How A Houston Hospital Stays Afloat During Extreme Weather
Texas Medical Center in Houston is the world’s largest medical complex. It’s big enough to have its own skyline — dozens of buildings, 106,000 employees who care for some 10 million patients per year.
Back in 2001, it was in the path of a tropical storm, Allison. At first, folks didn’t think that was such a big deal.
“We have tropical storms all the time on the Gulf Coast, and it’s lots of rain and some minor street flooding and it goes away,” said Claire Bassett, chief communications officer at the Baylor College of Medicine in Houston, describing the atmosphere ahead of landfall.
“It was just, ‘Oh, it’s another tropical storm. It’s going to be a wet weekend, [then] it’ll be over and done with,’” she said.
But day after day, Allison’s heavy rains did not stop. Four days after landfall, the storm wheeled back over the city with intense downpours. The ground was already saturated, leading to widespread flooding.
And Texas Medical Center was in trouble. High water got into a tunnel system and flooded multiple buildings. Patients were evacuated and several medical facilities closed down.
Bassett made her way to the medical school the day after the rains subsided.
“So our entire sub-basement was submerged, and then five feet of the floor above that,” she said. “And we had the vast majority of our animal research in our sub-basement. “
It’s what’s called a vivarium — animals in cages with their food, bedding and scientific equipment.
“We actually had, a cow, we had rabbits, we had canines. And all of the large animals were able to be led up to a higher floor by one of our animal care attendants, who had waded through chest-deep water to get here,” Bassett said.
He somehow led the cow up two flights of stairs.
“This gentleman, who I’d never met before, walked up to me and said, ‘I just put a cow in the ladies room,’” said Bassett. “I said, ‘OK, that’s great. Um, did you put a sign on the door?’”
He had not, that slipped his mind somehow.
“So we put signage on the door, and he said, ‘Is it OK if I put dogs and pigs in a vacant conference room and a vacant office?” she said.
So a cow, dogs and pigs were all in the clear. But the research mice were not so lucky.
There are photos of the room just after recovery crews got in. Apparent are stacks of these plastic cages, four high, all filled with foggy water. In some, blurry little white things are floating.
“We lost about 30,000 research mice,” said Bassett. Many of those mice had been bred over several generations as part of genetic studies.
A bank of breast cancer tissue with 25 years worth of samples also was destroyed. Total losses exceeded $300 million.
But things could have been much worse. The nightmare scenario — losing patients during a crisis — was avoided.
The worst case: New Orleans after Katrina
That wasn’t the case in New Orleans after Hurricane Katrina. Management and urban-planning researchers Lucy Arendt and David Hess traveled there in 2005 just after the storm.
Their mission was to go hospital to hospital to see what went right and what went wrong.
“Hospitals in general are incredibly complex organizations, far more so than most other types of organizations, in that hospitals — typically at least acute-care hospitals — tend to be just like communities,” said Arendt. The closest comparable institutions are universities and colleges, she added.
During extreme weather, these complex little communities have two choices. There’s shelter in place — ride out the storm. Or there’s evacuation — which, Hess says, is even more dangerous.
“Worst-case scenario for hospital administrators is to think about a complete evacuation and having to move everybody,” he said.
Part of the reason why is that only the very sickest, most vulnerable patients will still be at a hospital when a storm makes landfall. It can be dangerous to move a patient, for instance, that relies on a complex life-support system or ventilators. Less sick patients will have already been evacuated, and routine surgeries will have been canceled.
But New Orleans’ hospitals weren’t built to withstand Katrina’s wrath and the flooding that followed levee failures. They were forced to evacuate.
“At Memorial [Medical Center] … it was the same story over and over. It was just this thing out of some horror movie,” said Arendt.
If Memorial sounds familiar, it’s because dozens of patients died there. Health care workers were accused of euthanizing some amid desperate conditions.
The hospitals became very unsafe places to be, said Hess. “In fact, one hospital administrator, his recollection of the hospital following Hurricane Katrina is that it was like a war zone inside.”
Both researchers say New Orleans was especially vulnerable, but that doesn’t mean hospitals elsewhere are safe. With climate change driving more frequent and intense storms, experts say hospital systems have to be better able, essentially, to batten down the hatches.
