While investigations continue into the deadly fire that raged early Tuesday morning at Hospital Calderón Guardia in downtown San José, burning questions have arisen as to whether this tragedy was preventable. After flames gutted the fourth and fifth floors of the oldest part of the hospital complex, claiming 19 lives including those of three nurses and 16 patients, and forcing the evacuation of hundreds, authorities have drawn criticism for not heeding warnings that the patients were boxed into a firetrap. The fire and its aftermath have elicited not only an outpouring of grief – President Abel Pacheco on Tuesday declared three days of national mourning – but also concerns about the critical lack of basic fire-safety preparedness at Calderón Guardia and the nation’s other public hospitals, prompting renewed calls for long-awaited improvements. THOUGH investigators have yet to announce any final conclusions, the Judicial Investigation Police (OIJ) suspect the fire was not an act of arson, but was likely caused by a ceiling lamp that may have overheated. The National Insurance Institute (INS) and the Prosecutor’s Office are conducting investigations as well. The fire began before 2:30 a.m. on the fifth floor, near the neurosurgery wing. The first firefighters arrived on the scene within four minutes of the call for help, but encountered difficulties, said Héctor Chaves, head of the National Firefighters’ Corps, which is part of INS. “The design of the building presented many problems in getting to the victims,” Chaves told The Tico Times. “Our job was to rescue the people, but we could only save 25, the ones who could walk to the stairs.” That area of the hospital, built in 1943, lacked a functioning fire alarm system, a functioning fire suppression system, emergency lighting, fire escapes and ramps for bed-ridden and wheelchair-bound patients, Chaves said. These facts put Caja officials in damage control mode, forcing them to defend their lack of preparedness. “Unfortunately, we’re a poor country,” said Alberto Sáenz, president of the Social Security System (Caja), the government institution that oversees public hospitals, echoing President Abel Pacheco’s words from earlier that day. “THAT part of the hospital didn’t have emergency exits because it is a building that was constructed in 1943. The people who designed the hospital were not Nostradamus,” Sáenz said. Chaves painted a grim picture of the inferno those inside contended with – beds blocked passage to the doors, the ceiling collapsed, and patients who could not save themselves were burnt beyond recognition, lying in their beds. Many Costa Ricans watched on live television as patients jumped from windows to the rooftops below, shimmied along window ledges and climbed down firefighters’ ladders. One group of patients tied sheets together to form a makeshift rope and used it to descend from a fifth floor window. Others made it to the stairs, some with the help of heroic nurses such as Patricia Fallas, who reportedly died with a flashlight in her hand, heading back into the fire to find more patients. Firefighters extinguished the flames five hours later, and rescue officials moved 176 patients into seven neighboring public hospitals. Many of the hospitals were already near, or at, capacity before the influx. The intermediate and new wings of Calderón Guardia continue to serve patients, and area clinics have remained open around the clock to help ease the new load. HOSPITAL authorities had been alerted on several occasions about the vulnerability of their building, and in particular that wing. The INS warned Calderón Guardia’s current director in a report 10 years ago that the facility had a “very high” risk of fire. With almost eerie accuracy, the report makes two important points that, if addressed, could have prevented some, if not all, of Tuesday’s deaths. First, it pointed out that most patients who could not move by their own means were found on upper floors, in understaffed units where “safe and adequate escape routes stand out in their absence.” Second, the report draws the hospital director’s attention to the major fire risk caused by the placement of lighting ballasts near easily combustible material, “principally in the older buildings.” The OIJ told the Tico Times that its investigations have led them to believe the fire was caused by a lighting ballast on the fifth floor. The report also makes a list of recommendations to improve fire safety, though on the day of the fire, 10 years later, very few, if any, of those precautions had been taken. THE INS report is only one of several from the past decade that have surfaced in the wake of the tragedy, all warning the hospital of its risk of fire and lack of prevention and emergency systems. From 1995 to 2004, the INS warned the Caja of fire danger in the building three times, according to a study by the daily La Nación. Then, in January, a smaller fire broke out in the fifth floor, very near where Tuesday’s fire began. A hospital