As of 8:46 a.m. EDT that day, everything was forever changed. After the terroists struck, the healthcare industry's priorities immediately shifted, in lockstep with those of the entire nation. The healthcare policy focus was no longer so much on issues such as the high cost of pharmaceuticals, the need for a radical overhaul of Medicare or the push for more money to address hospitals' staffing crises. The top concern quickly became the answer to one question: Are we prepared for future attacks?
When the emergency calls started flooding in on the morning of Sept. 11, healthcare providers mobilized in force. The casualty count as a result of the attacks potentially could have tallied in the tens of thousands, but it became painfully obvious within hours that no matter what the final toll would be, only a tiny fraction of that number survived.
At ground zero-the twin towers of New York's World Trade Center-at the Pentagon and in rural western Pennsylvania, doctors, nurses and other caregivers stood waiting for the injured to arrive. Across the country, citizens also stood waiting to donate their blood. Meanwhile, thousands of others stood ready with their checkbooks to help fund relief efforts.
The American Red Cross was one of the biggest beneficiaries of the public's largesse, but it soon became a heavy burden. The organization came under intense criticism for its handling of cash and blood donations, and its president, Bernadine Healy, M.D., later announced she would step down effective Dec. 31 after two tumultuous years at the helm.
Even though lower Manhattan hospitals didn't suffer the costs of treating large numbers of injured patients, the terrorist attacks still took a heavy financial and operational toll on the facilities because of the devastation in the area and the damaged infrastructure. Indeed, hospitals throughout the city faced serious billing problems. Citywide disruptions in telecommunications crippled the flow of claims transactions, and entire accounting systems were incapacitated.
At NYU Downtown Hospital the 149-bed facility that was closest to the Word Trade Center, phone service still wasn't completely restored weeks after the attacks, and barricades closed access except for pedestrian traffic. At 978-bed St. Vincent's Hospital Manhattan, the closest trauma center to ground zero, inpatient numbers dropped by more than 40% and outpatient volume plunged 70%. New York-Presbyterian Hospital, with 2,346 beds, reported heavy capital costs resulting from the disaster, including nine ambulances destroyed in the collapse of the twin towers. Officials at three-hospital Liberty Healthcare System, Jersey City, N.J., estimated the attacks cost its facilities about $1 million, mostly labor and supply costs and lost revenue. Early estimates from the Greater New York Hospital Association put the overall tab for area hospitals at about $340 million.
To help ease the pain, the federal government rushed to appropriate some $5 billion in emergency relief money to the cities affected, including funds to reimburse New York and Washington hospitals for some of their losses.
As hospitals struggled to recover, healthcare executives as well as public safety and national security officials began turning their attention to the vulnerabilities of the healthcare system. Job 1 became readiness for future terrorist attacks, especially the possible use of weapons of mass destruction such as bioterrorism or chemical warfare, and the huge numbers of casualties that could result. Members of Congress immediately wanted to know about the nation's state of preparedness and appeared ready to spend hundreds of millions of dollars to improve hospitals' response capabilities.
Attack by mail
A few weeks after Sept. 11, the healthcare system again found itself in the eye of the storm. By the end of the month, the nation appeared to be under renewed attack. This time the weapons were anthrax and the U.S. mail. Although first reports of infection indicated the cases were isolated, by early October, several cases had been confirmed and at least one person was dead from the inhaled form of anthrax.
New cases began to mount. Letters laced with anthrax arrived at several news organizations, including American Media, a Florida-based publisher of supermarket tabloids, and the offices of anchorman Tom Brokaw at NBC News in New York, as well as ABC News and the New York Post. A staffer of CBS News anchorman Dan Rather also contracted the skin form of anthrax. By mid-October, tainted letters had been mailed to the Washington offices of Senate Democratic Leader Tom Daschle of South Dakota and Sen. Patrick Leahy (D-Vt.). After dozens of congressional staffers tested positive for exposure to the bacteria, House leaders took the unprecedented step of shutting down the House while office buildings were screened for anthrax spores. Postal service workers demanded to be tested for anthrax exposure after two postal employees from a Washington facility died of the inhaled form of anthrax and other postal facilities were found to be contaminated.
The first person in New York to die of inhalation anthrax infection was a 61-year-old hospital supply room worker. Her death was one of the most mysterious cases because investigators initially were at a loss to explain how she contracted the infection. Fears that the facility where she worked, 30-bed Manhattan Eye, Ear and Throat Hospital, could have been contaminated with anthrax prompted officials to shut the facility for a week as an investigation was conducted. The cause was later determined to be cross-contamination of mail.
How much is enough?
As the anthrax scare subsided in November, the battle continued to rage over federal funding to ready the healthcare industry for future biological, chemical or even nuclear attacks. How much would the hospital industry need to do the job? The first industry estimate was a whopping $27 billion. After a more thorough study, hospitals pegged the cost at $11 billion-contending each metropolitan hospital would need to spend about $3 million and each rural hospital would need about $1.4 million for vaccine and pharmaceutical stockpiling, construction of decontamination facilities and increased disease surveillance. The first bill sponsored in the U.S. Senate allotted just $1.4 billion for bioterrorism preparedness, including $350 million for hospitals. Senate leaders later raised that figure to $3.2 billion, including about $370 million for hospitals, but the American Hospital Association stated it couldn't support the bill without first seeking more money. When the House of Representatives passed its version of bioterrorism legislation, the total figure was $2.7 billion with no direct funding for hospitals.
To raise the industry's voice in the debate over bioterrorism preparedness and the fight over the size of the check from Washington, the AHA and eight other groups early in December formed the national Partnership for Community Safety.
"You have to have a commitment of resources," AHA President Richard Davidson said at a press conference announcing the group's formation. "The legislation that's being considered comes up somewhat short. That's putting it politely. So we've got a lot of work to do."