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How To Prepare Your Medical Practice For a Disaster

There are occasionally topics that I describe and relate to my readers that I am not an unadulterated expert. However, on the topic of disasters, particularly hurricanes, I feel uniquely qualified to write and share my experience with my colleagues. I am a physician in private practice in the New Orleans and work at two hospitals located in the middle of the city, Uptown and Garden District areas. On August 29, 2005, I was on one of the last flights out of New Orleans and moved my family to Austin, Texas. On the next day, our city and much of the Mississippi Gulf Coast was violently thrashed by Hurricane Katrina creating one of the worst disasters to ever hit the United States. After the storm, I was caring for patients using the Internet, my electronic medical records program, and the telephone. I know you have all heard and seen the devastation that has enveloped this region. There are so many stories of the heroics performed by the medical profession in this community that they certainly eclipse some of the unfortunate events that took place with a few terminal patients. Since the clinical activities have been so well reported, I want to share with you my experience on disaster prevention and the next article I would like to discuss managing a disaster after it has occurred.

Disaster preparedness. The best time to respond to a disaster is before it happens. A relatively small investment of time and money now may prevent severe, irreparable loss and disruption of business in the future. Please don't think that this kind of disaster is unique to the areas at risk for hurricanes. Every area of the country is subjected to some kind of disaster-flood, hurricane, earthquake, ice storm, landslide-to name a few. Even man-made disasters-oil spill, civil unrest, and since September 11, 2001, a terrorist attack- can devastate the surrounding neighborhood and the economy. Even though an area has never been damaged before, there is no guarantee that it will not happen tomorrow.

I suggest you begin by asking yourself these questions, "What if the worst happened?" "How would it affect my business and my family?" "Would we survive if the practice was closed for weeks, months, or perhaps indefinitely?" This was indeed the case for many medical practices that were located in the low-lying areas of New Orleans that had flood waters in excess of 20 feet and may not be able to be rebuilt. My message here is that you should be a little pessimistic now and assume that it can happen to you. The likelihood of a direct hit from a level 4 hurricane to the city of New Orleans was predicted on computer models at less than one percent. Therefore, you need to develop a disaster plan for your practice so you can sleep a little more easily and not have the havoc that took place in my community, in my own practice, and in the practices of many of my colleagues.

Next I suggest finding out which natural and technological disasters can happen in your area or community. Even if you are not in a disaster-prone area, like the Gulf Coast, something like a chemical tanker truck overturning can prevent you and your staff from reaching your facility. Even if a flood doesn't put your business under water, patients and supplies may not be able to reach you or your practice. Many disasters, like wind storms, tornadoes and earthquakes, can strike quickly and with little or no warning. At this time when so many of our practices are dependent upon computers and the Internet for their daily operations, power outages, brown-outs or surges can affect your business and bring it to a screeching halt.

No medical practice should be without a disaster plan. Numerous reports have shown that as many as 40% of small businesses do not reopen after a major disaster like a flood, tornado or earthquake. These shattered practices were unprepared for a disaster; they had no plan or backup systems and suffered financial ruin.

Developing your disaster plan--down and dirty plan construction. Begin by keeping a phone list of your employees, vendors, hospitals, and key contacts. For example, we needed the phone numbers of the pathology laboratories since patients who had prostate biopsies before the hurricane wanted to know the results even when our practice was closed. By having this information we were able to contact patients and then provide them with transitional care for those who had positive biopsies.

If you have a voice mail system in place at your office, designate one remote number on which you can record messages for employees. Provide this number to all employees and suggest they keep it in their wallet or purse. If you are unable to go to your office because of the disaster as happened in New Orleans, you should arrange to have a programmable call forwarding service for your main telephone line. Now you can call in and reprogram the phones to ring elsewhere where you or an office staff member can field the calls.

I suggest that you have a weather radio with a tone alert feature. Keep it on and when the signal sounds, listen for information about severe weather and protective actions to take. Keep emergency supplies handy including: flashlights with plenty of extra batteries, first aid kit, a tool kit, and food and water for employees and patients to use during a period of unexpected confinement at your office.

Keep your computer close. Keep a backup copy of your computer's basic operating system and critical software. Store a copy of all vital information on-site and a second in a safe off-site location. Make it a critical part of your routine to regularly back up files.

Make arrangements with your computer and hardware vendors to quickly replace damaged vital hardware. Keep invoices, shipping lists, and other documentation of your hardware and software configuration off-site so you can quickly order the appropriate replacement components. I suggest you surge-protect all computer and phone equipment through power and phone lines. A power surge through a telephone line can destroy an entire computer system through a connected modem. Invest in a surge protector that has a battery backup to assure that systems keep working though blackouts and until the phone systems have been restored. Also, maintain an up-to-date copy of phone numbers, computer and Internet logon codes and passwords, employee phone numbers and other critical information in an accessible location. Also, if you have a large number of employees, develop an employee "telephone tree" to rapidly contact employees in an emergency.

And now for the Big "I"-Insurance. Business interruption insurance can be as vital to your survival as a medical practice as fire insurance. Most physicians would never consider opening a practice without buying insurance to cover damage due to fire and windstorms. But too many physicians fail to think about how they would manage if a fire or other disaster damaged their office premises so that they were temporarily unusable. Business interruption coverage is not sold separately. It is added to a property insurance policy or included in a package policy.

Questions that you need to ask and discuss with your insurance agent include? Is my insurance adequate to get my practice back in operation? Can I pay my employees, and cover my own needs during a prolonged shutdown? How long can I survive if we are shut down?

One solution to this problem that I strongly recommend is business interruption insurance. I have this policy and it has made it possible for me to maintain my staff as well as pay my expenses during the period when the city was evacuated and it was not possible to have access to my building. Business interruption insurance compensates you for lost income if you have to vacate the premises due to disaster-related damage such as that which occurs as result of a fire or a flood. Business interruption insurance covers the profits you would have earned, based on your financial records, had the disaster not occurred. The policy also covers operating expenses, like electricity, that continue even though business activities have come to a temporary halt.

I suggest that you make sure the policy limits are sufficient to cover your company for more than a few days. After a major disaster, it can take more time than many people anticipate getting the business back on track. There is generally a 48-hour waiting period before business interruption coverage kicks in.

These are some lessons learned from Katrina. Some of these lessons were learned the hard way, i.e., by errors of omission. It is these errors that I don't want you to make and I hope you will read this article and take action for you and your practice. Finally message: "To know and not to do is not to know!" I hope you now know, so please take it from one who has been there, DO!