When she made it back to her office five days after Hurricane Harvey devastated the Gulf Coast, Webster pediatrician Angelina Farella, MD, thought the storm had let her off easy. When she thought she saw only blown-in water, her initial assessment that day was, “We escaped.”
But the next several weeks revealed the converted house where she runs her solo practice hadn’t escaped Harvey’s wrath at all.
First, a backup circuit breaker blowout knocked out the refrigerators where she kept about $5,000 worth of newly purchased vaccines. Dr. Farella later found out the elec-tricity in the building had been off and on several times over the course of the storm, leaving the viability of the vaccines in doubt and rendering them unusable.
Soon she noticed the floor peaking and the tile cracking in her waiting area. When she also had trouble with her doors, she discovered foundation problems after the surrounding water had receded and dried out.
“Because [water] didn’t actually physically get into the building, it’s not insurance-coverable,” she said. “The other problem is that because the foundation shifted, it also caused my roof to shift.”
Dr. Farella sought disaster relief from the vaccine companies but was told she didn’t qualify. That’s when she applied for help from the Texas Medical Association’s Disaster Relief Fund. She received about $15,000, which covered the vaccines and some repairs.
Dr. Farella’s post-Harvey recovery is still far from over. “It’s a pain, it’s a hassle, but I’m eternally grateful for the [TMA] grant that I got, because that honestly really relieved so much stress that I was under at that particular moment. It was just a relief that the other doctors are coming through to our rescue,” she said.
One year after the storm, many practices are still marching back to normalcy, and physicians are applying lessons they learned during Harvey to prepare for the next disaster.
“The needs are overwhelming. We will never reconstruct everything that we had before, but we need to try to get to a new normal as soon as we possibly can,” David Teuscher, MD, a retired orthopedic surgeon from Beaumont and former regional director for the U.S. Department of Health and Human Services, told Texas Medicine. “I know it seems like it’s been a long time, and now, we’re in another hurricane season. But this is going to be at least another two to five years to get to that new normal. It’s just going to take that long.”
Roadblocks and relief
As of June, Dr. Farella was practicing out of the same office while arranging renovations. In May, more patients started coming in, but patient visits were significantly down in the seven months or so before that.
“In today’s medical milieu of reimbursements and payments, and delay of payment, and all that fun stuff, and just the sheer volume of people that got affected, [the] economic ripple effect is that people don’t go to the doctor. Unless they’re really, really, really sick, they’re not going to go to the doctor, because they don’t have the $25 or $30 copay to come in,” she said.
If Dr. Farella can’t get permission from the city to operate out of a temporary trailer on the same property while she renovates, she says she’ll probably have to close her practice and completely relocate.
About 75 percent of Port Arthur obstetrician-gynecologist Charles Moses, MD’s patients are on Medicaid, so the low payments he typically receives meant any major flood damage would be hard to absorb. But with TMA’s disaster assistance, he replaced his ruined ultrasound machine, which he initially wasn’t going to do because of the cost.
The new equipment “enabled me to stop what I was doing up until that time, which was send my patients to the hospital for ultrasound — something I’d never done the whole time since I went into private practice,” Dr. Moses said.
Internist Esteban Berberian, MD, previously at East Houston Regional Medical Center, is finally back on the path to business as usual after Harvey flooding forced the practice into a cramped temporary location. (See “Expecting the Unexpected,” Decem-ber 2017 Texas Medicine, pages 31-35, or visit www.texmed.org/Unexpected/.) In May, Dr. Berberian moved into a new permanent building. Although the practice lost five electric examination tables worth $5,000 each, TMA Disaster Relief funds helped replace them with five new, non-electric ones for $1,000 apiece.
“We had to go from our perfect, optimal practice to, ‘What do we need to run right now?’” said Mark Owens, Dr. Berberian’s office manager. “Over the years, we can add some of those kinds of luxuries back.”
Preparing for the next one
The idea of preparing for a hurricane — especially one described as a once-in-a-lifetime storm — might seem absurd. But Harvey provided lessons on what physicians can have in place next time as they watch the Weather Channel through gritted teeth.
