Financially strapped New York hospitals are spending millions of dollars to enhance their disaster readiness capabilities, according to the results of a new GNYHA survey. Since virtually no outside funding has been made available or is slated to be available, hospitals have been funding important emergency preparedness projects from their day-to-day, already lean operating budgets. The hospitals responding to the survey also identified critically needed unfunded projects that they would undertake immediately if funding were available.

"Hospitals are the first line of defense against a terrorist attack, and they are taking every possible step to ensure the safety of the public and their communities," said GNYHA President Kenneth E. Raske. "But the lack of outside funding for emergency preparedness activities, coupled with large Medicare cutbacks in Washington and now proposed massive cutbacks in State Medicaid funding, are placing an enormous burden on cash-strapped hospitals and could disrupt their disaster readiness activities."

The survey, conducted in December 2002, gathered information from GNYHA's downstate hospital members about the scope of expenditures (actual and projected) and initiatives identified for emergency preparedness. It focused specifically on incremental costs associated with activities to improve providers' ability and capacity to serve their communities in the event of a nuclear, biological, chemical, or other terrorist attack.

Survey Findings: As shown in Table 1, the 54 respondents spent $90.2 million from September 11, 2001, through the end of 2002, an average of $1.7 million per hospital or $4,000 per staffed bed. These 54 hospitals hoped to spend an additional $110.5 million in 2003—an average of $2.0 million per hospital or $4,900 per staffed bed—and identified an additional $469 million in spending for important projects if funding were to become available. Of those amounts, only $5.9 million, or less than 7%, was available from sources other than general operating revenue through 2002, and only $685,000, or 0.6% of total expenditures, will be available in 2003 from outside sources. If extrapolated to all 106 hospitals in GNYHA's downstate membership in the NYC metropolitan area according to teaching versus non-teaching status, $150 million would have been spent through 2002 and $184 million would be targeted for spending in 2003. Investments have been made, and needs identified, in areas including emergency department redesign to ensure efficient diagnosis and treatment of mass casualties, modification of heating and ventilation systems to protect the rest of the hospital from the spread of detected contaminants, and installation of decontamination showers. Table 2 shows the distribution of actual and planned expenditures reported by the 54 respondents by major category.

The survey results showed that teaching hospitals and Level 1 trauma centers have invested more heavily in emergency preparedness than their peers. This finding is not surprising since teaching hospitals and trauma centers are more likely to serve as regional, specialized centers; possess advanced disease surveillance capabilities; have analytical laboratory capabilities; and tend to have a greater scope of services than community hospitals.

If you have any questions or would like to obtain a copy of the full report, please contact Ellen Lukens or Patricia Wang at GNYHA.

Table 1. Hospital Expenditures and Projected Expenditures, by Time Period, Among GNYHA Downstate Hospitals
Category and Time Period	Total Expenditures ($)	Average Expenditure Hospital ($)	Expenditure/ Staffed Bed ($)
Spent (9/11/01-12/31/02)	90.2 million	1.7 million	4,000
Planned Expenditures (1/1/03-12/31/03)	110.5 million	2.0 million	4,900
Unfunded Projects (1/1/03-12/31/03)	469 million	8.7 million	21,000
Note: N = 54.

Table 2. Proportion of Total Emergency Preparedness Expenditures in GNYHA Downstate Hospitals, by Expenditure Category
Expenditure Categories	% Expenditures, 9/11/01-12/31/02	% Planned Expenditures, 1/1/03-12/31/03	% Unfunded Project Expenditures, 1/1/03-12/31/03
Security	4.6	3.3	5.4
Facilitya	20.4	25.5	41.0
Medical/surgical and pharmaceutical supplies - treatment	6.1	4.2	2.0
Other equipment and suppliesb	8.7	14.0	6.3
Information systemsc	31.9	32.1	32.2
Communication	2.4	3.0	1.8
Staff resourcesd	25.8	17.7	10.9
Other	0.2	0.2	0.5
Total	100.0	100.0	100.0
a Including dedicated decontamination facilities. b Including personal protective equipment. c Including disease surveillance, reporting, and laboratory identification. d Including training and drills and consultants.