Hurricane shows faults in hospital planning and potential liability
Special Report: Lessons from Hurricane Katrina
Hurricane shows faults in hospital planning and potential liability
Warning: Your disaster plan may not work when it matters most
[Editor's note: This month's issue includes a special report on the risk management issues revealed by the experience of health care providers involved in Hurricane Katrina. Some of the key issues involve administrative liability, credentialing, and the need for realistic, practical disaster planning. Next month's Healthcare Risk Management will include more coverage of the lessons from Hurricane Katrina, including the liability risks of sending crews to work in a disaster zone.]
Risk managers will reap lessons from the experience of health care providers in the Gulf Coast for years to come, but one of the most apparent lessons from Hurricane Katrina should send you rushing to reassess your organization's disaster plans. What looks good on paper may not work at all in the midst of a major crisis in your community, some hospitals learned, and failing to plan adequately could set your organization up for tremendous liability in the aftermath of a disaster.
Hospitals in New Orleans were forced to evacuate as floodwaters rose, and others stayed open only to find themselves waiting for help far longer than they ever expected they would have to during an emergency. Some hospitals were besieged by looters, and most had to make do with dwindling supplies and failing power supplies.
Warner L. Thomas, president and chief operating officer of the Ochsner Clinic Foundation, saw it all firsthand. The Ochsner main campus, which includes the hospital and clinic, are in Jefferson Parish, LA, just miles from downtown New Orleans. Ochsner was one of the few hospitals that remained open throughout the hurricane and its aftermath, and Thomas tells Healthcare Risk Management that good planning and execution were the reasons.
Eight other hospitals in the community closed their doors. Ochsner fared better than some hospitals in the city because it is on somewhat higher ground, but Thomas says the hospital had planned well for surviving a hurricane.
Their focus, as they saw the storm coming, was to go through all the steps they had planned and drilled, he says. “We ordered additional supplies [food, medical supplies, and fuel] and backup generators, in addition to the ones we always have on hand," he recalls. “All of the things we had planned long before helped us keep our operations going."
Thomas explains that the hospital transferred some critically ill patients, but did not have to evacuate. Memorial Herman in Houston airlifted some patients to its facility, and the University of Alabama airlifted others. About 40 patients were moved from the other Ochsner facility in New Orleans to the main campus, so about 400 patients were there during the disaster.
When the area began to flood, Ochsner was ready to implement the part of its disaster plan that called for “vertical evacuation," which means moving patients, personnel, and supplies up higher in the 11-story building. The floodwaters eventually came up to the doors of the hospital but no further.
The hospital relied on its own armed security guards and did not experience any violence, Thomas reports. The hospital's e-mail connection stayed up, and phone lines could sometimes dial out. Ochsner was able to contact a sister facility in Baton Rouge, which then relayed any messages requesting aid. The hospital was one of the few in the area that still had ground access, because it was on high ground.
“I don't know how much you can plan for everything in a situation like this, but I guess we planned as much we could," Thomas says. “A huge thing for us was that we had people in all the key areas who could think on their feet and not lose their cool. That's probably the best thing you can do."
Thomas cites these elements that helped Ochsner stay operational in the face of Hurricane Katrina:
• As part of their planning, hospital leaders consulted their counterparts at other facilities that had been through hurricanes recently. By talking one on one, they learned about several small things they had not considered before, such as the need for portable toilets in the event power and water supplies were interrupted.
• The hospital recently built a retaining wall around its emergency generator last year, which guaranteed that the hospital could sustain at least 8 feet of floodwater before losing the emergency power supply.
• Hospital leaders were highly visible during the crisis. They lent a hand on the floors and fielded questions and requests. Thomas and other executives also met frequently with physician leaders and others every day to keep the staff abreast of fast-changing developments.
Despite weathering the hurricane fairly well, Thomas says Ochsner already is noting the lessons learned. Even with the retaining wall around the generator, Ochsner leaders were worried that the floodwaters could rise and drown the equipment. To make that even less likely in the next flood, the hospital is planning to move the generator and critical switching equipment to a higher location on the hospital campus. “We realized how important it is not only to have an emergency power supply, but to protect it," he says.
That kind of independence is what can make the difference in whether your facility survives a disaster, says Fred Roll, CHPA-F, CPP, president of the International Association for Healthcare Security and Safety in Glendale Heights, IL. Hospitals managers — and everyone else — in New Orleans found out that they could not rely on outside agencies and local authorities to help. They may be busy with everything else going on in the community, or worse, they may just be inept.
“When I review disaster plans for hospitals, there's often a page that says that if things get really bad they will call the city and the city will send over a bunch of buses to evacuate the hospital," he says. “I tell them that's OK for the first preliminary plan, but what are you going to do if those buses don't come?"
Cross-training can be one solution to evacuation and security needs during a crisis, he says. Facilities can cross train their emergency medical technicians, maintenance staff, and other staff to perform limited security functions, for instance, so that the dedicated security personnel can handle the most serious situations.
The big lesson from Hurricane Katrina should be that disaster plans are not just a required precaution that you can compile, put in a nice binder on the shelf, and then forget about, says Cheryl Camin, JD, is an attorney with the Dallas law firm of Gardere Wynne who works closely with health care providers in disaster planning and other issues. Even if you will never be in the path of a hurricane, she says, something equally disastrous could befall nearly every health care facility in the United States. Whether it is a flood, tornado, blizzard, earthquake, pandemic, civil unrest, or terrorist attack, risk managers should ensure that their organizations have practical and thorough disaster plans that have been well tested.
Camin specifically cautions against relying on an off-the-shelf, generic hospital disaster plan that you can buy from a consulting company. Those can be good starting points, but real disaster planning requires more than just plugging your hospital's name into an all-purpose document.
“There are so many reasons to do it right, but if you as the risk manager need one more bit of ammunition to take to the CEO who doesn't want do spend money on a big drill, tell them that there won't be any more excuses after what happened in New Orleans," she says. “This caught a lot of people by surprise, but it's going to be harder next time to say that you didn't know what could go wrong. We do know now, and that creates a duty to act."
Risk managers will reap lessons from the experience of health care providers in the Gulf Coast for years to come, but one of the most apparent lessons from Hurricane Katrina should send you rushing to reassess your organization's disaster plans. What looks good on paper may not work at all in the midst of a major crisis in your community, some hospitals learned, and failing to plan adequately could set your organization up for tremendous liability in the aftermath of a disaster.Subscribe Now for Access
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