As general counsel for the New York Hospital Association, Susan Waltman (AB '73, MSW '75) helped orchestrate the city's emergency medical response to the terrorist attacks of Sept. 11

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inutes after Susan Waltman arrived at her Manhattan office on the morning of Sept. 11, the Mayor's Office of Emergency Management called to say there had been "a major explosion" at the World Trade Center. No mention of a plane, just an urgent request that her organization send a representative to the city's Emergency Operations Center.

Waltman (AB '73, MSW '75) is senior vice president and general counsel for the Greater New York Hospital Association, which represents more than 200 public and not-for-profit hospitals and continuing care facilities. A tall, slim woman with short auburn hair, Waltman has spent 15 years training hospitals in emergency preparedness, and she knew what to do on Sept. 11.

The first thing she did was call associate counsel Doris Varlese and tell her to report to the city's emergency command center at 7 World Trade Center. Neither of them could know that 7 World Trade Center and the twin towers would soon lie in ruin.

While briefing association president Kenneth Raske, Waltman learned that a plane had caused the explosion. A colleague then burst in to tell them he'd seen a second plane crash into the World Trade Center. He had assumed it was a surveillance plane assessing damage to the north tower—until he saw it slam into the south tower.

"Oh, my God, it's a kamikaze!" Waltman exclaimed.

She tried calling Varlese's cell phone to pull her back to safety, but couldn't get through. She tried the command center. No answer.

"The state department of health called and asked us to direct our hospitals to activate their disaster plans," says Waltman. "So I sent an e-mail to our emergency departments and told them to expect mass casualties."

Waltman then called the fire commissioner's office and the police to find out why she couldn't reach the command center. No one knew.

At about 10 a.m., Waltman learned that the command center had been evacuated. She sent a fax to hospital CEOs explaining the situation, telling them she was coordinating with police and that they could call her office for assistance. It was another hour and a half before Waltman learned that Varlese had arrived at the World Trade Center site just in time to see the south tower collapse. She continued toward the command center only to find people running in the opposite direction. Varlese then joined the group accompanying Mayor Rudolph Giuliani to a temporary command center at the nearby police academy.

Waltman began calling hospitals to get a fix on the number of available beds and staff. Hospitals, in turn, were trying to free beds by transferring patients to nursing homes, releasing others early, and canceling all elective surgery.

"The sad thing was that we didn't need all the beds," says Waltman, assessing the situation months later. Which is not to say the hospitals weren't busy; those in lower Manhattan were overwhelmed. New York University Downtown Hospital was flooded with patients; in the first four hours they saw 400-500—but many didn't even need treatment. "People see hospitals as safe havens," says Waltman. "They go there to be safe, to hide."

The same thing happened at Beth Israel Medical Center, another hospital close to Ground Zero, where some 300 people showed up. The hospital's staff did triage out in the street, but fewer than 30 were admitted.

All told, some 6,000 people sought medical attention in New York hospitals, says Waltman. Fewer than 500 were admitted. And it wasn't always easy to predict where they would turn up. Statewide, people went to 100 different hospitals. Some walked across the Brooklyn Bridge and then sought medical attention. Another 1,000 made their way to New Jersey hospitals—some crossing the Hudson River in tug boats.

"You can't control where they'll go," says Waltman. "People will get on trains and go home, then go to hospitals."

In other words, a regional disaster plan may look great on paper, but people don't always behave the way officials think they will—a Sept. 11 lesson Waltman and her colleagues shared in a recent meeting with Homeland Security Director Tom Ridge.

But back in September, they had to go with what they knew at that time. Waltman and other association personnel took turns staffing the command center, first at the police academy and later at Pier 92, which became its temporary home. In the weeks following Sept. 11, a representative of the hospital association was on duty 24/7, as were their counterparts at police, fire, transportation, and health. Downtown Manhattan was cordoned off by police, who also closed bridges and tunnels. When doctors and hospital staff were stopped at barricades, along with trucks bearing medicine, Waltman and her colleagues had to intervene.

