A Flood of Problems
By Sean Price Texas Medicine November 2017

Hurricane Harvey's Impact on Health Care Will Be Felt in Texas for Years to Come. What Can Physicians Do in Their Own Exam Rooms to Help Those Who Were Affected?

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Cover Story — November 2017 

Tex Med. 2017;113(11):22-35.

By Sean Price

Like a lot of people in Houston, Ann Saunders, MD, had seen flooding before. Her house on Brays Bayou in southwest Houston flooded briefly in 2015 and almost flooded in 2016.

But then came Hurricane Harvey. 

The storm dropped a record 51 inches of rain on the Houston area over five days in late August. Dr. Saunders watched as water crept up one foot, two feet, then nearly three feet into her living room. That forced her daughter, son-in-law, and 2-year-old grandson up to the attic. Yet Dr. Saunders knew others had it worse. People on the other side of the bayou had water up to their ceilings.

Dr. Saunders, a child psychiatrist and an associate professor at the McGovern Medical School at The University of Texas Health Science Center at Houston, says that like a lot of physicians, she's concerned about the trauma the storm caused her city and most of coastal Texas.

"I think it's because of the enormity of it," she said. "In one afternoon or night, all your things are swept away and/or ruined. You've had that concern about whether you were going to be safe or not. … My daughter said, 'Well, we always have our attic if it floods too much.' But then you're up there and you're thinking, 'Oh, my God, is this really happening?'"

Even though Hurricane Harvey no longer dominates news cycles, its health consequences will continue to reverberate around the state for months and even years to come, says David Lakey, MD, chair of the Texas Medical Association's Council on Science and Public Health. Many of those consequences will be physical, such as a jump in illness tied to mold or polluted flood waters, says Dr. Lakey, who is a former commissioner of the Texas Department of State Health Services. Others will be psychological, such as depression and post-traumatic stress disorder (PTSD).

"I think we've learned from our experience that these things are predictable," Dr. Lakey said. "But I don't think the primary care physician thinks a lot about those in their busy day-to-day clinic ― thinking through the burden of the things they might see. It's probably not at the top of their list." 

Physicians across Texas will need to be vigilant for health problems caused by Hurricane Harvey over time, says John Mutter, PhD, professor at Columbia University's Earth Institute, who studies the impact of natural disasters. Doctors in coastal areas might pay closer attention to flood-related health problems because they lived through the hurricane. But some of the most serious issues are likely to arise among patients who fled to other parts of the state and didn't go back home ― especially those who are poor or elderly, Dr. Mutter says.

"Sometimes, the displaced population needs more attention or as much attention as the people who've stayed or come back," Dr. Mutter said.   


"She was on the ground, pulseless, not breathing"

Lane Aiena, MD, and head nurse Tamara Blanton had already worked one shift at the Lone Star Convention Center in Conroe. But at about 6 pm on Aug. 30, they joined a group of new nurses in a team huddle to discuss that evening's work when some of the shelter residents began screaming. 

"[An elderly woman had] literally walked in and collapsed," said Dr. Aiena, a family physician. "By the time I got to her, she was on the ground, pulseless, not breathing, with blood coming out of her mouth."

Dr. Aiena was acquainted with Ms. Blanton, but nobody on the team had worked together in an emergency.

"Even though we had just met each other, it was as if we had run mock codes for months," Dr. Aiena said. "I ordered compressions started and began divvying up jobs. 'You go find an AED.' 'You call 911.' The compressions were fantastic. They miraculously found an AED, which I'm pretty sure they had to dust off."

The AED advised shock, so the shock was administered. The patient started to move. 

"I said we need to find oxygen quickly ― that was another thing that we didn't have on hand immediately," he said. "Believe it or not, a National Guard medic showed up out of nowhere with an oxygen tank and an ambu bag, and he started to assemble it on the spot. He started bagging her. I started talking to her, you know, 'Deep breaths, deep breaths.' She's not making sense, but she's vocalizing and getting more and more responsive."

