Associated Press Writer
MIAMI - As hundreds of injured survivors of the Haiti earthquake overwhelmed Florida hospitals in January, state officials pleaded with the federal government for basic information about arriving patients but got little assistance, e-mails obtained by The Associated Press show.
More than two weeks after the quake, Florida officials warned they could not treat any more victims. In response, the American military abruptly halted medical airlifts, saying Florida had refused to take additional patients and provoking a bitter exchange over who was responsible for the delays.
"I have advised the federal government that until we see a plan for the future transportation and care of these patients that Florida could not agree to accepting more patients," the state emergency management chief, David Halstead, wrote in a Jan. 28 e-mail. "We have been forced to daily react to last-minute requests to accept large number of long-term care patients."
Nearly five years after Hurricane Katrina exposed serious flaws in the nation's disaster-response capabilities, e-mails obtained by the AP under Florida's open-records law show state and federal officials squabbling over where to send patients while an epic humanitarian crisis unfolded hundreds of miles to the south.
The picture that emerges is somewhat at odds with the one put forward by the Obama administration, which worked intensely in the weeks after the earthquake to mount a faster, more organized response than that of the Bush White House following Hurricane Katrina.
Moira Whelan, a spokeswoman for U.S. Agency for International Development, the agency leading U.S. relief efforts in Haiti, said the federal government worked through Florida's concerns during an unprecedented response to an international disaster.
The Jan. 12 earthquake killed more than 230,000 people. More than 18,000 survivors were evacuated to the United States by the end of January and more than 31,000 by the end of February. Hundreds ended up in hospitals in Florida, the nearest U.S. state.
Hospitals in three Florida counties alone accepted more than 450 quake victims in January, before patients were flown to the Tampa and Orlando areas.
While not an exceedingly large number in itself, those patients added to the hospitals' strain at the height of the snowbird season. They also arrived at the same time as tens of thousands of football fans flooded South Florida for the Pro Bowl and Super Bowl.
Within 10 days, the state was struggling to manage the influx of evacuees, the e-mails show.
Frustrated Florida officials complained that flights carrying seriously injured quake victims arrived with just a few minutes' notice and with no information about how many people were aboard, what they needed or how long they were expected to stay. State agencies also wanted to know how their rising costs would be reimbursed.
On Jan. 24, officials asked that a single federal agency be appointed to assist the state in communicating with federal officials and obtaining reimbursement. The lack of coordination, Halstead wrote, "is contrary to good emergency management principles" and led to "a number of denials by federal agencies who consider this a state mission."
Two days later, a flight landed at the Fort Lauderdale airport with 21 trauma patients and two burn victims. The additional quake victims "saturated" South Florida's hospitals, Halstead wrote, so they were sent farther north in the state. The next day, another flight landed in Tampa with 22 more patients.
Halstead protested that Florida hospitals were "rapidly approaching the breaking point" and would accept no more patients without a plan for their transportation and care.
Military medical transports were immediately grounded, although some private flights continued.
Halstead spokesman John Cherry said Florida never told the military that the flights could not land. Instead, the state said it was irresponsible to accept more patients where there weren't enough beds.
As the dispute unfolded, some survivors waited, near death, at field hospitals in Port-au-Prince for an airlift out of the leveled city.
An American doctor in the capital city said he had at least 100 critically ill patients who could die "in the next day or two" if they did not get to better hospitals. Dr. Barth Green said he relied on military transport flights because they were bigger and better equipped to handle seriously injured patients.
A Transportation Command spokesman told The New York Times that a cost dispute had made Florida unwilling to accept any more patients, prompting an angry response from Halstead.
"Instead of praising all of our support (yesterday alone another 800+ US citizens and foreign nationals were repatriated with 100+ receiving direct support from Florida) we read that the state is not doing enough or what appears to be nothing at all," Halstead wrote to TransCom's deputy command surgeon.
An estimate by the Florida Hospital Association put hospital costs related to earthquake relief at $8.8 million when the airlift was suspended.
In an e-mail to the governor's staff and legislators, Halstead suggested it would be helpful to activate the National Disaster Medical System, which seeks to evenly distribute patients among hospitals and reimburses those facilities.
Assistant Secretary of Health and Human Services Carmen Nazario replied that HHS would await a formal request from the state, which came Jan. 27 from Florida Gov. Charlie Crist.
State officials also appealed to the U.S. Transportation Command, the State Department and the American Embassy in Haiti for better coordination with federal relief efforts. The Transportation Command told Halstead that Florida's concerns were being addressed "at the highest levels" in Washington.
Finally responding to the Florida governor on Jan. 29, HHS Secretary Kathleen Sebelius thanked him for the state's "rapid and comprehensive response," but her office said more follow-up was needed to fulfill the request.
Halstead's pleas for some kind of plan persisted through Jan. 31, when he told the Transportation Command's deputy command surgeon that unless he personally cleared the flights, none were approved to land in Florida.
On Feb. 1, the National Disaster Medical System was activated, and the medical transports resumed. Hundreds more injured Haitians were evacuated to the U.S. in the following days, including dozens who were sent to Atlanta and elsewhere.
Richard Olson, a Florida International University expert on disaster response, said the lesson the U.S. government can take from the Haiti quake is to plan for the domestic impact of international disasters, and not to concentrate the response in one state.
"Florida did pretty well, considering," Olson said. "But loading it all onto one state, it's not logical. There are going to have to be three or four states minimum in the U.S. involved in dispersing relief."