The National Weather Service has predicted another active hurricane season in 2013. As many hospitals around the country have learned, a hurricane can be devastating to both a hospital and the surrounding community.
Hurricane Katrina, which made landfall in southern Florida and then in southeastern Louisiana in August 2005, caused hundreds of deaths and over $100 billion in damages, according to the National Climatic Data Center.
New Orleans suffered much of the damage, and local hospitals were no exception. "Katrina placed many changes and obstacles for all New Orleans hospitals, some of which remain today," says Norris Yarbrough, assistant vice president for emergency preparedness and response at New Orleans-based Ochsner Health System.
Much of the coastal New York and New Jersey region faces a similar prolonged recovery period following Hurricane Sandy, which made landfall as a superstorm in the region in October 2012. The region as a whole suffered staggering damages. South Nassau Hospital in Oceanside, N.Y., suffered between $8 and $10 million in total damages, according to CFO Mark Bogen. One of the biggest impacts was the flooding of the hospital's outpatient dialysis center, which left 140 chronic dialysis patients "without a home," says Mr. Bogen. A FEMA claim is still being processed for reimbursement.
These hospitals' combined experiences offer five lessons for preparing for, and recovering from, a hurricane or tropical storm.
1. Identify vulnerabilities, and invest accordingly. Both hospitals stress the value of investing time and resources into fortifying the hospital against the damages of a natural disaster. "Have an assessment done to identify areas of vulnerability to flooding, power loss, communications failure, etc.," says Jennifer Mandel, project coordinator, emergency preparedness and performance improvement at South Nassau Hospital.
She specifically recommends focusing on improvements that would keep emergency generators functional in a crisis: "Take whatever physical steps you can take to prevent flooding and protect your generators. The investment is worth the dollars that you will save in repairs and will decrease the chances of needing to evacuate," she says.
Mr. Yarbrough of Ochsner advocates similar preparation: "Take an honest assessment of your vulnerabilities, both from a physical plant standpoint and an operational standpoint," he says, and then "identify contingencies based on those findings."
2. Be prepared to care for staff. "Immediately after the storm, over 80 percent of Ochsner's workforce had some level of damage to their homes," says Mr. Yarbrough. The hospital took action to meet the needs of affected staff. "For months, the hospital provided housing in local hotels and other accommodations as well as transportation to and from work," he says.
"Supporting your staff is key to success" in recovering from a disaster, says South Nassau's Ms. Mandel. A significant portion of the hospital's staff were affected by the storm, and "many lost everything," she says. The hospital helped staff recover and rebuild by connecting them to state and federal resources, providing salary advances and facilitating the donation of supplies among staff members.
Looking back, Ms. Mandel says she would have gone even further, and worked to have a memo of agreement in place with local gas stations and hotels so that hospital staff could have been given priority on what quickly became limited resources.
"Staff must feel supported and cared for, otherwise how can they care for others?" she says.
3. Be prepared to care for the entire community. Because hospitals are priorities when it comes to restoring utilities, hospitals in areas affected by natural disasters become hubs not only for healthcare but also social and government services, and hospitals should account for this in their disaster preparation plan.
According to Mr. Bogen, following Sandy South Nassau Hospital "served as a 'defend in place' for the entire area. A number of local residents were rescued and brought to our main lobby (in some instances including pets) and people constantly wandered into the main building as they saw the lights and used the facilities to catch some sleep, charge cell phones and other devices and generally escape form the elements outside and the lack of a safe home to return to."
"In a natural disaster where an entire community is affected, be prepared to provide assistance to the community. Not only may you be expected to take in patients from other hospitals, but people from the community will flock to the hospital. Designate areas where these people can temporarily stay until social services can provide assistance, or patients can reach shelters" says South Nassau's Ms. Mandel.
4. Seize opportunities. There were over 37 hospitals in the area before Hurricane Katrina, says Mr. Yarbrough. Now there are 29. "Ochsner made a conscious decision to lead the recovery of healthcare in this region," he says, and to that end acquired and rehabilitated several hospitals that were severely affected by the storm, and partnered with others.
Ochsner's long-term recovery plans include "the expansion of our system and a realignment to allow us to be the key provider of total healthcare in Louisiana," says Mr. Yarbrough. Ochsner seized "the unique opportunity to reinvent the healthcare in this area. The immediate investments made for our employees’ personal needs coupled with the steps taken to rehabilitate healthcare in this region have been among Ochsner’s wisest decisions," he says.
5. Be able to adapt to permanent change. Much like Homestead (Fla.) Hospital discovered after Hurricane Andrew, and St. John's Mercy in Joplin, Mo., and Morgan County ARH in West Liberty, Ky., discovered after devastating tornados, natural disasters fundamentally change the communities they hit.
On Long Island, South Nassau Hospital has had to fill the role of primary provider for the community following the closure of several affected area hospitals. "A medical unit that had been closed and ready for construction was re-opened to accommodate the increase in patient volume that resulted from the closure of Long Beach Medical Center," says Ms. Mandel.
"Our hospital has picked up over 100 admissions a month from areas historically serviced by Long Beach. Additionally, we are seeing approximately 250 more emergency department 'treat and release' cases per month," says South Nassau's Mr. Bogen.
"However, our overall uncompensated care (combination of bad debts and charity care) as a percentage of net revenue has climbed from 7 percent to 9 percent since the closure of Long Beach," he says.
Hurricane Katrina fundamentally altered the healthcare landscape in New Orleans as well, in addition to the city itself. "Katrina brought many changes and obstacles for all New Orleans hospitals, some of which remain today. They include, but are not limited to, a decrease in available hospital beds in the region, a sharp decline in the number of psychiatric beds available, a population exodus that is still recovering, financial challenges in loss of revenue, damaged property and employee exodus," says Mr. Yarbrough.
"The recovery process continues today not only for Ochsner, but for the city of New Orleans," he says.