At about that time, an ambulance arrived and took the woman away. Twenty or 30 minutes later, Dr. Aiena got a call from the emergency department: The woman was up and talking. 

Dr. Aiena says the incident served as a giant pick-me-up for the shelter's medical team.

"It was like a home run at the end of a baseball game," he said. "It fired us up. You know, team's down, we need something, and — boom — there's something. I was ready to work two more shifts."



Learning From Katrina

Hurricane Katrina, which flooded most of New Orleans in 2005, provided numerous lessons in disaster response — mainly in what not to do. Slow reaction at the federal, state, and local levels was blamed in part for the storm's high death toll of about 1,800. Katrina also forced at least 1 million people to flee the Big Easy — hundreds of thousands of whom never returned home. It was the largest U.S. migration since the Dust Bowl of the 1930s. 

About 250,000 Katrina evacuees fled to the Houston area. If there was a bright spot to Harvey, it's that — thanks to the lessons of Katrina — Houston's shelters, hospitals, and other medical facilities were much better prepared, says Lisa Ehrlich, MD, president of the Harris County Medical Society, who was codirector of medical operations at Houston's NRG Stadium shelter during Harvey. Physicians at shelters screened for both physical and behavioral problems more aggressively and addressed problems more quickly, Dr. Ehrlich says.

"The hospitals had an uptick in volume, obviously, but they weren't overwhelmed like we saw in Katrina," she said. 

Many low-income residents said they received better health care at the shelters than they would have otherwise, including physical checkups, dental exams, prescriptions, eye checkups, and glasses for the first time in years, Dr. Ehrlich says.

"They're getting good wraparound services," she said. "They're getting medical care, they're getting good meals. But they don't have anywhere to go, and they've lost their jobs." 

Unfortunately, health care services for low-income people tend to deteriorate even further after natural disasters, Dr. Mutter says. 

"If they're in poorly served areas for medical attention in the first place, and some fraction of that is destroyed, now they're in really underserved communities," he said. "It just got worse."

Christopher Ziebell, MD, an assistant professor of surgery and perioperative care at The University of Texas at Austin Dell Medical School, says disruption of treatment is the biggest health problem tied to natural disasters. For instance, the flooding briefly shut down dialysis centers across the Houston area. An even more common problem is the interruption of medication refills for evacuees.

"They might have had the wherewithal to grab their pill bottle, and there might have been 64 days of pills left in that pill bottle," said Dr. Ziebell, who has helped coordinate health care for evacuees after several hurricanes. "But when you're completely uprooted and a refugee and having to find a new place to live and a new way to make money and a new support system, that 64 days goes by pretty fast. And then suddenly, you find yourself ― 'Oh, wait a minute, I'm down to my last three pills, and I have no way to get one.' That certainly can come up late in the game."   


"We've got to take care of what we've got"

Tom Garcia, MD, was the only cardiologist available at West Houston Medical Center during the storm. The hospital itself remained untouched by the flood waters, but on Aug. 29, officials there were told a nearby flood-control dam was giving way.

"We were told that the dam was going to bust," he said. "So as a precaution, we closed the hospital [to new arrivals] for 24 hours to prepare for the flood." 

That was a huge inconvenience for the many people who needed the hospital, most of whom had to go into more badly flooded areas to get health care.

"But we didn't have any choice," said Dr. Garcia, the 2015-16 TMA president. "We have 200 patients in our hospital, and we've got to take care of what we've got."

The fears of flooding also meant the staff had to move all the equipment from the first floor to the second floor and close its emergency department. More importantly, all the patients had to be evacuated.

"We called in 12 helicopters," he said. "One would land, we'd put the patient in, and they would go to Dallas. And another one would land, and we'd put another one in, and that one would go to San Antonio. Our ICU was vacant within four hours."   


Public Health Concerns

Any major flood causes serious environmental health threats, says Dr. Mutter, the Columbia University professor. Increased mold in soggy buildings causes respiratory problems for those with asthma and allergies. Mosquitoes breed more easily in the stagnant storm water, making viral infections like West Nile, dengue, and Zika more likely.

