Early in May when a milewide tornado ripped through Greensburg, Kan., killing nine people, 25-bed Kiowa County Memorial Hospital crumbled along with the town of about 1,500 people.
Within 20 minutes of the twister, Ron Tucker says he rushed to help some neighbors get out of their house, then rushed to the hospital to help with the calming and then safe evacuation of about 20 patients, including 10 psychiatric patients, from the hospitals basement to other facilities. Coming up into the darkness from the basement after six hours, he was overwhelmed to see 15 ambulances from all over the state as well as several from Oklahoma parked in the driveway. The hospital building was for all intents and purposes destroyed, and Tuckers real work as the hospitals chief financial officer was just beginning.
The first thing was to make sure everybody was OK, then what are you going to do and when are you going to do it, he says. Now decisions have to be made. We are trying to get some idea of what the new norm is.
Like all accredited hospitals in the country, Kiowa had a general, hospitalwide disaster plan in place, but basically you throw it out the window and do what you can, Tucker says. Just from his casual observations of the recovery efforts at New Orleans hospitals in the wake of Hurricane Katrina, Tucker says he knows that there are going to be a lot more questions than answers (about the rebuilding process), and it is going to take a lot longer than anyone wants to think about to recover.
Digging out is one thing, recouping expenses is another. Roger John, president and chief executive officer of Great Plains Health Alliance, Phillipsburg, Kan., which leases the hospital from the county, says very little was salvaged from the building. Officials have already settled with the insurance company and will receive about $4.3 million, but the building was grossly underinsured, he says. The Federal Emergency Management Agency, or FEMA, will pay up to 75% of the difference between what the insurance will pay and the cost of rebuilding, and the state of Kansas will pick up another 10%, so well have to find another way to finance 15% of the building, John says.
Based on the experience of healthcare providers in New Orleans after the devastation of late August 2005, it could take months or years for Kiowa to become financially whole again. In Louisiana, the process has been excruciatingly slow, especially in recovering sheltering costs from FEMA, which has to go over every claim in detail, according to Michelle Clement, a spokeswoman for the Louisiana Hospital Association. Of 28 hospitals that submitted reimbursement claim forms through the LHA for a total of $6.6 million in expenses, 15 of those hospitals as of March received approval, and only 11 hospitals have received any payment: approximately $138,000 in total, she says.
Whats more, in April, doctors at 362-bed West Jefferson Medical Center in Marrero, La., sued the state and health department for $100 million to be reimbursed for caring for displaced poor and uninsured patients in the wake of Katrina. The doctors reportedly said in the lawsuit that they had not received any money for their work.
Hospitals around the country are nervously taking note, imagining their own worst-case scenarios, financially planning for them as best they can and applying for a small nest egg of federal funding that became available for hospital disaster preparedness in the eye-opening, hospital-changing aftermath of the Sept. 11 attacks.
In the six fiscal years since 2002, Congress has appropriated approximately $2.6 billion for national hospital bioterrorism preparedness, according to Roslyne Schulman, senior associate director for policy at the American Hospital Association. The $135 million appropriated the first year didnt take us very far, and even the roughly
$450 million average in the years since is hardly enough to pay for one additional staff person at each hospital, she says.
I have to say certainly hospital preparedness has improved, but it is important to keep in mind that preparedness is not a final state, Schulman says. It has to be done constantly. There are always new threats and equipment and supplies become obsolete. So one thing we have said consistently is that there has to be sustained investment in hospital disaster preparedness.