employee who worked on the floor told The Tico Times that the building’s hoses did not work and the nurses had to put the blaze out with buckets. Nor did the hoses work in Tuesday’s fire. The internal pump could not deliver water to the fifth floor, where most victims died. Caja officials say they have been working continuously to make the hospital safer. “Firemen reviewed the buildings,” said Daniel Quesada, coordinator for the Caja’s Institutional Emergency Commission. “In fact, 15 or 20 days ago they reviewed that building to see how the fire extinguisher systems worked.” The firefighters made recommendations, but, he said, “unfortunately, the event came before we (could comply).” A survey of nine public hospitals in the greater metropolitan area by the daily La República revealed that, while all have evacuation plans and fire extinguishers, more than half do not have emergency stairs, ramps to all floors, or maps and signs indicating all exits and emergency procedures. Four do not have emergency lights, and three did not respond to the question. Two, Calderón Guardia and San Juan de Dios, another conglomeration of aging buildings in downtown San José, do not have emergency exits. The most exemplary hospitals are the National Children’s Hospital and the new Alajuela Hospital, which complied with nearly every safety recommendation. Private hospitals are well protected (see separate story). FOR many, Tuesday morning was filled with fear and uncertainty as they waited for hours in front of the hospital for news of their loved ones. “I have been asking for hours and they haven’t told me anything,” said Areceli Ramírez, who, since 4 a.m., had been hoping for good news about the fate of her mother, who was on the fourth floor. Authorities tried to compile lists of the patients and the hospitals to which they were moved, but they were confounded by patients who had gone home after the fire and the suspicion that there were more bodies inside the wreckage. Hospital San Juan de Dios, in downtown San José, had received 142 patients from the burned hospital and was at capacity hours after the fire was extinguished. Ana Josefina Guell, social work chief at the San Juan de Dios, and her team of social workers helped people piece together what might have happened to their family members. “Families (of the evacuated patients) are suffering the crisis of not knowing where their family members are and going through the shock and uncertainty that one has in this kind of accident,” Guell said. A nurse’s aid who worked in the ward, and whose shift ended just hours before the fire started, had heard rumors Tuesday evening that would be confirmed the next day: only one of the patients he had been caring for survived the flames. “IT hurts me to not know what happened because some of them could have saved themselves,” he told The Tico Times, asking that his name be withheld. “One was 14, a boy who hurt himself on a bike; he had a hematoma in his head. Another was 16. I hope they are okay because they were so young. I was told they died, but I can’t be sure.” While fending off criticism, Caja president Sáenz turned his attention toward reconstruction. “This is a generous country,” Sáenz said. “I believe we should do a national crusade for the reconstruction of the hospital. We’re going to establish a special account. This is an issue that concerns all of us. It’s a personal responsibility and I believe the people will respond, given that it is not only a hospital that suffered damage, but the whole health system.” As of press time the account number had not been made public. According to Caja spokeswoman Damaris Marín, the Caja will also hold a telethon and solicit private donations to help cover the hospital’s reconstruction costs. A Hollywood Escape Tuesday afternoon, while the smell of smoke still hung in the air, tied together bed sheets hung from a window on the fifth floor of the northeast corner of Hospital Calderón Guardia, representing the desperation of those who found themselves trapped by the flames that horrific morning. Rodrigo Charpentier, 72, explained to The Tico Times how he and other patients knotted together what they could find in the wing’s laundry room after they discovered all other avenues of escape blocked by fire and smoke. “I got the idea because I had seen it in the movies,” he said. “There were some thieves at a hotel. They robbed some things, and then didn’t pay, and got out like that.” Charpentier explained that the idea came after he and his fellow patients spent an hour running through a smoky maze of hospital beds and hallways, finally breaking windows to call for help. The patients tied the cloth together, and about seven or eight men, Charpentier recalled, descended the improvised escape route (still visible behind the policeman at right). Firefighters then arrived with a crane and basket to help him, and other less able-bodied patients, to safety. “A hero? No,” he said. “I feel satisfied and proud to have helped those people.”
