According to the National Climatic Data Center, over 1,200 tornados touch down in the United States every year. Many of these tornados are not strong enough to cause significant damage, but that ones that are often leave extreme damage in their wake.
St. John's Mercy in Joplin, Mo., was directly in the path of a massive tornado that touched down on May 22, 2011. The storm was six miles long and over a mile wide, and left the hospital's infrastructure destroyed and unusable. All 183 patients were evacuated the night of the tornado, and in 2012, the hospital building was demolished. Shelly Hunter, current CFO for Mercy Joplin Kansas, was the administrator on call the night the tornado hit. She estimates the damage comes to $1 billion, including the cost of the recently-completed replacement hospital.
On March 2, 2012, Morgan County ARH Hospital, a critical access hospital in West Liberty, Ky., was hit by a powerful tornado that tore off the roof, severed utility connections, destroyed equipment and blew pieces from surrounding houses into the hospital. All patients were evacuated, services were severely limited and many local tornado victims had to be taken elsewhere. Stephen M. Gavalchik, the hospital's CEO, estimates the total damage at $4 million.
Both Ms. Hunter and Mr. Gavalchik have crucial advice for hospital administrators to prepare for a tornado or other natural disaster.
1. Be ready for anything, and everything. When the West Liberty tornado struck, Morgan County ARH Hospital lost six out of seven of its communication methods, leaving only one FM radio for the hospital to use to communicate. Mr. Gavalchik said that, if he could go back, he would have expanded emergency drills to prepare for multiple downed systems at once: "I would have trained more multiple failures of redundant systems like communications, and inject one or two additional conditions into the scenarios," he said. "Because who would have ever thought the phone lines would be down, the cell carriers would be down, the HAM radio would be down and the antennae would be blown off the roof all at once?"
Mr. Gavalchik also stressed focusing on outcomes and not causes. For example, he said it is better to focus on a response to downed communication systems than what caused the downed communications system. "You can't identify every bizarre scenario that may come your way," he said. "But preparing a response for a loss of electric power, no heat or decreased staffing— that covers you for tornados, hurricanes, floods, aliens, whatever."
2. Take the time to review contracts for recovery supplies and services. Ms. Hunter recommends taking the time to thoroughly review all contracts for supplies and services needed directly after a natural disaster. Looking back, she sees an opportunity existed to cut back on these expenses, as the "purchasing and build-out of temporary services and process for record recovery [are] all very expensive."
"Make sure you have a central legal review for every contract," she said, even in the time-pressed post-storm period, to make sure what are bound to be limited funds are spent as wisely as possible.
3. Build relationships with community leaders. Mr. Gavalchik stressed the importance of building real relationships with community leaders and personnel, from elected officials to EMS personnel to employees at the state office of emergency services. After the tornado hit, Mr. Gavalchik's strong relationship with community officials "made operating the hospital during the crisis much more efficient and easier," he said.
"You want to be in a position where they say, 'I know Steve, and if he says he needs three generators, he needs three generators,' and you get what you need," he said.
4. Learn to live with less. Similar to what Homestead (Fla.) Hospital President Wayne Brackin discovered after Hurricane Andrew caused significant damage to both the hospital and surrounding area, a community struck by a natural disaster will only slowly, if at all, fully recover.
Following the storm, St. John's Mercy was faced with decreased revenue, as the smaller replacement hospital built following the storm "saw an increased burden of charity care and bad debt," from residents of the recovering community, said Ms. Hunter. "We still provide all services we did pre-storm but at lower volumes," said Ms. Hunter. The hospital's finances are improving as the hospital improves operational performance with the lower volumes, but Mercy still has to fund the hospital's losses through income from the rest of the system. "Once the new hospital is complete [in March 2015], we will be back operating at our normal volume if not at a higher volume. We are just taking it one day at a time at this point, taking care of our patients while pushing through until we can get into our replacement hospital," said Ms. Hunter.
Morgan County ARH also has had to adapt to serving a smaller community. "Our ER volumes are down 19 percent, admissions down 13 percent, outpatient visits down 17 percent," said Mr. Gavalchik. He attributes the decline to the 400 families from the community who were displaced by the tornado, and one prominent admitting physician who went into semi-retirement following the storm.
While repairs to the Morgan County ARH are expected to be completed in August, Mr. Gavalchik estimates it will be about three years until the community has recovered, and anticipates a new normal for the community. His focus now is seeing his hospital through the community's recovery, while preparing for this new normal.
"If we can stay alive, we'll be okay," he said. "And I believe we will."