Officials Testify on Disaster Plans

Chertoff, Leavitt Admit 'Deficiencies' in Hospitals' Abilities

Two Bush administration Cabinet members yesterday acknowledged gaps in the capability of U.S. hospitals to deal with a mass-casualty terrorist attack or other disaster, but they said a congressional effort to block pending Medicaid cuts will not fix the problem.

Testifying before the House Committee on Oversight and Government Reform, Homeland Security Secretary Michael Chertoff and Health and Human Services Secretary Michael Leavitt said lawmakers could target funds at the shortcomings more directly, such as by financing the stockpiling of hospital beds, ventilator units or medicines, if needed.

Stopping a White House plan to tighten Medicaid would not necessarily improve the nation's "surge capacity" to handle an attack on the scale of the 2004 train bombings in Madrid, they said. "There are deficiencies in our surge capacity. I just don't believe Medicaid dollars is the source of funds that ought to be directed or looked to link to that solution," Leavitt testified.

Leavitt and Chertoff spoke two days after the committee's chairman, Rep. Henry A. Waxman (D-Calif.), released a survey showing that hospitals in seven major U.S. cities would be overwhelmed in case of a Madrid-scale attack. In that incident, 191 people were killed and as many as 270 patients were sent to a single hospital within hours.

President Bush has threatened to veto House legislation that would impose a one-year moratorium on changes sought by HHS to Medicaid, the federal insurance program for the poor. Congressional budget analysts say the reimbursement changes would lower federal spending by $17.8 billion over five years. State officials said the impact would be greater, including cuts to physicians at teaching hospitals and to urban public hospitals whose emergency rooms are already strained.

Waxman said Chertoff's and Leavitt's departments were "irresponsible" because they had not analyzed the impact of cuts on emergency rooms.

"Why would [HHS] . . . withdraw billions of federal dollars from the hospitals that provide the most comprehensive emergency care to the most seriously injured?" he said. "It's a substantial breach in what I think is our mutual responsibility to make sure we can deal with a homeland security attack."

Leavitt said HHS will report by the end of the year the results of a nationwide survey of surge plans and capabilities. He said a survey is underway of hospitals' ability to electronically track and report the number of available beds on one hour's notice.

"Surge capacity is about using existing assets to convert to a hospital capacity very quickly. It is not simply using the emergency room," Leavitt said.

He also defended the proposed Medicaid changes, saying they are designed to stop states from using federal funds for hospitals as a substitute for state funding. "This is about states not paying their fair share," he said.