For doctors caring for earthquake victims in Haiti, this was a week that began in crisis.
That's because after pushing trauma centers in South Florida to what the state's governor called the "saturation" point, the military had halted all medical evacuation flights from the island. Doctors were warning that, unless flights were quickly resumed, patients would die.
But then federal officials agreed to cover the costs and to enlist other areas to help care for injured Haitians. The federal government activated the National Disaster Medical System, a program that in the past had been used only for domestic disasters like Hurricane Katrina.
In Florida, the head of the state's Department of Children and Families, George Sheldon, hailed the federal action.
"This will take care of Florida's medical cost for the future," Sheldon said. He said it would also improve the quality of care by distributing patients to hospitals around the country.
In the first weeks after the earthquake, hospitals in Miami-Dade, Broward and Palm Beach counties provided care for more than 500 earthquake victims.
Fred Keroff, director of emergency services at the Broward Memorial Health System, said his hospitals have seen more than 100 patients from Haiti. Many arrived in critical condition — with multiple fractures, spinal and head injuries.
"All these people are going to be in the hospital for months to come and then require, once they get out of the hospital, some significant rehabilitation, just to get back to functional status," Keroff said.
Doctors say treating severe injuries like these may end up costing $100,000 or more per patient.
Under the medical disaster designation, the federal government will reimburse hospitals at 110 percent of the Medicare rate for hospitalization.
Jeanne Eckes, director of emergency preparedness for the Broward Health hospital system, says there are still lots of unanswered questions: Will the federal government cover costs of caring for earthquake victims who were admitted before the disaster designation? And will it pay for rehabilitation and the cost of long-term care?
"Some of this is unprecedented, so the rules are being written as we go along," Eckes said.
After three weeks of receiving medical evacuees, South Florida hospitals are in standby mode. Earthquake victims from Haiti are now being flown to Atlanta and are expected soon in the Tampa area.
Meanwhile in Haiti, doctors from the University of Miami Miller School of Medicine are still on the front lines. Since the day after the earthquake, the university has staffed and run a field hospital in Port-au-Prince, with 150 doctors and nurses, and beds for 260 patients.
Pascal Goldschmidt, dean of the medical school, says the effort has received good support from donors, but he's worried about the expense over the long term. He estimated costs at $10 million in the first month alone.
"Once the problem is less in the news, the tendency for support is substantially reduced," Goldschmidt said. "I'm concerned that in the long run, we may end up with financial problems at a time when patients will still have substantial problems that need to be cared for."
Over the past month, University of Miami doctors and volunteers from other institutions have rotated through Port-au-Prince doing procedures many haven't seen since their student days. William O'Neill, a cardiologist and top administrator at the medical school, was there just days after the earthquake.
He soon found himself inserting intravenous lines, treating fractures and at one point even holding a patient down while her foot was amputated.
"It was just absolutely a profoundly moving experience — sort of getting back the joy of practicing and healing," O'Neill said.
The University of Miami hospital in Port-au-Prince is still full. The school is beginning to work on a plan to turn the temporary facility — now housed in four large tents — into something more permanent. And within the next few months, the school hopes to turn the facility over to Haitian doctors and have its staff work mostly as trainers and consultants.