“It's something that happened in New Orleans, and it's a shame that it has happened again,” said Bradford Gray, a health policy researcher and a senior fellow with the Urban Institute who studied hospital damage and response to the 2005 hurricane.
The Joint Commission and the CMS require hospitals to follow standards for emergency power supply that require hospitals to locate the generators, pumps and other emergency power supply equipment “to minimize the damage from flooding.”
But the Joint Commission and the CMS rely on outdated versions of codes issued by the National Fire Protection Association in 2000 that lack revisions based on lessons learned during intervening years, Stymiest said.
The CMS declined an interview request, but said in a statement hospitals must meet rules for emergency power to receive payment from Medicare. Federal rules also require emergency power and lighting for a hospital's stairwells and its operating, recovery, intensive-care and emergency rooms.
“We are always looking at ways to update and improve our regulations, and we will apply our experiences with Sandy and other events to see if there are lessons there for improving the rules governing emergency preparedness,” the agency said.
In New York City, where officials evacuated hospitals in 2011 before Hurricane Irene made landfall, Mayor Michael Bloomberg said during the emergency evacuation of NYU Langone that the city had been assured the hospital's backup power would work.
State health officials inspected generators ahead of the storm, he said. “Teams from the city's Health Department are at these facilities making sure their emergency generators are working and that they have backup fuel supplies,” Bloomberg said as he announced mandatory evacuations of flood-prone areas of the city, but added that hospitals were largely exempt. Hospitals facing flood risk would move patients to higher floors, he said.
The mayor's office and New York's health department did not respond to interview requests.
Dr. Robert Grossman, dean and CEO of NYU Langone, said the hospital did not evacuate ahead of Sandy based on projections for the storm surge and to avoid the risks of moving recent surgery and ventilator patients and other acutely ill patients.
Floodwater rose “extremely high and extremely fast” at the hospital and breached the vault that housed underground fuel tanks, though the vault was designed to withstand flooding, said Richard Cohen, vice president for facilities management for the medical center.
That prompted safety sensors to shut down pumps that carry fuel to the hospital's rooftop generators, which were installed about four years ago. New York City rules say fuel tanks must be located below ground or at a building's lowest level, he said. Fuel pumps are located near fuel tanks for a number of reasons, he said.
NYU Langone will bring in outside experts to analyze the system failure and review the medical center's own analysis of what went wrong.
Gary Cohn, the president of Goldman Sachs and a trustee at NYU Langone, told Bloomberg TV: “I am acutely aware that the infrastructure at NYU is somewhat old,” he said. “We do have backup generation facilities. They are not state-of-the-art, they're not in the most state-of-the-art location. That's all very, very well-known by the board of directors of NYU.”
The hospital's namesake, billionaire Kenneth Langone, who was hospitalized at the facility during the storm, defended NYU Langone's preparations. “We believed we had the machines, we believed the machines would work, and we believed everything we were told about the scope and size of the storm,” he told Bloomberg News.
Officials at Bellevue did not yet know the cause of the fuel pump failure there. Floodwater may be to blame but so may an issue with power lines to the fuel pumps, said Alan Aviles, president and CEO of the New York City Health and Hospitals Corp., which owns Bellevue.
Bellevue was expected to be closed for two or three weeks, if not longer, according to early projections. NYU Langone said last week in a statement it was too soon to know when it would reopen.
Generators at the Health and Hospital Corp.'s Coney Island Hospital in Brooklyn, which was also evacuated after the storm, are located above ground by a couple of feet and advancing floodwater forced the hospital to turn them off to prevent damage, leaving the hospital in the dark for four hours, Aviles said.
A system spokesman said flood projections did not suggest either hospital's generators were at risk, but water levels later exceeded expectations.
New Orleans hospitals took flooding during Katrina to heart. “All the generators have been moved up and are protected from floodwaters,” said John Matessino, president and CEO of the Louisiana Hospital Association. In addition, “We've improved our generators so that they'll run some, if not all, of their HVAC systems,” Matessino said.
But he's not pointing fingers at the Northeast, which doesn't get the hurricane activity that Louisiana does, having seen four since Katrina in 2005. “They don't think about them as much,” he said.
In Atlantic City, near where Sandy made landfall, AtlantiCare Regional Medical Center moved its generator last year from ground level to the third floor to better prepare for potential flooding. The move was made based on the hospital's prior experience with storms and experiences of other hospitals, a spokeswoman said.
But hospitals are not generally required to relocate generators, only to adhere to standards in place when they were built, the ASHE's Stymiest said.
Dr. David Marcozzi, director of the Hospital Preparedness Program within HHS' Office of the Assistant Secretary for Preparedness and Response, said hospital executives have to consider the cost of moving existing generators as well as how big a generator they can afford to buy and maintain. “It's a balancing act of what is the biggest generator they can buy, and how much can they afford,” Marcozzi said. “It's a little bit of a gamble.”
Hospitals that did not lose power or those that regained it in darkened communities quickly became more than a source of acute medical care.
At CentraState Healthcare System in New Jersey, which regained its power more quickly than its neighbors, the hospital's cafeteria now doubles as a restaurant, its fitness center's showers are open to the public, and some residents and staff have recharged dying cell phone batteries using the hospital's outlets, said Abbey Luterick, a system spokeswoman.