Florida hospital endures trial by hurricane — again
With Wilma, 'we started earlier'
When Hurricane Wilma hit the east coast of Florida on Oct. 24, 2005, staff at Martin Memorial Medical Center in Stuart were able to do "more laughing than crying," says Carol Plato, CPAM, CMPA, director of corporate business services, thanks to the experience gained from the facility's two encounters with hurricanes in 2004.
During Hurricane Francis, which hit Stuart in early September 2004, a tornado tore off chunks of the roof, all five elevators flooded, and the sixth floor flooded, Plato says. "We evacuated the hospital to the best of our ability, but we pulled the trigger a little too late."
When Hurricane Wilma arrived, she adds, "we didn't evacuate, but we figured out other ways to get the census down. We canceled electives, talked to physicians about discharge plans, contacted nursing homes, and reiterated to the public that hospitals are not shelters. We started the process earlier."
In the case of Francis, hospital officials didn't want to call for evacuation too early, concerned that the hurricane might change direction, Plato explains. "This time, the CEO said, 'Even if it takes a turn, we're not taking any more chances.'" With Francis, she notes, hospital staff had to move patients through stairwells to lower floors, using blankets as makeshift stretchers, after the storm disrupted power and flooded elevators.
"This year, he made the decision earlier," Plato adds. "He said he was willing to take the financial hit [of emptying the hospital] rather than endure the hit [of the hurricane]."
Although the hospital allowed family members to stay in patients' rooms during this year's storm, it limited the number who could stay, Plato says. "We said they could have the spouse or parents, and that was it."
To help monitor that situation, she says, hospital staff made sure that not only patients, but family members, had wrist bands marked with the patient's name and room number. The bands helped ensure that the requirements of the Health Insurance Portability and Accountability Act (HIPAA) privacy rule were followed, and that food was distributed appropriately, Plato explains.
"If they weren't banded, they didn't get fed," she says, "and because of HIPAA, we didn't want visitors doing anything they shouldn't be doing. We made sure they were confined to the patient's room."
During the two days of Hurricane Francis, Plato notes, there was a shortage of food, and the new policy — which was followed for Hurricane Jean, the second hurricane that hit Stuart in September 2004, as well as for Hurricane Wilma — helped prevent that from happening again.
Because people knew what to expect by the time Wilma came along, "even the emergency department [ED] visits were different," she says. "There was less of the hysterical 'walking well,' and there were fewer people running out of medications and oxygen."
With a new roof, built to code, there was also less damage to the facility, Plato says. Although several windows were blown in, she adds, "we didn't have any patients in those areas. You start to know where the tornadoes are coming from." Much of the facility damage to hospitals near the coast is not from the hurricane winds, Plato points out, but from the water spouts that turn into tornadoes.
At the spring 2005 conference of the American Association of Healthcare Administrative Management (AAHAM), held in Orlando, FL, patient financial services directors from a number of Florida hospitals affected by the hurricanes of the previous season gathered for roundtable discussions, Plato notes.
One of the discussions, she says, centered on the appropriate role for a hospital's ED access staff when one of the disaster medical assistance teams (DMAT) coordinated by the federal Office of Emergency Preparedness comes in and sets up a treatment tent for the hurricane's "walking wounded."
"Do you register [those patients], do you not register them? Since the hospital staff are seeing them, do you charge, or not charge? There are EMTALA issues — everything you can think of," Plato adds. "Not everybody had a DMAT team, but we all decided that those patients have to be registered, that you have to keep track of all the paperwork, whether they're seen at a tent or inside the hospital."
While DMAT teams traditionally have set up in the middle of a town, rather than at an individual hospital, that changed when Martin Memorial called for a team in 2004 and asked that it place the treatment area outside its ED, she points out. "That was one of the first times they set up outside an ED, but it worked so well that now that is standard protocol."
Martin Memorial called for the DMAT team "as soon as the wind stopped blowing" after Hurricane Francis, and again after Hurricane Jeanne, Plato says. "We all learned to go ahead and register those patients, and to charge them for any laboratory or radiology [service]. There was no ED facility or physician charge, because that is what DMAT provided."
