A Summary of MCEER Reconnaissance Efforts HURRICANE GUSTAV RECONNAISSANCE : LESSONS LEARNED BY NEW OR L EANS HOSPITA L S FROM KATRINA TO GUSTAV Lucy A. Arendt and Daniel B. Hess University of Wisconsin-Green Bay and University at Buffalo, State University of New York This reconnaissance trip, undertaken following Hurricane Gustav, was funded by the National Science Founda- tion and MCEER. It provided the team with a unique opportunity to return to New Orleans to collect and compare information on the operations of the city's acute care hospital system following Hurricane Gustav. Both authors had previously participated in an extensive NSF/MCEER-sponsored reconnaissance effort following Hurricane Katrina (see Arendt and Hess, 2006), and this trip enabled them to determine if the hospital system had become more resilient. A companion MCEER Response report provides an aerial and ground remote sensing survey of infrastructure damage. n September 1, 2008, Hurricane Gustav made landfall near Cocodrie, Louisi- Oana, about 70 miles southwest of New Orleans, Louisiana. New Orleans was better pre- pared in 2008 for Hurricane Gustav than it was in 2005 for Hurricane Katrina, though many ques- tioned the strength of its battered levee system. Still, Hurricane Gustav passed over New Orleans leaving minimal structural damage in its wake. The nearly two million people who had evacuated in advance of Hurricane Gustav began returning to the city as of September 4, 2008. Of the 10 acute care hospitals in the New Orleans area, including hospitals in Jeffer- Figure 1. Ochsner Baptist, formerly Memorial Medical Center, son and Orleans Parishes, all but two had remained in uptown New Orleans. open throughout Gustav. Of the two that temporar- Katrina and if they took steps in the three interven- ily closed, one was evacuated pre-storm to a larger ing years to become more resilient against disasters. facility, and one was evacuated post-storm, when an The research investigates all acute care hospitals in emergency generator failed. Overall, the acute care the New Orleans area about two weeks after Hur- hospital system in the New Orleans area appears to ricane Gustav made landfall. Perhaps more than have fared better during Hurricane Gustav than it did most organizations, hospitals must learn from their during Hurricane Katrina. disaster experiences and implement policy changes URPOSE to strengthen their resiliency against predicted and P unpredicted events (Quarantelli, 1985). The primary purpose of this field research is to The 15 acute care hospitals that dotted the New determine whether New Orleans hospitals benefit- Orleans healthcare landscape before Hurricane ted from the harsh lessons offered by Hurricane Katrina were devastated by the storm and subse- A Summary of MCEER Reconnaissance Efforts quent flooding that affected about 80 percent of also examines the extent to which the hospitals the city. Since then, about half of the hospitals have developed and implemented improved emergency closed or been subject to ownership changes (see preparedness and response policies and procedures Table 1). in the wake of Katrina. While the physical damage caused by Hur- ricane Gustav in the New Orleans area was not as Acute care hospitals in the New Orleans severe as the damage associated with Hurricane area were prepared to be self-sufficient, Katrina, hospital emergency plans were operation- in some cases for up to a month. alized, hospital Incident Command Centers (ICCs) were established, and hospitals evacuated patients. The research reported here examines whether These conditions provide a “natural experiment” for Hurricane Katrina was a “turning point” for New pre/post research to investigate hospital emergency Orleans acute care hospitals. Unfortunately, the preparedness and outcomes. only way to know if a disaster is a turning point is retrospectively, in the wake of a subsequent MET H ODO L O G Y disaster. We suggest that Hurricane Gustav rep- The research employs quick response method- resents the first true test of whether New Orleans ology to gather information via semi-structured, acute care hospitals learned the lessons taught by face-to-face interviews, observation of behaviors Katrina (Rodriguez & Aguirre, 2006). The research and facilities, and document acquisition. This qualitative approach provides a rich, context-aware Table 1. Current Status of New Orleans Area Acute Care Hospitals Post-Gustav Katrina Facility Ownership Current Status Interviews Damage September 2008 Investor-owned (Universal Chalmette Medical Center Extensive Demolished Not possible Health Svcs) Meadowcrest Hospital (now Purchased by Investor-owned (Tenet) None Yes Ochsner Westbank) Ochsner West Jefferson Medical Center Not-for-profit Limited Open Yes