In 2005 after hurricane Katrina, 200 patients died in hospitals that were unprepared for power outages and extreme heat. Doctors triaged patients to be evacuated (including leaving behind sick patients with do not resuscitate orders), and some doctors even sped the death of some patients they believed to be suffering too much.
A soon to be released federal rule could improve the outlook for health care centers facing disasters. The rule would require hospitals to meet standards of emergency preparedness in order to participate in Medicare and Medicaid and receiving funding.
The requirements of the rule originated in 2007, but they faced delays in approval for a number of reasons. Planning for a disaster can make for difficult politics when there are current, pressing needs. Another reason for the delay was backlash from health care groups that still feel that parts of the federal rule would financially burden health care facilities too much.
Currently, disaster preparedness in hospitals is regulated by requirements at the state and federal level. But the state requirements vary across the country, and federal provisions are usually recommendations, like those issued by the Joint Commission. The federal rule would require health care facilities to take steps such as conducting regular disaster drills, testing backup generators, creating plans for maintaining health care services during power failures, and maintaining a concrete system for displaced patients.
Claiming malpractice for deficient disaster preparedness in a health care facility is complicated because regulations come from the national government, state authorities, and from within the facility itself. In the case of hurricane Katrina, the hospitals’ plans had no provisions for a disaster at that level, so it was up to the best judgment of individual health care professionals to make up the emergency plan as the disaster occurred. It is clear that everyone involved should provide the best possible care available to their patients. But it is not clear what exactly that means, or if health care facilities can prevent such dire circumstances by following more stringent standards.
Medicare calculated that the new federal rule would cost hospitals about $8,000 the first year, and $1,262 each subsequent year to maintain standards, but many people dispute these figures saying the estimates are generally too low, and that smaller health care facilities will face a much larger burden. Still others say that the intent of the federal rule is good, but that it is going about regulating the wrong way. Some would like to see the standards set out by the Joint Commission to be used as federal mandates.
There is no easy answer. Forcing health care facilities to budget for disasters will cost the facilities thousands of dollars that will seem gratuitous until disaster strikes and those preparations save lives. If a hospital never faces a disaster, it just loses revenue.
For now, the federal rule is locked in a review stage while the discussion continues. Hopefully, we won’t need another major disaster to show us the importance of disaster preparedness for health care facilities.
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