“Take care of our employees and they will take care of our patients.” – Doug Higginbotham, President & CEO, South Central Regional Medical Center
On Monday, August 29, 2005, disaster struck the very place we call home. Being the largest and third strongest hurricane recorded to make landfall in United States history, Hurricane Katrina made its mark on South Central Mississippi. This year marks the 10th year since Hurricane Katrina changed the lives of so many creating experiences that would never be forgotten.
Doug Higginbotham, President and Chief Executive Officer at South Central Regional Medical Center said, “We faced numerous challenges in the hours during and after Hurricane Katrina. Each of the challenges were met with creativity and hard work by all of our staff. The mantra of our management team during the storm became, ‘take care of our employees and they will take care of our patients’. The following is my personal summary of the activities I documented during and after the hurricane. There were so many other experiences and stories which have been told over and over about the days that followed the hurricane. This information by no means includes everything that occurred during that time.”
“We have always considered ourselves family at South Central, but this event created a bond among our staff like no other event could. I continue to be so proud of our employees and our physicians who worked tirelessly to take care of patients and others who needed our medical assistance, support and care.”
The storm was not considered a factor for Mississippi until Friday afternoon, August 26th. Steve Earnest, our Director of Public Safety sent emails and text messages to the management team advising them to pay attention to the storm and to be prepared to work over the weekend. Because we have been through this drill multiple times, each member of our management team was familiar with the requirements.
On Sunday, August 28th, at 6:30 a.m., Linda Gavin, administrator on call for the weekend, called stating that Slidell Memorial Hospital wanted to transfer patients to us. We met at the hospital, evaluated our capacity and agreed to take up to 10 patients (4 ICU patients and up to 6 Medical/Surgical patients). Ultimately 6 patients were transferred here. Our inpatient census was around 170 at the time. We considered that if transfers were already being requested, there was a strong likelihood that we would have a greater need as the storm progressed.
At 4 p.m. the management team was assembled and we discussed the information we had about the potential impact of the storm. Each member of the management team was asked to make sure their area was prepared. Most directors had already been at the facility working on preparations and most had left the building by 8 p.m. Sunday evening. The management team at South Central returned to the hospital between 2:45 a.m. and 8 a.m. the following morning. Like most health care facilities in Mississippi and Louisiana, we had plans in place for disasters, but no one could prepare enough for Hurricane Katrina.
Leaks and Building Damage
The driving rain created more leaks than we had ever seen in the facility. There were leaks in every hall; significant leaks in surgery; leaks in the obstetrics and gynecology area, ICU, the cafeteria, and the kitchen. The wind was driving the rain through window seals and cracks in caulking. The wind blew open two of the front doors and broke them. Two patient room windows were blown out.
We handled the broken windows by placing steel plates in the frames and screwing those plates into place. All leaks had to be contained by buckets, towels, sheets, garbage cans, and a wet vac. Considering the winds and rain we faced, the buildings held up relatively well, but we did sustain damages.
Loss of Power
The power went out at 12:40 p.m. on Monday, August 29th. The generators, which the Board of Trustees at South Central had approved the previous year, came up to full speed 7 seconds later. We had full power to all circuits, including the chillers during the entire storm. The generators performed flawlessly for 39 hours. During this period they burned approximately 4,500 gallons of diesel fuel. One key factor to the relatively good performance we experienced at South Central during hurricane Katrina, was the flawless performance of the generators.
Incredibly, during the storm we had some local phone communication with ComfortCare Nursing Center, but lost all other communication. There was no communication by cell phone, pager or the internet. This created several problems including the inability to communicate with other facilities, as well as our own, about the need for patient transport to and from our hospital. Communication regarding some of our transfers had to be handled via the state-wide emergency radio network.
While communication was a huge problem, perhaps the biggest issue was we could not reach our medical staff. Many physicians recognized they could not be reached and made arrangements with us to be housed in our facility until phone service could be established. About 48 hours after losing phone service, BellSouth had us working again, although service was spotty. Cell phones for some came up about 72 hours after going down.
Impact of Loss of Water
The loss of water was the most critical issue for us during the storm. Going 60 hours with no water or inadequate water pressure was never contemplated by us or any other facility in planning scenarios. Without water, we had no fire suppression, no way to flush toilets, no water for cooling towers, no way to wash dishes, to run laundry, to cook food requiring water, to give water to our patients or staff, to run certain lab tests, to run our sterilizers or to run our medical vacuum system. In short, water was our critical factor. We handled the water issues as follows.
