Hospitals prioritize to equip for bioterror

NEW YORK (AP) -- Amid the horror of the September 11 attacks, Dr. Dan Wiener had an even more horrifying thought.

He watched nearly 100 shocked, soot-covered victims of World Trade Center collapse rush through a hospital emergency room door usually only used by ambulance drivers. And he wondered what the awful impact would be if they were carrying contagion from a biological or chemical attack.

Now, St. Luke's-Roosevelt Hospital Center in Manhattan is building a door over that entrance and revamping security. It is also developing a rapid screening process for anthrax, buying new protective suits, planning for more decontamination showers and training an additional 100 staffers in coping with a bioterrorism attack.

"We think with a different mindset now," said Wiener.

"In a way, you always knew some sort of a bioterrorism attack could happen" added Wiener, the hospital's chairman of emergency medicine. "But now that possibility is more real, and we've been adding a whole new level of expertise."

High costs in a strapped sector

Hospitals traditionally have done some planning for accidents such as plane wrecks or building fires, and for hurricanes or other natural disasters. But, experts say, they are not ready for a major chemical, biological or nuclear attack.

"On a grand scale, hospitals are ill-prepared to deal with bioterrorism or chemical attacks," said James Snyder, a microbiology professor at the University of Louisville and the author of "The Anthrax Vaccine: A Question of Safety. "We just never thought it would happen. We had a false sense of security."

The hospitals say that equipment and training for such an emergency would cost billions of dollars at a time when they are already struggling with financial losses and shortages of equipment, nurses, pharmacists and lab technicians.

A third of the United States' 4,900 hospitals lost money last year. More than 300 have closed since 1990.

The American Hospital Association is seeking $11.3 billion from Congress for more drugs, protective clothing and decontamination showers, among other things. But large amounts of money aren't forthcoming.

The Bush administration has proposed $1.5 billion to fight bioterrorism, with about $50 million earmarked for hospitals. A bioterrorism bill sponsored by senators Edward Kennedy, D-Massachusetts, and Bill Frist, R-Tennessee, has been whittled down to $1.5 billion from $10 billion. A $7 billion proposal by House Democrats has no Republican support.

James Bentley, senior vice president for the hospital association, acknowledges that many industries are asking for government help in connection with the attacks, and the threat of more terrorism.

"But the nation has to ask itself: Would it rather bail out the airlines or have a safe community?" he said.

Trying to 'spend wisely'

The association recommends city hospitals be prepared to treat up to 1,000 people for 24 to 48 hours. Smaller hospitals should be ready for 200 patients.

"We'd be overwhelmed by 100 patients," said Kris Roce, chief executive officer of Ohio-based Forum Health, which runs hospitals in Youngstown and Warren. "Even if I could open 100 extra beds, I wouldn't have nurses to staff them."

Forum Health has spent about $30,000 to purchase new two-way radios and add additional drugs. The hospitals had an operating loss of $5 million last year, and can't afford to buy more protective suits that can cost $260 each or decontamination showers that can cost $500,000 to install, Roce said.

"Buying equipment is a good insurance policy, but how practical is it?" he said. "What is the likelihood that someone will hit Youngstown, when there are bigger cities near us like Cleveland or Pittsburgh?"

OSF Saint Francis Medical Center in Peoria, Illinois, spent about $60,000 to purchase some four portable decontamination showers and hazmat suits. But its stocks of antidotes for biological and chemical weapons, such as the Atropine used for treatment of mustard gas victims, is limited.

"You try to spend money as wisely as you can," said Dr. George Hevesy, chairman of the hospital's emergency department.

Like most hospitals, OSF has distributed information to doctors on how to identify conditions such as smallpox and anthrax. In a government-run mock disaster test four years ago in Denver, 3,000 people "died" from the plague, in part because it took more than 18 hours to diagnose the highly contagious disease.

Dr. Stephen Cantrill, associate director of emergency at Denver Health medical center, said he believes the experiment left his city better prepared than most. Colorado passed a law requiring hospitals to have a certain level of drugs on hand because it took longer than expected for Federal supplies of medicines to reach the institutions.

The confusion from the trial prompted area hospitals, police, firefighters and emergency workers to realize they needed better coordination.

"I think we'd do better now," he said. "But you can't be prepared for everything."