Hurricane Rita - November 2005
By Ken Ortolon
Texas physicians were just catching their breath after the unprecedented medical response to Hurricane Katrina in late September, when another unwelcome visitor showed up on the state's doorstep. Hurricane Rita, which came ashore on the Texas-Louisiana coast in the early morning hours of Sept. 24, sent some 2.5 million coastal residents fleeing inland, causing physicians to mobilize one more time.
"As we were just beginning to have some respite from that [Hurricane Katrina], we again had to initiate another response to receive and serve thousands who were coming into our community and its shelters," said Fernando Guerra, MD, director of the San Antonio Metropolitan Health District.
San Antonio was not alone. Cities and towns across much of north, central, and south Texas found themselves preparing relief shelters again for those seeking to escape the storm. And as they did when thousands of evacuees from New Orleans arrived in Texas just days after Katrina, Texas physicians, nurses, and other health care professionals geared up to meet the medical needs of those displaced by the second natural disaster in less than a month.
Throughout the weekend that Rita hit the Texas coast, the Texas Medical Association e-mailed physicians in cities large and small, urging them to volunteer to provide medical care at shelters housing the influx of people in the state's largest cities, as well as smaller towns like Whitewright, Gainesville, Woodville, Nacogdoches, Tyler, and Bridgeport.
In College Station, Texas A&M University and the Texas A&M University Health Science Center collaborated to turn a large animal veterinary clinic into a hospital for human patients.
Paul K. Carlton Jr., MD, director of the Homeland Security Department at the health science center, says that the health science center had approached the College Station City Council in April about developing a plan to use the veterinary clinic as a hospital during a crisis. Planning had been ongoing since June. Hurricane Rita, however, necessitated a stepped-up timetable to actually put the plan into practice.
"All you need for a hospital is space and ingenuity," said Dr. Carlton. "There are many other nice-to-haves; this had all of them -- redundant power, oxygen outlets, compressed air, suction, and a very, very sterile environment."
Wide hallways designed to accommodate large animals were turned into wards with hundreds of cots. Large examination rooms also served as small wards for human patients.
Dr. Carlton says the facility mainly was an extended special needs facility. No acute care was provided there. Patients from a pediatric special needs group from Houston, burn patients transferred from Shriners Hospital in Galveston, and several groups of nursing home patients were among some 600 patients cared for in the veterinary clinic.
In Tyler, the Texas Medical Rangers and faculty and residents from The University of Texas Health Center at Tyler established a 300-bed hospital and special needs clinic in a gymnasium at Tyler Junior College. The shelter was organized by the North East Texas Public Health Department and initially was intended to be a skilled nursing facility. It ended up as a fully operational field hospital.
"It was a joint effort from the Texas Medical Rangers, the family medicine residency program and nursing students at UT Tyler, the junior college, Smith County Medical Society, Texas Nurses Association, and the local hospitals," said Jonathan MacClements, MD, director of medical education at UT Tyler and a lieutenant colonel in the Medical Rangers.
The shelter dealt mainly with nursing home patients evacuated from the hurricane's path, so most of the patients had chronic conditions such as diabetes and hypertension, as well as other conditions associated with aging.
Even the Tyler Junior College football team pitched in. "We had these big, brawny football players carrying nursing home patients off of buses and helping them to the restroom," Dr. MacClements said.
Austin also received a large number of nursing home and other special needs patients, including several evacuated from Wharton, said Austin internist Isabel Hoverman, MD, who volunteered at shelters during both hurricanes.
"Apparently, when they first evacuated, they had planned on taking people with medical needs to Temple," Dr. Hoverman said. "But 12 hours into the journey people just weren't going to go any further."
A sports complex at Austin's Reagan High School was set up for people with both medical and special needs. That soon filled up, and Austin established an additional shelter at nearby Johnston High School.
But city officials then decided having multiple shelters for those patients could cause logistical problems, so all were moved to the Austin Convention Center, which just days before had still housed a handful of evacuees from Hurricane Katrina. The Travis County Medical Society arranged for physician volunteers to provide 24-hour coverage at that facility from Saturday through Monday, Sept. 26.
Dr. Hoverman says physicians there again treated many chronic conditions, mental health issues, and other special needs.
Even before Rita reached the Texas coast, hospital officials were taking measures to move their patients out of harm's way. In Galveston, which weather forecasters at first predicted would take a direct hit from the storm, officials at The University of Texas Medical Branch (UTMB) began preparing on Tuesday, Sept. 20, to evacuate patients from all six UTMB hospitals.