Working with the Red Cross, we were allowed into Wal-Mart about 1:00 a.m. Tuesday morning. While there, using flash lights, we were able to acquire two pallets of water, large quantities of paper cups, paper plates, napkins, plastic utensils, and rice and pasta to “stretch” meals prepared by our food services staff. With paper products, washing dishes was no longer an issue. The pallets of water were used in conjunction with the water that had been ordered in preparation for the storm and was on hand to meet our immediate patient and cooking needs.
The morning after the storm (Tuesday), our Plant Engineer Stanley Coco had made arrangements, via an employee in Public Safety, for the Calhoun and Powers Volunteer Fire Departments to have water delivered to the hospital for two uses. First, the cooling towers required water to keep the chillers working. Secondly, a pool was established for water to flush toilets. The volunteer fire departments brought approximately 3,500 gallons of water to the hospital every 3 hours. Also, Tuesday morning, a representative from the Coca-Cola bottling company, came by and asked what we needed. We asked for water and beverages and within an hour and one-half, he had emptied his warehouse of bottled water and supplied four pallets of drinking water. He also provided other Coca-Cola products. Southern Beverage brought canned water and we had loggers from Ohio show up in the middle of the night to drop off about 20 cases of water. Nurses were instructed to limit water as much as possible and staff was asked to conserve water for patients as much as possible.
The availability of lab tests was reduced because the instruments that run the tests require a pressurized water source. The medical staff was informed about what tests were available and worked with us to insure that appropriate tests were ordered.
Toilet flushing was a broad effort of many. Plant operations set up a pump which was used to fill any available waste basket, bucket or other water bearing vessel that could be lifted to flush toilets throughout the hospital. People from all departments including plant operations, environmental services, administration, the business office, and nursing participated in an endless parade of buggies to floors to flush commodes. The term for the process was the “potty patrol”. It was not always done with precision, but the toilets got flushed.
That afternoon (Tuesday), we made the decision to bring in portable toilets and close the public toilets. While it was very odd to see portable toilets out in front and back of our hospital, the idea worked very well. We were able to limit our flushing/cleaning requirements to the patients and staff restrooms which reduced the work load tremendously for all involved. Hauling the water was a very labor intensive effort.
We typically keep three days of laundry on hand. However, we went two and a half days without water, and used a tremendous amount of laundry – towels, sheets, and blankets to dry up or stop leaks during the storm. Our critical need by Wednesday was laundry. When the water was restored to the hospital, we made the decision to keep the water to the west wing shut off and to continue the potty patrol until enough pressure could be developed to run at least one boiler and two washing machines. The boiler was essential for three reasons. First, steam was necessary to run our sterilizer. Secondly, steam was required for our dryers and finally, steam was needed for hot water. After we were able to garner enough water pressure and steam to run the laundry, we ran the laundry from 7:00 p.m. Wednesday evening until about 1:00 a.m. Thursday with 5 laundry employees, and as many as 11 volunteers. Within 6 hours, laundry produced over 2,200 pounds of finished linen. Starting with their regular shifts (around 6:00 a.m.) Thursday morning, and with volunteer help Thursday evening until about 2:00 a.m. Friday morning, every piece of laundry was washed and a three day supply was again available. In addition to the tremendous effort by the laundry staff to get laundry completed, we were able to provide laundry service to Jones County Rest Home. To put this into perspective, a typical day’s laundry takes about 13 hours to complete. We completed about 6 days’ laundry in about 30 hours.
By Thursday afternoon we were able to turn on the west wing water supply and have adequate pressure to flush all toilets and run our normal operations. We maintained the pool in the back for staff that needed water for their homes.
Surgery and Sterilizers
With the exception of emergency surgery, all surgeries were postponed. We did have to perform emergency surgery and c-sections during the storm which led to a critical shortage of sterile supplies and instruments. Because we had no steam, we could not run our sterilizers. This created a shortage of sterile instruments as we could not clean the instruments which had been used. At one point during this period, we were in a position that we could only perform one more c-section or surgery case. To make it through until we had sterilizers, the surgery staff was very creative – preserving sterile instruments from other packs, and finding what disposable supplies we could.
Ensuring our staff was able to make it to and from work was a monumental problem, because fuel was not available. The only stations pumping gas were the stations set aside for emergency vehicles, however, our staff was not allowed to use those stations.
