California Wildfires, Power Outages Are Disrupting Health Care

Across California, wildfires and outages have forced health-care providers to close hospitals and medical clinics, or greatly limit services. Both Kaiser Permanente and Sutter Health evacuated their Santa Rosa hospitals.

by Cathie Anderson, The Sacramento Bee / October 30, 2019

(TNS) — Healthcare leaders told The Bee that they are confronting a level of disruption to delivering care and running their businesses that they have never seen in their careers as a result of the California wildfires and Pacific Gas and Electric Co.’s planned blackouts.

“I actually have never experienced a power outage where we were on emergency generator backup for 40 hours or more,” said Dr. Brian Evans, the chief executive officer at Sierra Nevada Memorial Hospital in Grass Valley. “We’ve had short-term disruptions, but typically it wasn’t one of these planned outages that lasted for quite some time. I would say, for me personally, it’s been a career first.”

Evans, who has worked in hospitals for 22 years, is weathering the third PG&E public safety power shutoff this month. He said it’s really tough on patients and finances, but counts himself lucky because his hospital caught a major break after the first planned blackout.

PG&E set up utility-scale generators at one of its utility substations in the Grass Valley area, creating a so-called continuity zone that is supplying electricity to 3,800 customers, including the hospital, Evans said. He added that doesn’t mean there isn’t any impact on Sierra Nevada, but unlike a number of hospitals in the blackout zone, it has been able to avoid shutting down elective surgeries, laboratory exams and radiology treatments during the last two outages.

Across California, wildfires and outages have forced healthcare providers to close hospitals and medical clinics, or greatly limit services. Both Kaiser Permanente and Sutter Health evacuated their hospitals in Santa Rosa last weekend, the second time in three years the medical centers had to be abandoned as flames and fumes approached. At least eight nursing homes also had to evacuate, and state officials requested additional beds from assisted living facilities to accommodate senior citizens and feeble patients.

While people can readily understand the logistical difficulty of evacuating and then re-opening a hospital or other types of health care facilities, said Theresa Frei, the CEO of the Sutter Valley Medical Foundation, what often goes unnoticed is the impact the wildfires and the closures have on patients and providers. The stress of the Kincade Fire, coming two years after the Tubbs Fire, has taken a toll, she said.

“We set up an employee assistance program out of our call center in Utah. We have been having our employees call for assistance,” Frei said. “We give short-term loans, but most of all, they’ve been calling for counseling. This is a very difficult thing for them to go through again, so we put that system in place right away and made our employees aware of that.”

Turbulence for patients

Healthcare leaders said power outages create challenges for patients. They have to reschedule appointments, drive farther to get the service they need and, in the case of medically frail individuals, take extraordinary steps to ensure they have what they need to survive.

“It’s really tough on patients, on the finances, on everything,” Evans said. “You don’t know all the various impacts. One thing that was interesting and very surprising was how it affected people in our community who are on oxygen. ... We ended up admitting 11 people to the hospital during the first outage because they didn’t have power to run equipment they needed.”

Todd Goss, who manages service for durable medical equipment at Superior Healthcare, said the company works with hospices from Chico to Bakersfield to ensure that power outages won’t sacrifice the comfort of more than 2,500 patients who depend on machines that produce the oxygen many need to survive.

Many hospice patients rely upon electric-powered oxygen concentrators to process the air into oxygen-enriched concoctions needed to breathe, he said, but during power outages, Superior Healthcare sends techs to deliver oxygen tanks that have the prescribed concentrations.

“We discuss just what level of oxygen they’re at so we know exactly how many tanks they’ll need during an outage,” Goss said. “We have our techs visit the homes to make sure the families are all right. We ... like to stay in constant contact with the family and see what their level of support is going to be and ensure that our warehouses are properly stocked up.”

Sutter Health said the outages have posed a challenge to serving residents in rural and remote regions. The company has long operated a rural health clinic in Brownsville, near the Plumas National Forest, and it had a generator which helped keep the clinic and its lab open and running through prior power outages. On Monday, Frei and other Sutter leaders got bad news.

