Preparing for disaster: How would your practice cope?

There were only 30 seconds from the time the radio announced a tornado sighting until the 180 mph twister pummeled the medical office, removing the roof and destroying the front part of the building.

Ronald Simpson, MD, crouched under three desks while the storm ripped through his office, the neighboring hospital and the community of Mountain View, Ark.

"I couldn't see anything. What sounded like the loudest hail I ever heard in my life was actually debris flying," the family physician said. "When the storm was over, I crawled out and saw my car had been blown away and a new Chevy was in its place. The two-story portion of my building was gone. Two wings at the hospital behind it were gone."

His 40 seconds of terror was part of a multistate outbreak dubbed the Super Tuesday tornadoes, because they struck Feb. 5, the same day 24 states held their presidential primaries.

The aftermath lingers. Dr. Simpson and administrators at the Stone County Medical Center are facing two years' of disruption and hundreds of thousands of dollars in expenses before their buildings are fully restored.

Dr. Simpson believes his road to recovery would have been clearer if he had had a preparedness plan.

What's in a plan

A disaster plan is a set of procedures that clearly dictates what has to be done, when and by whom, before and after a disastrous event, whether a hurricane, fire, or broken water pipe.

This is not a simple evacuation plan. Rather, it is a systematic preparation for coping, including having proper insurance, medical record protection, procedures for staff response, and a procedure for contacting patients, said Carol Chastang at the U.S. Small Business Administration Office of Disaster Assistance. These emergency procedures should be documented and the staff should be made aware of them.

Dr. Simpson said he was fortunate in that Stone County Medical Center provided him temporary office space. But even the hospital couldn't help with all of the problems he faced.

Because he had no preparedness plan, he found himself underinsured and saddled with about $120,000 in uncovered losses. Because he had not lined up an alternate practice location, he found himself making do with facilities that were less than ideal. And, for the first week after the tornado, he paid his eight staff members to dig through the rubble.

"I had worked on an emergency plan from the hospital standpoint, but not for my clinic. I now wish I had done that," Dr. Simpson said.

Nationwide, few physicians and medical group managers are prepared.

Some 87% of 188 group managers responding to a Medical Group Management Assn. poll said their practices have a moderate or high chance of being hit by a disaster. But only 30.2% said they had an emergency plan.

Two reasons for this lapse of planning are lack of time and lack of compensation for the cost of running emergency drills, said David Gans, MGMA's vice president of practice management resources. The association recommends all practices take the time to create a plan and wants the government to provide compensation for drills.

In drawing up a preparedness plan, experts say, physicians should consider:

• How would everyone in the office be kept safe if a disaster occurs during business hours?
• Would employees be paid during down time, and if so, how?
• Where would the practice move if the existing office is unusable?
• How would patients and staff be kept informed during the recovery process?
• How would medical records be safeguarded?
• How would expenses be covered?
• What kind of insurance would be needed and how much?

For loan and insurance purposes, the plan should include records of the practice's taxes, payroll, income, overhead, furniture and equipment.

Experts recommend practicing an office evacuation and the duties that staff will take on afterward. Staff should practice meeting at a set location, and simulating phone calls to patients to tell them what happened and where they will be seen. "The best thing is for a practice to be prepared," Chastang said.

Experts suggest drills be done at least once a year.

Many practices have made some steps toward preparedness. MGMA found, for example, that most of the medical groups it surveyed had at least some type of idea how they would notify patients. But when disaster hits, physicians often discover they aren't as well prepared as they thought.

Last summer, family physician Robert Kavelman, MD, sustained $30,000 to $40,000 in losses when a small creek overflowed and flooded much of Columbus, Ind. -- including his practice and his employer, Columbus Regional Hospital.

Dr. Kavelman had flood insurance through the hospital, but found it was not enough to cover his losses. He did not have an alternate work site, and considers himself lucky that the hospital allowed him to practice at its urgent care clinic in nearby Edinburgh during the five weeks his office was closed.

"I only had one day of down time, but still, business was slow immediately after the flood, causing a decrease in income. People had their own flooding issues to contend with, they weren't coming to see the doctor," he said.

"I didn't have a disaster plan in place, but working on getting one in place is definitely at the top of my list now," Dr. Kavelman said. "I thought about a lot of things before I opened my practice, but not being hit by a disaster. I would advise other physicians to have enough capital for a rainy day, have an emergency preparedness plan and check to see if you have the right insurance. If I had owned my own practice, I would be in worse shape than I am in now."

Experts say relocation and insurance often are the issues that trip up doctors after a disaster.

Hospital-owned practices often assume, incorrectly, that policies they have through their hospitals will cover all costs. Even individual property insurance alone doesn't always cover the damages.

If your practice is in an area prone to flooding, hurricane or other natural disasters, Chastang suggests having specific named-peril insurance, in addition to general insurance.

Also, replacement-value insurance would cover costs for work that complies with new building codes. And business interruption insurance can cover employee salaries during down time.

Experts recommend that part of preparedness is reviewing insurance policies to determine what is covered, and for how much.

Physicians should consider affiliating with another group that can offer a backup office in the event the primary office becomes unusable, Chastang said. Having this kind of arrangement makes it easier to get back to work and see patients right away. Also needed are procedures to quickly inform the other practice so those physicians and staff are prepared to make room, she said.

Dealing with the aftermath

Nine months after his office was demolished by the twister, Dr. Simpson and his partner, family physician Michelle Bishop, MD, are still practicing out of a modular unit on the hospital grounds. It will be another 18 months before the new office is completed.

The temporary site "is very workable, though very basic," he said. It's certainly an improvement. "The first six weeks, I was camped out in the hospital emergency room. I saw patients who needed to be seen. I took care of a lot of patients over the phone, where I normally wouldn't, because of a lack of infrastructure. I did house calls."

Dr. Simpson since has taken steps toward a disaster plan. He increased his insurance coverage and is looking at electronic health records with off-site back-up. "You can't predict this kind of disaster. But I'll be more prepared."

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