Water poured into hospitals. Ambulances were caught up in roiling floodwaters. Medical transport helicopters were grounded by high winds. Houston’s world-renowned health care infrastructure found itself battered by Hurricane Harvey, struggling to treat storm victims while becoming a victim itself.
The coming days will inevitably bring more hazards for storm-damaged hospitals and nursing homes, and their patients and staff. The scenes of turmoil across Texas raised the specter of the extreme flooding following Hurricane Katrina in 2005, when dozens of hospital and nursing home patients died, and doctors awaiting rescue at one stranded, powerless hospital became so desperate, they intentionally hastened the deaths of their patients.
The response to Harvey, now a tropical storm but still wreaking havoc over the state, promises answers to whether health officials learned lessons from the catastrophe of Katrina when it comes to the medically vulnerable — in particular whether they did enough to prepare for the disaster and to move patients out of its path.
“We’ve made significant investments,” Dr. Umair Shah, executive director of Harris County’s public health department, said in a telephone interview on Sunday. “The challenge is until it unfolds there’s so many moving pieces and it’s never the same as the situations you’ve previously encountered.”
Responders point to dozens of improvements, from better engineered structures to well-practiced cooperation, that are helping protect lives. Still, sometimes even the soundest plans have been foiled.
Water rose in the basement of Ben Taub Hospital, a major county trauma center in the vast Texas Medical Center campus that had spent billions of dollars on flood protections after being devastated in Tropical Storm Allison in 2001. Officials announced an evacuation Sunday, but hours later, a hospital spokesman said it had not yet begun because the hospital was surrounded by water and rescuers could not reach its 350 patients.
Six to 10 other hospitals and various nursing homes, some in rural communities, were also evacuated after the storm made landfall, said Darrell Pile, chief executive of the Southeast Texas Regional Advisory Council, which established a catastrophic medical operations center in Houston’s emergency command center.
While some vulnerable hospitals and nursing homes opted to move their patients out of the region in the hours before the storm, Mr. Pile said, others “did not know to necessarily expect this level of chaos.” A large coalition of medical providers had drilled and planned regularly for catastrophes, he added, “but honestly, not at this epic level.”
Most hospitals in Houston continued operating and they reported that they were doing well. But some, ringed by floodwater, were cut off from patients trying to reach them. Hospital staff members had trouble getting to work as well.
In other parts of the state, Harvey knocked out utilities, forcing hospitals to rely on vulnerable backup systems. The wind and rain were threatening at Citizens Medical Center in Victoria, a city of about 68,000 people roughly 125 miles southwest of Houston, when emergency workers loaded patients onto a mass evacuation ambulance while roads were passable late Saturday night. Amid the stressful scene, one older woman clutched a brown teddy bear while waiting to be taken aboard.
“As much as we want to help our patients, I know we can help them more by getting them to a safer spot,” said Dr. Daniel Cano, the hospital’s medical director. The hospital’s generators did not power air conditioning and when city power switched it back on after a day without, it took hours for the humidity to seep out of the hospital.
Hundreds of patients had remained in Victoria’s hospitals during Harvey. But after a power outage and a threat to the running water supply, and with flooding in the area expected to worsen, all were taken to San Antonio and elsewhere across the state, officials said.
Jennifer Schulte, director of marketing for Citizens, said some critically ill patients had been transferred before Harvey made landfall, when a mandatory evacuation of the city was announced a day before. But the short time window meant that 80 other patients could not be moved. “The roadways there were very clogged up,” she said. “That would require patients to sit and wait. For some, in their condition, it would not be safe.”
That was a lesson etched in memories by Hurricane Rita in 2005. A charter bus with an illegal license caught fire on its way to Dallas from a nursing home near Houston. Oxygen tanks in the luggage bays exploded. Twenty-three people aboard the bus burned to death. In the end, the storm spared Houston.
However, decisions not to shut nursing homes for Hurricane Harvey left some residents in peril. In Dickinson on Sunday, rescuers removed about two dozen people from the La Vita Bella assisted living center. An alarming photograph spread across social media of the center’s residents in wheelchairs and lounge chairs, sitting in water to their waists. All survived, officials said.
Ideally, hospitals should not only withstand disasters, but also provide safe haven to those injured in them. As of Monday morning, the fortification of the Texas Medical Center in Houston appeared to have paid off for most of its 23 hospitals. Submarine doors were locked on Saturday afternoon, protecting foundations that had flooded catastrophically after Allison in 2001, knocking out power and forcing emergency patient evacuations.
With ambulance routes flooded, however, potential patients had difficulty reaching the complex. “I’ve never heard so few sirens as I have in the last few days, which is upsetting,” said William McKeon, the center’s president and chief executive. “We can be dry and open but if you can’t deliver patients to the medical center, that’s our biggest concern.” For hours on Sunday, he said, the system’s eight helicopters could not fly to the center because of high winds and tornado warnings.
“With one of the most devastating hurricanes in Texas, I’m looking out my window now, all the lights are on, the largest medical city in the world is operating today, that’s a feat of engineering that is really amazing,” Mr. McKeon said late Sunday night.
Law enforcement officials helped identify routes to the hospitals and shared them with emergency medical service agencies. And when water needed to be let out of a reservoir overnight from Sunday to Monday, responders were given advance notice to re-establish a massive staging area for ambulances and medical equipment.
“That kind of coordination and teamwork has prevented some hardships that might have happened in prior years when people were not communicating and were operating in their own little silos,” Mr. Pile of the Southeast Texas Regional Advisory Council said.
He and others also said that a new federal rule stemming from Katrina — which requires a wide range of health providers to establish emergency plans — had led to significantly better responses among nursing homes.
They also highlighted lifesaving contributions of organizations and assets funded with federal hospital preparedness program dollars.
President Trump has proposed cutbacks to that program and two other medical preparedness programs overseen by the Federal Emergency Management Agency and the Department of Health and Human Services.
Those programs helped establish emergency medical task forces that have dispatched ambulances, personnel and equipment from across the state.
Hilary Watt, executive director of the Coastal Bend Regional Advisory Council, also used those federal funds to purchase special sleds and stretchers that allow extremely overweight people to be transported, after she read about the death of one heavy man at a hospital after Katrina when doctors could not figure out how to move him. Ms. Watt spread those stretchers strategically through ambulance services in her region.
As Harvey approached, she called on those ambulance teams. Five patients were moved from Rockport and Aransas Pass in the hours before the storm, likely saving the patients’ lives when the hurricane roared ashore there as a Category 4.
“We’ve definitely learned from the unfortunate outcomes in other areas,” Ms. Watt said.