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

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

State Emergency Management Preparations

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)

All Memorial team members were assigned to one of three teams – Team A, whose job it was to maintain operations during the storm…

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

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…

2

• 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…

Challenge Number Three Camping out with 1000 of your closest friends…

Supplies became a challenge quickly…

And so began the “Linen Underground”…

Patients in the community who began to run out of meds turned to us…

2

Challenge Number Four: Rest Became Imperative…and Impossible

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…

• 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.

What to Do in the Event of Damage:

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

• File application for Public Assistance

• E-mail Notification of acceptance

• FEMA/GEMA Exploratory Call

FEMA

• Public Assistance Program Delivery Manager (PDM)

• GEMA Point of Contact (POC)

• CRM Tool – Grants Portal Website

• Damage Inventory (DI) Spreadsheet

• Site Inspections

Recovery Scoping Meeting (RSM)

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

•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 B – Emergency Measures

•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.

Category E – Buildings and Equipment

Cost Eligibility

• 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.

Must Be:

Category A – Debris Removal

Straight Federal Cost Share of 75%

Option A 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

Option B

CAT A – Debris Removal • GNR Environmental Protection Division Approval Letter

• EPD recommends predetermined management sites Debris Staging Areas

• Pre-Qualified – additional 2% reimbursement

• Emergent

Debris Removal Contracts

• Amount/type of debris

• Price per cubic yard Load Tickets

• Approved by the GA Dept. of Natural Resources Landfill Permits

• Straight Time Only

• Time Records/Wages Forced Account Labor

• 2 ft. or larger in diameter measured 2 ft. above the ground

• Extraction is required Stumps

• Before, During & After!! Photos

Category B – Emergency Measures

• Overtime Pay Only

Forced Account Labor

• Policy language

Standby/Hazard Pay

• County Emergency Management Plan

Sheltering/Medical Needs Patients

• Sand bags, tarps, removal & storage, meals for staff, etc.

Supplies, Food, Protection

CAT E – Buildings & Equipment

• 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

Buildings

• Vehicles

• Construction Equipment

Equipment

• Straight Time

• Overtime

Force Account Labor

• Ceiling Tiles, Paint, Tools, Tarps, etc.

Supplies

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

Questions?