The fuel issue was first addressed by Howard Industries. Mrs. Linda Howard asked about our needs and we explained our greatest need was fuel. She called to let us know that Howard Industries had acquired the Exxon station on Highway 11. She indicated that our staff could use the station, along with their employees, for fueling beginning Wednesday. This worked for a day, but our staff needs were too great and another source had to be located. Dr. Patel offered to allow our staff to use his station on Highway 84 East, but by the time that was set up, there was no gas available. As a result of Mrs. Howard’s help, we were able to develop an agreement with Mr. Tom Saucier allowing our employees and physicians to use the Shell station on 16th Avenue across from Shoney’s. For two and one-half days, beginning September 1st about 4 p.m., South Central Regional Medical Center employees operated the gas station. State Senator, Stacey Pickering, U.S. Congressman, Chip Pickering and Judge Charles Pickering called to lend their assistance and support. Our employees, at first, were allowed to buy up to 10 gallons with a voucher through payroll deduction. The voucher system was later dropped as unnecessary, but payroll deduction was maintained. On day 2 and later, we allowed Ellisville State School employees, local clinic employees, physicians, Clearview Recovery staff, and Hattiesburg Clinic Dialysis nurses access. Without this step, we would not have had adequate staffing at either the hospital, nursing home or extended care. In total, our staff purchased $40,410 of gas or somewhere in the neighborhood of 16,500 gallons of gas. We don’t have a total for physicians, clinics, or others. We estimated the total for all was near 23,000 gallons of gas.
Special Needs Shelter
It became obvious early in the aftermath of the storm that the Special Needs Shelter established by the Salvation Army to house oxygen dependent patients needed to relocate due to ventilation issues created by their generators. The patients located there were in danger of becoming patients at the hospital. At that time, our emergency room was being overrun with patients seeking oxygen. At one point on Monday evening, we had 11 patients in the ER waiting room waiting for oxygen and we had only 24 E-Cylinders left (about 8 hours of portable oxygen). We placed the oxygen patients in the outpatient area where we could connect them to the wall oxygen outlets. These outlets are fed through our bulk oxygen system. We then secured additional oxygen to meet our needs during the 36 hour crisis period.
On Tuesday (8/30), we met with Don McKinnon of the EOC to discuss alternative locations for the special needs shelter. Realizing that the Cameron Center was not a resource, several members of our administrative team including Beth Endom, Vice President of Nursing at South Central, worked with the Salvation Army and our staff to move the evacuees to our daycare center once the power was restored. This location worked well. Stan Runnels with St. John’s Episcopal Church indicated to us that power had been restored at their facility and they would be willing to house the Special Needs Shelter. We moved all evacuees to St. John’s where the shelter remained opened until September 13, when the last 4 evacuees were moved to assisted living beds in our nursing home. At its highest point, the shelter had as many as 50 patients. During this time, we provided supplies, oxygen equipment/generators, an electrician to address an electrical problem, linen, and nursing/medical support. The Department of Health also provided nursing support, as did the Surgeon General’s office. Also, Jones County Medical Supply was instrumental in meeting many of the needs for those patients.
Red Cross – Magnolia Center
At its peak, the Magnolia Center had 1,026 registered evacuees, although the actual number staying at the Shelter was far less. As of September 14, there were less than 80. To the Shelter, we provided supplies, medicines, nursing support and medical support.
Milne Asylum for Destitute Orphan Girls – Glade Baptist Church
On Monday, September 5, we received a call from Glade Baptist Church asking for some assistance with evacuees from the Milne Asylum for Destitute Orphan Girls. The school was located near the New Orleans Fair Grounds and was flooded due to the hurricane. The administrator and key nursing personnel had connections to Laurel and had evacuated to Glade Baptist Church previously during a storm.
The group no longer had a facility in New Orleans to which they could return. The Asylum had been in existence since 1905 and had been a tax-exempt not-for-profit, private foundation since 1946. Forty five (45) mentally challenged women were housed in the gymnasium at Glade. We provided medical supplies, medical equipment, set up Physical Therapy, activities therapy, and speech therapy during that time. In addition, members of our nursing staff and our medical staff also provided care.
