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September 5, 2017

How Houston hospitals fared during Harvey—and what they're preparing for next

Daily Briefing

Although Hurricane Harvey led to the closure of at least 16 hospitals, crisis management coordination between Texas hospitals and the state minimized care interruptions, and officials estimate that most facilities in affected areas will return to full service within the next several weeks.

When natural disasters threaten, here's how to protect your critical data—and your patients

Harvey made landfall in Texas as a Category 4 hurricane on Aug. 25. The storm has since passed, but the region is still recovering from severe flooding.

How hospitals have fared

Officials on Wednesday said while there have been some service disruptions, hospital shutdowns, and patient transfers, the overall interruption to care has been far less severe than it was during Tropical Storm Allison or in other areas of the country that faced similar natural disasters.

Darrell Pile—CEO of the Southeast Texas Regional Advisory Council (SETRAC), which operates the Catastrophic Medical Operations Center (CMOC)—said, "The majority of our hospitals stayed open," adding, "The teamwork of hospitals and [emergency medical services] agencies through our coalition kept it from becoming an even a bigger disaster." Further, of the Houston-area hospitals affected by the storm, Pile said he expects "90 to 95 percent of hospitals [to] be back in full service [by the end of September]. That's a first." 

However, Pile said Harvey "was paralyzing," noting that it has "challenged every plan we've written, every resource, every piece of inventory." Overall, according to officials, at least 16 hospitals as of Wednesday were closed because of the flooding, and several hospitals had to suspend elective surgeries and postponed appointments.

For example, MD Anderson Cancer Center on Sunday closed down its outpatient services to focus on patients already in the hospital who required time-sensitive care. The hospital staff worked with patients and other medical facilities around the United States to reschedule appointments and ensure patients who required immediate cancer care could receive treatment closer to their homes. As of Tuesday, Sept. 5, all of MD Anderson's clinics were up and running, STAT News reports.

Meanwhile, as of the latest notification available on HCA Healthcare's website today, the health system said its East Houston Regional Medical Center remains closed, its facilities in Corpus Christi have reopened, and two of the system's hospitals in Houston have maintained minor damage from flooding. Separately, Community Health Systems said five of its hospitals have been affected by Harvey, with one of those—DeTar Hospital North—likely to remain closed through this week.

But not all hospitals were forced to close their doors. According to CNN, one hospital that remained open throughout the storm was St. Joseph's Medical Center in Houston. St. Joseph's had ordered enough food and supplies to weather the storm, and its floodgates held, but linens were running low until a nearby Embassy Suites donated about 4,000 sets of sheets. St. Joseph's also had to set up a triage center on a loading dock to handle an influx of new patients. Separately, LifePoint Health said all of its hospitals in south Texas are operating normally.

Patient evacuations

As of Wednesday, about 20 of the 110 hospitals in Houston and surrounding counties had evacuated some or all of their patients, including Memorial Hermann Sugar Land Hospital, which on Tuesday moved 75 patients, and the Lake Arthur Place nursing home, which evacuated all residents on Wednesday. Overall, almost 1,500 patients in hospitals, nursing homes, and other health care facilities in the state have been evacuated.

According to Pile, hospitals have been providing electronic updates to CMOC three times each day as to the number and type of beds available, if any.

Pile added that SETRAC has independently and in collaboration with the Texas Department of State Health Services (DSHS) worked to make sure that hospitals selected to receive any patient transfers were not in harm's way from Harvey, thereby ensuring patients do not have to be moved twice. As of Thursday, Chris Van Deusen, DSHS' director of media relations, said if area hospitals ran out of room, there were about 2,000 available hospital beds throughout Austin and Dallas.