But he says concerns about mosquitoes and mold can often be overblown because those problems are treatable or preventable. For instance, in the weeks that followed Harvey, the U.S. military conducted aerial spraying for mosquitoes in most coastal counties. 

"[Mold and mosquitoes are] an issue, but they're not a dramatic issue," he said. "There may be a couple of cases. But we know how to deal with mosquitoes. That's not new. And we know how to deal with mold. It's not new, either."

Water-borne illnesses and infections will remain a problem for months as people clean up flood-damaged homes and flood waters drain away, says Dr. Ziebell, the Dell Medical School professor. One of the deaths attributed to Harvey was caused by necrotizing fasciitis, better known as flesh-eating bacteria.

"One of the things I don't think people realize is that the sewer system is underground, and it's connected to the outside world with pipes and tubes and whatnot, and when you flood all of that, that means the floodwater and the sewer water are in contact with each other," Dr. Ziebell said. "So we start to see a lot more infections with things that would be present in sewage. We'll be watching for things like E. coli infections in wounds and things like that. But also things like cholera and food-borne illness and hepatitis and that kind of stuff can also spike up."

After every flood, toxic chemicals like gasoline and oil from swamped cars leak into the flood water. In most cases, it is too diluted to be a significant threat, but Houston presents special problems: The region that was flooded is responsible for 40 percent of the nation's petrochemical production and 30 percent of its oil refining.

According to the Houston Chronicle, more than a dozen chemical and refining plants reported damaged storage tanks, ruptured containment systems, and malfunctioning pressure relief valves because of Hurricane Harvey. Harvey also flooded at least 14 Superfund sites where toxic waste was formerly stored. Health problems from these mishaps could linger for years. 

Volunteer physicians working at shelters saw few signs of toxic poisoning among first-responders or people who spent time in the water in the days after the flood, Dr. Ehrlich says. But a special task force of state and federal environmental specialists has been named to monitor the problem long-term.

Jeffrey Levin, MD, professor of occupational and environmental medicine at The University of Texas Health Northeast in Tyler, says physicians also should be on the lookout for more common types of toxic poisoning. For instance, people cleaning up flood-damaged houses could come into contact with lead paint. 

"That's more difficult to diagnose in some cases," he said. "But it is also more insidious and chronic." 


"There was the smell, and there were no lights"

The office of Esteban Berberian, MD, at the East Houston Regional Medical Center building was almost completely wiped out in the record flooding.

"We spent a couple of days going through the old office, which was about seven feet under water, … trying to salvage whatever we could," said Mark Owens, Dr. Berberian's office manager. "Luckily, I had put all our computers and everything about eight feet up, so we were able to save all the patients' information, because we're completely electronic. But everything else was pretty much a total loss."

Getting the salvageable stuff out was not easy. The hospital had immediately started yanking out damaged drywall, and that just added to the unpleasantness.

"There was the smell, and there were no lights, and you had drywall dust flying around everywhere," Mr. Owens said. "By the second day, mold had already started to form."

Getting everything out was just the first step. After that, everything had to be scrubbed and made ready for the new office.

"With a U-Haul, we actually took everything to the physician's house," Mr. Owens said. "His kids and family were cleaning everything up."

At first, it wasn't clear that they would be able to open a new office. The job just looked too big. But the staff was able to find new space ― at the same building where Dr. Berberian first opened his internal medicine practice back in 1999. 

After that, they put the equipment into the new office along with some inexpensive Ikea furniture. Mr. Owens and other staffers spent extremely long days getting the office up and running again. But after just one week, Dr. Berberian was back in business. 

"So we have a physician and a physician's assistant pretty much with full schedules trying to make up for the backlog," Mr. Owens said, three weeks after the storm. "It has been crazy trying to do that. The small waiting room is full. Patients are uncomfortable and inconvenienced. On the other hand, they're happy that we're open." 



