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Hospitals exist to cope with disaster. Ordinarily, those disasters come through the doors one by one — embodied by the quotidian, personal calamities of broken bones, heart attacks and cancers. Occasionally, the emergency department is thronged with victims of multicar accidents, train derailments, airplane crashes and the like. Hospitals gear for such desperate surges with comprehensive emergency preparedness plans.

And then there are the natural disasters like hurricanes and tornadoes. Hospitals include such rare eventualities in their planning, sometimes with foresight, sometimes — usually ruefully — in hindsight. They've learned to install their generators and essential equipment well-above ground in flood zones; they've hardened and bolted down their structures in earthquake country. But no matter how well-prepared they are, at the moment of crisis they depend on the collective courage of the doctors, nurses, allied medical personnel and leaders who work together to keep these complex organizations functioning.

More often than not, a hospital provides paychecks that sustain its local economy. Hospital staffers serve the community and they are the community — at least a big, essential part of it. Knocked out by surging seas, rising rivers, lurching fault lines or seething twisters, the hospital may cease to function in its customary mode. But the people whose collective expertise makes it a hospital soldier on. And when the wind dies or the waters recede, they regroup and pitch in to help their neighbors recover.

Consider the case of Touro Infirmary in New Orleans. Touro risked — and lost — its independence so that its city could rise from the dead.


At 6:10 a.m. on Monday, Aug. 29, 2005, the sixth strongest hurricane in U.S. history screamed ashore over southeastern Louisiana.

Two days earlier, alert to the potential destructiveness of Category 3 tropical storm Katrina, former New Orleans Mayor Ray Nagin had ordered his sub-sea-level city evacuated. The area's 11 hospitals were excepted.

Like the rest of its counterparts, Touro Infirmary, a 260-bed community hospital, chose to ride out the nasty weather. Core staff and many of their family members assembled alongside the 240 patients convalescing within the facility. By dawn on Tuesday, large sections of the city were deeply flooded.

Located on comparatively high ground (5 feet above sea level) in the city's Garden District, Touro escaped the flooding. But emergency fuel delivered by the National Guard was contaminated, and poisoned the generators. Air conditioning died and the inside temperature soared; elevators stalled; water faucets went dry and all communications were lost except for a single lobby pay phone. Several patients succumbed. On Thursday, Sept. 1, the president of the medical staff was able to secure evacuation of all the trapped occupants by helicopter and a convoy of buses sent by the sheriff of a neighboring parish.

Within a matter of days, every hospital in New Orleans had emptied and shut down.

'Moral and Civic Duty'

Hospitals are their own fellowship. When one taps out an SOS, others will speed to the rescue. So when New Orleans' Children's Hospital got word out that it had lost water pressure and air conditioning on Aug. 31, children's hospitals in several states sent helicopters and planes, loaded with physicians, nurses and medical supplies, and ready to ferry intensive-care children out of danger.

Baton Rouge, some 75 miles northwest, is the closest large city to New Orleans. Refugees from the Big Easy "will tend to come in this direction," notes Teri Fontenot, CEO of Woman's Hospital and immediate past chair of the American Hospital Association. Indeed, when Katrina hit, nurses and physicians at Woman's — like Dore Binder, M.D., an ob-gyn and trustee — scrambled as if they were combat medics as the announcement, "Incoming," repeatedly crackled over the intercom and helicopters descended to offload New Orleans evacuees.

Many had injuries seldom seen at a hospital oriented to women's needs. Many, appropriately, were babies from neonatal intensive care units at Touro, Children's and other facilities in the flooded city. Their sodden paper medical records had been tucked into their bassinets, but identifying and locating parents who'd been evacuated separately to God-knows-where often presented Woman's staffers with a daunting puzzle they worked tirelessly to solve. And when an emotional parent-child reunion took place, they looked on proudly, dabbed their eyes and set about orchestrating another.

