Colleagues in disaster recovery: Hospital CEO humbled by outpouring of help following tornado

On his sixth day as the interim CEO of Winston Medical Center, Paul Black was crouched behind a wall in the emergency department, bracing for the impact of a tornado that was barreling toward his hospital campus on the afternoon of April 28, 2014.

The sound of shattering glass heralded the twister's arrival. “You start hearing things flying around and hitting the walls, and in 15 seconds it's over,” Black said. “Then you look around, and it's not what you planned for.”

In a matter of seconds, his not-for-profit hospital serving the 19,000 residents of central Mississippi's rural Winston County was in ruins. The main 41-bed brick hospital building was covered in broken glass and debris. The roof and walls of the ED, two clinics and a dialysis center had collapsed. The 120-bed nursing home had severe roof damage and was taking on destructive amounts of water. Remarkably, among the more than 150 people who were on the medical center campus that Monday afternoon, the only injury was a scalp laceration.

Black, a Mississippi native who had been the hospital's chief financial officer for the previous three years, remembers few details from that first night, as he tried to comprehend the extent of the damage. Plans and exercises had prepared his staff for the initial response, but not for recovering from the scenario unfolding around them. “We get tornado watches and warnings all the time. We have drills. We know what to do,” he said. “What you don't prepare for is being the victim.”

Over the following months, Black and his colleagues at the medical center struggled to reconcile the need to provide healthcare for the community and keep workers employed with the maddeningly slow reality of resolving insurance claims and rebuilding shattered infrastructure. Despite the isolation Black felt in the first dark and rainy moments after the tornado, strong relationships built among local, state and regional emergency responders long before the storm paid dividends for his hospital. There was an outpouring of support from across the country. And Black established a strong emotional bond with a hospital system CEO more than 600 miles away who was rebuilding one of his own facilities after a tornado.

Winston Medical Center was at the western edge of a three-quarter-mile wide swath cut by the EF4 tornado—the second-strongest category—as it moved across Louisville, Miss., population 6,500, and stayed on the ground for 34 miles. Ten people died and hundreds were injured.

The three physicians on the hospital campus when the storm hit worked with nurses to set up a makeshift triage and care area in an old surgical suite that was on generator power and still had an intact roof. They treated more than 100 patients from the community who arrived that night with storm-related injuries. Many victims were carried in on doors or other sturdy surfaces their neighbors could find.

One of the first patients to arrive was Lee McCall, whom Black had succeeded as CEO less than a week earlier. McCall's house was lifted off its foundation. He was brought in on a tabletop, suffering from severe leg and foot injuries.

Response teams from the Jackson-based University of Mississippi Medical Center, which co-leads public health and medical emergency support in Mississippi with the state health department, arrived within hours to help staff the incident command system and coordinate patient transfers. By midnight, UMMC had established its Mobile Emergency Treatment and Training System, an 18-wheel trailer fully equipped as an eight-bed ED, in the parking lot of the local Wal-Mart to take over the town's interim medical care.

In his office in Norman, Okla., David Whitaker, CEO of Norman Regional Health System, learned what happened in Louisville via an email alert from the American Hospital Association. He recognized a familiar story. Norman Regional Health System owns Moore Medical Center, a 45-bed hospital in the Oklahoma City suburbs that was destroyed by a EF5 tornado on May 20, 2013.

When that tornado hit, “I can remember sitting in the command center at our main campus thinking, 'Oh my God, how do we handle this?' ” Whitaker said. “Quite frankly, as a CEO, it becomes very, very lonely at that point.”

Nearly one year into a painful recovery, Whitaker knew the challenges that lay ahead for the Winston Medical Center staff. “I'm sitting there thinking, 'Who is the poor guy who's having to deal with this?' ” he said. “That said to me, 'OK, payback time.' It was time for us to do to others what was done to us—in a good way.”

He had his staff set a plan in motion to help their colleagues in Mississippi, while Whitaker tracked down a phone number for Paul Black and called him.

Mississippi authorities wanted to head off what happened following Hurricane Katrina in 2005, when many healthcare professionals left their southern Mississippi and Louisiana communities to seek work elsewhere because they could not afford to wait out the long recovery of local healthcare systems. So state and UMMC officials met with local leaders two days after the Louisville tornado to begin planning how to get staff back to work as soon as possible.

“We want to keep people living here and working here,” said Lacey Vowell, administrator of Winston Medical Center Nursing Home.

The Mississippi officials' solution was to call on North Carolina's emergency management team, with whom they had developed a close relationship in the years since Katrina. The two states often conducted exercises together, maintained interoperable assets and had discussed the logistics of deploying the Federal Emergency Management Agency Mobile Disaster Hospital housed in North Carolina to Mississippi should the need arise.

Four days after the tornado raked Louisville, a convoy of trucks carrying the tents, trailers and equipment that make up FEMA's Mobile Disaster Hospital hit the road from Mocksville, N.C. The trucks rolled into Louisville on May 4. Within 15 days, workers had converted an empty concrete slab in the center of town into an 11-bed inpatient facility and a five-bed ED complete with laboratory, X-ray, pharmacy and outpatient therapy capabilities. FEMA Administrator Craig Fugate was on hand for the official opening of the facility. It was expected to serve the community for 18 to 24 months.

