| Home > Events > 2nd National Symposium > Ken Bloem Treating the Sick: Capacity of the U.S. Healthcare System to Respond to an Epidemic
Ken Bloem The department representatives like we had in the previous panel, community based agencies, Red Cross, local Rotarians, home healthcare agencies, possibly even the media or security services, and as well, potentially many other public health organizations and community organizations, many of whom are represented by you in the audience this afternoon. So recognizing from the outset that we have before you some, but not all of the critical players in a response to a bioterrorist event, the question before us to our panelists is: could our health care system adequately respond in the event of a bioterrorist attack? Are the pieces in place? Are the necessary players coordinated, aware, prepared for the threat? Will there be adequate coordination and back-up between government agencies, civilian and military, and our private, non-governmental health organizations? Do we have appropriate federal and state policies supportive of this coordinated or even integrated response? The format of our session, which will adjourn promptly at five o'clock for an exciting evening reception and dinner and presentations, will be as follows:
I'll introduce our speakers. I'll make two minutes of introductory comments. Our speakers then, without further introduction, will speak each for 15 minutes. Then we'll open it up to questions, which hopefully we'll have many. Our five speakers are: Jim Bentley, Senior Vice President for Strategic Policy Planning at the American Hospital Association. Jim is truly one of the leaders of the AHA, prior to which for 15 years he was one of the leaders of the Association of American Medical Colleges. He spent five years in the U.S. Navy Medical Corps service, among many other activities. He's been a member of the Board of Examiners for the Malcolm Baldridge National Quality Award. He's published in a wide variety of journals. He was educated at Michigan State University and at the University of Michigan. Dr. John Bartlett, Chief of Infectious Disease at Johns Hopkins University. Dr. Bartlett received his M.D. from the Upstate Medical Center in Syracuse, completed his training in internal medicine at Peter Bent Brigham and at the University of Alabama in Birmingham. He's enjoyed faculty positions at UCLA, at Tufts. At Hopkins he's been the principal investigator for over $30 million of research funds, has written more than 600 articles, 13 books, and is truly one of the giants in his field. Jeff Rubin has been involved in health care administration planning at the level of disaster medical service planning of which he is the Chief for the State of California, a state, by the way, that truly under his tenure has been tested time and again. He's had leadership positions in public health programs, in primary care clinics, in emergency medical services, and others. Admiral Robert Knouss is Director of the Office of Emergency Preparedness of the U.S. Public Health Service. Dr. Knouss was trained at the University of Pennsylvania, and prior to that at the University of Wisconsin. He entered the Public Health Service and was first Chief of the Physician Education Branch in NIH and Director of the Division of Medicine in the Health Resources Administration. Among his numerous assignments, he's directed the Public Health Service's refugee health activities in the Cuban-Haitian and in the Southeast Asian refugee crises.
He was for ten years deputy director of the Pan America Health Organization, and in his more distant past, he was a staff member for the Senate Committee on Labor and Human Resources. Brigadier General Bruce Lawlor is the first Commanding General of the Joint Task Force, Civil Support, located in Norfolk, Virginia. General Lawlor was educated at George Washington University, subsequently received his law degree at George Washington, a Master's in national security affairs from Norwich University; a graduate of the Harvard National Security Fellows Program. He has taught at the U.S. Army War College, served as a consultant to the Defense Sciences Board. He has a highly distinguished military career that includes major assignments and commands in Europe, in Vietnam, and among his military awards and declarations include the Defense Superior Service Medal, the Legion of Merit, Defense Meritorious Service Medal, the Republic of Vietnam Gallantry Cross with one gold and one bronze star, and the Vietnamese Honor Medal, first class. Now, the number of speeches that you've heard today is many, and to battle against what Dr. Poste elegantly described as induced lethargy, I've been encouraged to add a note of shall we say pungency in the hope that our speakers and you, the audience, will focus as much as can be on the big issues, to focus on the forest, if you will, rather than to perhaps get lost in the trees. So in setting the stage for our presentations and discussions, let me provide just a few personal observations. I speak to you now as a hospital administrator, a manager who's led institutions on both coasts, as well as in the Midwest, and here are some personal observations, hopefully not overly provocative. If so, apologies for any overstatement. The physicians that I have worked with aren't trained to diagnose anthrax, smallpox, or plague. In fact, they've never seen a single case. The CEOs that I know, that is, CEOs of hospitals, just don't have bioterrorism on their screens. Bioterrorism, after all, is a low probability danger with no federal funding when my CEO colleagues deal daily with 100 percent certain dangers which have significant financial ramifications for their institutions, in addition to dealing with staff shortages, shrinking hospital margins, rapidly runaway pharmacy costs, to mention just a few. Thirdly, in some U.S. cities, in some of those where I have served, the public health departments and the hospital leaderships don't talk to one another, at least certainly at the senior most level. In fact, in my opinion, I think they live in parallel universes, not knowing each other's names, not having met one another, not knowing each other's telephone numbers, not truly knowing each other's responsibilities or problems. Fourthly, federal policy is based on a premise that the feds will act only in support of, as I understand it, local civilian efforts. Now, this policy just may, it seems to me, be flawed from the outset in that it assumes, first of all, that there are local plans for local effort, and secondly, that those local plans, in fact, could manage for the necessary 48 or 72 or 96 hours, before, in fact, federal support would come in. Many of my colleagues in hospital leadership positions are unconvinced on the premise of this policy. Furthermore, federal policy profoundly underestimates, in my opinion, the lack of surge capacity in the U.S. hospital sector. The manpower shortages that affect current, that is, daily Cortidian (phonetic) operations. For ten days, for example, in last December, 1999, during a relatively mild flu epidemic, three-quarters of Los Angeles' emergency departments were so full that ambulances had to be rerouted. Now, as a leader and as a part-time student of complex organizations, I am lastly a believer in simplicity, simplicity insofar as routine operations are concerned and all the more so in times of crisis or disaster. However, as regards the full panoply of federal and civilian agency response plan to bioterrorism, well, I must confess even with an advanced degree and having heard numerous descriptions of the federal response plan, I am still confused. The complexity, the alphabet soup of agencies, units defies at least my common sense. My hope is that our panelists will disabuse me of some of these impressions or at least that we will set the stage for an energetic discussion to follow. Jim Bentley and then without any further introduction will be followed by Dr. Bartlett and others.
(Applause.)
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