NY TIMES
University Hospital of Brooklyn, in the heart of 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.
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 who tried to rip out her breathing tube when her arm restraints were unfastened.
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. 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 E. 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 percent of its revenue from government programs like Medicare and Medicaid. 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.
The central Brooklyn neighborhoods 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.
University Hospital doctors wore plastic bags as bootees to protect themselves while treating patients who had contracted the coronavirus.
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 from a nearby home for domestic violence survivors to fill prescriptions or to 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, the chairman of the hospital’s department of medicine.
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.
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.
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.
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 the “aged and crumbling” facilities had made the job of caring for patients much harder.
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 hospitalized for weeks, their limbs nestled in yellow foam cushions to prevent bed sores.
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.”
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 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.
Medical workers began to get sick, and several nurses ended up intubated in the hospital’s I.C.U. Doctors and nurses complained that the conditions put them at greater risk than colleagues at other hospitals.
Dr. Foronjy, the I.C.U. 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.
A lack of protective gear remains a problem. Much of what the nurses are wearing is mismatched, donated from friends and neighbors 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.
