Sam Bucholz holds a patient's hand at University Hospital of Brooklyn, which created makeshift rooms for coronavirus patients with plastic tarps and tape. Photo / Kirsten Luce, The New York Times
The inequities of New York City's health care system are clear at a public hospital in a section of Brooklyn hit hard by the coronavirus pandemic.
It has been hours since the 71-year-old man in Room 3 of the intensive care unit succumbed to Covid-19, the disease caused by the coronavirus. His body has been cleaned, packed in an orange bag and covered in a white sheet, but the overextended transport team from the morgue has yet to arrive.
The nurses on duty have too many other worries. University Hospital of Brooklyn, in the heart of New York, the city hit hardest by a world-altering pandemic, can seem like it is falling apart. The roof leaks. The corroded pipes burst with alarming frequency. On one of the intensive care units, plastic tarps and duct tape serve as flimsy barriers separating patients. Nurses record vital signs with pen and paper rather than computer systems.
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A patient in Room 2 is losing blood pressure and needs an ultrasound. A therapist is working to calm a woman in Room 4 who is intubated and semiconscious and tried to rip out her breathing tube when her arm restraints were unfastened.
Genevieve Watson-Grey, the head nurse on duty, said she relies on faith and prayer to fill the gap between need and reality. "Knowing there is a higher force above," she said, gives her hope.
Every hospital in New York has struggled to cope with the pandemic, but the outbreak has laid bare the deep disparities in the city's health care system. The virus is killing black and Latino New Yorkers at about twice the rate of white residents, and hospitals serving the sickest patients often work with the fewest resources.
Wealthy private hospitals, primarily in Manhattan, have been able to marshal reserves of cash and political clout to increase patient capacity quickly, ramp up testing and acquire protective gear. At the height of the surge, the Mount Sinai health system was able to enlist private planes from Warren Buffett's company to fly in coveted N95 masks from China.
University Hospital, which is publicly funded and part of SUNY Downstate Health Sciences University, has tried to raise money for protective gear through a GoFundMe page started by a resident physician.
Most of the hospital's patients are poor and people of color, and it gets more than 80% of its revenue from government programs like Medicare and Medicaid.
Dr. Robert Foronjy, the hospital's chief of pulmonary and critical care medicine, oversees the unit with the plastic tarps and duct tape. He said that he did not believe that any patients were lost because of inadequate resources. But the "aged and crumbling" facilities, he said, had made the job of caring for such patients much harder.
"Why shouldn't an African American have facilities that are at the same level of other patient populations?" he said.
When George James, a 60-year-old former public housing superintendent arrived at University Hospital in March to have an infection unrelated to the coronavirus treated, he did not have Covid-19 symptoms. Within days, though, he tested positive for the disease. As he gasped for breath one night in his hospital bed, he panicked when he was unable to call a nurse.
"I didn't go to sleep the whole night because I was scared," he said. "I couldn't breathe."
Instead of a modern call button or intercom system, all he had was a silver bell, the kind used in hotels decades ago to summon the concierge.
It was late February and Dr. Wayne Riley, president of SUNY Downstate Health Sciences University, was at a conference in Atlanta when his phone began to ping with ominous messages. It was becoming clearer that the novel coronavirus, which had ravaged parts of China and Italy, had begun to spread rapidly in the United States.
"I said, 'My gosh, if this thing really does take root in the United States, then, here in Brooklyn, we're going to have a problem,'" he recalled.
Not only did Riley worry about the resources that would be needed to provide care during a pandemic, he feared that the hospital's patients would be particularly susceptible to the disease.
The central Brooklyn neighbourhoods where most of University Hospital's patients live, East Flatbush and Prospect Lefferts Gardens, have higher-than-average concentrations of chronic diseases like diabetes, hypertension and obesity, which preliminary studies have shown make Covid-19 most deadly.
The hospital opened in 1963, and it was meant to accommodate about 60,000 visits a year. Despite having almost no physical improvements, it now handles about 200,000 visits annually. The bunkerlike concrete building is crumbling from within. Earlier this year, a leaky roof forced a temporary evacuation of premature babies from a neonatal intensive care unit.
"It is too, too old compared to other hospitals across the water," Riley said. "We need a new hospital to be prepared for the next pandemic and to better serve our community."
Signs inside the hospital are written in English, Spanish and Creole, a reflection of the large number of immigrants in the area, particularly from the West Indies.
Many of the patients work but are poor or receive government assistance. Many are uninsured and use the hospital for emergencies and primary care. They come from a men's shelter up the street or a nearby home for domestic violence survivors to fill prescriptions or have their diabetes checked.
"The day-to-day stress on these communities is just incredible, and that is driving these conditions," said Dr. Moro Salifu, chairman of the hospital's department of medicine.
The hospital has been in financial disarray for years. A 2013 audit by the state comptroller's office found that it was on a path toward insolvency. It was bleeding millions of dollars every week, the audit found, and only infusions of state money were keeping it afloat. It has also been poorly managed. Subsequent audits found that hospital leaders had used government money on a lavish birthday celebration in Bermuda for a consultant who was paid tens of millions of dollars but did very little to improve the hospital's finances.
