| Quick Take>>> |
| After being struck by one of the worst natural disasters in the history of the United States, the health care industry has responded in an amazing and even more efficient way than even the U.S. government. Health care workers from all over the country have concentrated their efforts as one in conjunction with suppliers, vendors and GPOs to help rescue and aid victims left in the wake of Katrina's tumult. They lent their hands, hearts, supplies and money to assist wherever help was needed. One hospital in Houston was even able to work with its suppliers to respond even faster to the needs of evacuees because of lessons learned from Hurricane Allison. |
What was already a developing disaster instantly escalated to something much worse when the levees broke. A submerged New Orleans quickly became the center of international attention, but the devastation caused by Hurricane Katrina was spread across a number of cities in the Gulf region, and it was the job of individuals working in the health care industry to respond to the disaster. (At press time, a similarly powerful hurricane, Rita, emerged in the Gulf Coast threatening Houston and flooding New Orleans again.)
Although every hospital in the country has plans on how to take action in a disaster, few had seen something of this magnitude in their lifetimes.
"The devastation is something of biblical proportions," says Ross Simmonds, chief operating officer at Long Beach (Calif.) Memorial Medical Center/Miller Children's Hospital.
Simmonds led a team of seven clinicians and a pastor into Louisiana days after the storm hit. MedAssets, Alpharetta, Ga., which doesn't have a relationship with the California hospital, provided a jet to transport the team, which included three emergency room physicians, a surgeon, a pediatrician, an operating room nurse and a nurse practitioner.
The trip was hurriedly arranged after Simmonds received a call on Sept. 3 from Kirk Wilson, president of Our Lady of the Lake Regional Medical Center in Baton Rouge, La., which was receiving an influx of patients from New Orleans.
Formerly, Wilson had been a hospital administrator at the Long Beach facility, and called on friends to bring help for his staff as well as those working at a 500-bed field hospital the Federal Emergency Management Agency (FEMA), Washington, D.C., had set up in a basketball arena at nearby Louisiana State University (LSU), Baton Rouge.
"The No. 1 problem we saw was diabetes," says Jeanne Jones, R.N., operating room nurse and vice president of perioperative services at Memorial Medical Center.
"Patients hadn't eaten right for three days, so even if they were mild diabetics to begin with, they were flaming diabetics by the time they got something to eat. That was the No. 1 issue along with high blood pressure."
In what President Bush now admits was a slow federal response to the crisis, thousands of people in New Orleans went without proper nutrition and sanitary living conditions for an extended time. The effect of which was even harsher on the elderly and those with chronic medical conditions.
The sudden need for medical care put a burden on a number of places besides Baton Rouge. Caregivers and medical supplies were in high demand in numerous cities in Louisiana, Mississippi, and Alabama--all of which took direct hits from the deadly hurricane--and Texas.
The most severe patients were admitted to hospitals while others were treated at mobile hospitals by HHS or temporary emergency facilities such as the one at LSU. It's not clear how many storm victims received care in Baton Rouge, the largest city closest to New Orleans, but one report estimates the figure at more than 3,000 in the first few days after Katrina hit. However, despite the large number of patients, officials at Our Lady of the Lake say the task was "challenging, but not overwhelming." Supplies were being delivered to hospitals, though drop-off times were erratic.
"There were days when we waited and waited for a truck, and sometimes it didn't get here. Sometimes we got two or three trucks in one day," says Karen Parker, vice president of finance for Our Lady of the Lake.
Cardinal Health, one of the hospital's primary distributors, usually services the hospitals from a distribution center in Hammond, La., which is about 45 minutes from Baton Rouge. However, Katrina knocked out power to the facility for a time, and although the center wasn't badly damaged, it wasn't operational.
The Hammond facility is normally run by about 100 employees, but many of those people were affected by the hurricane and couldn't get to the distribution center. A couple of managers made it to the facility, but without electricity and staffing, that center couldn't ship supplies, says Donna Gaidamak, a spokeswoman for Cardinal.
