As usual when one deals with a bureaucracy, there were no good answers. Bureaucracy takes comfort in the status quo, relying on an almost arrogant belief that there is an inherent wisdom in the current system. It’s usually quite the opposite. For me, the health-care system was a single chain; if one link breaks anywhere in the system, the whole chain is broken.
In fairness, this was an unprecedented crisis, and the old model simply couldn’t deal with it. While our concept of one coordinated statewide hospital system was a good one, the shift would be more traumatic and difficult than anyone anticipated. COVID was exposing many existing problems. Fundamental ones like a divided country and dysfunctional government, social inequities in health care and education, but also the failure of basic operating systems.
I started speaking to the hospital executives again because I had to educate myself as to exactly how they operated.
What was becoming clear was that for all the talk of a “public health system,” this nation was wholly unprepared for an emergency. How could that be after all the warnings we’d had with Ebola, swine flu, MERS, and SARS? Who knows? But that’s where we were.
It was no time for recriminations; we had to deal with the situation. Winston Churchill came to mind. Imagine how frustrated he was in the early years of the war when he was fighting Germany and he couldn’t get the United States to join forces against the obvious common threat. He was on his own, and he improvised. He needed to cross the English Channel to rescue the soldiers at Dunkirk. I’m sure he wanted to complain about the fact that the government didn’t have enough ships, but there was no time for that. He scrambled and put together a “citizen navy” to form a flotilla of private craft to cross the channel and rescue hundreds of thousands. There is an old saying that you go to war with the army you have, not the army you want.
The breadth and depth of our need was clear. We would have to create an emergency public health system out of whole cloth. We were told by all the experts that we would need between 110,000 and 140,000 hospital beds, and we had only 53,000. If we didn’t accomplish that goal, we would repeat the experience in Italy, where the hospital system was overwhelmed. That couldn’t happen here. I understood fully that it was an impossible task, but we had to do the best we could.
We had sketched out the concepts. All hospitals increasing capacity 50 percent, building thousands of emergency beds and coordinating a unified, cooperative hospital system. But this was a massive and revolutionary undertaking. It would normally take years to implement. The hospital industry is a $100 billion industry in New York with 415,000 employees. You don’t turn it inside out overnight. That was our goal. We had the concept, but we had to do it!
For a plan to work, we would need specific operating procedures and leave nothing to the imagination. As I had learned too many times before, it’s not enough to have a good idea; you have to know how to implement the idea. If you want to make a change, you must know exactly what you want to do and how to do it.
The Northwell hospital system, New York’s largest, was run by Michael Dowling. Luckily, Michael had been a friend for thirty years and was the top health-care professional for my father during his twelve-year administration. As a former government official and now hospital administrator, Michael understood the system from both perspectives. If Northwell bought into a new model, other institutions would follow. We spent many hours talking through the details, addressing all the questions, and leaving nothing to chance. We knew what we needed to do; now we needed to do it.
I called a dozen of my staff into the Red Room. We had to move beyond conceptualization to implementation. We sat—socially distanced—around a square table. The chamber operations team, led by Reid Sims—who has been a dedicated and loyal member of my staff since I was elected governor—can turn the Red Room from a press conference setup to a TV studio to a meeting room in a matter of minutes. I am not sure how they do it so quickly and efficiently, but they do.
I explained to my team gathered in the Red Room my view of the situation: Testing was up; we were now doing more than twenty thousand tests per day. PPE and ventilators were being pursued. Staff was signing up by the thousands on our portal to volunteer. And thousands of new beds were coming online as hospitals increased capacity and new emergency facilities such as the Javits Center opened. As we barreled toward what was projected to be our apex, the problems at Elmhurst showed that it was going to be all about management. The Elmhurst Hospital debacle made that point. I wanted it all done centrally, in one room—no space for miscommunication or errors. Getting it right was a matter of life and death. Many of my most senior staff were wearing two hats at this time; the state budget was due at midnight that night! Melissa, Robert, Beth, and Dana Carotenuto Rico (my adept and tireless legislative director) were simultaneously addressing the COVID crisis while negotiating the final pieces of the budget bill. Rob is an extraordinary talent on the budget and finance. I trust his judgment and it took a major burden off my shoulders. I laid out my vision for a hospital capacity coordination center—a central nerve center where any hospital in the state could call 24/7 to request patient transfers, staff support, PPE, ventilators, or