The Mobile Disaster Hospital and Winston Medical Center's decision to set up a separate temporary clinic facility brought continued employment for some of its 198 full-time staff members. But facing the financial realities of recovery, the medical center laid off 130 employees at the end of May; 92 of those workers were let go from the nursing home. “That was a difficult day,” Black said.

On the night of the storm, nursing home administrator Vowell had overseen the evacuation of 114 residents with the help of dozens of volunteers, including Deborah Bryant, the wife of Gov. Phil Bryant, who had been passing through the area and took shelter at city hall. By 4:30 p.m. the next day, all the nursing home residents had either been taken in by their relatives or transferred to one of a dozen nursing homes across central and northern Mississippi where Vowell had found open beds.

Black and Vowell identified the reopening of their nursing home in the fall as their top priority. But they recognized that their employees would still be out of work for months.

The strain on the medical center, the county's second-largest employer, did not go unnoticed by local political leaders. In May, Louisville Mayor William Hill applied for and received a National Emergency Grant, which allowed the city and county governments to temporarily hire people who had been displaced from their jobs by the disaster to do everything from clerical work to debris cleanup. The grant provided work for about 50 medical center employees.

The staff of Winston Medical Center received a flood of direct support from their local community and from across the state, including a $37,000 donation from the Mississippi Hospital Association Cares Fund. Black described the outpouring as one of the most humbling experiences of his life.

On June 18, Whitaker traveled from Oklahoma to Mississippi to meet Black for the first time. Since their first phone conversation four days after the tornado, the two men had talked at least a half-dozen times. As Black struggled with the challenges of recovery, Whitaker provided advice on insurance consultants, FEMA reimbursement applications and the merits of modular buildings as temporary facilities.

But Whitaker's most important contribution was moral support. “The biggest thing he gave me was the ability to talk to someone who knew what I was going through,” Black said. “The best advice he gave me is, he told me to be patient because things don't move nearly as fast as you want them to.”

It's the same advice Whitaker received the year before. Feeling overwhelmed in the days after the tornado struck Moore Medical Center, he and his team had called on their peers at St. John's Regional Medical Center, a Joplin, Mo., hospital destroyed by a tornado in 2011. The Moore staff also received financial donations, cards expressing best wishes, and other support from healthcare colleagues around the country, and they had vowed to pay it forward.

Whitaker arrived in Louisville to present a $48,000 check to Winston Medical Center's employee relief fund. The money had been raised by his staff—victims themselves just 13 months earlier—and his health system's foundation and volunteer organization. The check presentation was accompanied by banners signed by hundreds of Moore Medical Center employees.

Cheers erupted from the crowd gathered under the hot sun in Louisville to meet Whitaker. He cautioned everyone that there was a long road ahead. Moore Medical Center had just broken ground on its new facility. Although most of his employees were back to work in temporary facilities, several had not yet returned because of issues associated with post-traumatic stress disorder.

“We may all be different in what we do and where we work,” he told the crowd. “But the thing about healthcare workers that is always the same (is) we always stand ready to help our community in their time of greatest need. Sometimes we do that at the expense of our own welfare and health.”

This past December, Black, Vowell and Whitaker traveled to Denver to share their story at the National Healthcare Coalition Preparedness Conference, an annual meeting where coalition stakeholders across the country share best practices to improve emergency preparedness. In addition to technical lessons learned, Black and Vowell provided an update on Winston Medical Center's recovery.

After several months of repairs, the nursing home reopened with 74 beds on Oct. 1, returning about two-thirds of Vowell's staff to work. When insurance claims are settled and the hospital and nursing home are rebuilt, the plan is to return the nursing home to its full 120-bed capacity.

The FEMA Mobile Disaster Hospital continues to operate in Louisville, but not at a capacity sufficient to employ all Winston Medical Center staff. Dozens are still on layoff. Black is finalizing plans to transition to a different type of temporary hospital facility in the coming weeks that will allow the medical center to reopen inpatient geriatric psychiatric care, one of the services lost in the storm. That will bring more staff back to work and generate essential revenue for recovery.

Black said the long-term plan is to rebuild the Winston Medical Center campus with funding from insurance, supplemented by FEMA reimbursements, anticipated revenue from the reopened nursing home and the return of geriatric psychiatric services. It likely will be at least 2016 before Louisville sees the new permanent Winston Medical Center.

In the meantime, Vowell said no one on her staff is complaining.

“Those little things that get underneath your skin in healthcare, like call bells and alarms—all those sounds are welcome,” she said. “It's easy to get caught up in the rat race of life, and you trudge to your job and think, 'Oh, it's Monday.' Everybody at Winston Medical Center Nursing Home is glad when Monday rolls around.”

Jessica I. Brown is an independent writer in Seattle. She wrote this article while working on staff at MESH Inc., a not-for-profit public-private coalition in Indianapolis that helps healthcare providers respond to emergency events and remain viable through recovery.