Emergency Department Volume
The Emergency Department at South Central became a shelter and was the only source of healthcare as all clinics were closed. We had an incredible volume on Tuesday with more than 220 registered patients and many unregistered shelter patients. During that time, we had numerous medical evacuees, including dialysis patients and patients seeking oxygen supplies. One of our scheduled Emergency Department physicians did not arrive for her shift, because she had been trapped on the coast. Dr. James Holston handled the volume by opening our outpatient area for medical evacuees and by enlisting additional physician support and help in the Emergency Department. Staff from all over the organization came to assist in the flow of patients and visitors. The volumes remained high for the next several days and we were able to open the outpatient area with nurse practitioners to handle the increased volume. The Emergency Department staff and other medical center personnel performed very well before, during and after the storm.
Because we were uncertain that our vendors could get food to us on a regular schedule, we made the decision to limit the access to the cafeteria. Monday, before and shortly after the storm, we saw a record number of people go through the cafeteria. We were the only source of hot food available to many. We made the decision to close the hospital entrances and limit access to the building. We had a limited menu in the cafeteria and restricted certain times to staff only. Visitors were inconvenienced, but it was our stated goal to make sure all patients and those who cared for them were fed. Also, prior to any delivery trucks making their way to us, the Jones County Schools offered us the food in their freezers and kitchens for our use. This food was the staple for two days.
To ensure everyone was updated throughout each day, we had meetings of the management team, physicians and other key personnel twice each day. The briefings were generally 30 minutes or less in length to discuss progress about current issues or to concentrate resources on new areas if needed. These meetings were helpful in focusing everyone’s efforts in one direction and were particularly useful in working with the medical staff. Dr. Mark Norton, President of the Medical Staff at the time, attended all meetings. After our morning meetings, Dr. Norton held a meeting of the medical staff to keep them up-to-date on what issues we faced. Dr. Norton’s performance during this disaster was exceptional and he was absolutely critical in his leadership role.
Our garbage was usually picked up three times a week by Enviro. Our garbage increased, because we were having to use so many paper products. Since Enviro was tied up on other projects, South Central staff had to haul garbage to offsite dumpsters, which required a considerable amount of manpower.
Our staff was tired and concerned about their personal affairs at home. We decided that we had to address those issues to assure that we had an adequate work force to take care of our patients. Toward that end, in addition to the fuel provisions we made, we undertook the following steps:
While ice was freely available at “distribution points in the community,” our working staff could not get there, because they were working. We made the decision to acquire ice for distribution to staff. The ice distribution to South Central employees began on Saturday, September 3rd, and concluded on September 8th.
Because there was no power or water for many of our staff, our employees had no clean uniforms/clothes to wear to work. We made the decision to establish a washateria in the back parking area of the hospital. The washateria was set up in the doctors’ parking lot and consisted of 8 washing machines. The staff was allowed to use them free of charge. From idea to implementation it took about 6 hours to set up the service. The plant operations staff did a tremendous job in setting up and keeping the washateria in operation.
We made a decision before the storm to offer daycare on a 24-hour basis for employees that needed the service. At one point, we cared for nearly 100 children of various ages. The daycare staff slept here and had help from many other staff members and volunteers. When the number of children had grown to unmanageable proportions and after power was restored to the daycare building, we split the daycare into two parts. The younger children were housed during the day in the daycare building and the older children were kept in the conference rooms at the medical center.
Having access to the medical staff and to some of our key people was essential. We provided rooms for staff that could not get home so they could rest before working the next shift. Other employees chose to stay in the building at their convenience.
While we did not establish the mechanism, Wal-Mart made the decision to allow South Central employees priority on accessing their store. This allowed our employees to get needed personal items without having to wait in long lines. This was very much appreciated by the staff which took advantage of the opportunity by purchasing goods via payroll deduction in the amount of $31,140 over a three day period.
Payroll for South Central is handled electronically. With the power being out due to Katrina, the system was inoperable and the paper checks were no good. Tom Canizaro, Vice President and Chief Financial Officer at South Central, worked with local BancorpSouth branches agreed to cash employee checks up to $250 so essential purchases could be made.
During Hurricane Katrina, the South Central employees truly displayed exactly what makes Jones County an incredible place. In this area, people care about each other and step up to the plate in times of need.
Mark Norton, M.D. said, “I feel very humbled and privileged to be a part of the South Central community. The leadership at South Central and the staff stepped up to the plate and performed remarkably during this time of emergency.”
“Looking back at this natural disaster, one can see how Laurel and Jones County did not let Hurricane Katrina tear our sense of community apart. With assistance from other organizations and agencies, we persevered. Katrina helped our community join together and become what it is today, 10 years later – our home,” Higginbotham concluded.