What could be more frightening than being wheeled into the ER at your local hospital on New Year''s Eve 2000, only to find that the hospital''s machines aren''t working because of the time-date glitch built into the microprocessors embedded in every piece of equipment, from pulse monitors to infusion pumps to defibrillators?

That scenario is unlikely, at least at Monterey County hospitals, where in-house committees have been reviewing, testing and replacing or upgrading every piece of equipment that may be affected by the Y2K bug. But for smaller health care providers, in the county and around the country, the scenario may be much different.

At Community Hospital of the Monterey Peninsula (CHOMP), representatives from every department have been meeting regularly for more than two years as part of the hospital''s Century Compliance Task Force. CHOMP Vice President Cynthia Peck says the task force has checked out every piece of equipment in the hospital, from medical instruments and life-saving devices to elevators and heating systems, and has written to every outside vendor doing business with the hospital to ensure that they, too, are Y2K compliant.

They''ve been replacing, upgrading, and drawing up contingency plans. Even if power goes out, Peck says the hospital is equipped to run on its own generators for an indefinite period of time. That''s something they have to do quite often, whenever heavy storms down power lines, or earthquakes knock out power connections. "As long as a truck can deliver fuel to us, we can run [without PG&E] indefinitely," she says. "To the degree we can control what goes on within our building, we feel confident." (see sidebar).

Natividad Medical Center in Salinas has been working to bring its facility up to speed for Y2K for 10 months now, slightly less time than CHOMP. Teams from radiology, laboratory services, pharmacy, nursing, biometrics, biomedics, information services, and any other department that relies heavily on technology have been reviewing and updating their equipment and educating their employees.

Assistant Administrator Pat Wainwright says the bulk of the work has fallen on the hospital''s biomedical engineering department. They reviewed the hospital''s information management systems; all biomedical equipment that provides patient care, both diagnostic and support (the so-called life-sustaining equipment that is every hospital''s first priority and every patient''s first concern in a power failure); and facility equipment such as elevators and air-conditioning.

"In each category we itemized all the equipment [as to] high-, medium- or low-risk vulnerability," Wainwright explains. "We''re well into the testing process now. We have evaluated 50 to 75 percent of the high- and medium-risk medical equipment, for both diagnostic and patient support."

Because Natividad has just moved into a new facility, building systems such as alarms and fire sprinklers are already Y2K compliant. Reviewing the hospital''s data processing and information management systems is less far along, however. The mainframe has been checked out, but they''re still in the middle of examining managers'' PCs.

"We''re pretty far along," Wainwright says. "We feel relatively comfortable. You''re never 100 percent. The hospital industry was slow to get on board [with Y2K readiness]. But once we did, we''re moving along."

The public shouldn''t be overly concerned about computer failures in the larger hospitals, facilities with the money, personnel and expertise to deal with the Y2K problem, she says. It''s the smaller clinics, nursing homes and doctors'' offices that may be more at risk.

In fact, a special Senate panel report released last week warned that a number of U.S. economic sectors, especially the health care industry, appear at significant risk for technological failures and business disruptions.

The report points a finger directly at smaller health care businesses, stating that more than 90 percent of doctors'' offices and 50 percent of small- and medium-sized companies have not yet addressed the Y2K problem.

It''s not something smaller businesses are eager to discuss. Phone calls to half a dozen Monterey-area nursing homes and doctors'' offices were not returned.

Central Coast IV Services, headquartered in Ryan Ranch, Monterey, is prepared. Liz Johnson, director of operations, says they did Y2K checks on all their relevant medical equipment, including infusion and pole-mounted pumps that work with microchips that are date- and time-sensitive. The company''s internal computer system, used for keeping track of patient records and prescriptions, is compliant, she says.

But in areas where the company has to rely on outside vendors, they''re not as confident. "We do have concerns that Medicare and MediCal will have problems with their billing," she says. "They say they''ll be OK, but we''ll see."

So far, most of the publicity and efforts regarding Y2K compliance in the health care industry has focused on medical equipment and in-house computer systems, actual machines like pacemakers and X-ray machines that have embedded microprocessors that could malfunction when the year changes. Relatively little attention has been devoted to how the health care industry plans to ensure timely and sufficient delivery of drugs and other pharmaceutical supplies to patients who depend on daily doses of certain medications.

Diabetics, AIDS patients, stroke victims and other folks who depend on life-maintaining drugs could be at risk if raw supplies are held up at factories because of power failures or manufacturing line breakdowns; if transportation systems falter when the drugs are on their way to pharmacies; or if HMOs and insurance companies can''t authorize payments for those drugs, and patient credit cards and ATM machines don''t work.

Rx2000 Solutions Institute, a Minneapolis-based group focused on Y2K-related medical issues, told the New York Times last month that this is where the real health care problems will crop up, if the industry doesn''t begin serious preparations right away. "I think people are going to be furious with drug companies and pharmacies," a consultant with Rx2000 told the Times. "And it''s not just the chronically ill we need to consider. If you have a terminally ill patient you have to have enough narcotics to allow them to go humanely."

Rx2000 is one of a growing number of consumer organizations urging people to stock up on needed drugs ahead of time, just in case. They''re also urging the federal government and insurance companies to authorize a one-time waiver of the 30-day limit on reimbursement for prescription drugs, so that folks can afford to buy two or three months'' worth before Dec. 31.

Blue Cross of California hasn''t received any such requests from its customers yet. "So there has been no movement to address it," says Rob Seidman, vice president of Blue Cross of California Pharmacy. That doesn''t mean the company wouldn''t consider such a request, if it were made. "We consider all avenues available to ensure access to appropriate pharmaceutical care."

Neither CHOMP nor Natividad has begun stockpiling pharmaceuticals in anticipation of any run on drugs at year''s end. "That would be part of the ''what-if'' process," says Natividad''s Wainwright.

CHOMP''s Peck echoes her assessment, saying CHOMP''s actions will "depend on what everyone else" in the industry does. "If pharmaceutical companies are getting a run on their supplies, you don''t want to be the only one caught without what you need," she says. "We''ll be watching it very closely."

Area pharmacies don''t seem concerned yet about this potential problem. "I think it might be blown out of all proportion," says John Mowry, pharmacist at Carmel Drug Store. "Y2K won''t change the fact that I''ll have medications on the shelf."

Mowry points out that pharmacies are required to keep patient records on hard copy, as well as in their computers. "It has to be ''readily available,''" he says. "That''s standard across the pharmaceutical industry. It''s the law." In any case, although his computer is Y2K compatible, he does most of his work by hand, so customers can rest assured that if power is out on Jan. 1, the pharmacy will have access to their records and prescriptions. "This computer is just an adding and memory machine for us," he says.

Dana Gordon, owner and pharmacist at Central Avenue Pharmacy in Pacific Grove, says that he''s not anticipating any lack of supplies and medications. It''s when it comes to paying for it that the Y2K problems may come into play; if Medicare, MediCal and other insurance companies experience computer malfunctions.

"The only concern I would have is insurance," he says. "If computers went down, that wouldn''t prohibit me from dispensing medications. It''s communicating with the person who pays the bills that might be a problem."

Gordon''s doors will, he says, be open. "You''ll still be able to get your nitroglycerine, and your Viagra," he promises. "But going to the bank to get money out, that''s a concern, I would think." cw