The greatest challenge for the hospitals was communication. The terrorist attacks knocked out phone service in lower Manhattan, area hospitals included. When thousands of people were unable to contact friends, colleagues, and loved ones, they began phoning hospitals. When they couldn't get through—even hospitals with service couldn't handle the volume—many of those distraught people showed up in person, wandering from one medical facility to another, searching for the missing.

The hospitals called Waltman, pleading for help. Mark Ackermann, chief corporate officer for St. Vincents Catholic Medical Centers of New York, remembers the crisis that ensued. The hospitals wanted to make their patient lists available, but the mayor's office was telling them that was illegal.

"We were not allowed to share that information for a time," says Ackermann. But Waltman, whom he calls "a calming force," worked through the legal issues. "There is nothing private or protected about the fact that a patient has been treated at a hospital," says Waltman, who suggested the city establish a telephone hotline. Hospitals supplied the names of World Trade Center patients they had seen; people answering the phones tried to match them with the person callers were trying to locate.

By the morning of Sept. 12, the hotline was swamped. Waltman suggested posting the information online. It took nearly two days to allay various concerns of the mayor's office, but by the evening of Sept. 13 the Web page was up. Families could search for patients by typing in a name. "That single act," says Ackermann, "saved anxiety for hundreds of thousands of people."

learly, Susan Waltman is not your average attorney in a typical legal job—nor did she follow a time-honored path to get where she is.

Growing up in the southern New Jersey town of Millville—which is actually south of the Mason-Dixon Line—Waltman was drawn to the South from an early age. Genetics may have played a role. Her mother, a lab technician, hailed from Virginia. Her father, who exercised the greatest influence on her life, was not a Southerner by birth but he was in spirit, says Waltman. A lawyer by profession, Waltman's father and his father shared a small legal practice. During his spare time, her father was a Civil War buff. Nearly every vacation, her parents packed Waltman and her younger sister into a station wagon to tour the battlefields.

"It wasn't that interesting for a little kid," Waltman remembers with a laugh, but it did make a deep impression. "My father would literally stand there and say, 'And over this hill came Stonewall Jackson's army.' He was supportive of the South's side, so I was oriented toward going to a Southern school."

Her mother pushed Radcliffe, but Waltman wanted a large school with a collegiate atmosphere, which she defined by what it was not—not a school where intellectual pursuits were divorced from practical pursuits and prized for their own sake, and not a school where drugs and demonstrations dominated campus life. In the late 1960s, those were characteristics Waltman associated with northern colleges.

She can't say exactly why she chose UGA, but her intuition proved correct. "I really enjoyed the University of Georgia," she recalls. "I was in the Honors Program, which meant I could take smaller classes that were perhaps a little more advanced." She majored in sociology and also took French and German—not the typical pre-law route. She also spent a semester at the University of Saltzberg, then returned to UGA to earn a master's in social work.

What interested Waltman about social work was the focus on community organization. "When I went to school," she says, "girls were nurses or teachers." As a helping profession, social work also qualified. Though she had an idea she would one day go to law school, it didn't change her perspective on social work. "When I went to law school," she says, "it was to be a more effective social worker, a more effective community organization person."

Waltman's most memorable experience at UGA was the practicum portion of her MSW. She lived in Atlanta and worked for the Fulton County Department of Family and Children's Services on a project designed to help children bouncing from one foster home to another find permanent homes. Later, she helped draft a model law for a child abuse and neglect statute. She also interviewed candidates for governor to assess their positions on children's programs.

Waltman has high praise for UGA professors Pauline Lide and Katie Thompson. "They really looked at me and at my talents," she says, "and tried to design practicum experiences that would capture what was probably a nontraditional social work interest."

Waltman went to law school at Columbia, where her father and grandfather had gone before her. Next, came a six-year stint at a Philadelphia firm where she focused on commercial litigation. She especially enjoyed the work she did for the Medical College of Pennsylvania—and when she advised administrators that she could save them money if they hired her as a general counsel, they took her advice. The job helped shape her view of what it means to be a lawyer.