"We spent Tuesday night copying pertinent medical records; our physicians were writing transfer summaries, and our nurses were preparing all the other appropriate paperwork," said Karen Sexton, RN, PhD, vice president and chief executive officer for the UTMB hospitals and clinics. "And our pharmacy was preparing medications for patients to take with them."
UTMB had about 600 patients in house on Tuesday. To reduce the patient population, elective procedures were canceled and patients well enough to leave were discharged. But more than 400 - almost one-quarter of them in critical condition - remained the next day.
Using nearly 100 ambulances and 32 aircraft made available by the state, as well as numerous buses, UTMB evacuated all of the patients within 12 hours. Many of them went to Seton Medical Center in Austin. Others went to Parkland Hospital in Dallas. A few went to hospitals in Beaumont and had to be evacuated again when the storm turned in that direction.
Dr. Sexton praised hospital physicians and staff for their work in executing the evacuation plan. "It was like an orchestra," she said. "All the musicians were doing their part."
Once the patients were safely transferred, Dr. Sexton still worried about essential personnel who had stayed behind to carry out the hospital evacuations. On Thursday, Sept. 22, she decided to evacuate all personnel who would not be needed to staff the emergency department during the storm. But by then, the roads were clogged with fleeing residents.
"I knew that we had lost our timing and that our staff had nowhere to go," Dr. Sexton said. "The interstates were all blocked. Once again I called upon the resources of the state and was able to get two cargo planes to fly out as many of our staff as we could."
Staffed by only a skeleton crew, UTMB hunkered down to ride out the storm and care for any injured patients who came into the emergency department. Luckily for Galveston, the storm turned east and the island city was spared the devastation that occurred in Port Arthur, Orange, and elsewhere.
Still, UTMB emergency department staff treated one burn victim and several firefighters who were injured during a blaze sparked by the hurricane. The hospitals there suffered some power outages and lost telephone service, but damage was minimal.
Dealing With the Aftermath
The same cannot be said of the Beaumont-Port Arthur area. While a majority of residents in the Golden Triangle were able to escape ahead of the storm, thousands of prison inmates in several Texas Department of Criminal Justice (TDCJ) units located in the area rode out the hurricane along with their guards and other prison personnel.
Robert Behrns, MD, a UTMB physician who serves as medical director for several of those units under a contract with TDCJ, says his physicians, nurses, and other personnel were left to treat both urgent and emergent conditions among inmates under some of the most trying conditions.
The prisons lost electrical power and air conditioning. Their electronic medical records system was inoperable, and medical supplies were scarce.
On top of that, many of the medical personnel worked almost nonstop even though they lost their own homes in the storm.
"There has been a quite remarkable response from our medical staff to meet this challenge," Dr. Behrns said. "They've really stepped up and stepped forward."
Two of the Beaumont-area prison units had to be evacuated, along with the infirmary from a third. Operating only on generator power and with communications severely restricted, infirmary staff had to drive to Sugar Land to get ice and medical supplies from prison units there. Dr. Behrns says they also raided the evacuated units for their medical supplies.
"When this thing hit, one of the key issues was simply getting medicine out to the population," Dr. Behrns said. "What we had before the storm was really a state-of-the-art electronic medical records system. When we lost that, we had to revert to providing key meds any way we could."
While many of the conditions being treated among the inmate population were general medical issues, Dr. Behrns says there were a number of strokes, heart attacks, and seizures that occurred following the storm.
In Houston, staff at the county-owned Ben Taub General Hospital were prepared for an onslaught of Hurricane Rita victims. It never materialized.
"On the day Rita hit, our hospital was a tomb," said Kenneth Mattox, MD, Ben Taub's chief of staff. "There were almost no emergency visits whatsoever."
Two or three days later, emergency visits were still light and were mostly from evacuated Houstonians returning to the city, Dr. Mattox says.
One storm-related emergency case that did arrive at Ben Taub involved a man who was shot while siphoning gasoline from someone else's car. He will be okay, Dr. Mattox says.
Several special needs patients were taken to shelters in the Houston area, including those at Ellington Air Force Base and the George R. Brown Convention Center. Dr. Mattox says the Ben Taub staff did its best to keep special needs patients out of the hospital to save beds for critically ill patients who might be arriving. Family physicians were sent to the shelters to care for the special needs patients.