Focus on Mental Health

Despite the many problems caused by physical ailments and injuries, Dr. Mutter, the Columbia University professor, says that most of the biggest and longest-lasting issues are likely to be tied to behavioral health. For instance, he says, domestic abuse tends to rise in the wake of natural disasters. 

"I think the increase in family stress surprises some people," he said. "It shouldn't surprise you, but it does. People who live in a [Federal Emergency Management Agency] trailer who used to live in a house get sick of each other quickly, and that leads to trouble. … Post-disaster health issues are as much mental health issues as they are physical health issues."

Valerie Rosen, MD, is an assistant professor of psychiatry at Dell Medical School and an expert in PTSD. She says primary care physicians in Texas, especially those in the coastal areas, should screen their patients for signs of emotional distress. 

Dr. Rosen says after a traumatic event, the large majority of people will have some symptoms consistent with PTSD, but most will recover without medical help and not go on to have full-blown PTSD. Only about 20 percent to 30 percent of people go on to meet the full criteria for PTSD.

"If someone has not recovered on their own, they probably do need to seek treatment to prevent it from being lifelong," she said. "But it is something that is very treatable." 

A major event like Hurricane Harvey can also kick up memories of past traumas, Dr. Rosen says. For instance, a person who suffered childhood sexual abuse might function well under normal circumstances but face difficulty after a natural disaster. 

Many people also will be dealing with grief, says Dr. Levin, the University of Texas Health Northeast professor. The hurricane's death toll was relatively low: at least 82 as of press time. Even so, people will be moving through the five stages of grief over lost houses, jobs, schools, friends, and neighbors.

"We'll be progressing through that, and everyone does that at a different rate," Dr. Levin said. "There will be a sense of being physically and emotionally drained. People may experience difficulty making decisions, staying focused."

Dr. Rosen agrees that there is plenty of reason to be concerned about the health issues Texans will be facing because of Hurricane Harvey. But she says it's equally important to understand that not all the effects will be harmful or create more problems.

"It's helpful when we're talking about all these negative things that could happen to remember that there's also post-traumatic growth, or positive outcomes, where people can really prioritize their lives differently and get a different perspective on things," she said. "They can also increase their faith in humanity with all the volunteers and increased social connectivity. I think sometimes people are surprised at their own ability to skillfully manage new challenges or adversity." 


"When I came to, the baby was there"

Around 12:30 am on Aug. 27, Nacole Myers and her husband, Kevin, realized that water had risen to more than a foot on their street in Friendswood, and more rain just kept falling. They and their two young sons, ages 6 and 3, were trapped. 

"The water was moving so fast that it was like white-water rapids in the middle of the street," said Nacole, who was 39 weeks pregnant. "The neighbor's basketball goal was floating down the road, and my husband went out there and got it." 

But the water seemed to recede at times, leading them to believe for a while that everything would be okay. Instead, it rose sharply through the night and began pouring into their house. Kevin tried to flag down rescue boats to get his pregnant wife and two sons to safety. One boat refused to take them because the water wasn't deep enough and other residents were in more serious trouble. Another boat's rescuers couldn't hear Kevin over the sound of their boat motor. Still other boats were full.

Meanwhile, Nacole ― who is a registered nurse ― was in her room trying to rest and stay calm with her two sons. That became harder when her contractions started. 

"I'm thinking if I lay down and be still, they'll go away," she said. "And they just kept getting stronger, and they were about 15 minutes apart. But they weren't regular." 

By 7:20 am, the contractions had become faster and harder. Kevin finally got hold of a neighbor at the nearby Westwood Elementary School shelter, and he let authorities know of Nacole's predicament. About 20 minutes later, a boat showed up. Kevin stayed behind to help rescue the family dog as well as some neighbor's dogs ― and to try to save what was left of the house, which was now waist-high in water. 

When Nacole got into the flat-bottomed rescue boat, the contractions became even more intense. To make things worse, the boat had to stop to rescue seven more people and three dogs on the way back to the elementary school. 

