Advance Planning Minimized Storm Impact for Oncology Practices

Vivek Kavadi, MD

The storms were powerful. They were headed straight for land. And the forecasts were nearly apocalyptic.

Texas Oncology and Florida Cancer Specialists & Research Institute knew their ability to recover from hurricanes Harvey and Irma would hinge upon the work they did before either storm arrived. Acting on the warnings, both practices built on existing disaster plans already refined by experiences with several tropical storms each year.

Similar preparations led to similar plans and similar success in minimizing the damage to both patient health and practice prosperity, yet there is no way to perfectly protect a business against something as powerful as a hurricane.

The very different nature of the actual storms led to very different experiences in the 2 states. Florida Cancer Specialists & Research Institute lost power at locations from Naples to Jacksonville, but nearly all were operating again a day after Irma left. Texas Oncology felt Harvey’s impact over a much smaller area, but flooding throughout the Houston region was so severe that most local offices closed for an entire week.

“The rain just kept coming, falling harder than any of the monsoons where I grew up in India for days on end,” said Vivek Kavadi, MD, the medical director of Texas Oncology’s Gulf Coast practices. “Some areas got 50 inches of rain, which was enough to flood interstate highways and render much of the region impassable for days after the rain stopped.

“Our facilities escaped without too much damage—6 inches of water in Clear Lake, which is the region’s largest office, and minor flooding in a few others—but we had several employees whose homes were severely damaged and many whose cars were essentially totaled,” Kavadi said. “Each day brought more bad news. It seemed never-ending, and that was the worst of it. We had to summon the energy and focus to stay in full emergency mode for more than a week.”

Things might have been even worse but for the fact that Texas Oncology had plenty of warning. Forecasters made unusually early and accurate predictions about the behavior of Hurricane Harvey, giving businesses across the region time to adapt normal emergency plans to a storm that was unlike anything to hit Texas in living memory.

Offices located inside the storm’s predicted path prepared for potential flooding using both the latest technology (backing up computers to distant server farms) and the oldest strategies (moving valuable items as far above the floor as possible). They also took the unusual step of moving temperature-sensitive medications away from blackoutprone offices, storing them either at offices equipped with emergency generators or at local hospitals.

Around noon on Friday, August 25, Texas Oncology closed all 12 of the Houston-area offices that lay within the storm’s projected path. The rain began late the next morning.

Before the first drops hit the ground, Kavadi and other regional officials had activated an emergency communications protocol designed to keep the practice’s regional leadership and emergency response team fully connected to employees and patients at each location. Designated individuals served as liaisons between decision makers and the staff and patients from each office, passing information up and down the line each day.

They didn’t stop there. Texas Oncology kept in touch with stakeholders every conceivable way—via landline, cell phone, text, e-mail, Facebook, Twitter, and its website—not only for the sake of convenience but also to guard against the possibility that some channels would fail, either because of storm damage or overuse.

As things turned out, Harvey did not hinder communications all that much. Its winds were relatively mild, and just 300,000 people in a metro area with 6.5 million residents lost electricity.

Texas Oncology had little trouble keeping in touch with its stakeholders, but the scope of the flooding kept all its Gulf Coast offices closed for nearly a week. When conditions finally allowed some offices to reopen, practice officials created new treatment schedules, giving available slots to patients with the most urgent treatment needs, and then alerted staff and patients.

In many cases, the emergency response team had to direct patients away from the offices they normally used, because those locations were either still closed or could not accommodate all time-sensitive cases. The practice also had to transfer many employees from facility to facility to cover for people who could not make it to work. Roughly 50 of Texas Oncology’s 400 Houston-area employees sustained severe damage to their homes or cars, and many others had to miss work to care for loved ones.

“It was a significant logistical challenge to match the available pool of staff members with the available facilities, and then fill all of the available appointment slots across the region with the patients who were most in need of care, but the system and the tools and the people we had in place performed almost flawlessly,” said Kevin Vineyard, the executive director of Texas Oncology’s Gulf Coast practices. “You need to prepare yourself as best as you can for a wide variety of possibilities, but the specifics of any natural disaster are unpredictable, so you need a plan that allows you to adapt to whatever conditions arise and do the most with whatever resources you have at any given moment.”

