Sonny Barnes, Esq. Legal Counsel for McLeod Health Corporate Director of Risk Management Tammy S. Phillips, CPHRM, CPSO Director, Risk Management St. Joseph's/Candler Health System Ann Marie Swindler, BSN, JD, CPHRM Executive Director Corporate Risk Management & Insurance Memorial Health University Medical Center
Storm Preparations Northeast South Carolina - McLeod Health Savannah, Georgia
Facilities Involved -Seacoast Medical Center Little River, SC -McLeod Loris Hospital Loris, SC -McLeod Regional Florence, SC -McLeod Darlington Darlington, SC -McLeod Health Dillon Dillon, SC -McLeod Health Cheraw Cheraw, SC -McLeod Health Clarendon Manning, SC -St. Joseph s/candler Savannah, GA -Memorial Health Savannah, GA
Source: weather.com
State Emergency Management Preparations Sunday 10/2/2016 SC EMD begins preparations goes to OPCON 4 Monday 10/3/2016 SC EMD partially activates its Emergency Management Center NC and FLA declare State of Emergency Tuesday 10/4/2016 GA declares State of Emergency for 13 Counties (inc. Chatham) SC Gov. Haley orders coastal residents to prepare for evacuation on Wednesday; orders coastal schools and nonessential government offices to close Wednesday
State Emergency Management Preparations Wednesday 10/5/2016 Gov. Haley orders low country coastal evacuation I-26 reversed 32 Hurricane Shelters open (SC DSS as lead agency, plus Red Cross, Salvation Army and DHEC) Thursday 10/6/2016 GA Gov. Nathan Deal orders mandatory evacuations of 6 coastal counties (East of I-95) Gov. Haley orders evacuation of Horry, Georgetown, Jasper & Colleton Counties
Facility Preparations Monday 10/3/2016 Emergency Management Staff begins daily updates with NOAA Began communications SCDHEC Instructions sent out to Department Directors re: planning for staffing and supplies Facilities essentially under local leadership for preparation Plan for joint incident command for Loris and Seacoast
Facility Preparations Tuesday 10/4/2016 Evacuation warning from Governor Emergency Management Staff begins daily updates with NOAA Supply coordination with other facilities Plans for traffic disruptions Still focused on Horry County facilities Began communications with SCHA Began coordinating with physician offices EM periodically updates system leadership Horry County Facilities order 2,000 sandbags
Facility Preparations Wednesday 10/5/2016 Low Country Evacuation Order Calls from coastal hospitals and nursing homes regarding possible transfers resource balancing Transfer Center and Nursing Supervisors given responsibility for staff rooming assignments Planning and preparations with the assumption that McLeod Regional in Florence would fill support role for the coastal facilities Supplies on site at Loris and Seacoast Almost 2 days required for grounds crews to fill sand bags
Facility Preparations Thursday 10/6/2016 Evacuation in effect for Horry County (East of 17) Leadership declares Inclement Weather Policy in effect Staffing considerations (including physicians) Assumptions of 5-8 inches of rain and maximum winds of 36 mph Concerns over construction sites, including a crane on Florence campus Shelter Planning (community vs DHEC) Home health patients Discharges Physician Offices Water supply planning
Facility Preparations Friday 10/7/2016 Storm effects begin in NE SC at approx. 10:00 pm Incident Command Center established for McLeod Health in Florence Key Leaders remained on all campuses Vaccine storage from physician offices Planning to feed staff Planning for water failures Forced to open community shelters for Home Health patients Saw increase in ED flow Began shifting engineering assets inland
Facility Preparations Saturday 10/8/2016 Full effects of storm 11:00 a.m. Power outage backup generators Water intrusion throughout Engineering begins working around the clock Community shelter taking people from all over county with medical needs mostly O2 issues Day hospital becomes shelter at McLeod Regional, disputing surgical schedule Cell phone problems throughout insufficient 2 way radios Rooming plan for staff and accountability Realization that major issues were occurring inland: Loris, Florence and Dillon
Weathering the Storm Lessons Learned 2
The Not-So-Quiet Before the Storm It began as do so many big events, with loads of anticipation
and Parking Issues. (Challenge Number One)
Team B Team members who were to come in and relieve Team A as soon as possible after the storm & Team C Team members who were to accompany any evacuated patients to offsite facilities All Memorial team members were assigned to one of three teams Team A, whose job it was to maintain operations during the storm
OUR A Team
Challenge Number Two Communication for all Hospital Incident Command
We listened, waited, updated But by 10AM Thursday, October 6, with the leading edge of the storm only a day away, it was too late to safely evacuate most of our patients. When CEMA finally gave the order for mandatory evacuation, we had some serious risk assessment to undertake. In the end, it was clear that there was only one safest alternative
Instead of evacuating, we entered the height of the storm with about 800 team members caring for 363 patients. (Editor s note: It would be 366 patients before the storm was over.) In addition, we were housing just over 300 first- responders police officers, firefighters, National Guardsmen 2
Challenge Number Three Camping out with 1000 of your closest friends And so began the Linen Underground Patients in the community who began to run out of meds turned to us Supplies became a challenge quickly
Challenge Number Four: Rest Became Imperative and Impossible 2
And then the water came in and we got creative
But we made it through the storm and learned some valuable lessons for next time
Control What Can be Controlled
Document Everything Else
Preparing for the Inevitable What to Do in the Event of Damage: Protect property from further damage. As applicable, board up the property and eliminate or reduce unsafe conditions. Take photographs of all damage prior to removal of any debris. Proceed with emergency measures such as drying and cleaning to prevent additional damage. Provide security for the property. Separate damaged property from undamaged property and begin repairing critical equipment. Obtain identification of any civil authorities involved such as the fire, police, health department, OSHA, EPA or building inspectors. Collect and retain all documentation to support the claim including invoices, purchase orders, repair quotations and clean-up costs.