Owens & Minor (O&M), Glen Allen, Va., had similar problems with its New Orleans center, which was inaccessible due to flooded roads and debris that prevented trucks, cars or any type of land vehicles from reaching the center.
"We had one area vice president walk through three feet of water to get to the distribution center to service a customer, who'd also made his way to the facility," says Rick Russell, O&M's vice president of operations.
However, for the most part, O&M, Cardinal, McKesson, San Francisco, and other suppliers were operating under previously established disaster plans that called for supplies to come from other distribution centers outside the affected areas.
The system kept supplies moving to hospitals. Cardinal reports supply ordering patterns doubled and tripled for a time from facilities in Baton Rouge as well as cities in Mississippi and Texas.
But, it was a different situation in New Orleans. Communications were difficult or nonexistent at times, and with 80 percent of the city under water, getting to hospitals that were open wasn't always possible. Disaster plans for the region had been drawn up with the expectation that government agencies would assist in evacuating patients and bring in supplies during a disaster.
(An investigation is under way to determine where things went wrong. Finger pointing among federal, state and local officials began before the water was pumped out of New Orleans.)
Looking to the West
One of the biggest operations assisting evacuees was organized in the Houston Astrodome. The large sports facility quickly reached its capacity, however, and the George R. Brown Convention Center also was opened. Memorial Hermann Healthcare System, Houston, was asked to ready an area of the convention center to provide shelter and medical treatment for evacuees.
"We got a phone call on Sept. 2, asking us to set up for supplies, drugs and equipment," says Dan Humphrey, assistant vice president of supply chain management for Memorial Hermann.
Humphrey says the University of Texas, Austin, provided most of the physicians, nurses and other clinicians as well as managing the overall operation and patient flow. Memorial Hermann was needed for its expertise in providing logistics so a large amount of supplies could be brought in quickly.
The Houston health system operates nine hospitals in the state that run on a low-unit-of-measure, just-in-time system with Cardinal, so the materials team set up for frequent communications for orders and daily deliveries.
"The setup was no different than if the hurricane had actually hit Galveston or some place closer to us," Humphrey says.
O&M and other suppliers such as Universal Hospital Services (UHS), Bloomington, Minn., helped out as well. UHS in particular helped locate much-needed equipment such as pulse oximetry machines, feeding pumps, blood pressure equipment and wheelchairs.
Johnson & Johnson, New Brunswick, N.J., was asked to provide a large number of glucometers and insulin strips, which were in high demand. Humphrey says that in 10 days the Astrodome and convention center handed out 3,000 to 4,000 devices.
Real-life training
Memorial Hermann was prepared for a disaster after suffering through tropical storm Allison, which dropped more than 35 inches of water on Houston in less than a week in June 2001.
The storm revealed some of the weaknesses in the health system's disaster planning, and officials responded by reworking the plan, which involved Cardinal as the primary supplier.
The large migration of patients from Louisiana was the first real test of that planning, and Humphrey says Cardinal had sufficient inventory and transportation capabilities to make the operation run as smoothly as possible.
"As soon as we made the call, they brought an extra half-dozen or so employees to help take orders and work on other things," he says. "The idea was that we didn't want to cause our normal hospital operations any sort of problems, because they were already even busier than normal with extra patients."
A purchasing manager, Laura Newman, who Humphrey says is one of Memorial Hermann's most qualified people, was put in charge of inventory at the convention center. She ran an operation that allowed clinicians to request a product and receive it almost immediately if it was available at the convention center.
If an item needed to be ordered, a wireless laptop was used to send an online order to Cardinal, which handled basic med-surg and drug supplies.
An internal database was created of all order requests to avoid filling multiple orders from different clinicians. Humphrey says it didn't take long to amass a sizable inventory of basic medical supplies at the convention center.
"In the beginning, we were just kind of guessing at the amount of items that would be needed," he says. "We were told there would be 4,000 to 5,000 people coming in, many of them quite sick, but we had no idea how many patients we might actually have."
