The view from inside major medical centers
KELLY: We've got time for some questions. I see a few. Jim, you can – if you would identify yourself –
Q: Mike Anderson, Homeland Security. I'd like to ask the panel if any of your organizations have considered altered standards of care in your plans?
PEACOCK: Yeah, I would say that we have that in our policy actually that if we are overwhelmed by a disaster, the moribund patient – the person who is going to take a tremendous amount of resources to save and you don't have the hands or the time – you have to have the contingency, which is those patients are going to get some morphine and get set in the corner. And when you're done treating the 30 patients you have over here and they're okay, you go back to them, but the probability is they will not survive. And that's the definition of disaster is need exceeds resources, and you make those decisions. And as the gentleman to my right was talking, the ethics had come in. That's a very difficult situation.
RUNNING: Brian?
KELLY: Yeah, Alex.
Q: Hi, I'm Jane Birnbaum. I'd like to follow up on the remarks of Cleveland's Dr. Peacock, who I think has hit a number of nails on the head. If what we have here is a money problem, an infrastructure problem today when we're in an era of for-profit healthcare delivery, are medical directors such as yourselves prepared to go to Washington and lobby members of Congress and say, well, we have tax cuts for millionaires but we need more money from Washington?
PEACOCK: Well, what I would like to see is we should mothball battleships – I think we should mothball buildings that are set up for a hospital. Every major city could take an old warehouse and stock it, not with perishables, but with a bed and with oxygen and that sort of thing so that you would have an option. It would not be high cost, but you know, there is no private industry going to do that unless there is funding source. And so, I sort of perceive this as lobbying Washington, but you had a more specific question.
SALEM: I think that I've recently interfaced with a number of senators and congressmen at least from our state and they have an acute awareness of these issues. And they have, of course, appropriated a substantive expenditure at least as it deals with avian influenza, and so I think that they want to solve the problem, but the issue of this kind of insurance and preparedness and buying buildings and providing surge capacity – I'm not sure has been addressed.
Q: I'm a psychiatrist, chairman of a large mental health company. During Katrina, there was serious mental issues as to what to do with the mentally ill, particularly the seriously mentally ill. Have you had any thoughts of how to deal with that population during such a crisis?
BURKE: Well, I think during the Katrina event, we had a special mental health team at both the Astrodome and the George R. Brown Convention Center, which were the two evacuee sites. And they were there specifically to meet the mental health needs of patients who were evacuated. That was a team that was separate from the regular medical team that was triaging for medical issues. And we had separate areas set up for those patients as they came in. That's an acute issue, not a long-term one, obviously.
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