However, while evacuation numbers increased during the middle of last week, Pile noted that several hospitals scaled back or canceled evacuation plans, citing improved circumstances. For instance, Ben Taub Hospital planned to evacuate 350 patients after the facility's basement was flooded and a sewage pipe burst, requiring the hospital to shut down part of its kitchen, pharmacy, and supply area for linens and needles. But "as the waters went down, and additional staff were able to arrive, they whittled down their [evacuation] list," Pile said on Wednesday.

In total, according to Pile, only about 25 of the hospitals affected by Harvey declared an "internal disaster"—a status a hospital declares when it is facing challenges completing daily operations—and SETRAC was able to promptly update first responders, ensuring incoming patients were diverted to facilities capable of providing care. Pile said CMOC will conduct a retrospective study to assess how hospitals handled the storm.

Looking ahead

According to the Wall Street Journal, hospitals are expecting an influx of patients as floodwaters recede and the roads clear up.

Hospital officials added that they are also strategizing on how to minimize staffing shortages as hospital workers navigate personal losses from the flooding. According to Reuters, hospital officials said they were assessing whether to put staff up in temporary housing near facilities and provide daycare options.

Alex Loessin, a spokesperson for Memorial Hermann Health System, said of the expected surge in patients, "We know what's coming." Loessin said the health system on Aug. 29 reopened two urgent-care facilities and hoped to open an additional four to divert some of the patients expected to come into the health system's EDs.

McLeod said Ben Taub was expecting a "surge of patients" as roads clear. The hospital on Aug. 30 was able to discharge several patients, which McLeod said was "was important so we can maintain the proper staff level and so that we can again start accepting patients who will need us." According to McLeod, the hospital intends to send staff home as the floodwaters continue to clear and replace them with fresh crews.

State and federal officials are also helping out, STAT News reports. Texas is permitting out-of-state doctors in good standing in their state of residence to provide care for Texas patients in need so long as there's a disaster declaration in place. And HHS has dispatched more than 1,000 employees to provide patient care, physician support, and public health services in the state, while CDC has established two medical stations in Houston and readied four more—two in Dallas and two in Baton Rouge—if needed.

Among other health concerns, medical experts say people in areas affected by Harvey could have to deal with contaminated water, which could lead to burns, rashes, or other symptoms; mosquito-borne illnesses, such as West Nile virus and Zika, particularly as floodwaters recede and mosquitoes infest areas with standing water; lost medications, particularly among people who had to leave medical drugs or equipment behind as they evacuated; mold in buildings that survived flooding, which can cause allergic reactions, asthma attacks, and, in rare cases, death; and the spread of infectious diseases, such as the flu or norovirus, especially in shelters where large groups of people live in close quarters.

Medical providers are also anticipating a greater need for mental health services in the coming months, Modern Healthcare reports. "There will be a huge need for mental health care going forward," Sophia Banu, an attending physician at Ben Taub, said. Banu with about nine other providers has been on call to provide evacuees with mental health care services at the George R. Brown Convention Center this week, where at least 11,000 Houston residents took shelter.

Financial outlook

Separately, Jessica Gladstone, VP at Moody's Investor Service, in a note to clients said affected hospitals likely will see lower patient volumes and extra costs for cleanup efforts.

However, she said the dip in patient volumes likely will be temporary, given that most public hospitals were prepared for the storm and hospitals were able to transfer patients as needed without incident (Goldstein/McGinley, Washington Post, 8/30; Blau, STAT News, 8/30; Christensen, CNN, 8/31; Coombs, CNBC, 8/30; Hsu/Sullivan, "Shots," NPR, 8/30; Evans, Wall Street Journal, 8/30; Ross Johnson, Modern Healthcare, 8/31; Sullivan/Weixel, The Hill, 8/31; Abutaleb, Reuters, 8/31; UPI, 8/30; Thielking, Morning Rounds, 9/5).

When natural disasters threaten, here's how to protect your critical data—and your patients

A robust and well-tested IT disaster recovery plan can help your organization withstand service disruptions including cyber incidents, human error, hardware and software malfunctions, and natural disasters.

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