Riley, who became president in 2017, after the Bermuda birthday celebration, insisted that the limited resources had not affected the quality of care. The hospital, though, has at times been accused of violating safety standards.
Last July, the hospital suspended its transplant program after a review uncovered high mortality rates and serious safety concerns. Two doctors — the surgery department's former chairman and another surgeon — filed wrongful termination lawsuits, accusing hospital officials of firing them as retaliation for their complaints about lax safety standards. The program has since been reactivated.
Even so, the hospital is vital to the community. Together with its affiliated teaching university, it is Brooklyn's fourth-largest employer. The university, which is part of the State University of New York system, is the largest medical college in New York City, and it produces a large percentage of the doctors working here.
When the pandemic first hit the city, Andrew Cuomo, New York's governor, ordered the hospital to take only patients who had the virus. The decision rankled medical workers and others, who complained about having to shoulder the heavy burden with limited resources.
"We're now in a situation where an underresourced hospital is being asked to manage the epicentre of the crisis," said Zellnor Myrie, a Democratic state senator whose district includes University Hospital. "The dollars that we failed to invest years ago are affecting life-and-death decisions now."
The first patient with Covid-19 at University Hospital, a 74-year-old woman on dialysis with hypertension and diabetes, was identified March 12.
"I got the first call at 5:51pm that we had our first case," said Salifu, the department of medicine chairman. "I remember exactly where I was on 9/11, and I knew exactly where I was when I got this call."
Within days, the cramped emergency room, which looks much the same as it did when the hospital first opened, was inundated. At times, more than 100 coughing, feverish patients were packed into hallways and side rooms or clustered around the nursing station, spewing virus into the air.
The hospital came close to running out of ventilators. Julie Eason, the director of respiratory therapy, said she had to "get a little bit creative" as she tried to ration resources while keeping up with all of the Code 99s, the term used when a patient needs to be intubated.
"It was just endless," she said. "Code 99s would come in three, four different rooms, all within a few minutes of each other, all day long."
Medical workers began to get sick, and several nurses ended up intubated in the hospital's ICU.
"We were stewing in it," an emergency room doctor, Lorenzo Paladino, said.
Doctors and nurses complained that the conditions put them at greater risk than colleagues at other hospitals.
Foronjy, the ICU physician, said he knew a doctor at a well-funded Manhattan hospital who walked around without a mask, assured that the sealed-off negative-pressure rooms there would protect him from the virus-infected patients inside.
Not so at University Hospital.
"Having to work with such an antiquated infrastructure is incredibly stressful," Foronjy said. "You have to worry more about your own safety."
The city and state health departments have not released data on mortality rates by hospital, but given the high instance of preexisting conditions among patients at University Hospital, doctors there estimated that its mortality rates must be among the highest in the city.
As the death toll began to mount, the bodies overwhelmed the hospital's small, 10-person morgue. Then they filled not one but two refrigerated tractor-trailers parked outside.
The hospital's mortician, Michael McGillicuddy, had to hire six additional staff members to help manage the morgue. Recently, a steady stream of black hearses has arrived at the hospital each day to pick up bodies, but new ones soon replace those that are taken away.
"I'm doing it with dignity, trying not to pile the bodies up," McGillicuddy said. "This is someone's mother or grandmother."
Although the rate of new infections is dropping in New York, the intensive care units at University Hospital are full. Nearly 50 patients remain in serious condition, attached to ventilators. Some have been hospitalised for weeks, their limbs nestled in yellow foam cushions to prevent bed sores. (Reporters with The New York Times spent two days at the hospital but did not have access to patient information because of privacy regulations.)
Nurses on the units said they were overworked and understaffed. In normal times, their jobs are so demanding that they are required to care for no more than two patients at once. Now they are tending to three or four at a time, increasing the risk of mistakes.
Ventilators, which take over for virus-battered lungs and have been crucial in the pandemic, require constant calibration to keep patients' oxygen levels just right. Nurses must monitor endotracheal tubes, which can get clogged and block airways. In Covid-19 patients, the heart or the kidneys can fail without warning.
A lack of protective gear remains a problem. Much of what the nurses are wearing is mismatched, donated from friends and neighbours or brought from home. One nurse complained that she had bought her mask herself and had been wearing the same bootees on her feet for the past three days.
"As you know, we are a state facility. We don't have a lot of money," said Rose Green, a nurse who was helping to staff the unit on her day off.
The hospital has begun to celebrate some successes. Recently, a nurse and a nursing assistant were taken off ventilators. On April 16, the hospital posted a video on Twitter of another nurse who had been intubated after coming down with Covid-19. She was being wheeled out of the emergency room to applause from colleagues.
On a recent day, a man in his 50s who had just come off a ventilator was sitting up in his room drinking a bottle of juice.
A nurse passed by and waved excitedly.
Written by: Michael Schwirtz
Photographs by: Kirsten Luce
© 2020 THE NEW YORK TIMES
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