Public Health Feature - October 2009
Tex Med . 2009;105(10):47-50.
By Crystal Conde
The $10,000 check brought Houston pediatrician Norris Payne, MD, to tears. The big check came from the Texas Medical Association's Disaster Relief Program. Dr. Payne and his wife, Margaret Payne, MD, have practiced medicine in the Houston area for more than 20 years and never endured financial and emotional turmoil like Hurricane Ike wrought last year.
Dr. Payne and his wife, along with two partners, had just moved into new office space at Texas Medical Center in late August 2008 when a string of unfortunate events unraveled.
"It was an expensive move for us, but it allowed us to expand; it was an investment in the future of our practice," Dr. Norris Payne said.
Right after opening the new office, one of Dr. Payne's associates had to leave the practice unexpectedly. Reeling from the loss of a much-needed colleague, Dr. Payne wasn't prepared for what would happen next.
In mid-September, Hurricane Ike made landfall, knocking out power throughout parts of Houston and devastating portions of East and Southeast Texas. Although Dr. Payne's office did not incur any significant physical damage and was able to reopen quickly, the storm's aftermath took a crippling financial toll on the practice.
"After the storm, many of our employees couldn't get to work, and in that first month following Hurricane Ike we saw five or six patients a day. We typically saw 60 on a daily basis before that," Dr. Norris Payne said.
The hurricane drove patients from their homes and made accessing medical care once they returned increasingly difficult. Dr. Payne says many couldn't back out of their driveways due to heavy debris or couldn't find gas to fill up their cars.
The drastic reduction in patients, he says, meant that last September's revenue was only 20 percent of what the practice typically generates. To make payroll, Dr. Payne borrowed from a line of credit, but says he fell behind on rent payments and was unable to pay a $75,000 vaccine bill. Last October, the pediatrician tried to obtain a bridge loan for $50,000 to $100,000, but the banking crisis made it impossible for him to get the funding.
"We're still trying to catch up, and my wife and I have had to cut our incomes in half. We still owe the vaccine companies $25,000," he said. "I searched everywhere and turned to many sources for funding. I was so grateful to TMA, and I cried when I got the letter saying we would get the $10,000. That money allowed us to stay open for another month and helped us start getting back on our feet."
Dr. Payne is one of 65 practicing Texas physicians, along with 62 resident physicians, who received a portion of $534,560 raised by TMA. Thanks to generous donors, the association collected $700,000 to help residents and practicing physicians affected by Hurricane Ike. (See " Hurricane Ike Disaster Relief Program Donors .")
The remaining $160,540, donated by the Physicians' Foundation, remains in TMA's Physicians Benevolent Fund to provide help for physicians in future natural disasters.
Medical students received financial help, as well. At the request of TMA's Medical Student Section, TMA created the UTMB Medical Student Recovery Program and asked its philanthropic arm, the TMA Foundation (TMAF), to launch a fund-raising campaign last year to help students recover. The more than $70,000 raised by TMAF provided aid in the form of bookstore vouchers, gift cards for gasoline, funds for school supplies, computers, and household items to 65 University of Texas Medical Branch at Galveston (UTMB) students displaced by Hurricane Ike. (See " A Vagabond Education ," June 2009 Texas Medicine , pages 41-44.)
Getting Back to Practice
To make funding recommendations, TMA created the Hurricane Ike Disaster Relief Committee, chaired by Stephen Brotherton, MD, a Fort Worth orthopedic surgeon and speaker of the TMA House of Delegates. He says the committee focused on meeting the needs of practices that required money to keep the doors open and to continue delivering medical care. (See " Hurricane Ike Disaster Relief Committee Members .")
"The response to TMA's call for help was overwhelming. I think we have physicians and partners who are motivated to be helpful. There was strong perception of a need because many patients weren't getting care," he said.
Dr. Brotherton credits TMA staff members with their ability to streamline the application process and keep costs down. Administrative expenses amounted to about $4,900, or less than 1 percent of both funds raised and total expenses.
Based on the committee's recommendations, the TMA Board of Trustees made the final funding determinations. Physicians had to meet these criteria to be eligible to receive disaster relief funds:
- Physicians must be licensed and practicing in the state of Texas;
- Physicians are not required to be members of TMA;
- Physicians may apply only one time per disaster;
- Physicians may submit amendments to previously submitted applications should additional information become available; and
- Physicians may not be current officers, trustees, or employees of TMA or the Physicians Benevolent Fund, nor may their spouses, dependent children, or parents.
The criteria will remain the basis for funding awards in the event of future natural disasters.
