New York hospitals struggled to regain their footing during a mind-numbing week interrupted by an endless round of memorials.
Stunned by the human toll caused when New York's World Trade Center toppled, breaking the financial heart of the nation's largest city, hospital executives were only beginning to think about the toll on operations. They began to dismantle the staging areas that went tragically underused in the hours after the disaster, and they tried the best they could to resume business as usual with patients frightened away.
It was a week in which the accounting term "days' cash on hand" suddenly took on a grim sense of reality.
Hospitals throughout the city were just beginning to tackle mounting billing headaches. Citywide disruptions in telecommunications crippled the flow of claims transmissions. Entire billing systems were incapacitated by the attack, said Patricia Wang, senior vice president of finance and managed care for the Greater New York Hospital Association.
"All of the plans have expressed tremendous good will and their intent to help hospitals," Wang said. "We are trying to confirm more exactly what they are willing to do. Hopefully, there will be a waiver of requirements for a period of time."
The disaster aftermath put a chokehold on NYU Downtown Hospital, the already financially struggling 149-bed community hospital that lies closest to the World Trade Center, serving workers and residents in the city's financial district as well as residents of Chinatown on the other side of the Brooklyn Bridge. The neighborhood firehouse next door lost four firefighters in the disaster.
Still visibly shaken after a week in which all power and telephone lines were cut and a layer of dust and debris settled on and around it, NYU Downtown last week tried its best to get back to the daily grind of patient care. But nine days after the attack, only 70% of its telephone service had been restored, and police and National Guard barricades cut off the neighborhood to everything but pedestrian traffic.
With the hospital's patient population cut off, President and Chief Executive Officer Leonard Aubrey said he set up van services to bring patients in, and the hospital also was working with the Chinese-language press to "tell people that we are open for business."
Even before the disaster, NYU Downtown was not in the best financial shape. In 1991, it won a dubious distinction as a state-designated "financially distressed" hospital because of its large number of Medicaid and uninsured patients, Aubrey said. From 1996 to 2000, the hospital lost an average $5 million a year on $105 million in patient service revenue. On the bright side, volumes in key parts of the hospital grew nearly 20% in the last two years.
"Obviously we have suffered a reduction in business," Aubrey said, sitting at a conference table littered with the remnants of a command center.
On a normal day, the hospital would tally as many as 30 ambulatory surgeries. On Tuesday, one week after the disaster, 15 ambulatory surgeries were scheduled, but only seven patients actually showed up for them, he said.
NYU Downtown's emergency room was painfully quiet except for a straggle of worn-out neighborhood residents and rescue workers seeking treatment for minor injuries and exhaustion, said David Goldschmitt, M.D., its director.
"Everybody in the country has gone through a grieving process, but some of us here are going through it this week," Goldschmitt said. "Now it's starting to all sink in, and we're worried about the hospital, too."
St. Vincent's Hospital Manhattan was not in much better shape. The closest trauma center to the disaster area, St. Vincent's valiant efforts in the hours after the disaster were more visible on national television screens because it lay outside the police barricades, providing easy access to the press.
"Manhattan was losing money, and this is going to exacerbate that. We've had a significant loss of business," said Jane Connorton, president of the 978-bed hospital.