"They didn't have a choice," Nacole said. "By this time … people are in chest-deep water. They're screaming, they're hollering, they've got babies." 

The ride to the school probably took only 15 minutes. But the minute-apart contractions made it feel like an eternity. 

"I was grabbing on to my 6-year-old's leg so hard he said, 'Mommy, you're hurting me,' and I didn't even know I was doing it," she said. 

She finally got to the school and an ambulance arrived quickly, but then there was another difficulty. The nurses there said her two sons couldn't ride in the ambulance because it wasn't safe. They'd have to stay at the shelter. Luckily, Nacole saw some neighbors she knew. She reluctantly left the boys with them. 

Paramedics showed up, got Nacole into the ambulance on the way to Clear Lake Regional Medical Center. Then a whole new set of problems emerged. Her blood pressure was high, and the paramedics feared she was going into preeclampsia because of the stress. On the way to Clear Lake, the ambulance hit high water and had to turn around to find another, longer route. 

Nacole finally arrived at the hospital around 11 am. Still more complications emerged. The epidural was only partially successful, so she felt every contraction on her right side. More alarmingly, the baby's heart rate dropped with each contraction. The nurses soon realized that the baby's umbilical cord was wrapped around its neck. So Rafinie Johnson, MD, performed an emergency cesarean section. 

Tyler Cole Myers was born at 1:33 am. on Aug. 28. He weighed 6 pounds, 6 ounces. Nacole had to be put under anesthesia for the procedure. Her next memory was of seeing her whole family together in her hospital room.

"When I came to, the baby was there with Kevin and the boys," she said. "He was perfectly healthy. His Apgar score was nine out of nine." 

Sean Price can be reached by phone at (800) 880-1300, ext. 1392, or (512) 370-1392; by fax at (512) 370-1629; or by email.


Harvey by the Numbers

2: Hospitals closed indefinitely because of flooding: East Houston Regional and Care Regional in Aransas Pass
9: Federal mortuary trailers deployed
18: Federal Disaster Medical Assistance teams deployed
35: Percentage of physicians in disaster-area counties who had to reduce hours or services
39: Counties placed under a federal disaster declaration
51: Inches of rain Harvey dropped on Houston
54: Medical airplanes and helicopters among the federal resources deployed to affected areas
60: Counties placed under a state disaster declaration
65: Percentage of physicians in disaster-area counties forced to close practices temporarily
83: Harvey's death toll as of late September
200+: The number of out-of-state physicians who came to Texas working under a temporary license
206: Ambulances among the federal resources deployed to affected areas
34,575: The largest single-night shelter population throughout Texas
56,000: Number of calls to Houston 911 in the first 15 hours of Harvey's landfall

Sources: Texas Department of State Health Services, Texas Department of Public Safety, U.S. Department of Health and Human Services, Red Cross of North America, and Texas Medical Association


Almost $1 Million Raised to Help Physicians Rebuild

When physicians lost homes and practices because of the devastation caused by Hurricane Harvey, their colleagues across Texas and throughout the United States stepped up to offer their support.

Thanks to that generosity, TMA's Disaster Relief Program has received almost $1 million in donations to help physicians whose practices sustained physical Harvey-related damage not covered by insurance or other sources of assistance.  

TMA's philanthropic arm, the TMA Foundation, is raising funds, and a special committee of The Physicians Benevolent Fund is administering the TMA Disaster Relief Program. 

Donations have been received from more than 20 states and the District of Columbia as well as state medical societies in California, Colorado, Massachusetts, and Rhode Island. In addition, representatives from the American Medical Association and The Physicians Foundation presented checks for contributions in the amount of $150,000 and $500,000, respectively, at the 2017 TMA Fall Conference in September.

Physicians in a Harvey federally declared disaster area needing financial assistance to rebuild their practice can apply online or email questions to TMA. You can make a tax-deductible donation to the Disaster Relief Fund.

In addition, Frost Bank, TMA's primary bank, is offering business disaster relief loans to its business customers who were affected by Hurricane Harvey ― regardless of where they are located in Texas. Practices with any Frost business account who also use Active Online Banking can apply online.