Departmental Property Loss Check List Department Involved: Date of Loss: Description of the Loss: Cause of Loss: Expenses Incurred: Cleanup of Premises (vendor charges, contracts, engineering reports): Removal of Debris and damaged property: In-house labor for cleanup (work order summaries, payroll registers, time cards, payment rates): External labor for cleanup: Premium/overtime labor: Machinery/Equipment Replacement Costs (work orders, original invoices, replacement invoices): Building/Machinery/Equipment Repairs (contracts, itemized invoices for labor, materials, profit and overhead): Temporary Equipment/Facilities Costs: External Services Costs: Extra expense in continuation of operations to reduce loss of services i.e. meals, supplies, laundry services, linen, etc.: Shipping Costs: Excess Fuel Consumption: Substitute Materials: Efficiency Variances:
Initial Cost Estimate Worksheet St Joseph's/Candler Health System Estimation of Hurricane Matthew Event Detail not necessary, for estimation purposes only Facility Department Name/Number Additional labor hours Avg Pay Rate Additional Supply Costs Additional Contract Services Estimated Building/Equipment Repair Costs Prepared by
Cost Recovery Insurance Coverage Damage Deductible Federal Emergency Management Agency (FEMA) Disaster 4284DR Private Non-Profit (PNP) A facility that provides a critical service, which is defined as education, utility, emergency or medical
FEMA Application Process Local Emergency Management Agency Meetings FEMA File application for Public Assistance E-mail Notification of acceptance FEMA/GEMA Exploratory Call Recovery Scoping Meeting (RSM) Public Assistance Program Delivery Manager (PDM) GEMA Point of Contact (POC) CRM Tool Grants Portal Website Damage Inventory (DI) Spreadsheet Site Inspections
FEMA Talk CRC Consolidated Resource Center DAC Direct Administrative Costs DMP Debris Management Plan EC Exploratory Call EHP Environmental and Historic Preservation FAL Forced Account Labor Emergency Labor Regular Time Overtime JFO Joint Field Office PAPPG Public Assistance Program and Policy Guide PDMG Public Assistance Program Delivery Manager POC Point of Contact RFI Request for Information RPA Request for Public Assistance RSM Recovery Scoping Meeting SOW Scope of Work T&M Time and Materials
Policies Wage & Salary Stand-By Pay Emergency Management Plan Procurement Manpower FEMA POC Finance Plant Ops Consultant? Property Locations Age Contracts Existing New (procurement)
What is Recoverable through FEMA? Category A Debris Removal Category B Emergency Measures Temporary facility related costs to continue operations until permanent restoration work is completed Emergency evacuations Labor costs for emergency mass care or shelter operations Emergency protective measures Temporary generators Category E Buildings and Equipment Repairs to buildings, structural components, interior systems such as mechanical, electrical and plumbing systems, equipment and contents including furnishings May reimburse for upgrades that are required by code; replacement of damaged building eligible if the repair costs are more than 50% of the replacement costs.
Cost Eligibility Must Be: Directly tied to the performance of eligible work Adequately documented Reduced by all applicable credits, such as insurance proceeds and salvage values Authorized and not prohibited under Federal, State, Territorial, Tribal, or local government laws or regulations Consistent with the Applicant s internal policies, regulations, and procedures that apply uniformly to both Federal awards and other activities of the Applicant Necessary and reasonable to accomplish the work properly and efficiently.
Category A Debris Removal Option A Straight Federal Cost Share of 75% Option B Public Assistance Alternative Procedures Pilot Program for Debris Removal Sliding Scale 1-30 days 85% - 10/4/16-11/2/16 31-90 days 80% - 11/3/16-1/1/17 91-180 days 75% - 1/2/17-4/1/17
CAT A Debris Removal Debris Staging Areas Debris Removal Contracts Load Tickets GNR Environmental Protection Division Approval Letter EPD recommends predetermined management sites Pre-Qualified additional 2% reimbursement Emergent Amount/type of debris Price per cubic yard Landfill Permits Approved by the GA Dept. of Natural Resources Forced Account Labor Straight Time Only Time Records/Wages Stumps 2 ft. or larger in diameter measured 2 ft. above the ground Extraction is required Photos Before, During & After!!
Category B Emergency Measures Forced Account Labor Overtime Pay Only Standby/Hazard Pay Policy language Sheltering/Medical Needs Patients County Emergency Management Plan Supplies, Food, Protection Sand bags, tarps, removal & storage, meals for staff, etc.
CAT E Buildings & Equipment Buildings If PNP operates multiple facilities FEMA must evaluate each building independently, even if all are located on the same grounds. All structural and non-structural components, including mechanical, electrical, and plumbing systems Contents and equipment within the building Furnishings Equipment Vehicles Construction Equipment Force Account Labor Straight Time Overtime Supplies Ceiling Tiles, Paint, Tools, Tarps, etc.
Time Frames Buckle Up! Damage Inventory Draft due at Recovery Scoping Meeting Final due 60 days after Recovery Scoping Meeting Category A-B (Emergency) Up to 6 months to complete Dependent upon JFO workload Category E (Permanent) Up to 18 months to complete Dependent upon JFO workload
Denials Preliminary FEMA Public Assistance (Pre) Determination Memo Alternative Dispute Resolution > 1M Official Public Assistance Eligibility Determination FEMA to GEMA Eligibility Determination Letter from GEMA to Applicant Appeals 60 days from receipt to file written appeal Arbitration
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