“We had a failure of that generator, so we had to send those patients to Yuba City, which is about an hour driving time south,” she said. “We’ve got somebody in there who’s repairing the generator.”

Sutter also has clinics in Jackson that it has kept open, despite staff and doctors working without power, because it would be a hardship for patients to travel to the next available center, Frei said. Other providers said they also choose to keep offices open either because they can provide services that patients need even without electricity or because phone systems go down and patients drive over to the facility to check on whether they can get help.

When it makes sense, Frei said, Sutter will also leverage the size of its operation, relocating staff and doctors to another facility that has room to accommodate them and communicating with patients about where they should go. In some cases, though, she said the company has simply had to shut down facilities.

In times like these, Frei said, the company works to remind patients that they can also use the company’s patient portal for tele-health visits with clinicians.

A logistical challenge

A lot of care and planning goes into ensuring that employees have what they need to continue serving patients, Frei and Evans said, but not everyone will be able to work amid a power outage or evacuation.

Senior leadership at Dignity, Sutter and many other healthcare companies are holding daily meetings to ensure their employees have what they need for patient care.

At Sutter, a logistics team looks at each community’s needs and coordinates with staff to get things in place, Frei said. The company ordered headlamps for the staff at Sutter Care at Home to ensure they would have the lighting to check on patients in homes that had no power.

It has workers getting emergency privileges for Sutter doctors whose patients were evacuated to other hospitals. And, after tracking air quality over the weekend, the Sutter staff delivered air scrubbers to clinics in Solano County.

“We constantly are looking at how we can support again the clinics, the hospitals, the community but also how we can support our own employees during this time,” Frei said. “We were very fortunate because we learned a lot from two years ago.”

All around Northern California, nursing homes and hospitals are running are running on emergency generators and have canceled elective surgeries and other services to avoid taxing their electrical system.

While generators allow hospitals to remain up and running, engineers have to check them for damage and ensure they are working properly each time they turn off and on, Evans said. Hospitals are very complex with very complicated electrical systems, he said, and it takes a lot of expertise to make sure things are operating effectively.

“We have our own employees who are on the plant operations team, and that includes hospital engineers,” he said. “Normally, when we’re not having these power interruptions, they work a typical day, and we have somebody on call. Lately, we have people here all the time, making sure things are up and running and that there will be no issues.”

It can be worrisome for a hospital leader, Evans said, when you’re powering up these generators for lengthy periods they have never before been used to cover.

Evans said he welcomed news that PG&E would be able to provide an alternate source of power to his hospital during the last two outages, but that hasn’t eliminated the use of Sierra Nevada’s emergency power system. The power still goes out at the hospital, he said, and the generators kick on for about an hour before the PG&E substation fires up and sends energy their way.

PG&E spokesperson Brandi Merlo said the utility has been able to create electric continuity zones in portions of three cities — Calistoga, Grass Valley and Placerville — that are outside the high fire threat area and have a specific grid configuration that allows them to plug in huge generators to supply power. In addition to the 3,800 customers it’s serving this way in Grass Valley, it also is able to supply electricity to 530 customers in Placerville and 830 in Calistoga.

While the continuity zone allows Evans to run all his operations, he still has to cope with a challenge that many hospitals and medical clinics face when it comes to staffing. Many of their employees live in areas where schools have no power and they can’t come to work if they can’t find baby-sitters for school-age children.

Although the power is off and evacuation orders are in force, Frei said, Sutter already has people setting up the plans for the day they get the go-ahead to re-open.

“It’s extremely important at the time of an emergency like this that people know what their role is, know how to show up and know how to get done what they need to get done that day, so that we can reopen clinics or reopen hospitals,” she said. “There’s an encyclopedia when it comes to what you have to do to get a hospital reopened. But for the clinics, we go through a lot of details and checklists to make sure it’s safe. We also do a lot in communicating to our patients. That way, they know they can come in and be seen.”

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©2019 The Sacramento Bee (Sacramento, Calif.)

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