At Bellevue, a Desperate Fight to Ensure the Patients" Safety From the moment the water lapped above street level in Lower Manhattan, the doctors and nurses of Bellevue Hospital Center began a desperate struggle to keep patients safe. By 9 p.m. Monday, the hospital was on backup power, and an hour later, the basement was flooded. Outside Bellevue Hospital Center, a line of ambulances lined up to evacuate patients on Wednesday after fuel pumps for the hospital's backup generators failed. Officials rushed to move the most critically ill patients closer to an emergency generator. After midnight, doctors heard shouts in the hallway. The basement fuel pumps had stopped working, and medical residents, nurses and administrators formed a bucket brigade to ferry fuel up 13 flights to the main backup generators. By Tuesday, the elevator shafts at Bellevue, the country's oldest public hospital, had flooded, so all 32 elevators stopped working. There was limited compressed air to run ventilators, so oxygen tanks were placed next to the beds of patients who needed them. Water faucets went dry, food ran low, and buckets of water had to be carried up to flush toilets. Some doctors began urging evacuations, and on Tuesday, at least two dozen ambulances lined up around the block to pick up many of the 725 patients housed there. People carried babies down flights of stairs. The National Guard was called in to help. On Thursday afternoon, the last two patients were waiting to be taken out. The evacuation went quickly only because Bellevue had planned for such a possibility before Hurricane Irene hit last year, several doctors said. But the city, which had evacuated two nearby hospitals before that storm, decided not to clear out Bellevue. In the wake of Hurricane Sandy, the consequences of bad calls, bad luck and equipment failures cascaded through the region's health care system, as sleep-deprived health care workers and patients were confronted by a new kind of disarray. A patient recovering from a triple bypass operation at Bellevue walked down 10 flights of stairs to a waiting ambulance, one of the dozens provided through the Federal Emergency Management Agency to speed patients across the metropolitan region. Mount Sinai Medical Center, already dealing with the 2 a.m. arrival of a dozen psychiatric patients who spoke only Chinese, was struggling to identify the relatives of brain-injured traffic victims from Bellevue who arrived three hours later with only rudimentary medical records. Maimonides Medical Center in Brooklyn was straining to meet a rising need for emergency dialysis for hundreds of people shut out of storm-crippled private dialysis centers. Patients who would normally get three hours of dialysis were getting only two, to ensure the maximum number of people received at least a minimal amount of care. "The catastrophe is growing by the minute," said Eileen Tynion, a Maimonides spokeswoman. Here we thought we'd reached a quiet point after the storm. Every hospital maintains an elaborate disaster plan, but after Hurricane Sandy, the fact that many health care facilities are in low-lying areas proved to be something of an Achilles" heel. Bellevue became the third hospital in the city to evacuate after the storm's landfall, after NYU Langone Medical Center, just north of Bellevue, and Coney Island Hospital, another public hospital. New York Downtown Hospital, the only hospital south of 14th Street in Manhattan, and the Veterans Affairs Hospital, just below Bellevue, had evacuated before the storm. Hospital executives were reluctant to criticize their colleagues or city officials. But the sequence of events left them with many questions. "All hospitals are required to do disaster planning and disaster drills," Pamela Brier, the chief executive of Maimonides, noted. All hospitals are required as a condition of being accredited, to have generators, backup generators. City health department and emergency officials have been particularly fervent about citywide disaster drills, she added, but "as prepared as we think we are we've never had a mock disaster drill where we carried patients downstairs. I'm shocked that we didn't do that. Now we're going to. The city's health commissioner, Dr. Thomas Farley, defended the decision not to require evacuations of Bellevue, Coney Island and NYU Langone hospitals before the storm, which he said had been made in consultation with the state health commissioner, Dr. Nirav Shah.