Hurricanes Bring Destruction and Lessons Learned

Lessons learned from last year’s Hurricane Florence have helped one North Carolina hospital prepare for Hurricane Dorian. Meanwhile, Florida has responded to the nursing home tragedy caused by Hurricane Irma.

EDITOR’S NOTE: Contributing to this story was Timothy Powell, reporting on the tragedy of the Hollywood Hills nursing home.

Like an unwanted guest arriving for dinner, Hurricane Dorian, now a Category 2 storm, is expected to bring high winds and dangerous storm surges to coastal North and South Carolina tonight and into Friday – just 10 days shy of the one-year anniversary of Hurricane Florence.

Today, hospital personnel at CarolinaEast Medical Center are bracing for conditions described as an “enhanced threat” by the Craven County (N.C.) Emergency Management Center. Earlier this week, while the sun was still shining, patients at skilled nursing facilities (SNFs) in North Carolina’s Outer Banks region had been transferred to similar facilities in New Bern, N.C., according to Daniel Zirkman, MD. Zirkman, senior physician advisor at CarolinaEast Medical Center, weathered last year’s Hurricane Florence, as reported by RACmonitor at the time.

“Building on the effective pre-storm planning utilized last year, as well as reviewing lessons learned following Florence’s severe challenges, the hospital is effectively preparing for Hurricane Dorian,” Zirkman wrote in an email to RACmonitor, adding “that regardless of the weather conditions, our patients will receive the quality care they deserve.”

An overview of the planning process provided by Zirkman includes the following:

General:

1. Craven County has not called for a mandatory evacuation.
2. SNFs in the immediate area are not evacuating.
3. Incident command, set up Wednesday morning, will convene during scheduled meeting times, starting today.
4. Incident command will send a hospital representative to the Craven County Emergency Operations Center (EOC) to improve communications and reduce redundant efforts.

Staff:

1. Preparations are underway to provide adequate sleeping arrangements for staff that will remain overnight. Since last year’s hurricane, 100 new sleeping cots were added to the inventory.
2. Physicians will be remaining in-house and available for emergencies, including anesthesia, surgery, OB-GYN, medical specialist services, and hospitalist services. Sleeping locations will be provided.
3. All staff available on-site will assist in any tasks that need support. “No job is too small,” and this includes serving food at the cafeteria, transporting patients and supplies, helping deal with leaks, etc.

Pharmacy:

1. All clinics without backup generator power have been reminded to make arrangements to relocate medications that require refrigeration.
2. Hours of the local pharmacies will be determined.

Maintenance:

1. Plastic sheeting is to be supplied to areas with critical equipment identified as prone to leaking/flooding.
2. All emergency egress corridors are to remain clear.
3. Redundant supplies: flashlights, batteries, fuel for generators, etc.
4. Identified parking areas that flooded last year to be avoided.
5. Conservation of supplies such as linens, etc. Staff should bring their own supplies, as possible.

Social Media:

1. Use caution when sending and receiving information via social media. Lesson learned from the inadvertent dissemination of misinformation last year.

Additional:

1. Follow up with dialysis units to ensure we know and understand their response plans. Policies were changed as a result of challenges with inadequate dialysis coverage last year.
2. Contact local transportation companies to review their response plans…discharging patients safely was a major challenge last year.

Utilization Planning:

1. Anticipate decreased availability of SNFs during and after the storm. Discharge planning should begin pre-storm, with goals of encouraging increased activity and ambulation of hospitalized patients to decrease the subsequent dependence on post-discharge therapy.

Dorian, which bypassed Florida on Wednesday, is continuing its destructive path up the East Coast. Meanwhile, having dodged a bullet this time, Florida residents still shudder when they recall the tragedy that occurred at the Rehabilitation Center at Hollywood Hills nursing home during Hurricane Irma.

“In September of 2017, my wife and I waited out Hurricane Irma in Tampa, ” Timothy Powell, a healthcare consultant and national correspondent for ICD10monitor, told RACmonitor. “After hiding in a bathroom with 10 people during the storm, the storm passed over.”

Powell recalled that as Hurricane Irma approached, its power drained water from Tampa Bay, resulting in a warning that massive flooding would occur when the water returned to the bay after the reverse storm surge.

“Rattled, but thankful, we drove back to Hollywood (Fla.),” Powell continued. “Our neighbor Fernando texted me and told me part of my roof had blown off, and there was water damage to our home. We didn’t get full power back for almost a week. The Internet took a couple of weeks.”

Within walking distance from Powell’s home, a tragedy was happening. Powell explained that he and his wife often walked their dogs past the now-infamous Hollywood Hills.

“Despite the fact that power had returned, the nursing home’s main air condition system had failed,” Powell said. “Twelve nursing home residents lost their lives in the stifling heat. There was a hospital across the street to which they could have evacuated their 115 patients.”

There are 60 nursing homes in the metro area that could have absorbed the influx, according to Powell.

Just last month, arrest warrants were executed for four nursing home employees. More arrests are expected, and the facility’s nursing home license has been suspended.

“Gov. Rick Scott and the Florida legislature pushed through legislation that requires all nursing homes and assisted living facilities in the state to have functional backup generators,” said Powell. “I find what the nursing home employees did to be deplorable and criminal. I want people to understand that most of the people involved in long-term care are the kindest, most thoughtful people you could want to meet.”

Powell thinks the state of Florida and regulators are passing the buck. There are only 650 nursing homes in state of Florida. There are about 3,500 assisted living facilities.

“The state of Florida has the names and addresses of all the facilities, and the phone numbers of their owners,” he said. “My question would be, why weren’t wellness checks carried out by state regulators?”

This map shows how many nursing homes are around Hollywood Hills.

This map reveals that following the hurricane and the closure, there as at least a dozen nursing homes that could have taken the patients. Indeed, following the closure, that is exactly what did happen.

“I think it was not so much a failure of electricity that doomed the patients as a failure of the state and first responders,” Powell said. “Additionally, who is to say that during a hurricane, the generator would not be damaged, leaving the nursing home patients vulnerable? Does this mean first responders are not going to make site visits?”

“The cost of the generators is also a huge burden in an industry with a slim bottom line,” Powell added.