She eventually left the medical college after marrying an investment banker who lived in New York City. But she was so reluctant to make the job change that she stayed on for a year after getting married, commuting to New York on weekends. She took her present position in 1987 "as a good place to start," she says, "and found it was a good place to stay."

Her job has confirmed her belief that good lawyers solve problems—no matter what the arena.

Take the anthrax crisis, where Waltman and New York hospitals were also at Ground Zero. Immediately after Sept. 11, city, state and federal agencies began monitoring emergency rooms for clusters of symptoms that suggested a biological or chemical attack. Waltman organized a seminar two weeks later for representatives of those agencies and the Mayor's Office of Emergency Management. On two days' notice, 230 people showed up, most of them emergency room doctors, infectious disease experts, and hospital administrators. "They could have written the protocols themselves," says Waltman, "but it's very useful to have these refreshers."

Two weeks later came the news that a woman at NBC had contracted anthrax. Waltman was soon spending the bulk of her time fielding calls from reporters and the public in addition to hospitals. The greatest challenge was convincing the public not to overreact. "Everybody wanted to know about Cipro," she says, referring to the antibiotic, "and everybody wanted to know whether the hospitals were prepared." The message they wanted to convey was that there was no reason to panic and that drug hoarding and needless visits to emergency rooms were counterproductive. The best way to do so, Waltman found, was working closely with the mayor's office. When hospitals wanted to emphasize that only people in certain locations should be tested for the disease, Waltman arranged for the mayor to hammer home the message.

The formula worked well. In contrast to federal officials, who were criticized first for their silence and then for the imprecision of their messages, Giuliani was widely praised for the timeliness and clarity of his. It was thanks in part to people like Waltman working feverishly behind the scenes.

hy is a lawyer doing all this? Emergency planning is embedded in regulations that govern hospitals, and Waltman is their legal counsel. New York State requires plans and drills, she explains, as do accrediting agencies. If hospitals lack emergency plans and make mistakes, they can be held liable.

The emergency measures that Waltman implemented on Sept. 11 were developed, ironically, in anticipation of a Y2K emergency. In January 1999, Waltman organized biweekly seminars. Experts on medical devices explained how to test them to ensure they would function properly on Jan. 1, 2000. Utilities experts discussed what to do if hospitals found themselves without water and electricity. Waltman spent New Year's Eve at the emergency bunker at 7 World Trade Center—just in case. Though the Y2K emergency never materialized, she says the training served them well—and health care professionals are quick to praise her work.

"She's done a phenomenal job in leading us through this cumbersome, complex set of issues with real focus and follow-through," says Gail Donovan, COO of Continuum Health Partners.

St. Vincents' Ackermann attended the mid-January meeting with Homeland Security Director Ridge. Waltman was one of four speakers who gave reports in a meeting that was expected to last 30 minutes, but took nearly two hours. Ridge was particularly impressed with the coordination of the agencies, says Ackermann, adding: "The hospital association and Susan played a major role in making that happen."

Though she's an accomplished public speaker, Susan Waltman's normally rapid cadence slows to a crawl when asked to reflect on Sept. 11. What horrifies her most about the attacks, she says, is the combination of intelligence and evil: "It's horrible to think about the planning that went into this."

Persuaded to talk about her tour of Ground Zero—an experience she has previously shared only with her family—Waltman says it was nothing like trips to the Civil War battlefields.

She went on Sept. 13, the day before President Bush's visit. There were about a dozen of them in all, including her boss and Health and Human Services Secretary Tommy Thompson.

"It was beyond description, like some surreal movie," she says. "Even the air was still gray." She felt like an intruder. "It isn't like I couldn't handle it," she says. "I can handle anything. If someone told me to clean it up, I'd clean it up." She pauses. "I just felt it was kind of hallowed ground. It changed so many lives. I wasn't sure I deserved to see it."

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