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Last Updated

16 Apr 2003

Source: Wall Street Journal, April 16, 2003


Some Hospitals to Rebuff Victims of Bioterrorism

In the Event of a Terrorist Attack, Many Hospitals Opt for Lockdown


St. Vincent's Hospital, a 758-bed acute-care facility in Manhattan, recently held a drill to prepare for a nuclear, biological or chemical terrorist attack. The first step: Lock down the hospital so that no new patients could come in.

"If we can't protect the people who are here, we can't do our job," says Richard Westfal, assistant director of emergency medicine at St. Vincent's.

Doctors in the nation's emergency rooms have long sought to treat everyone. But as U.S. hospitals confront the possibility of terrorism -- especially acts resulting in victims who might contaminate others or spread infectious diseases -- a few health-care providers envision a significant, and highly controversial, change in mission.

In the case of an attack with nerve gas such as sarin or a radioactive "dirty bomb," Dr. Westfal says, St. Vincent's wouldn't admit patients until its staff was fully outfitted in protective gear. Even then, he says, it would open just one of its eight doors to the outside and take only two victims at a time, after each has had a decontamination shower. St. Vincent's has coordinated its plan with local police, who could be called on short notice to guard the outside of the building.

In Houston, St. Luke's Episcopal Hospital is vaccinating up to 75 of its staffers against the smallpox virus. But since smallpox doesn't have a cure and kills about 30% of its victims, hospital officials say they would lock down the moment conditions were deemed unsafe for those within.

Such a policy "may not have the needs of the [smallpox ] victims in mind," says Herbert DuPont, chief of internal medicine at St. Luke's, but he says St. Luke's first priority should be to its patients, staff and their families.

Last year, as part of push for smallpox preparedness, the Centers for Disease Control and Prevention urged state planners to identify facilities that might house patients in the event of an outbreak. But health-care facilities proved reluctant participants. Some feared losing revenue; others worried about a lingering stigma.

Still, in the matter of turning away victims of contagious diseases, or nuclear or chemical attack, many hospitals either haven't tackled the issue or rather have tackled it in such a way that they are hoping to meet the needs of the community with the resources they have. Some have no specific policy to lock down but won't rule it out as a last resort. For now, however, St. Luke's and St. Vincent's are not in the mainstream.

"Most [hospitals] have said it's not our job to shut people out," says Jim Bentley, senior vice president for strategic policy planning for the American Hospital Association in Washington, D.C.

David Hooper, chief of the infection-control unit at Massachusetts General Hospital, says, "Our goal is to take care of people who need medical help. Some may be on our doorstep, others may be in our hospital. But we're not closing our doors."

But health-care officials say that hospitals are generally ill equipped to deal with bioterrorism. A just-released report by the U.S. General Accounting Office found U.S. hospitals would need capital improvements and additional equipment to deal with an extraordinary bioterrorism attack -- from medical stockpiles to decontamination facilities.

"Bioterrorism preparedness is expensive and hospitals are reluctant to create capacity that is not needed on a routine basis and may never be utilized," the report concluded.

Since hospital accreditation requires disaster planning, many hospitals are ready to take emergency steps, such as following an American Hospital Association preparedness checklist, which includes a three-day supply of specified pharmaceuticals, emergency power, a loudspeaker and outdoor decontamination showers.

A group of Rhode Island hospitals are backing a state plan to use a mothballed mental-health facility in Pawtucket as a place to treat potential smallpox victims so that local facilities aren't overwhelmed, their staff and patients contaminated or infected.

Providence's Rhode Island Hospital has acquired two inflatable decontamination tents, raising its decontamination capacity to 150 from 30 in the case of a chemical attack and allowing the process to take place outside its regular facility. "We're just taking what we do on an everyday basis and extending it," says Thomas Magliocchetti, who heads emergency preparedness for the hospital.

Washington Hospital Center, Washington, D.C.'s largest trauma center, is using a $2.2 million grant from the Department of Health and Human Services to draw up plans for what it calls "EROne." Hospital officials are scheduled to unveil the design next month and they say construction will follow.

Among the features: ambulance access to the emergency room modeled after automobile drop-off and pickup at airports and rooms equipped with negative pressure, where air is vented outdoors, rather than recirculated through the hospital. "The objective is to handle three to four times the normal load with graceful degradation as opposed to catastrophic failure," says Mark Smith, chairman of emergency medicine at Washington Hospital Center.

At Washington Hospital Center, overflow in the event of a terror attack would likely be in the parking lot. "To try to isolate ourselves from the community would be hard," says Christopher Wuerker, medical director, MedSTAR transport at Washington Hospital Center.

The center has vaccinated 24 of its staff against smallpox , and intends to vaccinate all employees should the hospital treat a single case. But Dr. Wuerker says a full-fledged epidemic could possibly force the hospital to discharge some of those infected for lack of space. And, he says, locking down the hospital in the midst of such a crisis isn't out of the question. "It's sad to think that's what might be needed," he says. "But that's the reality."