TMA Working for Affected Members

In addition to raising funds to help affected physicians rebuild practices, TMA and Texas county medical societies helped members during the storm and subsequent recovery efforts, by: 

  • Providing the most up-to-date news and information via daily emails, web posts, and the TMA Knowledge Center;
  • Pushing for extensions, waivers, guidance, and updates on health plans, including Medicare, Medicaid, CHIP, and commercial plans;
  • Helping hundreds of members volunteer at medical shelters, including in Dallas, Harris, Travis, and Bexar counties;
  • Submitting legislative interim study proposals to find ways to improve Texas' response in any future disaster; and
  • Offering discounted consulting services for restarting practices. 

More information on Hurricane Harvey recovery can be found in TMA's Disaster Preparedness and Response Resource Center or by contacting the TMA Knowledge Center by email or at (800) 880-7955.


Lawmakers: Better Flood Control Worth a Look Post-Harvey

By Joey Berlin
Associate Editor

In the weeks after Hurricane Harvey devastated parts of the Texas coast, state and federal lawmakers began to assess possible lessons and legislative steps. On Oct. 2, the Texas House Appropriations Committee held its first post-Harvey hearing to examine some of the issues surrounding the storm.

"We want to get a clear sense that our schools aren't going to be left in a lurch, that our health programs aren't going to be left in a lurch, when there are additional resources available to the state," committee Chair John Zerwas, MD (R-Richmond), said before that hearing.

In mid-September, Texas House Speaker Joe Straus (R-San Antonio) directed several House committees to look at issues related to Harvey. Those included asking the Appropriations Committee to look at state agencies' use of federal funds, as well as the need for state resources, to respond to the storm; to identify how to make the most of federal funding to reduce the impact of future disasters; and to identify opportunities for infrastructure investment to curb the impact of future storms. At its Oct. 2 meeting, the Appropriations Committee studied that interim charge.

During the hearing, Houston Mayor Sylvester Turner ran through some of the estimated costs of the storm to the city, including debris removal costs of $260 million and $175 million in damage to public buildings. Debris removal and housing were Mayor Turner's top two immediate priorities.

"This is where people literally are emptying out their homes on the curb. So you see the refrigerators, the stoves, the furniture, all of those items literally outside on people's curbs," he said. "And so it can't stay there too long because it really becomes a public health hazard, and then it's a reminder [for] people of the storm that came through. So the top priority is to get this stuff up and out."

The city's own rainy day fund of about $20 million had already been used, Mayor Turner said. He said the environmental impact and cost of Harvey would "be coming in waves and shifts" for quite some time.

The state's rainy day fund, Representative Zerwas noted before the hearing, "has been protected by many, many people for an event exactly like we have right now." He says he wants the Appropriations Committee to get a good sense of whether the state has the resources available to meet the needs of public safety, schools, and health and human services.

"That's where we really want to get to make sure that we are adequately resourcing these areas," he said. "And if it looks like we're going to come up short before we can get back in the regular legislative session and perhaps pass a supplemental appropriations bill to make everything even, then we really need to think about, in my opinion, having a special session and consider appropriating some of the rainy day fund for the needs that exist in the region."

The Texas Legislature meets every two years, and the most recent biennial session ended in June. Only Gov. Greg Abbott can call a special session.

State Rep. Jim Murphy (R-Houston) says he wants lawmakers to examine operational policies associated with water reservoirs and water releases. Flood control districts stop at county lines ― which he believes is a problem, because "water doesn't."

Representative Murphy says flooding was an issue in parts of his district in west Houston.

"When the water was released from the dams, we had massive flooding ― thousands and thousands of homes. And that water remained in them for several weeks. [It causes] very significant structural issues and of course very significant health issues."

But he praised the coordination of the rescue and recovery resources and the "coordinated, real-time manner" in which they were deployed.

