A healthcare calamity is inevitable, with long-term effects on the citizenry. The public will demand to know why those in authority didnt see it coming, why we werent adequately prepared and who will be held accountable.
Hospitals have a critical, unique role in the fight against the triple threats of natural disasters, emerging infectious diseases and anticipated terrorist attacks. It also has a large role in minimizing the terror multiplier effect, when the collapse of a major public infrastructure magnifies the effect of an attack.
Captured terrorist documents have designated hospitals as targets for primary attacks in tandem with high value targets whose casualties will overwhelm the capability to deliver care. Recently, the news media among others are asking whether the zeal for budget cuts has undermined public safety and a false optimism has compromised our ability to respond effectively. Available evidence answers a resounding yes to both concerns.
We are alarmed by what appears to be institutional apathy for short-term and/or sustained homeland security all-hazards readiness within the nonfederal healthcare industry. Washington think tanks and national media characterize the industry as the weakest link in homeland security. Recently, one of us, together with other seasoned healthcare executives, performed an in-depth analysis of the nonfederal healthcare systems preparedness. That study found that it is poorly prepared for all-hazards incident response, engaged in self-acclaim to a trusting populace and overly optimistic about its state of readiness.
The nonfederal health system, which has ownership of more than 85% of the nations health delivery assets, must immediately bring itself into full partnership and compliance with the federal governments National Response Plan and the National Incident Management System. Unfortunately, the industry has resisted federal initiatives to voluntarily comply with national strategies to prepare the country for known future threats. Its not that there hasnt been any impetus for change; the array of federal initiatives from the president, Congress and federal departments is overwhelming.
In addition to the well-known NRP and NIMS, there have been two executive orders and six directives from the president; the Defense Against Weapons of Mass Destruction Act; the Disaster Mitigation Act; the Homeland Security Act; the Public Health Security Preparedness and Bioterrorism Response Act; the National Bioterrorism Hospital Preparedness Program; the National Strategy for the Physical Protection of Critical Infrastructure and Key Assets, and the list goes on.
The widespread failure of the healthcare system after Hurricanes Katrina and Rita raised questions about the industrys self-oversight mechanisms. Current and anticipated prosecutions for negligent or premeditated homicides of elderly and infirmed patients by physicians and other providers, and actions of administrators/owners of healthcare facilities after Katrina may be the harbinger of a seamy underbelly of future mass calamities.
The American College of Healthcare Executives has also consistently failed to advocate for a strong voluntary compliance with NRP/NIMS. Annual opinion poll responses by the healthcare CEO community fail to identify all-hazards preparation among the issues that really matter to executives. If this pivotal industry force fails to recognize the importance of all-hazards threats, then it, and the trusting society it serves (including board members and shareholders), are facing deep trouble ahead.
The federal government is the ultimate risk and threat manager, as well as disaster mitigator. For two decades, the government has repeatedly called on the nonfederal healthcare sector to voluntarily prepare for some aspects of all-hazards readiness. Unfortunately, private healthcare leaders have shown little appetite to advocate and practice readiness.
Federal mandates on design and construction of federal healthcare facilities for healthcare workplace protection, known as best practices, have been closely followed since the mid-1990s. But the nonfederal healthcare design and construction industry has done little to incorporate these practices into their new facilities, preferring great glass atriums and unprotected open spaces.
What a wasted opportunity! The current healthcare building boom could easily have followed federal principles to promote a protected workplace for future hospital stakeholders. Surprisingly, the American Institute of Architectures 2006 edition of its Guidelines for Design and Construction of Health Care Facilities is silent on homeland security readiness, and the latest edition of the American Society for Healthcare Risk Managements Risk Management Handbook also fails to incorporate the nations readiness strategy.
Until the nonfederal healthcare system wakes up to its dire lack of preparedness, its role in shielding citizens from the deadly aftermath of terrorist attacks, pandemic flu or a future Katrina will be compromised. At this point, only enlightened action by the federal government can force the industry to comply with the NRP and NIMS and help assure the benefit, security and protection of the people of this great nation.
Many individuals made magnificent heroic efforts in healthcare delivery in the response to Katrina and Rita; however, had the system been prepared, especially in light of the credible warnings delivered in the days before Katrinas landfall, then most of those efforts would never have been necessary. The U.S. cannot and should not tolerate continuation of this situation. Too much is at stake.