A professor Binder knew from Louisiana State University staggered off one of the flights looking "a little bedraggled," he recalls, "so I invited him to stay with me." The impromptu visit, shared with extended Binder family members routed from New Orleans, lasted for two weeks. Hospital employees and churches throughout Baton Rouge — under Woman's coordination — freed up rooms and cleared spaces for similar emergency accommodations.

As the floodwater receded and order was restored, Nagin waited to lift the evacuation decree for residents until at least one hospital was operating within city limits.

Touro, where Herculean efforts were under way to clean up and repair damage, agreed to shoulder the task. Its entire workforce had been kept on payroll despite being dispersed throughout the country. Richard Culbertson, a professor of health policy and systems management at the LSU Health Sciences Center who served as a Touro trustee from 2004 to 2009, estimates that half of New Orleans' pre-Katrina nurses relocated and have never returned.

Touro reopened Sept. 28, 2005. For the next five months, it was the only functioning hospital in town.

"Touro became the de facto open door for the city of New Orleans," Culbertson says. Through its doors passed every local victim of injury — many of them reconstruction workers from out of state or foreign countries — in addition to the types of patients needing the general med-surg services Touro always had provided. "The insured levels of the population receiving care declined fairly dramatically," he says. "We began hemorrhaging red ink."

Costs further soared as agency nurses had to be hired to fill gaps, and doctors from closed hospitals performed their surgeries in Touro ORs.

"The public and community mandate was for us to respond to the need. We saw it as our moral and civic duty to do so," Culbertson says. "The staff stepped up to the challenge and did so heroically. But at the end we were financially exhausted."

Touro had lost some $40.5 million in the year before Katrina hit. Insurance and federal disaster payments gave it a $22.8 million surplus for 2006. But in 2007 and 2008 the losses soared again, totaling almost $60 million. Touro's bond rating was downgraded twice. Finally, in 2009, "the board reached the conclusion that it was not possible to continue going it alone," Culbertson says.

After 160 years of independent operation, and with the promise of $100 million in capital improvements and the preservation of its name and mission, Touro Infirmary merged with Children's Hospital.

Rita, then Ike

You don't have to be a big medical center to anchor your community when it's pummeled by cataclysm.

Chambers County, on the Texas coast 300 miles west of New Orleans on I-10, was where the gas tanks of a lot of motorists in flight from Katrina ran dry. Hotels and motels all along the route were hung with "No Vacancy" signs. So, for several weeks the staff at Bayside Community Hospital, a 14-bed critical access hospital in Anahuac — population 2,200 — fanned out to hold clinics in hastily prepared shelters where they assessed, treated and helped hundreds of stranded refugees.

Just as this effort was winding down, a new hurricane boiled toward Galveston and Trinity Bay. On Sept. 23, the 2005 tropical storm dubbed Rita made landfall 40 miles east of Anahuac. In its wake, Bayside was the only working hospital in a swath of devastation between the Louisiana border and Houston to the north.

Once again, Bayside became a focal point of regional recovery efforts. Under the direction of board chairman Ben "Tommy" Willcox, a rancher and former school teacher, Bayside staff treated the injured, arranged the first deliveries of needed fuel to the area, served hot meals to rescue crews and provided dormitory space for emergency medical teams.

Three years later, Bayside, a member of Chambers Health, was put to an even sterner test. Hurricane Ike, the costliest storm in Texas history, slammed into Galveston and roared up Trinity Bay. Miraculously, it spared the hospital, which is only a few paces from the water's edge. A Chambers medical clinic on the west side of the county was not so lucky, but within hours its staff had rigged a generator and resumed treating patients. Meanwhile, a Bayside mobile clinic sped to the aid of two outlying communities that had, in the hospital administrator's words, been "all but wiped out from the face of the earth."

"When hurricane season rolls around, our doctors, nurses and staff agree to stay at the hospital. They camp out there and they carry on," Willcox notes. "Those people are showing a lot of courage, to put their lives in that dangerous situation. Everybody else locks down and runs. It's started kind of a tradition around here. It makes you proud of our employees and administration."

