In the days after Hurricane Harvey hit land, unleashing torrential rain and flash flooding, roughly two dozen Houston-area hospitals had to evacuate patients and the remaining hospitals were faced with round-the-clock challenges. As of Monday, at least 60 deaths had been attributed to Harvey, one of the most catastrophic storms in American history.
While the impact on the Houston health care system was immense, local hospital CEOs say it could have been worse if not for rigorous disaster planning, herculean efforts of staff and painful lessons learned from a massive flood that hit the area in 2001.
One of the biggest problems health care providers continued to face days after the storm was something they had no control over: Mile after mile of submerged transportation infrastructure prevented many patients, staff and suppliers from getting to their facilities.
“We did evacuate two of our  hospitals,” said Michael Covert, CEO of CHI St. Luke’s Health. Covert, who’s also the senior vice president of operations at Denver-based Catholic Health Initiatives, closed the facilities because supplies could not be brought in. "We couldn’t get them from Dallas. How do you deal with issues of blood and pharmaceuticals that you might need?” One ingenuous idea was to ferry supplies over flooded Houston streets via airboats.
Covert assembled a Hurricane Harvey incident command team for CHI St. Luke's hospitals, and the team grappled with a range of issues, from maintaining adequate staffing levels to avoiding the dangers of downed power lines. But, Covert said, it’s challenging to anticipate contingencies for an “800-year flood.”
The event’s ferocity drove desperate citizens from their homes to seek safe haven in CHI St. Luke’s hospitals, where executives found themselves crafting on-the-fly housing solutions with state and local agencies.
Lessons from Allison
Houston’s health care system has experience with the massive challenges Mother Nature can impose. In June 2001, Tropical Storm Allison roared off the Gulf of Mexico and stalled over the city, dumping 35 inches of rain. Considered the costliest natural disaster to strike Southeast Texas prior to Hurricane Harvey, Allison wrought $4.8 billion worth of damage in Harris County alone. At the time, no one knew Allison was putting Houston’s health care delivery infrastructure through a painful dress rehearsal for the fury that Harvey brought 16 years later.
In Allison’s aftermath, Houston hospital administrators began implementing a number of tactics for future crises. Among them: reliable phone systems for contacting outside facilities and coordinating the use of ambulances and helicopters for patient transfers.
“In Allison, we lost over $2 billion in research from the flooding of all of our buildings,” Texas Medical Center President and CEO Bill McKeon told the PBS News Hour last week. As a result, Texas Medical Center had floodgates in place long before the approach of Hurricane Harvey.
“None of our facilities were affected by the flooding,” said McKeon, whose sprawling medical complex southwest of downtown Houston includes MD Anderson Cancer Center. “We spent over $50 million creating this very sophisticated network of floodgates that actually protected all the assets. The floodgates are down, they did their job, and it’s really a marvelous feat of engineering.”
McKeon contradicted reports that flooding forced the evacuation of 350 patients from Houston’s Ben Taub Hospital. The problems at that Texas Medical Center facility stemmed from a ruptured pipe in the basement, he said.
By midweek, Harvey had been downgraded to a tropical storm, moved back into the Gulf of Mexico and then made landfall again in Louisiana. But as Houston’s floodwaters finally began to recede, hospitals expected a dramatic uptick in in emergency department visits.
The storm posed particular problems for Houston patients with chronic illnesses. “Dialysis patients have been a huge issue,” said Marc L. Boom, M.D., president and CEO of Houston Methodist. “One day, one of my emergency rooms had 150 patients, and 48 of them were individuals whose normal dialysis centers were shut down. So they’re coming into our hospitals and getting dialysis there.”
Boom said his system generally weathered Hurricane Harvey soundly. “I think it’s gone amazingly well. All eight of our hospitals stayed open during this disaster, I think our preparedness worked out really, really well. We have a pretty well-defined protocol." Of course, he added, "a protocol could never model the real-life situation this unique storm brought.”
Houston Methodist’s planning anticipated a hurricane where, “in 24 to 36 hours, the sun starts coming out.” Reality brought a Category 4 hurricane that essentially parked itself over Houston for the better part of a week while unleashing what scientists believe was the most extreme rain event in history in the continental U.S.
Dedication and determination
When discussing the performance of hospital staffs — dramatically depleted because of inundated roadways — Boom used a description echoed frequently by other Houston hospital leaders: heroic. “We have an incredibly heroic group of staff and physicians and nurses who’ve been working 12 hours on and 12 off, some of them for four or five days,” he said. “Which you can imagine is quite exhausting. And that 12-on and 12-off [means] sleeping in the facilities where they are working. We fortunately were able to get some good relief staff in.”
Covert saw the workforce at CHI St. Luke's put in double and triple shifts during the height of the hurricane. “One of the challenges [is] the numbers of people who came in to work and are now not going to have a home,” Covert said. “How do we help them not just financially but in terms of morale?”
Boom noted that Houston Methodist’s donors and board of directors created a fund of more than $7 million to help the system’s employees.
What would Boom, who’s a veteran of Tropical Storm Allison and other natural disasters, suggest to hospital leaders who have never been tested by catastrophe? “My advice to a CEO is: Everybody looks to you, and you’ve got to be a cheerleader. You have to take accountability. You’re out visibly talking to staff and hugging staff.”
Most important, Boom says: “It’s all about preparation — you need to take the worst-case scenario and multiply that by some percentage factor. It’s about making sure that everyone understands the disaster plan ... what’s expected of them and what they can expect.”