A hospital bottom line

It's beginning to sink in. The federal government is telling hospitals to get ready in case a pandemic arrives and the hospitals are looking at the bill and saying, "No way."

The U.S. government may be urging local officials and hospitals to get ready for a bird flu pandemic, but top hospital executives said on Tuesday they cannot do everything that is being called for.

"If the federal government doesn't help run this, it really isn't going to go well," Dr. Frank Peacock, who heads emergency preparedness at the Cleveland Clinic in Ohio, told a conference. (Maggie Fox, Reuters)

Department of Health and Human Services Michael Leavitt is doing yeoman's duty traveling to all 50 states, trying to get them to get ready. He is also telling them not to expect much help from the federal government. That's realistic, at this point. But how did we get to this point? You can't tell hospitals to do things they don't have the resources to do. And one reason they don't have those resources is a Republican Congress that has repeatedly slashed funding for essential services and starved the public health sector. After abandoning states and local communities, the message that they are "on their own" is a maddening one, made more so by Leavitt's comment that maybe they should be buying ventilators rather than renovating swimming pools.

"I think it is a good thing for the Secretary to say we have to stockpile ventilators. But I think a lot of us know we don't have the resources to buy another two, three, four hundred ventilators," he said.

Preparedness could come down to more than having the medical equipment.

"We may not have the staff needed to run those ventilators adequately," said Vicki Running, who heads disaster planning at Stanford University Medical Center in California.

Day-to-day business is already overwhelming hospitals, according to Running. "We are operating at capacity," she said.

So it is a matter of the bottom line. And if you want The Real Bottom Line, here it is:

Peacock said much of the response to a pandemic will involve very basic medical care -- including triage, or sorting out which patients cannot be helped except through heroic measures.

"Those patients are going to get some morphine and get sat in a corner. That is the definition of a disaster -- need exceeds resources," Peacock said.

Then health workers will turn to patients who are more easily helped, and the very sickest may have to be allowed to die as comfortably as possible, he said.