East Jefferson General Hospital Not-for-profit Limited Open Yes Ochsner Medical Center Not-for-profit Limited Open Yes Investor-owned (Hospital Tulane-Lakeside Hospital None Open Yes Corporation of America) Children’s Hospital Not-for-profit Limited Open Yes Sold; slated for Lindy Boggs Medical Center Investor-owned (Tenet) Extensive Not possible demolition MCL/NO Charity Hospital Public Extensive Closed Not possible MCL/NO University Hospital Public Extensive Open Yes Memorial Medical Center (now Purchased by Investor-owned (Tenet) Extensive Yes Ochsner Baptist) Ochsner Investor-owned (Universal Methodist Hospital Moderate Closed Not possible Health Svcs) Touro Not-for-profit Limited Open Yes Investor-owned (Hospital Tulane University Hospital Moderate Open Yes Corporation of America) Veterans Administration Hospital Federal government Extensive Closed Not possible 2 understanding of the decision making by hospital executives in the New Orleans area. We traveled to New Orleans from September 14-18, 2008, just two weeks after Gustav made landfall in Louisi- ana. Conducting interviews within this time frame increased the probability that “perishable” data would be gathered before memories faded and perceptions of effectiveness were altered (Neal & Webb, 2006). PRELIMINARY FINDIN G S The findings of the current research are reported using the seven themes identified in earlier reports on New Orleans area acute care hospitals after Hurricane Katrina (Arendt & Hess, 2006; Hess Figure 2. After Katrina, an additional well was drilled at the & Arendt, 2006). That research relied on field data Ochsner Medical Center main campus in Jefferson Parish. gathered within six weeks of Hurricane Katrina, in October, 2005. The themes were derived from in advance of potential storms. All of the larger interview data, observation, and document analy- hospitals have taken steps to connect air condition- sis. They address a variety of issues, including: ing systems to their emergency power, recogniz- constructing resilient building systems, planning to ing the necessity of air conditioning for staff and be self-sufficient, networking, staffing, communi- patient physical well-being and morale in the heat cating emergency plans before a disaster, commu- and humidity of New Orleans. During Hurricane nicating after a disaster, and leading effectively. Gustav, no hospital staff or patients were unnecessar- ily inconvenienced or their safety threatened due to CONSTRU C TING RESILIENT BUILDING SYSTEMS lack of power or water. Lesson from Hurricane Katrina: PLANNING TO B E SELF -SUFFI C IENT Hospitals should have power and water sup- plies independent of municipal utilities. Lesson from Hurricane Katrina: Apparent outcome during Hurricane Gustav: Hospitals should expect to operate indepen- Since Hurricane Katrina, most of the larger dently—without relying on external assistance— hospitals1 have either dug wells or made arrange- during an emergency. ments to have supplies of potable water delivered in Apparent outcome during Hurricane Gustav: advance of impending hurricanes. Likewise, all of Many of the hospitals now keep greater quanti- the larger hospitals have installed additional genera- ties of fuel and needed supplies (e.g., food, medi- tors, moved generators to higher ground, moved cine) pre-storm. Hospitals also strengthened shelter- generator switches to higher locations, or made in-place plans and strategies to further reduce arrangements to have portable generators delivered census counts during an impending hurricane. The larger hospitals installed helipads to facilitate air evacuation. During Hurricane Gustav, none of 1As of this report’s writing, the organization of acute care hospitals in New Orleans consists of larger, primary hospitals the hospitals’ staff or patients were unnecessarily and smaller, subsidiary hospitals. For example, the larger, primary inconvenienced or their safety threatened due to hospitals are: Children’s Hospital, East Jefferson General Hospital, lack of supplies or inability to evacuate pre-storm. MCL/NO University Hospital, Ochsner Medical Center, Touro, Still, the hospitals’ ability to evacuate post-storm Tulane University Hospital, and West Jefferson Medical Center. was not tested by Hurricane Gustav, as the city The smaller, subsidiary hospitals are: Ochsner Baptist, Ochsner did not experience the widespread flooding that Westbank, and Tulane-Lakeside. The larger, primary hospitals have occurred after Hurricane Katrina. Consequently, it significantly more beds and more robust facilities. is not possible to conclude with certainty whether 3 the hospitals’ contracts with surface and air trans- wide Louisiana Hospital Association. Since Hur- portation providers would have been sufficient to ricane Katrina,