While destruction from Hurricane Rita was severe in both East Texas and Louisiana, Texas medical personnel expressed considerable pride in their response to the disaster.
In Galveston, Dr. Sexton says her staff performed well in the face of imminent danger. There were no deaths associated with the evacuation of patients from the UTMB hospitals.
"The staff was incredible," Dr. Sexton said. "People were scared. We had a Category 5 barreling down on us. But they elected to stay with me and do what we felt was important for the community."
Dr. Mattox also says the Texas medical community acquitted itself well.
"We're proud to be Texans and we're proud to be Texas doctors," he said. "Texas rose to the occasion to serve our populous, and TMA should be proud."
Ken Ortolon can be reached by telephone at (800) 880-1300, ext. 1392, or (512) 370-1392; by fax at (512) 370-1629; or by email at Ken Ortolon.
Coastal Physicians, Hospitals Putting the Pieces Back Together
Beaumont orthopedic surgeon David Teuscher, MD, is luckier than many of his neighbors and colleagues.
"I have about a six-foot hole in my roof where a 100-foot pine tree decided to come over and knock a hole in it," Dr. Teuscher said.
Unlike some other homes in the region following Hurricane Rita, the house is still standing, and Dr. Teuscher's medical practice at the Beaumont Bone & Joint Institute appears to have suffered little damage, except to the exterior of the building.
For Dr. Teuscher and other physicians and health care facilities in the Beaumont-Port Arthur-Orange area, the problem with getting back in operation is not only a matter of damage, but the loss of electricity and water. As of early October, power still had not been restored to much of the area, and much of the medical community was still operating in only a limited fashion.
Employees and patients of the region's medical practices, hospitals, and other health care facilities were slowly returning home.
In Port Arthur, CHRISTUS St. Mary Hospital was evacuated and locked down ahead of the hurricane. The facility remained closed immediately after the storm because of flooding. By Oct. 3, it was operating on generator power, potable water had been restored, and a federal Disaster Medical Assistance Team managed the emergency room.
Texas Hospital Association (THA) spokesperson Ann Ward said a THA delegation toured eight hospitals in Beaumont, Port Arthur, Woodville, Jasper, and Livingston on Sept. 29 and found that only the Livingston hospital had full power.
Christie Fortune, system director of public affairs for CHRISTUS Health, says its hospitals in Beaumont, Port Arthur, Jasper, and Lake Charles, La., were hit hard by the storm.
As of Oct. 3, CHRISTUS Jasper Memorial Hospital still ran on generators and hoped to have city electricity restored within a few days. It was admitting surgical patients and obstetric patients for imminent deliveries, but monitors and other equipment in the ICU were still being evaluated, and rehabilitation services were not expected to reopen until Oct. 10.
Obstetrical services were available at CHRISTUS St. Elizabeth Hospital in Beaumont, but the hospital was awaiting city electricity service to be restored.
Meanwhile, some physicians were having difficulty getting their practices up and running. Dr. Teuscher says Beaumont Bone & Joint physicians saw patients in their offices for the first time on Oct. 3, but the practice was not fully functional.
On Oct. 2, Beaumont pediatric surgeon Leon M. Hicks, MD, reported that his office was not open because power in his building was unstable and his employees needed to tend to personal business at their homes.
Nederland ophthalmologist James A. Stoeckel, MD, said his office building was significantly damaged. He tried to return to salvage his medical records but authorities turned him away. He says he may not be able to reopen his practice for another three months.
Several physicians in the impacted area reported making alternate arrangements for patient care and recording telephone voice messages to tell patients how and where to obtain care.
Dr. Teuscher talked with many Beaumont-area physicians and reported that actual damage to most practices there appeared to be minimal. A few, however, said their medical records and some equipment could be a total loss because of water damage when the hurricane's wind blew out doors and windows or tore off parts of roofs.
"What I'm hearing down in Port Arthur and the mid-county area is significantly more damage and probably a much longer interruption of medical care." Texas Medicine was unable to contact any physicians in that area.
Dr. Teuscher returned to Beaumont to be available to take call on Oct. 4. He said his practice was seeing a lot of musculoskeletal injuries - not from the storm, but from the cleanup.
Dr. Teuscher thanked physicians in other parts of the state who have cared for patients who evacuated.
"To the rest of the physicians in Texas who took care of our patients and who are still taking care of our patients, thanks and please keep taking care of them until we can get back up and running," he said. "We really appreciate that."
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