Officials from Florida Cancer Specialists & Research Institute emerged with a similar perspective despite facing very different challenges. Irma did flood some regions of Florida—any significant rainfall can cause flooding in a state that’s flat as a pancake and waterlogged even before the first drops hit the ground—but the wind caused most of the damage. Irma first hit the state as a giant Category 4 hurricane on September 10, buffeting everywhere from Miami to the Panhandle, with sustained winds in excess of 100 mph.

The size of the impact zone made disaster response harder than normal for Florida Cancer Specialists & Research Institute, which has more than 90 locations spread along both coasts of the state and across the Interstate-4 corridor. The practice had always been able to shift operations away from relatively small disaster areas to nearby offices that remained unscathed. It had never faced a storm that made the entire state a disaster area.

Irma’s high winds hindered communications much more than Hurricane Harvey did. Some 4.4 million homes and businesses lost power at some point, and a similar percentage lost landline telephone and Internet service. Nevertheless, Florida Cancer Specialists & Research Institute had virtually no trouble communicating with patients and staff because it pursued the same sort of multichannel strategy that Texas Oncology used. Many people lost access to some form of communication during the storm and its aftermath, but few people lost all access for any extended period.

Many Florida Cancer Specialists & Research Institute offices were ready to open a day after the storm passed, but a significant number were not. Rather than simply keep appointments as normal in the open offices, Florida Cancer Specialists & Research Institute took a regional perspective that prioritized patients undergoing time-sensitive forms of curative therapy. The plan: Delay appointments for less-urgent patients and send the neediest to open offices in their region. That required full integration of things like calendar software and timely communications, but it worked very well.

The other major challenge for Florida Cancer Specialists & Research Institute was getting medications to patients. Like Texas Oncology, Florida Cancer Specialists & Research Institute had moved temperature-sensitive medications to hospitals and other facilities equipped with backup generators. That turned out to be a smart tactic, because power outages would otherwise have ruined some of the $30 million in medication that Florida Cancer Specialists & Research Institute offices have on hand at any given time. (Texas Oncology did not face that situation.)

Proper storage ensured that patients could be treated as soon as offices reopened, but Florida Cancer Specialists & Research Institute never has more than a couple of days’ worth of medication at the ready; without a steady supply, it could not continue offering treatment. Unfortunately, delivery services took the unprecedented step of suspending operations for a couple of days after Hurricane Irma. Florida Cancer Specialists & Research Institute responded successfully with an impromptu plan in collaboration with their drug distributor, Oncology Supply, to ensure that drugs were delivered in a timely fashion to all treatment locations.

“Our people did a very good job planning for the storm and then responding to events as they actually happened, but we also benefited a lot from recent improvements in communications technology. We couldn’t have shifted resources around so quickly or found ways to get our medications if we had nothing to rely upon but landline telephones,” said Brad Prechtl, chief executive officer of Florida Cancer Specialists & Research Institute.

Technology also safeguarded patient records in ways that would not have been possible when everything was kept on paper. As part of its disaster recovery plan, Florida Cancer Specialists & Research Institute ensures all its data and records are backed up in real time to a second data center located in the Northeast.

Officials at Florida Cancer Specialists & Research Institute, like those at Texas Oncology, thought the ability to transfer records might also prove valuable as a means of ensuring continuity of care to patients who evacuated to safer parts of the country, but neither practice received a significant number of data requests from practices in other states.

“We were very happy to be able to transfer records in the other direction on at least 1 occasion,” said Todd Schonherz, chief operating officer of Florida Cancer Specialists & Research Institute. “We had a gentleman who worked for a power company in Illinois, who missed what was to have been his last appointment for active treatment back home, come down with an emergency crew that helped restore power in Florida [right after Irma]. His oncologist sent us the information we needed, and we were able to do that last treatment while he was here.”