Sunday, Jan. 31, 2010

Who's to Blame for Suspending Haitian Medevac Flights?

The U.S. and its international partners knew from the start that aiding the victims of Haiti's Jan. 12 earthquake would be a logistical nightmare. Yet while their response has been laudable, less than tight coordination among government, nongovernmental and military forces has frequently undermined the effort. Right after the quake, for example, the U.S. aircraft carrier Carl Vinson raced into Port-au-Prince Bay, only to find that the U.S., the U.N. and NGOs had gotten relatively scant relief supplies in place for its helicopters to deliver. The military made its own missteps too, rerouting Doctors Without Borders flights and giving the impression that its foot soldiers mattered more to the relief campaign than physicians did.

But things seemed to hit a dysfunctional low point over the weekend when all those relief components began blaming one another for a suspension of military medevac flights from Haiti to Florida for more than four days — a decision that doctors say risked scores of patient deaths in Haiti. The military, whose large C-130 transport planes had until Jan. 27 ferried out some 500 of the worst injured, indicated that it halted the flights because Florida hospitals could no longer receive the patients owing to cost concerns that Republican Governor Charlie Crist expressed in a letter to the Obama Administration. Crist and the hospitals deny that assertion — "It's untrue," Crist said on Saturday, calling it "astounding" that the military would interpret his letter that way — and say they only asked the feds to help the economically battered state bear the long-term, multimillion-dollar price of treating Haiti's most seriously wounded casualties.

For its part, the Administration acknowledged that Crist's letter had not prompted the flight suspension and insisted that it was simply a logistical issue — one it promised to have resolved by Monday morning, when the flights were expected to resume. "It's a matter of finding [U.S.] medical facilities with the capacity to treat such a large amount of [critically injured] people and near runways where C-130s can land," White House spokesman Tommy Vietor told TIME. Vietor announced on Sunday that the U.S. had successfully "worked to increase cooperation with our international partners, NGOs and states to expand access to additional facilities." Crist said military planes were still flying less seriously injured people, including three on Sunday, to Florida hospitals.

At the same time, Florida officials complain that the military and medical NGOs in Haiti have done a poor job of keeping them informed about incoming flights and the kinds of high-level injuries on board. "We need a better coordinating plan from the federal government," says Florida Division of Emergency Management spokesman John Cherry. He points to one recent instance in which a transport plane took a serious burn victim to an unaware Tampa facility that couldn't treat the injury, forcing state officials to redirect the patient to one much further north in Gainesville.

On the ground in Haiti, doctors warn that the halting of flights meant hundreds of critically injured patients, including those with potentially fatal infections from lost limbs, could have died. "They need a degree of expertise and facilities not available anywhere here or on the Navy hospital ship Comfort" out in Port-au-Prince Bay, says Dr. Barth Green, chairman of the University of Miami's Global Institute for Community Health and Development, which is running a field hospital at the Haitian capital's Toussaint Louverture International Airport. "We're only talking about shipping out a few hundred patients, not thousands. But while people are dying, we don't know who to talk to and no one seems to know who made the decision to stop these flights." (On Sunday, a private jet circumvented the medevac muddle and whisked three critically injured Haitian children to a Philadelphia hospital.)

Even if the number of seriously injured patients being medevacked to Florida hasn't reached the thousands, state health officials say it has begun to strain their hospital infrastructure — which is also bracing for an influx of tourists for next weekend's Super Bowl in Miami. In his letter to Health and Human Services Secretary Kathleen Sebelius last week, Crist expressed fears that "Florida's health care system is quickly reaching saturation, especially in the area of high-level trauma care." On Saturday, he said the state's tab for the Haitian care had already reached $7 million, and that Washington needed to pitch in as well as help find hospitals and landing sites in other states. Toward that end, he also asked Sebelius to make an exception and activate the National Disaster Medical System, established for domestic emergencies, for the Haitians.

Disaster experts say Crist and his state could have avoided confusion by making it clearer from the outset that the letter didn't mean they wouldn't take any more Haitian victims. But it's still unclear why Crist's missive triggered a suspension of the medical flights on Wednesday evening — a move that Florida officials fumed made them the hardhearted scapegoats — or why the Homeland Security Department stopped issuing humanitarian-parole waivers, which allow non-U.S. citizen patients like the Haitian victims to be taken to U.S. facilities. (One Crist aide angrily denied that Crist's letter had anything to do with him looking more the fiscal conservative as he battles his party's right wing for its U.S. Senate nomination this year.)

As complaints roll in from medical NGOs, Crist and Florida hospital administrators insist that their doors are still open to Haitians. "We're willing to do whatever it takes to treat people if we have the capability," says Cherry, "and worry about the costs later."

Meanwhile, the military's U.S. Transportation Command, which controls the flights, on Saturday directed questions about the decision to the White House. Officials there said they didn't want to take part in the blame game. The U.S. Army Corps of Engineers says it plans to build a 250-bed tent hospital in Port-au-Prince to relieve the strain. But at this point, it appears that no one and everyone is to blame for the snafu. And that means an already difficult Haitian relief effort — from the White House to the U.N., from military brass to Florida officials and NGOs — risks looking like a victim itself. The difference is that their wounds seem self-inflicted.

Read more in the new TIME book Earthquake Haiti: Tragedy and Hope and support TIME's Haiti relief efforts.