While acknowledging the difficulty in mitigating an epic flood, Representative Zerwas says developing another reservoir in the Houston area is among items "we need to think about," although that would primarily be a federal project. 

"A lot of people think that flood waters are just clear water, and it's no big deal. But the truth of the matter is that it's actually sewage," Representative Zerwas said. "People are walking around in that, and certainly the most immediate potential issue is people having some kind of illness that develops as a consequence of wading around in sewage waters."

Congress already had stepped up to deliver some Harvey aid at press time, with more presumed to be on the way. Lawmakers and President Donald Trump signed off on an initial relief payment of more than $15 billion in early September. The same day, U.S. Rep. Sheila Jackson Lee (D-Texas) introduced a supplemental appropriations bill to add another $174 billion in federal aid. 

In an interview on C-SPAN later in September, Representative Lee said she wanted funding "to go directly to local government ― to the city of Houston, to the city of Port Arthur, and Galveston, and Beaumont, or Rockport, Port Aransas, and Corpus, and other places, so they can get to the local officials quickly, so they can begin to work as quickly as possible on getting people back into habitable places to live."

Governor Abbott named a commission to head up infrastructure rebuilding post-Harvey and to oversee the response and relief efforts between the state and local governments. John Sharp, chancellor of the Texas A&M University System, is the leader of that effort. 

In the final week of September, Lt. Gov. Dan Patrick issued the Senate's interim charges related to the state's response to Harvey. 

The lieutenant governor's charges to the Health and Human Services Committee included a review of the local and state public health response to Harvey, including an analysis of vector control, the use of health-related volunteers, immunization needs, emergency medical network adequacy, and government coordination.

He also asked the Agriculture, Water, and Rural Affairs Committee to study "how to move forward with water infrastructure projects in the State Water Plan to help mitigate floods" and evaluate plans for a possible third reservoir in the Houston region to accompany the Addicks and Barker reservoirs.

The Response: Texas Physicians "World-Famous"


At TMA's 2017 Fall Conference in September, TMA President Carlos J. Cardenas, MD, moderated a panel discussion on the relief response to Harvey. It included David Teuscher, MD, Dallas regional director of the U.S. Department of Health and Human Services (HHS), and Kirk Cole, senior advisor to the commissioner of the Texas Department of State Health Services (DSHS). The panelists recounted how federal, state, and local authorities worked together to battle the storm's impact.

Because Texas is a home-rule state, local governments are in charge of disaster response until doing so goes beyond their capabilities. Federal authorities were "pre-positioned with an incredible amount of effort," Dr. Teuscher said.

"We can't, as federals, go anywhere without the state asking for assistance, and the state can't go anywhere without the county judges asking for assistance," he explained. "So the county judges are kings; [with] home rule, that's the way we have our state government set up. Some of our county judges have said, 'We don't need assistance.' Okay, fine, that gives us an opportunity to deploy assets elsewhere where assistance is needed. And this thing ramped up extremely fast and made landfall."

Dr. Teuscher praised TMA's work during the storm.

"I can tell you … that Texas physicians and the TMA are world-famous right now," Dr. Teuscher said. "They don't want to hear any more in the secretary's operations center about the TMA, because that's all they talk about: 'TMA's doing this, TMA's doing that, TMA's identified this problem. How can you help?' And the secretary basically told them, 'Look, if Teuscher calls, you just fix it. Be helpful.' That's really important." 

Joey Berlin can be reached by phone at (800) 880-1300, ext. 1393, or (512) 370-1393; by fax at (512) 370-1629; or by email.

November 2017 Texas Medicine Contents
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Last Updated On

November 01, 2017

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Sean Price


(512) 370-1392

Sean Price is a reporter for Texas Medicine and Texas Medicine Today. He grew up in Fort Worth and graduated from the University of Texas at Austin. He's worked as an award-winning writer and editor for a variety of national magazine, book, and website publishers in New York and Washington. He's also helped produce Texas-based marketing campaigns designed to promote public health. Sean lives in Austin and enjoys hiking, photography, and spending time with his wife and two sons.

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