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<<   作成日時 : 2010/01/03 23:50   >>

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病院の脆弱性への新たなカトリーナの襲撃/米国医療事情
 ハリケーン・カトリーナによりニューオリンズで氾濫がおこる3年前に、ペンドルトン記念メソジスト教徒病院のシニアエグゼクティブは、長い間恐れられていた、氾濫などへの弱点を評価した。全国の病院にとって重要な意味を持つ訴訟においてこの結論は現在証拠となっている。
 病院を守る緊急発電装置と燃料供給を再配置するには750万ドルかかる。
 カトリーナ襲撃により73才のAlthea LaCosteが亡くなり、家族は病院が緊急事態に対応するためにどう準備すべきかについて法的問題を提起している。ハリケーン後にニューオリンズ地区の病院や老人ホームでバックアップ電力システムがダウンして搬送を待てずに100人以上の患者が死亡した。約200の訴訟が起こされている。緊急事態に備える医療機関の新たな責任問題であり、全国が注目している。
 ルイジアナ州最高裁は、医療過誤とな異なり怠慢に対する訴訟と決め、病院管理者の潜在的な責任を増大させた。家族は病院が10,000ドル未満の投資で浸水対応の燃料ポンプに換えていれば事態は避けられた可能性があるとしている。
 国内の病院での電気系統の標準的な基準では緊急事態に短時間の停電に電気を維持することに対応している。2001年6月のヒューストンの氾濫で、国内最大規模のテキサスメディカルセンターは電力を失った。
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パッチワーク・シティ/病院閉鎖が復興を遅らせるニューオリンズ
http://kurie.at.webry.info/200707/article_49.html
ハリケーン被害で病院職員の1/3を解雇/米国医療事情 テキサス州ガルベストン
http://kurie.at.webry.info/200811/article_32.html
ハリケーン後の子どもたち/米国
http://kurie.at.webry.info/200712/article_8.html
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The New Katrina Flood: Hospital Liability
http://www.nytimes.com/2010/01/03/weekinreview/03fink.html
By SHERI FINK
Published: December 31, 2009
画像

James Nielsen/Agence France-Presse ― Getty Images
ISLAND Pendleton Memorial Methodist Hospital was one of many health centers inundated by flood waters.

Three years before Hurricane Katrina inundated New Orleans, a senior executive at Pendleton Memorial Methodist Hospital assessed its vulnerability to the sort of flooding that had been long feared there.

Her conclusion is now evidence in a lawsuit against Methodist that could have significant implications for hospitals nationwide.

“The first question is, do we have generators placed to accommodate an emergency flood with 15 feet of water?” wrote Cameron B. Barr, then an executive vice president. “The answer to that question is no.” One of the two main generators was located on a roof, she said, but another “would be nonfunctional at about two feet of flood water around the generator.”

Not only would it have to be relocated, he said, but the power plant and an underground tunnel connecting the plant to the hospital would have to be protected.

As a “back of the envelope” estimate, Mr. Barr wrote, “to protect the Hospital, East Tower, power plant building and to relocate the emergency generators and fuel supply would probably be a $7.5 million project.”

But the money was never spent, the power went out, and the hospital’s life-support machines stopped working. Now, the family of Althea LaCoste, a 73-year-old patient who died in what her family’s lawyers allege was sweltering heat after nurses spent hours pumping air into her lungs by hand in the pitch dark, is raising a potentially far-reaching legal question: How prepared do hospitals have to be for the worst possible circumstances?

More than 100 deaths occurred in New Orleans-area hospitals and nursing homes after Hurricane Katrina when emergency backup power systems failed and patients languished for days awaiting transport. About 200 lawsuits have been filed in Louisiana alleging that these institutions are liable for the deaths and for the suffering of other patients who survived because corporate failure to plan adequately for flooding and implement evacuation constituted negligence or medical malpractice.

The LaCoste trial is set to begin on Monday. “This could be a new theory of liability against health care institutions ― lack of emergency preparedness,” said Kristin McMahon, an attorney and chief claims officer for IronHealth, a company that insures hospitals. “The courts across the country will be looking at it.”

The case has already been precedent-setting in Louisiana. The state’s Supreme Court decided the allegations were based on general negligence claims, as opposed to medical malpractice in which damages would be capped at $500,000. This markedly increased hospital owners’ potential liability.

Mrs. LaCoste’s family alleges that the hospital was negligent for having inadequate emergency power systems, evacuation plans and floodwater protection. They say a fuel pump that failed after it was flooded caused the higher generator to shut down ― an event they say could have been avoided if the hospital had invested less than $10,000 in a submersible pump.

The hospital’s owners argue in court filings that Hurricane Katrina was an “act of God” that could not be foreseen, that the hospital was not negligent, and that it would be unreasonable to expect a hospital to be impervious to all of the unlikely catastrophes its emergency plans contemplate, including tornadoes and a “terrorist event.”

Methodist’s owners also maintain that the hospital’s emergency power system “met or exceeded applicable electrical codes and standards.”

But systems that meet those standards are “not always sufficient” in major catastrophes, according to a warning issued after Katrina by the organization that accredits most American hospitals, the Joint Commission. National electrical standards for hospitals were traditionally oriented toward maintaining electricity during common, brief local power outages, not prolonged emergencies.

National Fire Protection Association standards call for “careful consideration” to be given to protecting electrical components from “natural forces common to the area” such as storms, floods and earthquakes, but that guidance is not specific. Emergency systems do not have to be designed to power air-conditioning or heating. Other aspects of hospital emergency planning are even less regulated.

These problems were recognized years before Katrina. When Tropical Storm Allison flooded Houston in June 2001, some hospitals in the nation’s largest medical complex, Texas Medical Center, lost power because either emergency generators or their associated electrical components were located below flood level.

The assessment by the former Methodist hospital executive was made in response to an inquiry from Dr. Kevin Stephens, the New Orleans health director, the year after Tropical Storm Allison. Dr. Stephens asked whether generators at each hospital in the city could withstand a flood, how much it would cost to elevate them, and whether there was interest in having the city look into the issue. “They said it would cost millions of dollars,” he said. “And nobody had the money. They thought I was crazy.”

Across the country, the vulnerability remains. “There are many places that still know they have to move their generator,” said Robert Wise, a vice president of the Joint Commission. Without power, he said, hospitals are “literally dead in the water. It’s a critical asset.”

But most hospitals are juggling multiple priorities and operating on thin margins. Raising generators is not mandatory for hospital accreditation, and government agencies have rarely provided funding for the expensive work prior to a disaster. “This is a zero-sum game now,” Dr. Wise said. “Who decides it’s not important to buy critical machines for the intensive care unit or the operating room versus moving the emergency electrical system?”

A jury in New Orleans might have an answer.

Sheri Fink, a doctor, is a staff reporter at ProPublica, the independent nonprofit investigative organization. More material can be found at ProPublica.org.


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