At press time, it wasn't known how many patients were treated at the convention center, but some reports have estimated as many as 10,000 people received medical care at the Astrodome and convention center combined.
"I think it's gone pretty well," Humphrey says. "They [the people at the convention center] have a large inventory and plenty of staff, and we're able to get enough volunteers to manage the operational part of it. The organizational part certainly has exceeded my expectations, as well as the expectations of the leadership at George R. Brown."
Necessary spend
Amid all the volunteered hours spent setting up, maintaining inventory and providing clinicians with supplies, the question of cost was not a major concern to Humphrey.
Besides some equipment and supplies that were donated, Memorial Hermann paid for the orders it made to Cardinal.
Humphrey says, "If there's money available from the government later, I suspect we'll get some portion of it, but it's just one of those things where it's the right thing to do and we're going to do it."
Just as the number of patients isn't yet known, the total cost to Memorial Hermann wasn't tallied in time for this story, but the health system kept a separate cost center for all expenses, which included labor, equipment and helicopter flights.
The hospital system has four helicopters that made several flights a day to Louisiana to pick up patients. Humphrey figures that compared with the cost of operating the aircrafts, the cost of supplies will probably be small. "We anticipate there may be some federal government support to help the facilities that have had a substantial cost related to Katrina, so we are accounting for spending separately right now. But certainly at this point, there's no guarantee we'll ever get reimbursed."
Lawmakers are working on relief spending and congressional leaders have indicated they understand the need to provide financial relief not only to the victims, but also to those who cared for them. Brad Fisher, communications director for DCH Regional Medical Center in Tuscaloosa, Ala., says his facility wasn't hit by the storm, but soon after it passed, people from Alabama, Mississippi and Louisiana began coming in for care.
Finding staples
For some hospitals, it wasn't that a large number of people required special medical attention, but they needed food, water, blankets or simply shelter, says Corris Boyd, vice president of materials management for Triad Hospitals, Plano, Texas.
A hospital becomes more than just a medical center during a disaster, he says. It's a beacon of hope and safety in a community, and people instinctively head to a hospital when they've got nowhere else to go. "Normally, in a disaster it's more of 'I've got a train wreck,' or 'I've got a bus accident' and you get a huge influx of patients and you mobilize and deal with that," Boyd says. "But in this case, you had all of these walk-ins from the community that needed assistance."
Triad facilities in Hattiesburg, Miss., and Vicksburg, Miss., saw an influx of patients and community members seeking help. Although the Hattiesburg facility, Wesley Medical Center, lost power for a while, it and the Vicksburg hospital, River Region Health System, were able to provide care and assistance to patients who showed up.
Orders were being placed with suppliers, and Boyd says Cardinal "did a good job of taking care of us," even though deliveries were hampered by road conditions, which were not only hindered by storm debris, but hundreds--possibly thousands--of vehicles that jammed the interstates. A trip that should have taken two hours, took a food delivery truck 17 hours to arrive from Jackson, Miss., about 90 miles from Hattiesburg, he says.
Fuel also became a big issue as prices spiked and shortages suddenly appeared, leaving suppliers scrambling to keep their trucks on the road. Boyd says he doesn't know exactly how his supply partners managed to keep supplies moving under the circumstances, but he was very satisfied with the results.
The next step is to clean up and try to return to normal operations, and he says that has already started. Roads have cleared and suppliers are making their normal deliveries again.
Still, he thinks it will take the affected communities some time to recover from the post-hurricane trauma. Mental health practitioners are in as big a need as medical practitioners. But, early signs of hope have already started to emerge, and at press time, some New Orleans facilities had started announcing reopenings.
Even Ochsner Clinic Foundation hospital, which received widespread attention after doctors and administrators pleaded for help in evacuating, announced it was fully operational.
Employees emphasized the point by painting a one-word message on the top of the facility's parking structure that read "OPEN."
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