An Unnamed Tornado

One of the deadliest tornadoes in U.S. history, the multivortex storm that scoured Joplin, Mo., on Sunday, May 22, 2011, killed 161 people and injured 1,100 others.
Nine-story St. John's Regional Medical Center, where 183 patients occupied beds, stood directly in its path.

Despite frantic last-minute efforts by staff to move patients to safer hallways, the "Execute Code Gray!" warning over the intercom had come too late. Windows imploded; glass and flying debris lacerated nearly everyone in the building. A visitor was killed and five critically ill patients on ventilators died when the emergency generator failed.

Freeman Hospital West, located directly across the street, was spared and immediately found space to squeeze in most of its competitor's patients as bloodied doctors and nurses patched and triaged in the parking lot. But only seven days later, St. John's was back in business — albeit in reduced circumstances — operating in a 60-bed military surgical field tent set up alongside the old, now useless structure. Within three months, the tent had been replaced by trailer-like components, and eight months later, the hospital moved into a more permanent, modular facility — "as much as we could afford and as big as we could afford," says President and CEO Gary Pulsipher — while awaiting completion in 2015 of a new 600,000-square-foot Mercy Hospital Joplin, twice the size of the abandoned structure. (St. John's became part of the Mercy system in 2009.)

Throughout the painful adjustments, Mercy kept all its 2,200 Joplin employees on the payroll. That's an important contribution to the community, Pulsipher notes. Studies have shown that for every hospital worker five additional local jobs are sustained.

Rivals united by an act of nature, Mercy and Freeman together have conducted a series of minihealth fairs in temporary Federal Emergency Management Agency housing villages. And they've hosted community dinners where "we bring people in and let them tell stories about how they've put their lives back together," Pulsipher says. "It's just part of the process of identifying those who have needs and matching them up with the sources that can help them. For many, that's simply getting into counseling.

"The great people of the Midwest have rallied," he says, modestly downplaying Mercy's role. "It's heartwarming to see."

Superstorm Sandy

When Superstorm Sandy blasted the U.S. eastern seaboard along a 1,100-mile front last October, hospitals from Maine to the Carolinas were braced for trouble.
Judith Persichilli, president and CEO of Catholic Health East, cited some of the brave performances at her system's facilities, where hundreds of doctors, nurses and support staff converged to spend one or two nights beyond their shifts to assure safe care, food and shelter for patients and visitors at hospitals in New Jersey, Pennsylvania and Delaware.
In New York City, NYU Langone Medical Center, Bellevue Hospital Center and Coney Island Hospital were among institutions knocked out by surging waters. Yet, even as patients were being evacuated — sometimes by flashlight, sometimes carried down staircases — urgent medical and mental health outreach services were under way to the ravaged hospitals' equally ravaged neighbors.

In Atlantic City, N.J., on the eve of Sandy's landfall, a group of key physicians, nurses and support personnel at AtlantiCare Regional Medical Center moved into rooms made available to them in surrounding casinos that were otherwise closed, so that they could report to their stations at the critical hour. Precautionary evacuation of patients had been regarded as too risky. And, ultimately, the hospital escaped damage.

Once the all-clear had sounded, AtlantiCare medical personnel set out with supplies to shelters that had been established throughout the area. Behavioral health personnel made home visits to patients in need of support; dialysis patients were provided transport to facilities where their treatment schedules could be maintained; a group of retired AtlantiCare nurses volunteered to assist at the shelters; and AtlantiCare vendors donated scrubs, linens, wash cloths and towels to the county office of emergency management.

And then the system's 5,000 employees extended hands to one another. Many had lost their own homes to Sandy; the lives of many, observes AtlantiCare trustee Gene Arnone, "have been so upended that it's going to be a long time, and for some maybe never, to get them back together." Hundreds of offers of mutual assistance were posted on an intranet forum. To date, says Arnone, they have raised, with the parent organization, more than $300,000 in cash to aid in the region's recovery.

"We have to be continually prepared for disasters," Arnone says.

After all, what are hospitals for?

David Ollier Weber is a principal of the Kila Springs Group in Placerville, Calif., and a regular contributor to H&HN Daily.

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