As Dr. Teuscher notes, hurricanes and their overwhelming flood waters aren’t the only catastrophe that can strike.
“[If] it’s not going to be a flood the next time, who knows what it’ll be?” he said. “We live in Region 6 (Texas, Arkansas, Louisiana, New Mexico, and Oklahoma). We’re No. 1 in disasters of all 10 regions every year. … Things will happen. Get prepared.”
One thing Dr. Farella learned as a veteran of some of the Gulf Coast’s other major storms was to remove all her computer equipment prior to Harvey’s arrival. Similarly, while Dr. Berberian’s practice lost its scanners to flooding, its computers were safely at higher ground, Mr. Owens says.
Backing up patient medical records, such as through a cloud service, is also essential. Having backup generators for your building’s electrical systems can help mitigate the disaster, too. Dr. Moses’ office lost “everything electrical,” said his wife, attorney Tonya Moses. But much of that loss could’ve been avoided.
“If we would’ve flipped our main breaker, we could have salvaged everything that wasn’t under water, which we weren’t able to do. Because once the water came up to the level of the electrical outlets on the wall, that’s when everything seized, so it had to be rewired,” she said.
She and Dr. Moses also learned another lesson when they found out about excess flood insurance. The Federal Emergency Management Agency’s National Flood Insurance Program insures buildings for up to $250,000 on the building and $100,000 on the building’s contents. But maxing that out didn’t come close to covering Dr. Moses’ losses, which topped $526,000 before insurance. Excess flood insurance can help fill in coverage gaps that business interruption insurance may not cover.
If a natural disaster could knock your practice out of commission, or force you to a new or temporary address, be sure to notify health plans, Medicare, and Medicaid so that any correspondence and transactions — including payments — can reach you, says Genevieve Davis, TMA’s associate vice president of payment advocacy. If you still receive paper checks from insurers, the threat of a catastrophic storm is a good reason to make the transition to arranging electronic funds transfers, she adds.
Dr. Teuscher says everyone in a hospital needs to know their facility’s disaster plan and practice it at least annually. Too many of the physicians he’s talked to don’t even know their hospital has a disaster plan.
Physicians who want to help on the frontlines of the next big storm can get credentialed as a member of a Disaster Medical Assistance Team, Dr. Teuscher adds. They can also volunteer with the government-sponsored Medical Reserve Corps, or with the Texas National Guard.
“If you want to be a part of the solution, get involved with one of those organizations in some way, shape, or form,” Dr. Teuscher said, “or at least just organize your community.”
Disaster preparation tips from TMA staff and physician practices that survived Hurricane Harvey:
- Back up your records, such as through a cloud-based system. That includes not only patients’ medical records, but also practice records such as contracts, compliance plans, and financial records.
- Move your computer and other electronic hardware out of your building, or place it at higher ground to reduce the chance the storm will destroy it.
- Notify health plans, Medicare, and Medicaid if you need to stop mail because your practice is out of commission, or if you’re moving the practice to a new location.
- Make sure you have flood insurance. The federal government’s National Flood Insurance Program provides up to $250,000 coverage on a building and up to $100,000 on the contents of the building. Also, supplemental flood insurance is available from private insurers.
- Have a way to communicate with your staff and patients.
- Assign one person in the office to update the practice’s website once electricity is restored.
TMA Disaster Relief Fund: Strength in Numbers
America’s physicians stepped up to help their colleagues in the aftermath of Hurricane Harvey, with physicians and organizations across the nation pouring generous contributions into the TMA Disaster Relief Fund. Thanks to these major donors, and many others, here’s a look at how TMA is helping practices recover and rebuild.
$500k: Physicians Foundation
$150k: American Medical Association
$25k: AMA Foundation
$25k: Massachusetts Medical Society
$25k: Marshfield Clinic Health System, Marshfield, Wisc.
$1m: Total money raised by TMA Disaster Relief Fund for rebuilding efforts
55: Physician practices that received monetary gifts
169: Individual physicians aided by the relief fund
1,304: Non-physician staff members aided
Tex Med. 2018;114(8):24-29
August 2018 Texas Medicine Contents
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