is part of a two-day hearing on hospital preparedness (Miller, Washington Times, 5/6). HHS Secretary Mike Leavitt and Department of Homeland Security Secretary Michael Chertoff will testify on the issue on Wednesday.

The report examined the ability of 34 EDs to handle a sudden surge of patients injured in a terrorist attack in Chicago, Denver, Houston, Los Angeles, Minneapolis, New York City and Washington, D.C. Researchers conducted a survey of the hospitals on March 25 at 4:30 p.m. local time in each city. Five of the cities are considered to have the highest risk for a terrorist attack, and two of the cities are hosting the political conventions this summer (Hall, USA Today, 5/6). The survey was taken by telephone (Powell, AP/Houston Chronicle, 5/5).

The report found that the EDs did not have the space to accommodate an influx of patients. In addition, the report found that the hospitals' intensive care units had few available beds and too few regular beds to handle patients with less severe injuries (USA Today, 5/6). According to the report, New York City had the most Level 1 ED treatment beds available on March 25, with 56 beds (Washington Post, 5/6). Level 1 EDs are considered the most sophisticated trauma centers. They are fully staffed and equipped 24 hours per day, conduct research and are a referral facility for neighboring regions. Level 2 facilities do not have research programs (Reichard, CQ HealthBeat, 5/5).

According to committee Chair Henry Waxman (D-Calif.), hospitals in Los Angeles and Washington, D.C., were particularly overburdened on the day the survey was administered (USA Today, 5/6). On March 25, three of five Los Angeles hospitals were sending ambulances to other hospitals, while two hospitals in Washington, D.C., said there were no available beds. The report found that the most overcrowded hospital in the seven cities was Washington Hospital Center, which was operating at 286% capacity. Waxman said, "America's emergency departments are already operating over capacity" (Washington Post, 5/6). Waxman added, "If a terrorist attack had occurred on March 25 when we did our survey, the consequences would have been catastrophic," adding, "The emergency care systems were stretched to the breaking point and had no capacity to respond to a surge of victims."

Medicaid Regulations
If proposed changes to Medicaid regulations go into effect, already overcrowded EDs will be even further strained, according to Waxman and emergency care experts (USA Today, 5/6). Waxman said HHS "has issued three Medicaid regulations that will reduce federal funds to public and teaching hospitals by tens of billions of dollars over the next five years" (Washington Post, 5/6). According to the report, the regulations would result in a loss of $27 million in federal funding annually for hospitals with Level 1 EDs, or 5% of their budgets, according to the report (Edney, CongressDaily, 5/5). Roger Lewis, an ED physician at the Harbor-UCLA Medical Center in Los Angeles County, said a decrease in federal funds "will severely cripple our ability to meet the nation's needs for emergency care, whether delivered under everyday conditions or in the extraordinary setting of a mass casualty event" (USA Today, 5/6).

Bruce Hoffman, a terrorism analyst at Georgetown University, said, "Given the increased financial stress on our nation's health system in general -- and urban hospitals in particular -- any degradation of our existing capabilities will pose major challenges to our nation's readiness for an attack."

Committee member Christopher Shays (R-Conn.) said that changes to the proposed Medicaid regulations need to be made but added, "Stabilizing Medicaid payment policies alone won't guarantee readiness against bombs or epidemics any more than annual cost-of-living raises assure people they're safe against inflation or a recession" (Washington Post, 5/6).

According to the AP/Houston Chronicle, Republicans "denounced" the report "as a politically motivated publicity stunt." Rep. Darrell Issa (R-Calif.) called the report "a partisan, amateur survey" that was designed to "get the answer they wanted" to justify House Democrats' efforts to block the proposed changes.

Committee Republicans issued a six-page memorandum rejecting Waxman's approach, stating that EDs' abilities to respond to a catastrophic attack "are complex and more dynamic" than day-to-day patient tallies (AP/Houston Chronicle, 5/5).

The report is available online.

C-SPAN video of the hearing is available online (C-SPAN, 5/5).

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