“Hospitals from outside of the Gulf area are learning the lessons of Katrina,” said Arendt. “In the past, they might not have thought, ‘Oh yeah, that might relate to us,’ but it is becoming pretty self-evident, I think, that in fact, those lessons are increasingly relevant to more hospitals.”
Hurricane Sandy, for instance, shut down New York City’s Bellevue Hospital in 2012, after basement fuel pumps flooded. The National Guard stepped in to help staff with fuel and water before evacuating everyone.
Arendt said hospitals reach their breaking points when they lose either power or water. The engineering that could help ensure that doesn’t happen is expensive, she said — especially in the context of a hospital.
“When you start talking about changing a building, a hospital structure, for example, we start talking millions of dollars,” she said. “And in a climate where health care costs are already considered pretty extraordinary, starting to talk to people about the need to modify a building so that we can be better prepared for something that may never happen, that can be a pretty tough sell.”
But in Houston, after Tropical Storm Allison, preparedness wasn’t such a tough sell anymore.
After Allison, “We got religion.”
Robert Emery is a professor of occupational health. He’s in charge of risk management at the University of Texas Health Science Center. “Safety Bob” points to a watermark on a Texas Medical Center building.
“So you can actually see the line right there. This was filled with 33 feet of water when Allison occurred,” Emery said. He had it preserved: “Do not pressure-wash that line off!”
When he talks about Allison, he repeats a curious phrase: “We got religion.”
He means the storm taught everyone a lesson: to respect a kind of higher power.
“You could see all the way through because all of this was cut out. All the walls, all the doors, everything because it was all underwater,” he said in the basement of the McGovern Medical School, part of Texas Medical Center. It was once the largest state-owned building in Texas.
After Allison, they weren’t going to get caught off guard again. Emery outlined the engineering built up in the years since the storm.
First, they built a moat — a hydrostatic wall, about seven feet tall, made from a mix of granite and a half-inch of glass. And outside that, an earthen berm.
There are pumps in this reverse moat to get rid of any water that makes it over. But then, even if all that fails, there are the flood doors.
“I guess the best way to describe it is to think of a bank
vault door,” said Emery. There are
nearly two dozen of these flood doors around the medical school, in various sizes, up to 16 feet tall.
“But they’re actually balanced in such a way that one person can actually move them and swing them and then put them into place,” he said.
Some pins lock into position, and a pump inflates rubber seals.
Emery drills staff on how to do this, and not long ago, they were put to the test.
Hurricane Harvey made landfall in 2017, and beat out Allison for total rainfall. It devastated the region. But what about Texas Medical Center?
“Maybe six inches of water in this loading-dock area compared to 33 feet of water in the past,” Emery said.
The engineering worked. In fact, the only major problem was getting staff to and from these relatively dry little islands in a flooded Houston. Emery’s team is working on a solution to that — two huge military trucks.
They’re military-surplus M35 series 2½-ton cargo trucks, about 9 feet tall — good in high water. The staff named them Laverne and Shirley because they come from Wisconsin.
And the research animals? Like generators and critical mechanicals, they’re now kept on upper floors.
Bassett, the communications officer who described the chaos at Baylor following Tropical Storm Allison, set up shop at the Texas Medical Center before Hurricane Harvey hit.
“You bring a nice air mattress and you bring water boots, and you bring a couple of changes of clothes,” she said.
This time she didn’t see some Texas Noah leading animals out of a flood. Instead, she just walked the mostly dry halls, checking for broken windows.
Bassett remembers cancer patients worrying about how they would get their regular treatments.
“One of the things that happened with Harvey was there was such devastation throughout the city that you had a lot of patients that were on chemotherapy that needed to come in for their infusion, and there were some places that had not opened their outpatient facilities yet,” she said.
Outpatient care was closed at Texas Medical Center facilities during the worst of the storm, but as soon as the roads were clear enough for patients get to there, they found it was ready for them.
“When we went and saw them, I guess three days after the storm is when we opened, there were people literally in tears,” she said. “They were so thankful.”
This article was originally published on WBUR.org.
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