There was a public relations issue, she notes, because many thought the DMAT services would be free. While much of the treatment fell under the charity care umbrella anyway, Plato adds, "we had to do a little bit of education, explaining to people that if they had insurance, they would be charged."
Another lesson gleaned from the roundtable, she says, is that the chaos caused by a hurricane makes it "an opportune time for the bad guys to come out of the woodwork."
"You have to double-check everything," Plato emphasizes. "We learned that when you're so overwhelmed with the numbers of patients, you really have to throw extra bodies at the admission process." Registrars working long hours under stressful conditions, she adds, need extra oversight lest they attach the wrong medical record or the wrong identification.
One of the suggestions she followed was to get help from the "labor pool" formed of employees from a hospital department or facility that wasn't operational during the hurricane response period.
"If you don't have [enough] experienced access personnel, you can get people from the labor pool," Plato says. "We had them double- and triple-checking information, not doing the actual registration, but helping with paperwork."
A little later in the hurricane aftermath, she notes, access personnel were pulled into the labor pool to provide babysitting services that allowed hospital nurses, as well as their access colleagues, to come back to work when schools were closed.
In some cases, Plato says, physician offices — many of which still work exclusively with paper files — may need the hospital's help.
During hurricanes Francis and Jeanne, "physicians not only set up shop wherever they could, but needed access to our information," Plato says. Martin Memorial loaned space on the hospital floors from which patients had been moved to several physicians, she adds, and provided people from the labor pool to act as an answering service.
"We had a group of surgeons in the same complex as our off-site business office that had their roof cave in," Plato says. "They lost all their computers, lost everything, and counted on us to run reports on their patients from our health information management system to help them recreate the patient information."
After the devastation of Hurricane Francis, Martin Memorial was left with 40 patients, she says, having moved out 110 of its original 250 patients just before the storm hit. "Just the sickest ones — those on vents and those who were too frail to move — were left behind. We had nurses who said they would stay with them through the storm, and we knew we had generator power."
'Along came Jeanne'
At that point, Plato says, "the hospital was basically shut down," with the intensive care unit and other specialty units used as regular wards. "We took all the patients we had to, and [afterward] kept the census at 50. Then along came Hurricane Jeanne [in late September 2004]."
The hospital suffered a little more damage, but didn't have to transfer any patients, she adds. "We were already as low as we could be." During the few weeks between hurricanes Francis and Jeanne, Plato notes, Martin Memorial officials talked with their counterparts at Lee Memorial Hospital in Fort Myers, a West Coast facility that had been devastated by Hurricane Charley, and got some valuable advice.
"They talked to us about how to help our associates [employees]," she says. "I have five people who lost their homes, but we get so wrapped up in taking care of business, we forget we have our own lives. Lee Memorial taught us how to set up an employee resource center, where employees who needed immediate help with their own homes and families could go."
This office helped with everything from buying groceries to contacting insurance companies and the Federal Emergency Management Association (FEMA) to providing employee counseling services, Plato adds. To help people get back on their feet after the hurricane, the hospital raised money, she says, getting donations from corporations and from fellow staff members.
One of the most gratifying parts of the hurricane experience, Plato says, was the sequence of events that occurred when Martin Memorial staff realized that Hurricane Francis "was coming right at us, and we had six hours to get patients out."
Plato got an offer of help from the employee of a local independent air ambulance company, who ended up manning the hospital's hurricane command center with her and the case manager, she notes. "Word got around, and air ambulances started coming from all over the state [to pick up patients]. We printed demographics sheets and transfer medical records, and off they went."
In the meantime, managers at other hospitals — realizing the immediacy of the threat to Martin Memorial — called and said, "We'll take whatever [patients] you have," Plato adds. "Before that, I had been determined not to send no-pay patients or difficult-discharge patients, so that these hospitals would at least get paid.
"We started the evacuation at 11 a.m., we knew the storm was coming by midnight, and we wanted to be done by dark but finished at 1 a.m.," she says, "when the winds were kicking up and the air ambulances couldn't fly."
[Editor's note: Carol Plato can be reached at (772) 223-5656 or by e-mail at [email protected].]
When Hurricane Wilma hit the east coast of Florida on Oct. 24, 2005, staff at Martin Memorial Medical Center in Stuart were able to do "more laughing than crying,"...You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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