In addition, eligible recipients under the Disaster Relief Program had to show that the disaster caused damage to their medical practices not covered by insurance or another source of reimbursement or funding. Physicians also had to demonstrate that delivery of medical care was interrupted because of uninsured or nonreimbursable damages to the medical practice and that other sources of adequate funding weren't available.
Bruce Mitchell, a physician assistant who manages the physician-owned Crystal Beach Medical Clinic in Port Bolivar, says three weeks passed before he could return to his damaged office space following Hurricane Ike. He says nine feet of water annihilated his 2,400-square-foot clinic.
Instead of giving up after assessing $165,000 worth of losses, Mr. Mitchell purchased a 39-foot recreational vehicle and used it as temporary office space from November 2008 to March this year. The practice received $12,500 in relief funding from TMA and allocated it toward converting 1,000 square feet of his Crystal Beach home into a medical office.
"The money from TMA was very generous, and it allowed me to remodel my home into office space and open back up for business," he said. "About 70 percent of my patients stayed with me, and I'm able to continue caring for a community that has done a lot for me."
Making a Difference for Residents
Although originally intended for medical practices only, the disaster relief committee decided to allow UTMB resident physicians to apply for monies. Resident applicants received grants to cover the purchase of new books, computers, stethoscopes, ophthalmoscopes, personal digital assistants (PDAs), lab coats, bookshelves, and microscopes, as well as other items.
For Grant Seeger, MD, a former UTMB resident who now is a radiation oncologist in North Dakota, the storm wrought chaos at home. Wind and rain from Hurricane Ike caused about $40,000 worth of damage to his League City home and created an ideal environment for the proliferation of mold. He spent $12,000 of his own money to remove mold-damaged drywall and clean affected areas, repairs only partially covered by his insurance policy.
Dr. Seeger's wife and children moved in with family members in Minnesota for three months until remodeling of the home was completed in late December.
Once Dr. Seeger returned to his office at UTMB, he discovered flooding had ruined many of his expensive medical textbooks, along with his PDA, computer, scanner, and credentialing documents. He says $2,350 granted to him by TMA, as well as $2,000 from the Texas Radiological Society, helped him replace needed items and kept him from accruing additional debt and overdraft charges.
Ashley Maltz, MD, an internal and preventive medicine resident at UTMB, says flooding left her condominium uninhabitable and destroyed her medical books. Because classes for her master in public health program began last October, she had to scramble to find living arrangements. She moved in with friends and wasn't able to return to her home until May of this year.
She describes the first few months following the storm as stressful for UTMB faculty, employees, medical students, and residents.
"Everyone had to pull themselves up; everyone was spread thin," she said. "My internal medicine colleagues were working all over Texas, having to adjust to working at different hospitals with different systems and ways of doing things."
Now, Dr. Maltz says, residents are happy to be back at UTMB. And she's grateful to TMA for a $2,000 grant she used to purchase new books and to replace some items that had been demolished in her condo.
Eric Nolen, MD, MBA, a family medicine resident at UTMB, stayed at the Ronald McDonald house in Austin the first two months after Hurricane Ike and worked at the Austin Medical Education Program at the Seton Family of Hospitals for two months. After that, he commuted to Galveston from Houston for six months.
"The UTMB Family Medicine Residency Program did a good job relocating the residents, and this allowed them to continue their training and to graduate on time," Dr. Nolen said. "Additionally, many family medicine programs throughout the state extended assistance by allowing residents to temporarily join their training programs."
Dr. Nolen says he's grateful to TMA for granting him $2,000.
"I was fortunate to receive some funds and was able to replace many of my lost books and supplies within a few months of the hurricane. I am very grateful for the aid, and I think that ongoing support of the TMA Physicians Benevolent Fund should be a priority for all Texas physicians," he said.
Crystal Conde can be reached at (800) 880-1300, ext. 1385, or (512) 370-1385; by fax at (512) 370-1629; or by-email at Crystal Conde .
Hurricane Ike Disaster Relief Program Donors
Texas Medical Liability Trust
TMA Insurance Trust
*The AMA Foundation donated funds directly to TMA applicants.
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Hurricane Ike Disaster Relief Committee Members
Stephen L. Brotherton, MD, chair, Fort Worth
Fred F. Ciarochi, MD, assistant chair, Duncanville
Susan Bailey, chair, Physicians Benevolent Fund Committee, Austin
A. Tomas Garcia III, MD, Houston
Mark J. Kubala, MD, Beaumont
Bernie Milstein, MD, League City
C. Joan Richardson, MD, Galveston
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